Substance Use Disorder (Final) Flashcards
Addiction
-Is a DISEASE, known as substance use disorder: affected by both environmental and biological factos
Rewarding effects of drugs come from large and ripd upsurges of
dopamine
Main neurotransmitter we focus on for addiction and substance use disorder
Mimics regular pleasure response, but greatly exceeds it
Lots of dopamine surges disturb normal dopamine pathways, thereby disturbing normal brain pathways/hierarchy (receptor down regulation)
Addiction is associated with issues in the
Prefrontal cortex
Bain changes in Substance Use Disorder
-Looking at dopamine transporters, red indicates high activity, yellow indicates moderate, green indicates little
-Over time our brain can go back to functioning normally
Substance Use Disorder: Risk Factors
-Aggressive childhood behavior
-Lack of parental supervision
-Poor social skills
-Drug experimentation
-Availability of drugs at school
-Community poverty
Substance use disorder: Protective factors
-Good self control
-Parental monitoring and support
-Good grades
-School anti-drug policies
-Neighborhood resources
Treatment of substance use disorder
-No single treatment is appropriate for everyone
-Therapy is crucial
CBT
12 step program
Motivation enhancement therapy
Family therapy
Contingency management
-Treatment must address the whole person
Medically assisted detoxification
-Rehab can be a first step
-Goes through withdrawal in a place with medically supervision
-Safest way to manage acute withdrawal symptoms associated with substance use disorders
Treatment programs
-Need to test patients for other disease associated with substance use disorder
-Blood borne pathogens are very likely to be transmitted
Endocarditis
-Side effects seen with long term IV drug use
-10 more likely to die or need surgery
-Cost a lot for our health care system
Opioid Withdrawal Timeline (Heroin and Prescription Painkillers)
Onset: 12-24 hours
Peak: 72 hours
Duration: 5-10 days
Opioid Withdrawal: S/S
-Flu-like symptoms, nausea, vomiting, stomach cramps, diarrhea, goosebumps, depression, craving, anxiety, sweating, muscle aches, fever
-Feel like you are dying
-Supportive treatment and MAT
Opiate Withdrawal Timeline tbc
72 hours physcial symptoms peak
1 week physical symptoms start to lessen
2 week psychological and emotional symptoms begin
1 month cravings and depression
Benzodiazepine and Alcohol Withdrawal
-Benzo’s and Alc both act on GABA receptors, therefore the withdrawal symptoms and treated the same
-Both have dangerous symptoms that can lead to death
Benzo and Alc withdrawal: S/S
-Sleep disturbances, dry retching, irritability, nausea, increased tension, weight loss, anxiety, palpitations, panic attacks, anxiety, headache, muscle aches, sweating, difficulty concentration, and perceptual changes
Dangerous symptoms of Benzo and Alc
-Seizures
-Hallucinations
-Delirium tremens (DT’s)
-Wernicke’s encephalopathy
Wernicke’s Encephalopathy: 3 traits
- Encephalopathy-profound disorientation, indifference, inattention
- Oculomotr dysfunction (nystagmus, lateral rectus palsy and conjugate gaze palsy)
- Gait ataxia
Delirium Tremens
Hallucination
Disorientation
Tachycardia
Hypertension
Fever
Agitation
Diaphoresis
Benzodiazepine Withdrawal Time Line
Onset: 1-4 days
Peak: 2 weeks
Duration: Months to years
Signs and Symptoms of Benzo Abuse
-Drowsiness
-Memory Issues
-Irritability
-Slower thinking
-Increased anxiety
-Muscle weakness
-Sleeping and Eating changes
Alcohol withdrawal timeline
Onset: 8 hours (Anxiety and insomnia)
Peak: 1-3 day peak (High BP, increased body temp)
Duration: 1 week (Hallucinations - Fever - Seizures - Agitation)
Treatment of Alc and Benzo Withdrawal
Benzodiazepine taper
Helps prevent DT and Seizures
12 step treatment and therapy is also recommended
Vitamine supplementation (thiamine vitamin B1)
methadone: Class
opioid
Methadone: MOA
Mu agonist
Take up opioid receptor that would be empty
methadone: Indications
-Used as medications treatment (MAT)
-Opioid withdrawal symptoms
-Heroin withdrawals
Methadone Nursing implications
-once daily dose in methadone clinics
-Can cause access problems. hard to get to clinics at the same time everyday
-stays steady to they done feel high or sick. Keeps them straight
Buprenorphine and naloxone
Opioid agonist and opioid antagonist
Suboxone
Combining helps patients recover more quickly from addictions
Still have potential for abuse but much less than methadone and buprenorphine alone
Sublingual and Buccal
