Substance Use Disorders Flashcards
Know mainly alcohol, opioids, and stimulants
Substance Use Disorder is a
cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems
use even though it causes the problems knowingly
Addiction –
chronic relapsing long lasting changes to the brain
Flashbacks –
drug free state, experiencing disturbances (hallucinations)
Tolerance –
reaction decrease with continued use (take more to see the same result)
Amotivational syndrome –
apathy with no motivation to do ADLs or societal role
Cross-tolerance
– one substance is also tolerance to another substance (morphine and other opioids)
Psychological dependence –
need for the drug subjectively and emotionally
Physical dependence
- no physical substance with no longer using the substance
Withdrawal –
psychological and physical dependence
Dual diagnosis –
substance use and other psych disorder as well
Goals for Substance Use Disorder Treatment
recognition of acute toxicity
facilitate of withdrawa
dx and tx medical complications of substance use
edu/counseling/therapy to sustain sobriety and long-term abstinence
10 categories of substances for abuse
caffeine
alcohol
nicotine
cannabis
dsedatives/hynotics/anxiolytics
opioids
stimulants
hallucinations
inhalants
**nutmeg and K2 and cough syrup
Substances have different types of reactions after taking a substance including
intoxication
toxicity
withdrawal
Abuse
Habitual use of a substance which falls outside of medical necessity or societal acceptance
Used solely for the purpose of altering mood, emotion or state of consciousness
Addiction
Chronic/relapsing disease
Compulsive substance-seeking behaviors motivated by cravings, despite harmful consequences
Long-lasting changes in the brain.
May include development of tolerance and withdrawal symptoms
SUD criteria
large amounts for a long period than intended
1+ unsuccessful to cut down or control use
time dedicated to obtain/use/recover
craving
failure to fulfill obligations (ADL or work)
persistent social problems
activities are neg. affected
continued use despite problems
hazardous situations in driving
tolerance
Tolerance of SUD
increased amounts to achieve intoxication/desired effect
diminished effects with continued use of the same amount
Withdrawal is manifested by
same substance taken to relieve or avoid withdrawal s/s
Mild SUD has how many criteria
2-3
Moderate SUD has how many criteria
4-5
Severe SUD has how many crieria
6+
Psychological risk factors for SUD
low frustration levels
poor impulse control
lack of meaningful relationships
childhood trauma
low self esteem
propensity for risk taking behaviors
Social risk factors for SUD
peer influences
family acceptance
Which gender has a greater risk for SUD
MALES
Patho of SUD
Brain reward system (reinforcement of behaviors and memories)
neurotransitters not effective
- double the amount of dopamine and floods the brain and neurotransmitters
Route Complications for SUD
IM/SubQ
scarring
lesions
abscesses
infections
Route Complications for SUD
IV
infectious
venous sclerosis
disease tranmission
endocarditis
- track marks on arms and legs with repeated injections
Route Complications for SUD
intranasal
Chronic sinusitis
Perforated nasal septum
Route Complications for SUD
smoking
respiratory problems
CNS Depressants are
alcohol
barbituates
bezodiazepines
- affect the GABA receptors
Barbituates are easier to
overdose
Benzodiazepines are extremely
addictive
Alcohol Use Disorder
- acute patho
binds with GABA/glutamate and dampens them
- activate reward circuit
- inhibits ADH (diuretic)
How much alcohol is too much?
4+ for men in 1 day or 14 in one week
3+ for women in 1 day or 7 in one week
Can moms drink alcohol and breastfeed at the same time?
no
Standard Drink formula
12 oz of beer =
8 oz of malt =
5 oz of wine =
1.5 oz o spirits
Life-threatening signs of alcohol poisoning
inability to wake up
vomiting
slow breathin <8
irregular breathing
seizures
hypothermia
0.05 mg = 1-2 drinks effects
chnages in mood and behavior, impaired judgment
0.08 mg = 5-6 drinks effects
legal limit of intoxication
-clumbsiness in voluntary activity
0.2 mg = 10-12 drinks effects
depressed fucntions
staggering and ataxia
emotional lability
0.3 mg = 15-19 drinks effects
confusion
stupor
0.4 mg = 20-24 drinks effects
coma
0.5 mg = 25-30 drinks effects
death by respiratory depression
CIWA evaluates for
N/V
Tactile disturbances
auditory and visual distrbances
anxiety
HA/fullness
orientation x4
tremor (stick out tongue and move fingers)
paroxymal sweats
agitation
In a CIWA, the nurse should get a BP and apical heart rate for how long
1 minute
If the CIWA score is _______ then notify the doctor
> 20
Alcohol Withdrawal peaks
within 24-48 hours
- rapid disappear unless goes to delirium
What is possible in 7-48 hours of an alcohol withdrawal
grand mal seizures
Alcohol withdrawal s/s
irritable
“shaking inside”
illusion (misinterpret)
early signs in a few hours
Delirium Tremens (rapid)
emergency and possible death
peak 2-3 days after cessation and reduction
autonomic hyperactivity
disturbances
fluctuating LOC
delusions
agitated
100+ temp
Autonomic hyperactivity
HTN
sweating
hyper/hypo thermia
The clock starts from the last
drink consumed
Acute withdrawal needs to be closely monitored on
BP and heart rate
Post-acute withdrawal syndrome
episodic
days to weeks
- up to 2 years
Post-acute withdrawal syndrome
s/s
Mood swings
Anxiety
Irritability
Tiredness
Variable energy
Low enthusiasm
Variable ability to concentrate
Disturbed sleep
Risks for Post-acute withdrawal syndrome
distressing
relapsing
- brain remodels to regular chemistry
Effects of chronic alcohol use
CV damage (cardiomyopathy),
liver damage (hepatitis, cirrhosis),
erosive gastritis,
GI bleed,
esophageal varices,
ascites,
acute pancreatitis,
thiamine deficiency,
peripheral neuropathy,
inc risk of cancer,
thrombocytopenia,
damage to the brain,
dilation of cutaneous blood vessels,
hypertension,
testicular atrophy, impotence, sterility, & breast enlargement in men
Wernicke’s encephalopathy
Inflammatory,
hemorrhagic,
degenerative condition of the brain
- caused by thiamine deficiency from poor diet & alcohol-induced suppression of thiamine absorption
Wernicke’s encephalopathy tx
- reversed if treated immediately and completely
- tx with tyramine and vitamin B
Wernicke’s encephalopathy can lead to
Korsakoff’s psychosis
Korsakoff’s psychosis
is a
irreversible form of amnesia with
- short term memory loss
- long term memory gaps
- inability to learn
Korsakoff’s psychosis
notable behavior
confusion
amnesia
Tx for Alcohol Withdrawal
1st Benzo (Lorazepam)
- cross tolerance taper
Gabapentin (low anxiety and prevent seizures)
Propanolol and Clondine (Beta and Alpha blocker) - autonmic and elevate vitals
Thiamine - prevent syndrome and correct high output heart failure
Folic acid, B12 (anemia and halt peripheral neuropathy)
If benzos aren’t effective in alcohol withdrawal, the nurse will
transfer to ICU and give barbituates - phenobarbital
Alcohol Withdrawal Sobriety
Naltrexone
opioid antagonist - block opioid recpetors with cravings
**reduce relapse
Alcohol Withdrawal Sobriety
Acamprosate (Campral)
reduce symptoms of long-lasting withdrawal insomnia, anxiety
Alcohol Withdrawal Sobriety
Disulfiram (Antabuse)
Interferes with breakdown of alcohol leading to unpleasant reactions such as flushing, NV
Stays in system up to 14 days
Alcohol Withdrawal Sobriety
Gabapentin (Neurontin)
Works on GABA to calm down the brain and mitigate hyper-aroused state
Reduces cravings by lowering anxiety, improving sleep
With Disulfiram, you should avoid alcohol for
14 days
- vanilla and mouthwash
Benzodiazepines toxicity s/s
Severe Confusion
Drowsiness
Lack of coordination/weakness
Lightheadedness
Memory loss
Fainting
Benzodiazepines overdose occurs with
ETOH, opiates, TCAs, or CNS depressants
Benzodiazepines withdrawal s/s
Body pain
Muscle tension
Cramping
Insomnia
Vomiting
Tremors
Sweating
Seizures
miserable
Benzodiazepines reversal agents
Flumazenil
Opiates include what types of drugs
Opium (poppy flower latex)
Oxycodone
Fentanyl
Heroin
Meperidine
Morphine
Codeine
Methadone
Hydromorphone
Heroin lipid solublity is
high
-easier to enter cells and overdose quicker
When Heroin crosses the blood-brain barrier it converts to
active form of morphine
Heroin effectiveness
IV
Internasal
7-8 sec
10-15 sec
Lethality comparison
Heroin 30 mg =
Fentanyl 3 mg =
Carfentanyl 30 mcg
Oxycodone is a
controlled release of morphine
- chew, crush, snort, inject
If tolerance is too high = risk for OD
Meperidine
effective when taken
orally - w/o obvious isgns of IV drug use
Meperidine
has minimal effects on
smooth muscles
- less constipation and less retention
less pupillary constriction
Opiates Intoxication s/s
constricted pupils
decreased respirations
sedation
decreased BP
slurred speech
psychomotor retardation
- slow and tight
Opiates Toxicity Triad
Pinpoint pupils (to nothing)
Respiratory Depression
Coma
Opiates Overdose can lead to death r/t
Shock
Seizures
Cardiac arrest
Opiates withdrawal s/s
Yawning (continuous)
Insomnia
Irritability
Rhinorrhea, lacrimation
Panic
Diaphoresis
Cramps
N/V/D
Muscle aches
Bone pain
Chills/fever
Increased BP & HR
- speed up and juicy fluid loss
Opiate Toxicity Tx
airway mgmt and O2
Naloxone (Narcan) - short acting
Nalmefene(Revex) - long acting
Naloxone (Narcan)
reverses s/s of opioid OD
**precipatate withdrawal s/s
short acting
- violent reaction at revival
shoter half-life than opioid (multiple doses)
Nafelmene (Refex)
long acting and longer half-life
- precipitate prolonged withdrawal syndrome
Opioid Withdrawal time line
Begins 1-12 hours after last use
Peaks 3-5 days
Lasts 1-4 weeks based on severity
Opiate Post-acute withdrawal time frame
Up to 2 years
Opiate Post-acute withdrawal
Mood swings
Anxiety
Depressive symptoms
Insomnia
Methadone used for opioid withdrawal is
long acting opioid
replace substance of abuse
titrate to ease withdrawal s/s
Clonidone (short term)
helps with autonomic s/s (VS)
What could occur as a result of an opioid withdrawal that is not addressed by medications?
- DEHYRATION AND HYPERNATREMIA = HEART FAILURE
- supportive
Opioid sobriety maintenance
Methadone - lower cravings and relapses (daily)
Buprenorphine (Subutex) - lower cravings and relapses
- milder in neonatal
Naltrexone - blocks euphoric effects
Suboxone - prevents high
CNS Stimulants - short acting
Cocaine
Crack
CNS Stimulants - long acting
Amphetamines
Methamphetamines
Cocaine patho
increase dopamine and norepinephrine
- anethetic and stimulant
Cocaine has two forms , what are they?
- cocaine hydrochloride (powder; snorted or uncommonly IV)
- cocaine base (aka crack, crystal & rock; smoked aka freebasing – faster the inhale the faster the effects leave)
Cocaine is found in
cocoa plant leaves
Cocaine Intoxication S/S
Euphoria
Dilated pupils
Elevated BP & HR
N/V
Insomnia – no sleep or hunger
Grandiosity - genius
Impaired judgment
Cocaine OD S/S
Respiratory distress
Ataxia
Hyperpyrexia
Convulsions
Hemorrhagic stroke
Ventricular dysrhythmias
MI
Coma
Death
Cocaine Withdrawal S/S
Fatigue, lethargy, sleepiness
Anxiety, agitation, insomnia
Disorientation
Apathy
Craving
Depression
Suicidal ideation
Cocaine ADVERSE EFFECTS
long term use
atrophy of the nasal mucosa
loss of smell
injury to lungs (from free-basing)
Cocaine use in pregnancy
Crosses placenta barrier
Can result in:
Early delivery,
Smaller head,
Decreased birth length
Low birth weight
Long term effects may include deficits in:
Attention
Memory & language development
Methamphetamines patho
Increases release of Norepi and dopamine
Reduces uptake of Norepi and dopamine
Methamphetamines aka
Speed, chalk, ice, meth, crystal, crank, blue, glass, rocket fuel
Methamphetamines dissolves in
water and becomes bitter
Methamphetamines easy to
manufacture - decongestat
Methamphetamines Intoxication
short term
Dialated pupils
Increased energy
Increased respirations
Hyperthermia
Euphoria
Methamphetamines Intoxication
long term
Paranoia with delusions
Hallucinations
Anxiety
Potential for violence
- increase physical strength
Resemble schizophrenia
- tooth infection and kidney liver damage
Methamphetamines OD
Respiratory distress
Ataxia
Hyperpyrexia
Convulsions
Hemorrhagic stroke
Ventricular dysrhythmias
MI
Coma
Death
Psych
Methamphetamines Withdrawal
Fatigue, lethargy, sleepiness
Anxiety, agitation, insomnia
Disorientation
Apathy
Craving
Depression
Suicidal ideation
Very hungry
Meth adverse effects for long use
Parkinsonian symptoms
Cracked teeth
Skin infections
HTN
Stroke
Angina
Dysrhythmias
Respiratory damage
Renal and hepatic damage
Meth use in pregnancy
Preterm birth
Hypertension
Placental abruption
Intrauterine growth restriction
Neonatal death
CNS Stimulant OD Tx
ABCs
O2
Benzodiazepines (sedation and prevent seizures)
Cooling measures
IV antihypertensives
CNS Stimulant Withdrawal Tx
excessive lethargy (Modafinil)
Agitation and sleeplessness (Diphenhydramine and Trazodone)
Minor pain relief
Benxodaizepines (sedative)
What are the 3 club drugs
Ecstasy (MDMA) - increase serotonin
Gamma-hydroxybutrate (GHB)
Rohypnol - date rape drug
Ecstasy Intoxication S/S
Euphoria
Disinhibition
Increased sensuality, empathy, closeness
Ecstacy OD S/S
Hyperthermia
Seizures
Hypertensive crises
Cardiac dysrhythmias
Serotonin syndrome
Neuro effects
Confusion
Delirium
Paranoia
Cognitive impairment
Ecstasy Withdrawal S/S
Profound depression
Confusion
Sleep problems
Anxiety
Cravings
Tx for Ecstasy OD
NO ANTIDOTE
- Activated Charcoal
Comprehensive Chemistry panel
Mgmt of symtoms
Symptom Mgmt for Ecstasy OD
ABCs and O2
Cooling measures
Calm quiet environment
Sedation with benzodiazepines
Gamma-hydroxybutyrate (GHB) Intoxication
Euphoria
Disinhibiton
Impaired judgment
Feeling drunk
Amnesia
Loss of control over movement
Dizziness
Confusion
Sedation
N/V
Respiratory depression
unconscious quickly
Gamma-hydroxybutyrate (GHB) OD
Cheyne-stokes respirations
Seizures
Slow Breathing
Low Heart rate
Low body temperature
Coma
Death
Gamma-hydroxybutyrate (GHB) Withdrawal
tremors
insomnia
anxiety
Rohypnol AKA roofies Intoxication S/S
Euphoria
Disinhibiton
Impaired judgment
Feeling drunk
Amnesia
Loss of control over movement
Dizziness
Confusion
Sedation
N/V
Respiratory depression
Rohypnol AKA roofies OD S/S
Cheyne-stokes respirations
Seizures
Slow Breathing
Low Heart rate
Low body temperature
Coma
Death
Rohypnol AKA roofies Withdrawal S/S
Seizures
Headache
Muscle pain
Anxiety
Delirium
RohypnoL is tasteless and
odorless
GHB and rohypnol overdose treatment
GHB - no antidote
Rohypnol - Flumazenil
Activated Charcoal
Stymptom Mgmt for GHB and Roofies is
ABC’s
cooling
calm and quiet
sedation with benzo
Dissocialtive Drugs
Phenylcyclohexyl piperidine (PCP)
Ketamine
Salvia
PCP Intoxication S/S
Impervious to pain - FEEL NO PAIN
Elevated VS
Ataxia
Assaultive
Impulsive
Impaired judgment
Severe effects
Hallucinations
Paranoia
Bizarre behavior
Regressive or violent behavior
Labile emotions
Risk for suicide
PCP OD S/S
Psychosis
Hypertensive crisis
Stroke
Respiratory arrest
Hyperthermia
Seizures
PCP Tx
Acidify urine
safe, quiet environment
low, slow, and clear speech
Benzodiazepines and Haldol
Support for hyperthermia, HTN, and respiratory distress
PCP is highly
lipid soluble
Ketamine Intoxication
floating and out of body experience
Ketamine OD
amnesia
confusion
HTN
Acute respiratory distress
Ketamine Tx
support airway, vents, and inhalation
HTN
Respiratory distress
Salvia Divinorum intoxication
hallucinations
dissociation
derealization
depersonalization
HallucinOGENS
LSD - Lysergic acid diethylaminde
Peyote - mescaline
Mushrooms - psilocybin
Hallucnogens Intoxication S/S
Dilated pupils
Tachycardia
Diaphoresis
Palpitations
Tremors
Discoordination
Elevated VS
Hallucinations
Synesthesia - smelling colors
Fear
Paranoia
Anxiety
Distorted space/time
Hallucinogens OD S/S
Psychosis
Can trigger other psychiatric disorders
Hallucinogens OD Tx
Low-stimulation environment
Safety
Speech
Low
Clear
Slow
Medication
Benzodiazepines
Haloperidol - hallucinations
Cathinones includes
Bath salts
K2
Spice
Cathinones Intoxication
Hallucination
Dissociation
Disinhibition
Increased sex-drive
Extreme agitation
Combativeness
Cathinones OD
Excited delirium
Dehydration
Rhabdomyolysis
Renal failure
Chest pain
Cathinones Withdrawal
Depression
Anxiety
Insomnia
Paranoia
Rhabdomyolysis
damaged muscle tissue releases its proteins and electrolytes into the blood. These substances can damage the heart and kidneys and cause permanent disability or even death.
Inhalants
Volittle solvents (Paint thinner, Glues, Gasoline, Nail polish remover, Dry cleaner fluid)
Gases (butane, propane, and nitrous oxide)
Nitrates (isoamyl and isobutyl)
Aerosols (spray paint, keyboard cleaner, cooking oil)
Inhalants Intoxication
Slurred speech
Disinhibition
Euphoria
Dizziness
Inhalants OD
Respiratory arrest
Suffocation
Brain damage
Liver damage
Kidneys damage
Dysrhythmia
Heart failure
Myelin sheath damage
Muscle spasms
Tremors
Ataxia
Hearing loss
Coma
Death
Inhalants Tx
Medical support
B12 and folate
Teachign points for inhalants
Which paint gets you a better high?
sparkling
Nicotine
highly addictive
toxic
abstinence syndrome whne stopped
Nicotine Toxicity
N/V/D
Salivation
Cold sweats
Visual and Auditory disturbance
Confusion
Syncope
Rapid weak pulse
Death r/t respiratory paralysis
Nicotine Withdrawal
Cravings
Impaired concentration
Nervousness
Increased appetite
Pharma. Aids in Nicotine Withdrawal
Patches – 8 hours no for acute
Gum
Lozenges
Nasal sprays
Inhalers
Varenicline (Chantix)
Bupropion (Zyban)
Cannabis is used for
anxiety
fibromyalgia
MS
Neuropathy
seizure disorders
glaucoma
antiemetic
appetite stimulant
muscle spasm
bronchodilator
Pharmacologic Cannabis is
Sativex
Dronabinol (Marinol)
Nabilone (Cesamet)
THC Cannabis is used in what ways
smoked
vape
edibles (potent and cute for children)
Cannabis Intoxication
Euphoria
Detachment
Relaxation
Increased appetite
Talkativeness
Slowed perception of time
Sensitivity to stimuli
Cannabis OD
Paranoia
Anxiety
N/V
Cannabis for long term use
Cannabis hyperemesis syndrome
Cannabis hyperemesis syndrome
Severe vomiting
Abdominal discomfort
Acute dehydration
Renal failure
Assessments for Hx of Substance Use includes
age of first use
substance
period of sobriety
Hx of Tx,
withdrawal complications
Hx of OD
level of insight
DO NOT ASK where or who with
Medical Hx for SUD
coexisting conditions
meds current
and medical status current
Psychiatric Hx Assessment for SUD
mental state
hx of disorders
- Rx meds and outcome
Hx of abuse, violence, suicide, violence toward others
- current Suicidal thought
Psychosocial Issues Assessment
work
relationships
role expectations
criminal/legal problems
support systems
lifestyle
What labs need to be done for a SUD?
urine drug screen
toxicology
BAC
Psychological Issues - defense mechanisms
denial
underreporting
minimization
ambivalance
Denial
clarifying
Underreporting
not saying the amount they really had
Minimization
not a problematic drug
Ambivalance
not able to be sober or afraid to go off the substance
Things that negatively affect the care you provide
CHECK YOUR BIASES!
- social stigma and prejudices
- personal neg experiences
- lack of understanding
- lack of empathy
Relapse is a
symptom of a complex disease
- not a sign of weakness
- part of the change process
- opportunity to learn
SUD nursing dx risk for
Injury
Dehydration
Delirium/confusion
Loneliness
Suicide
SUD nursing dx impaired
Cognition
Sleep
Self-care
Coping
Role performance
Family coping
SUD nursing dx for all drugs
Denial
Craving
Shame
Spiritual distress
Anxiety
Distorted thinking process
Hallucinations
Hopelessness/shame
Lack of family support
Expected Patient Outcomes for SUD
increased insight and accountability
coping
attend tx , relapse prevention, AA, group therapy
identify stress and social habit triggers
Relapse prevention
Common symptom
Part of the recovery process
Identify triggers
- confront triggers and manage cravings
- healthy coping strategies
Dual-diagnosis
Equal priority
Individualized treatment
Small steps over long period of time
Relapse prevention strategies starts with
emotional cues
mental reponses
physical cues
Psychotherapy Tx for SUD
Cognitive-behavioral therapy (CBT)
Motivational enhanvement therapy (MET)
Screening, brief intervention, referral to treatment (SBIRT)
Motivational interviewing
Recovery Model
Health - overcome/manage disease
Home - safe, stable place to live
Purpose - conduct meaningful activities
Community - support, friendship, and hope
AA and 12 steps helps them
Powerlessness over addiction
Responsible for recovery
Take ownership of problems and feelings
Spirituality
SMART Recovery helps them
Motivation to abstain
Coping with urges
Managing self
Lifestyle balance
- self-management
Residential Programs for SUD
Patients with long history of treatment
24/7 drug-free environment
Goal
Lifestyle change
Abstinence from all medications
Develop social skills
Eliminate problem behaviors
Outpatient programs for SUD help
Flexible
Diverse
Cost-effective
Evaluation of a SUD patient depends on
length and extent of sobriety
adherence to recovery
occupational functioning
improved family relationships
coping skills
support systems