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Psych Exam 2 > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

1
Q

Substance Use Disorders

A
  • Alcohol Use Disorder
  • Sedative, Hypnotic, Anxiolytic Use Disorder
  • Stimulant Use Disorder
  • Inhalant Use Disorder
  • Opioid Use Disorder
  • Hallucinogen Use Disorder
  • Cannabis Use Disorder
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2
Q

DSM-V Criterion for Substance Abuse Disorders

A
  • Criterion 1: Larger amounts or longer period than intended
  • Criterion 2: Persistent attempts to cut down
  • Criterion 3: Much time obtaining substance, using or detoxing
  • Criterion 4: Intense desire or “urge”
  • Criterion 5: Inability to maintain role functions
  • Criterion 6: Continues use despite interpersonal problems
  • Criterion 7: Withdrawal/isolation
  • Criterion 8: Hazardous activities while using
  • Criterion 9: Use despite knowledge of physical/psychological harm
  • Criterion 10: Tolerance
  • Criterion 11: Withdrawal

Now, two or more of 11 criteria need to be present for a diagnosis of SUD-Mild. For SUD-Moderate, it’s four or more, and for SUD-Severe, it’s six or more.

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3
Q

SUD

Predisposing Factors

A

Biological Factors
Genetics- Research to date has led to the identification of several genes that seem to influence the risk of alcohol dependence
Biochemical-
• Products of alcohol metabolism interact with dopamine and serotonin to produce morphine-like substances
• Opiates, such as heroin, mimic natural opiate-like neurotransmitters such as endorphins
• Stimulants, such as cocaine, block the reuptake of dopamine, serotonin, and norepinephrine.

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4
Q

SUD:

Predisposing Factors

A

Psychological Factors
• Emotion- difficulty expressing emotions, substance may become a form of self-medication
• Personality- low self-esteem, depression, passivity, inability to relax or to delay gratification

Sociocultural Factors
• Social Learning- modeling, imitation, identification
• Cultural and Ethnic Influences- differences in how substance use is viewed, most notable differences are with alcohol

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5
Q

SUD:

Lifespan Considerations

A
  • Half of U.S.12 and up are current drinkers
  • 23% of that half are current binge drinkers
  • 6.7% of that half use heavily
  • In 2012, 24% of 12th graders had one binge drinking episode during previous two weeks
  • In 2012, 24% of 12th graders binge drinking once during previous two weeks
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6
Q

Alcohol Use Disorder

A
  • Depressant effect on CNS
  • Most widely abused drug in the U.S.
  • Alcoholism is number one health problem
  • Third leading cause of preventable death
  • Heavy drinking contributes to heart disease, cancer and stroke
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7
Q

Alcohol: Effects on the Body

A 
• Peripheral Neuropathy/Alcoholic Myopathy 
• Wernicke Encephalopathy/Korsakoff’s Psychosis 
• Esophagitis/Gastritis 
• Pancreatitis/Alcoholic Hepatitis 
• Cirrhosis 
– Portal Hypertension 
– Ascites 
– Esophageal Varices 
– Hepatic Encephalopathy 
• Leukopenia/Thrombocytopenia
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8
Q

Possible Consequences of Drinking While Pregnant:

A

Fetal Alcohol Syndrome

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9
Q

Alcohol Intoxication

A
  • Euphoria
  • Disinhibition/Impulsivity
  • Mood Lability/Depression
  • Impaired Judgment/Attention
  • Slurred Speech
  • Incoordination/Unsteady Gait
  • Nystagmus
  • Flushed Face
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10
Q

Blood Alcohol Level (BAL)

A

• BAL can be measured by blood test,
breathalyzer or urine sample
• 0.08% or above is legally intoxicated
• 0.400% - 0.700% death is possible

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11
Q

Alcohol Withdrawal

DSM-V criteria

A

– Cessation of alcohol use that has been heavy and prolonged followed by 2 or more of the symptoms below:
• Autonomic hyperactivity (elevated Blood pressure, Elevated HR)
• Increased hand tremor
• Insomnia
• Nausea or vomiting
• Transient auditory, visual or tactile hallucinations
• Psychomotor agitation
• Anxiety
• Generalized tonic-clonic seizures

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12
Q

Medications Used for Alcohol Withdrawal

A

• Alcohol/Depressants
– Benzodiazepines (Substitution Therapy and taper off)
• Valium
• Librium
• Ativan (the benzodiazepine best tolerated by patients with advanced liver disease)

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13
Q

(Delirium Tremens DTs)

A 
Peak: 2nd or 3rd day (48-72 hours) 
• Autonomic hyperactivity 
• Severe disturbance in sensorium 
• Perceptual disturbances 
• Fluctuating levels of consciousness 
• Delusions, agitated behavior, fever
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14
Q

Sedative, Hypnotic, and Anxiolytic Use Disorder

A
  • CNS depressants
  • Tranquilizing relief of anxiety to anesthesia, coma and even death
  • Effects are additive with one another
  • Combination of alcohol and any of these can be fatal
  • Physiological and psychological addiction very similar to alcohol
  • Cross-tolerance
  • Cross-dependence
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15
Q

Sedative, Hypnotic, and Anxiolytic Drugs

A 
• Barbiturates- short-term sleep, pre-anesthesia, seizures 
– Phenobarbital 
• Nonbarbiturate Hypnotics- mostly for sleep 
– Eszoplicone (Lunesta) 
– Zolpidem (Ambien) 
• Antianxiety Agents (Benzodiazepines) 
– Chlordiazepoxide (Librium) 
– Diazepam (Valium) 
– Lorazepam (Ativan) 
– Clonazepam (Klonopin) 
• Club Drugs (Illegal) 
– Flunitrazepam (Rohypnol) 
– Gamma hydroxybutyrate (GHB)
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16
Q

Sedative, Hypnotic or Anxiolytic Effects on the Body

A
  • Barbiturates increase amount of sleep time in the dreaming phase
  • Respiratory Depression
  • Hypotension
  • Decreased cardiac output
  • May suppress renal function
  • Can greatly decrease body temperature
  • Initial increase in libido followed by decreased ability to function
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17
Q

Sedative, Hypnotic, Anxiolytic Intoxication and Withdrawal

A
  • Intoxication: decreased inhibition, impulsivity, mood lability, impaired judgment/attention/memory, slurred speech, unsteady gait, nystagmus, stupor or coma
  • Withdrawal: autonomic hyperactivity, hand tremor, nausea or vomiting, hallucinations, illusions, psychomotor agitation, anxiety, orthostatic hypotension or seizures
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18
Q

Stimulant Use Disorder

A

• In 2010, about 1.5 millions Americans were current cocaine users, highest use among ages18-25
• Effects on Body
– CNS- tremor, restlessness, anorexia, insomnia, agitation
– Cardiovascular/Pulmonary- increased HR and BP, cardiac arrhythmias, Cocaine intoxication can lead to MI due to these effects. Inhaled cocaine can cause pulmonary hemorrhage, chronic bronchiolitis, and pneumonia
– GI and Renal- constipation, various degrees of anorexia, difficulty urinating

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19
Q

Stimulant Drugs

A

• Amphetamines
– Methamphetamine (Desoxyn)
– Amphetamine + Dextroamphetamine (Adderall)

https://www.youtube.com/watch?v=evhM47sUIt0#action=share 
– Lisdexamfetamine Dimesylate (Vyvanse) 
• Synthetic Stimulants 
– Methylenedioxypyrovalerone (MDPV) “Bath Salts” 
• Nonamphetamine Stimulants 
– Benzphetamine (Didrex) 
– Methylphenidate (Ritalin) 
• Cocaine 
• Caffeine 
• Nicotine
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20
Q

Stimulant Effects on Body

A

– CNS- tremor, restlessness, anorexia, insomnia, agitation
– Cardiovascular/Pulmonary- increased HR and BP, cardiac arrhythmias, Cocaine intoxication can lead to MI due to these effects. Inhaled cocaine can cause pulmonary hemorrhage, chronic bronchiolitis, and pneumonia
– GI and Renal- constipation, various degrees of anorexia, difficulty urinating

21
Q

Stimulant Intoxication/Withdrawal

A

• Intoxication
– Tachycardia, hypertension, pupillary dilation, perspiration, chills, N&V
– Grandiosity, hypervigilance, psychomotor agitation, impaired judgement, aggression
• Withdrawal
– Craving, fatigue, insomnia or hypersomnia, psychomotor agitation
– Anxiety, depressed mood, irritability, paranoid and suicidal ideation

22
Q

Inhalant Use Disorder

A
  • Intoxication- dizziness, slurred speech, unsteady gait, lethargy, impaired judgment, apathy, depressed reflexes, tremor, blurred vision, stupor, coma
  • Intoxication- occurs within minutes, symptoms last 60-90 minutes, large doses can result in death from CNS depression or cardiac arrhythmia
  • May have irritation around eyes, mouth and nose
  • Withdrawal- mild, not clinically significant
23
Q

Hallucinogen Use Disorder

A

• Intoxication

24
Q

Hallucinogen Use Disorder:

• Physiological Effects

A 
– Increase in P, BP and T Heightened body awareness 
– Decrease in R Heightened senses 
– N&V Slowing of time 
– Chills Paranoia, panic 
– Pupil Dilation Depersonalization 
– Loss of Appetite Derealization 
– Insomnia Anxiety/Depression 
– Sweating Increased libido
25
Q

Hallucinogens

A 
• Naturally Occurring 
– Mescaline 
– Psilocybin 
– Ololiuqui 
• Synthetic Compounds 
– LSD- loss of appetite, impaired coordination, muscle weakness, body pain, N&V, reckless behavior 
– Ecstasy (MDMA) 
– Bath Salts (MDPV)- severe psychosis leading to aggressive/violent behavior
26
Q

Opioid Use Disorder

A
  • 4.3 million Americans- non-medical use of prescription pain-killers in the last month
  • 1.4 million people- prescription painkillers non-medically for the first time in the past year
  • 44 people die every day in the U.S. due to overdose of prescription pain-killers
  • 91 Americans die every day from an opioid overdose
  • Approximately 435,000 people- regular (past-month) users of heroin
  • Heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015
27
Q

Opioids and Related Substances

A

Opioids of natural origin
• Opium-from poppy seeds
• Morphine- the primary active ingredient of opium
• Codeine

Opioid Derivatives
• Heroin
• Oxycodone-(Percodan, OxyContin)
• Hydrocodone- (Vicodin)

Synthetic (Opiate-like)
• Meperidine (Demerol)
• Methadone (Dolophine)
• Fentanyl (Fentora)

28
Q

Opioid Intoxication

A
  • Euphoria/Dysphoria
  • Psychomotor Agitation/Retardation
  • Impaired Judgment
  • Pupil constriction
  • Drowsiness
  • Slurred Speech
  • Decreased Attention/Memory
  • Decreased Sexual Function/Diminished Libido
29
Q

Opioid Overdose

Signs of Life Threatening Overdose

A

• Respiratory Depression/Arrest

30
Q

Opioid Overdose Treatment

A

Narcan (Naloxone)
• Narcotic antagonist quickly reverses CNS depression
• IV, IM, SQ and now nasal spray for emergency use
• Given to babies who are born addicted,

31
Q

Opioid Withdrawal

A
  • Dysphoric Mood
  • Nausea, Vomiting, Diarrhea
  • Muscle Aches
  • Lacrimation or Rhinorrhea
  • Pupillary Dilation
  • Piloerection
  • Sweating
  • Yawning
  • Fever/Chills
32
Q

Medications Used for Opioid Withdrawal

A

Methadone
• Action: Binds to opioid receptors in CNS, resulting in decreased pain, moderates symptoms of detox and opioid maintenance therapy

Suboxone= Buprenorphine and Naloxone
• Buprenorphine(Subutex): binds to opioid receptors in CNS resulting in decreased pain, moderates symptoms of withdrawal
• Naloxone: Blocks opioid effects; reverses CNS/ respiratory depression without patient experiencing opioid benefits

33
Q

Treatment Related Modalities

A
  • Pharmacotherapy (to help maintain recovery)
  • Support Groups (12-step)
  • Counseling
  • Group Therapy
34
Q

Pharmacotherapy to Help in the Treatment of Alcoholism

A
  • Disulfiram (Antabuse)
  • Naltrexone (ReVia)
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Acamprosate (Campral)
35
Q

Support Groups (12-Step )

A

o “Alcoholics Anonymous Alcoholics Anonymous® is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking.
o Al-Anon: Through peer support group members apply principles to problems related to the effects of a problem drinker in their lives

36
Q

Counseling/Therapy

A 
• Individual Counseling 
– DBT 
– CBT 
• Group Therapy 
• Family Therapy
37
Q

Nursing Process

A 
• Assessment 
– Self-Reflection 
– Patient Interview/Substance History 
– Assessment Tools 
• Nursing Diagnoses/Outcome Identification 
– Goal Identification 
– Short-term/Long-term 
• Planning 
• Implementation 
• Evaluation
38
Q

Assessment

A

• Self-reflection
• Substance Use History and Assessment
• Assessment Tools
– Clinical Institute Withdrawal Assessment Scale, Revised (CIWA-Ar)
– Michigan Alcoholism Screening Test (MAST)
– CAGE Questionnaire
– Clinical Opiate Withdrawal Scale (COWS)

39
Q

Nursing Diagnoses

A
  • Risk for Suicide
  • Risk for Self-Inflicted Injury
  • Risk for Injury
  • Imbalance Nutrition: Less than Body Requirements
  • Deficient Fluid Volume
  • Ineffective Coping
  • Chronic Low Self-Esteem
  • Ineffective Denial
  • Deficient Knowledge
40
Q

Planning and Implementation Goals/Interventions/Evaluation

A
  • Please work in small groups
  • Choose two of the Nursing Diagnoses listed and provide 2 short-term and 2 long-term goals for each
  • Provide one Nursing Intervention for each goal
  • What are the related Nursing Concepts?
41
Q

Concepts Related to Addiction

A 
• Interpersonal Relationships (Family) 
– Lack of knowledge about disease 
– Poor communication 
• Nutrition 
– Using substances instead of eating 
– Depletion of B vitamins 
• Cognition 
– Confusion/disorientation due to delirium, sever Thiamine deficiency 
– May have decreased memory
42
Q

Concepts Related to Addiction

A 
• Coping and Adaptation 
– Anxiety due to withdrawal 
– Family/patient anxiety due to uncertainties 
• Mobility (Safety) 
– Risk of seizure with withdrawal 
– Risk for falls
43
Q

Marchman Act: Florida’s Substance Abuse Impairment Act

Two methods of initiation

A

• Emergency admission
– Emergency assessment and stabilization may be initiated once certificate is completed by Physician
– Initiated by providers, family and law enforcement
• Court involved:
– Family, law enforcement or physician can petition court

44
Q

Marchman Act Criteria

A

• Lost control/use of substance
– EITHER demonstrates risk of harm to self or others
– OR judgment so impaired person not able to make rational decisions about need for treatment.

Simply refusing treatment is not sufficient proof of lack of judgment

45
Q

Codependence

• Characteristics

A

– Poor relationship skills
– Excessive anxiety and worry
– Compulsive behaviors and resistance to change
– Enabling behavior
– Excessive sense of responsibility
– Extreme need to feel in control
– Low self-esteem and fears of abandonment

46
Q

Enabling Behavior

A

• Action taken by well meaning friends and/or family members who want to help
• Behavior that seems helpful on the surface but actually perpetuates the using behavior
• Behavior that prevents the substance user from facing consequences of own behavior.
– Wife calls in sick for her husband who really has a hangover
– Paying rent for adult children who are spending money on using substances
– Nurse makes excuses for patient’s behavior or does things for the patient that they can/should do for themselves

47
Q

Therapeutic Interventions

A
  • Assess for use of denial and other defense mechanisms
  • Compare patient’s description of situation to what has been observed (realistic appraisal)
  • If blaming and making excuses, use confrontation with care and nonjudgmental approach
  • Set limits on manipulative behavior and maintain consistency in responses
  • Avoid agreeing with inaccurate perceptions
  • Help patient gain insight through exercises, groups, and step work
48
Q

Substance Abuse Among Nurses

A
  • An estimated 10-15% of nurses suffer from the disease of chemical dependency
  • Alcohol is most widely used followed by narcotics
  • Substance abuse by nurses is very serious, putting patients and themselves at risk for harm
  • Nurses have an ethical and legal responsibility to report suspicious behavior to a supervisor
  • Do not handle situation alone or try to warn coworker
  • Reporting suspected abuse could be the crucial first step toward getting the help that is needed for that nurse

Psych Exam 2 (2 decks)

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