Substance Use DO Flashcards by Erika Lee

what is biochem theory

ETOH may produce morphine like substances in brain

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what is genetic vulnerability

children of alcoholics 3-4 times more likely to use

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personality defect theory

person experiences intense sensory input and uses for protection
low self esteem
passive
depressed
antisocial traits - can’t learn from aversive conditions

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psychoanalytic theory

oral phase
parental inconsistency
regressed, fixated
least accepted theory today

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socio cultural theory

social forces
role models/peer pressure
how we respond to stress
ethnic groups

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family systems theory

addiction serves family purpose, shifts focus away from family issues
rigid roles, family secrets, closed system
CODEPENDENT

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codependent issues

try to gain control with addict’s behavior
little self identity, depend on people thing outside of self
try to control events or people around them
rescues/blames/persecutes addict
focus thoughts/behaviors on other people
people pleasers
competent on the outside, helpless on inside
codependent nurses - control, want to rescue, self worth comes from feeling needed, risk for burnout

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minor sx of ETOH w/d

agitation
anxiety
irritability
n/v

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major sx of ETOH w/d

HTN
life threatening
tachycardia
confusion
tremors
hallucinations
seizures

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in what time frame does ETOH w/d delirium occur

2-3 days

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CAGE assessment tool

cut down
annoyed
guilty
eye opener

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ETOH med complications

GI - esoph bleed/varices, gastritis,
pancreatitis
cirrhosis - portal HTN & ascites
LV encephalopathy - can no longer convert NH3 to urea -> impaired mental
vit B deficient
Korsakoff/wernickes - cognitive and memory impairment
w/d - seizure, hallucination, delirium
TB, pneumonia
depression/suicide
HTN, cardiomyopathy
Cancer - LV, Pancreas, LI, oral, esophagus
leukopenia, thrombocytopenia - WBC and Platelets
Sex hormones - decrease testosterone
Birth defects

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what supplement can be used to tx seizures

MgSO4 - magnesium sulfate

can add Dilantin in Hx of seizure

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Tx for ETOH

monitor VS
fluid status assessment
prevent seizure
thiamine and multivits
banana bag
BDZ to prevent seizure and DTs - use Chlordiazepoxide &amp; Diazepam
BUSPAR for long term

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buspar teaching

long time to take effect - 3-4 weeks
interacts with 5HT and DA at presynapse
TAPER
no ETOH
take with food
may become dizzy, drowsy

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amphetamine w/d

depression
fatigue
restless/anxious
disturbed sleep/dreams
suicidal paranoid
crashing
cravings
psychomotor agitation

what are pupils like for amphetamine

dilated

what sx are assoc with OD on meth?

cardiac

barbiturate intoxication sx that stand out

fever
lability
long sleep times
gait prob
slurred speech
hallucinations
delirium
death

w/d sx of barbs

decreased resp
seizure
n/v
orthostatic drop, tachycardia
coma/death
muscle contraction

anxiolytic, sedative, hypnotic sx of intox

inapprop sexual
nystagmus
stupor or coma

sedative hypnotic anxiolytic w/d

autonomic hyperactivity - diaphoresis, pulse over 100

grand mal seizures

opioid narcotic intox

clammy skin
pin point pupils
resp/circulatory depression
coma

opioid w/d

diaphoresis/fever
rhinorrhea
dysphoric mood
dilated pupils
watery eyes
flu like

what are the pupils like for opioid intoxication

pin point

cocaine sx

``` dilated pupil arrhythmia sweating/chills n/v HTN, tachycardia NOSEBLEED congestion ```

cocaine w/d

``` craving depression anxiety hyperinsomnia psychomotor agitation ```

which pathway in CNS reinforces addictive beh

DA - pleasure reward system

inhalant sx

``` nystagmus dizziness lethargy depressed reflexes slurred speech unsteady gait ```

inhalant w/d sx

blurred vision/diplopia generalized musc weakness stupor/coma euphoria

long term effects of inhalants

loss of brain matter -> n. damage and pyramidal signs pulm HTN, dyspnea n/v, rash around nose and mouth, unusual breath odor renal failure

marijuana affect on brain

lower volume of cerebellar white matter

reasons for relapse

``` HALT hungry angry lonely tired ```

use of meds to prevent relapse

naltrxone (ReVia) acamprostate (Campral) Disulfiram (Antabuse)

Disulfiram (Antabuse) teaching

must wait 12 hours read all labels (no ETOH) - will cause severe n/v, abd pain take in AM inform HCP

dual diagnosis definition

those with both mental illness and substance abuse DO

meds for dual diagnosis

SSRIs, 2nd gen antipsychotics Buspar if necessary if need BDZ - clonazepam (Klonipin)

interactions of substances and meds

stimulants reduce effects of antipsychotics and antianxiety depressants decrease antidepressants MJ and hallucinogens decrease antipsychotic meds effect smoking increases processing of psychiatric meds