SUD Flashcards
social components of SUD
social stigma/controversy
environmental factors
peer influence
dysfunctional family dynamics
abusive hx
social maladaptation
family hx addiction
peer pressure
lack of family involvement
difficult family situations: lack of bond with parents or siblings; lack of bond with parents or siblings; lack of parental supervision
psychological aspects of addiction
STRESS
• DEPRESSION
• LOW SELF-ESTEEM
• INCREASED NEED FOR SUCCESS/POWER
• INABILITY TO COPE
• ANXIETY
• LONELINESS.
biological components of addiction
genetic predisposition
increased dopamine
immature brain development
function of acetate
having other mental health disorder
males
cocaine
stops molecules that mop up excess dopamine
amphetamines
push dopamine out of sacs where it is stored
heroin
makes dopamine neurons fire more
alcohol
helps release more dopamine
excess of dopamine
feeling high
immature brain development
early experiences affect brain development
early stress and trauma change brain responses
brain develops until age 24
adolescent brain develops back to front
back of brain
emotion, memory, impulse, psychomotor activity
front of brain
areas of executive function, planning, problem solving, judgement, impulse control, organization
biological alcohol craving and acetate
etoh breaks down into acetate
acetate triggers craving
liver and pancreas of addicted person processes alcohol slower than normal
normal drinkers acetate moves quicker and exits
in addicted person after 1st drink body craves more, after second drink they want more and more and cant stop
control is lost and the craving cycle has began
acetate accumulates in alcoholics body after only 1 drink and this never changes
The addicted brain
repeat use leads to tolerance and withdraw via changes in neurotransmitters
decreased dopamine receptors and decreased dopamine release resulting in compulsive behaviors, decreased inhibition, increased impulsivity, impaired regulation of intentional action
what do alcohol and nicotine metabolize down into?
acetate
substance intoxication
symptoms are drug specific
recent overdose/ excessive use of a substance such as acute alcohol intoxication, that results in a reversible substance-specific syndrome
judgement is impaired
CNS changes occur; disruption in physiological and psychological functioning
can happen with one time of use
substance withdraw
happens when substance is removed after heavy and prolonged use
symptoms of substance withdraw
anxiety
irritability
restlessness
insomnia
fatigue
symptoms differ and are specific to substance type
Medications for alcohol withdraw
chlordiazepoxide (librium)
Diazepam (valium)
Lorazepam (ativan)
Thiamine daily replacement
other meds: PHENOBARBITAL, INDERAL, CLONIDINE (goal to keep BP and HR low, MAGNESIUM SULFATE, MVI,
ANTIPSYCHOTICS
Opioid Withdraw: COWS
increased resting pulse (observe client being quiet for 5 min before checking)
sweating
restlessness
pupil size (3mm normal)
bone and joint aches
runny nose or tearing
GI upset
tremors
yawning
anxiety or irritability
gooseflesh skin (hallmark sign of severe w/d)
max score 48
treating opioid withdraw non medication
nausea (provide crackers, ginger ale, tea, flat warm coke)
muscle aches: (hot shower, warm compress, tylenol)
Anxiety reduction: (distraction, relaxation and talk therapy)
what do you give to reduce nausea and vomiting in opioid withdraw?
ondansetron, phenergan (oral or rectal, avoid IM gives pt a rush)
what do you give to reduce anxiety, lacrimation, and rhinorrhea in opioid withdraw?
Atarax or Hydroxizine
what meds do you avoid in opioid withdraw?
benzos
what do you give for insomnia in opioid withdraw?
desyrel
trazorel (trazodone)
Myalgiastyloneol (use caution in patients with esophageal varices or ulcers)
what do you give for diarrhea in opioid withdraw?
Kaopectate is preferred choice
AVOID lomotil (loperamide) causes sedative effect sought by patient
important facts about naltrexone
cannot use any opioids 10-14 days before starting
if pt uses opioids they will get very sick and will cause fast withdraw
blocks opioid receptors and blocks the feelings of
ETOH and decreases cravings
injection every 28 days
Vivtrol, Revia
Disulfiram (Antabuse)
prevents breakdown of acetyladohyde
can make pt very sick if they drink, decreases cravings
Pts cannot be close to alcohol, paint thinner, perfume, or anything containing alcohol or they will become very sick
vomiting profusely
clonidine
anti-HTN
helps to calm pt by lowering BP and HR
campral
decreases ETOH cravings
methodone
opioid to help with opioid withdraw
pts can be addicted to methadone
suboxone
Subutex and naloxone combo drug
subutex
reduced withdraw from opiods
emergency treatment of heroin overdose
nalaxone kits
narcan can be delivered by injection or nasal mist
quickly reverses the effects of heroin withdraw
can get free kits at UK ER or health departments
INSTANT withdraw
long term methadone maintenance for pregnant women
decreases variability of illicit drug effect on fetus
newborns have predictable outcomes
doses may need to be adjusted upward as pregnancy progresses
decreases cravings and withdraw
blocks effects of other opioids
maintained until delivery, then withdraw
infant can experience symptoms of withdraw that may be 2/3x as intense as mom
tolerance
must use increased amounts of drug over time to achieve the same effect
causes of wernicke’s encephalopathy
vitamin b1: Thiamine deficiency that directly intereferes with glucose production
caused by chronic alcoholism
other causes of thiamine deficiency
gastric carcinoma
starvation
chronic gastritis
hemodialysis in end stage renal disease
classic symptoms of Wernicke’s encephalopathy
mental confusion
ataxia
mental status changes
ophthalmoplegia (paralysis or weakness of the eye)
treatment of wernicke’s encephalopathy
reversible with thiamin replacement
improve nutritional status
without treatment may advance to korsakoff psychosis
korsakoff psychosis
not reversible
persistent learning and memory problems
chromic and debilitating syndrome
ataxia
disorientation
delirium/ psychosis
confabulation
neuropathy
wernicke-korsakoff syndrome
combination of both processes
requires long term care/institutionalization
BP and temp low
pule rate elevated
symptoms mirror intoxication even after BAC=0
prevention as a tx stragtegy
change in norms
form/join community/school coalitions
reduce access
limit exposure
enforce laws and policies
family involvement
access to behavioral health services
how many drinks are considered high risk?
women: 7 drinks per week
Men: 14 drinks per week
BAC levels
.02 for under 21
.8 for 21 and over
0.50 and greater = death
tolerance can result in a pt having a higher BAC and not showing many symptoms
typical effects of a BAC 0.8
decreased muscle coordination
harder to detect danger
judgement, self control, reasoning, and memory are impaired
impaired perception
short term memory loss
blackouts
not same as passing out, client functions as normal and cannot remember several hours
relapse
recurrence of alcohol or drug dependent behavior in an individual who previously achieved abstinence
dual diagnosis
co-occurring mental illness with substance abuse or addictive disorder
forms of denial
refusing outright- its not a problem
minimizing- no big deal im fine
rationalizing- everyone else is doing it
intellectualizing- i can stop if i want to
blaming/projecting- if you were stressed you would drink too
bargaining- just one more time
passivity- i cant do anything about it anyway
hostility-demanding- ill drink if i want too
nursing interventions for SUD
honest expression of feelings
listen to what the individual is really saying
express caring
monitor your reactions
hold the individual responsible
communicate the treatment plan to pt and team
