Topic 10 & 11: Substance Abuse & Addiction Flashcards
1
Q
alcohol is often…
A
*used in combination with other substances
2
Q
marijuana
A
*Recreational use
*Legalized in some states
*Medicinal use
*Legalized in several states
*Use remains federally prohibited
3
Q
nicotine
A
*Historic trends continue:
*cigarettes
* pipes
*chewing tobacco
*Newer trend:
*e-Cigarettes (“vaping”)
4
Q
opioids
A
*Includes prescription pain relievers & heroin
*Opioid overdose is at epidemic levels (A leading cause of death in the U.S.)
*Women dying of heroin overdose has tripled
5
Q
prescription abuse
A
*Opioids
*Sedatives (e.g., benzodiazepines)
*Stimulants
6
Q
medications that fall under the opioid class
A
*hydrocodone (e.g., Vicodin),
*oxycodone (e.g., OxyContin, Percocet),
*Hydromorphone (Dilaudid)
*morphine (e.g., Kadian, Avinza),
*codeine, and related drugs.
7
Q
Dependence/Addiction and changes in the brain
A
The most important structural or architectural change takes place in the circuitry of the brain — particularly in the wiring of the reward pathway
8
Q
withdrawal symptoms may occur if drug use is suddenly reduced or stopped are…
A
restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements.
9
Q
the 4 Cs of addiction
A
*Compulsive behavior (finding & taking the substance)
*Cravings
*Chronic, relapsing brain disorder
*Cognitive impairment
10
Q
How do drugs work in the brain to produce pleasure?
A
Most drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.
11
Q
Alcohol and other CNS depressants act on what NT
A
GABA
12
Q
tolerance can lead to
A
dependence, then addiction, then overdose
13
Q
Client -Centered Care:Assessment for Substance Abuse
A
1.Clarify presenting signs
2.Assess for withdrawal
3.Assess for overdose
4.Assess for self-harm potential
5.Evaluate physiologic response
6.Explore individual’s interest in taking action
7.Assess knowledge of community resources
14
Q
Since the brain is not fully developed until the mid-20s…
A
early drug abuse negatively impacts brain development.
15
Q
Identification & Reporting in Healthcare
A
-Reporting an impaired colleague is a peer responsibility (mandated reporter)
-Clear documentation by co-workers is crucial & mandatory
16
Q
you as the nurse can repot alcohol abuse about a colleague, but interventions is the responsibility of
A
the nurse manager and administrators
17
Q
If an impaired nurse remains in the practice situation and no action is taken by the nurse manager, the information must be…
A
taken to the next level in the chain of command
18
Q
alternative-to-discipline (ATD) programs
A
19
Q
Alcohol is the most teratogenic substance during
A
pregnancy
20
Q
*Fetal alcohol syndrome (FAS)
A
*Life-long effects (mental retardation, delayed growth and development, and distinctive facial abnormalities)
21
Q
breastfeeding considerations for alcoholics
A
22
Q
alcohol and aging
A
tolerance for alcohol is DECREASED due to:
*Slower emptying of stomach
*Slower metabolism (including hepatic)
*Increased sensitivity to alcohol in the brain
23
Q
Decline in lean muscle mass and increased fatty tissue contribute to…
A
increased blood alcohol levels (BALs).
24
Q
*Changes in the response to alcohol include: (older adults)
A
*Headaches
*Reduction in mental abilities
*Memory losses or lapses
*Feelings of malaise instead of well-being
25
older adults have decreased liver enzymes which
decrease the ability or break down alcohol, making higher BAL than in younger people
26
alcohol should not be mixed with
Antidepressants and tranquilizers because they further depress the CNS
27
Toxicity of other drugs (e.g., acetaminophen (Tylenol)) is enhanced by
alcohol-associated malnutrition.
28
Physiologic Effects of Alcohol
*Brain Function
*Fetal Alcohol Syndrome (FAS)
*Alcoholic Cardiomyopathy
*Arrhythmias
*Hypertension
29
Alcohol can cause your neurotransmitters to relay information too slowly, so you feel..
extremely drowsy
30
Alcohol related disruptions to the neurotransmitter balance also can trigger mood and behavioral changes, including...
depression, agitation, memory loss, and even seizures.
31
what NT is susceptible to even small amounts of alcohol, and what does it affect
glutamate
-glutamate affects memory
32
what NT does alcohol affect that sparks feeling of relaxation and euphoria
serotonin
33
alcohol damages liver function which can lead to
hepatic encephalopathy
34
s/s of hepatic encephalopathy
* Sleep disturbances
* Mood and personality changes
* Anxiety
* Depression
* Shortened attention span
* Coordination problems, including asterixis, which results in hand shaking or flapping
* Coma
* Death
35
Doctors can help treat hepatic encephalopathy with
compounds that lower blood ammonia concentrations and with devices that help remove harmful toxins from the blood.
36
Fetal Alcohol Syndromes
a medical condition in which body deformation or facial development or mental ability of a fetus is impaired because the mother drank alcohol while pregnant
37
Alcoholic Cardiomyopathy
Long term heavy drinking weakens the heart muscle, causing a condition called alcoholic cardiomyopathy. A weakened heart droops and stretches and cannot contract effectively. As a result, it cannot pump enough blood to sufficiently nourish the organs.
38
Symptoms of cardiomyopathy include
shortness of breath and other breathing difficulties, fatigue, swollen legs and feet, and irregular heartbeat. It can even lead to heart failure
39
Arrhythmias
Both binge drinking and long term drinking can affect how quickly a heart beats.
40
Strokes
A stroke occurs when blood cannot reach the brain.
Both binge drinking and long term heavy drinking can lead to strokes even in people without coronary heart disease
41
Hypertension
Chronic alcohol use, as well as binge drinking, can cause high blood pressure, or hypertension.
42
Alcohol affects all organ systems
*Alcohol is a CNS depressant
*Wernicke's Encephalopathy
*Korsakoff's Psychosis
*Esophagitis
*Pancreatitis
*Alcohol-induced hepatitis
*Fetal Alcohol Syndrome (FAS)
43
*Wernicke's Encephalopathy
*Confusion, abnormal eye movement (nystagmus) and unsteady gait (ataxia)
44
*Korsakoff's Psychosis
*Chronic condition
*Inability to learn new information, short-term and long-term memory problems
45
*Consequence of untreated Wernicke's encephalopathy is
Korsakoff's Psychosis
46
late effects of alcoholism
*Cirrhosis
*Jaundice
*Esophageal varices
*Ascites
*Hepatomegaly
*Splenomegaly
*Edema
*Spider angiomas
*Anemia/Thrombocytopenia
*Coagulation disorders
*Peripheral neuropathy
47
*thiamine (B1) deficiency is caused by
*Wernicke-Korsakoff's syndrome
48
treatment for thiamine (B1) deficiency
*thiamine for B1 replacement, magnesium sulfate, folic acid & multivitamin
49
how long does it take for the liver to detox 1oz of alcohol
1 hour
50
Blood alcohol level (BAL):
*determines level of intoxication and tolerance
51
BAL of 0.05% (1-2 drinks)
changes in mood and behavior; impaired judgment
52
BAL of 0.08% (5-6 drinks)
legal level of intoxication in most states. clumsiness in voluntary motor activity
53
BAL of 0.20% (10-12 drinks)
memory blackout, N/V
54
BAL of 0.30% (15-19 drinks)
dec. RR, hypothermia, hypotension, drowsy
55
BAL of 0.40% (20-24 drinks)
impaired VS and even death
56
alcohol withdrawal stages: mild
*Anxiety
*Tremors (feeling 'shaky')
*Insomnia
*Headache
*Palpitations
*Gastrointestinal disturbances (cramping)
*Orientation remains intact
57
alcohol withdrawal stages: moderate/severe
*Diaphoresis
*Elevated systolic blood pressure
*Tachypnea
*Tachycardia
*Confusion
*Mild hyperthermia
*Hallucinations (visual, tactile, and or auditory)
*Orientation remains intact
58
alcohol withdrawal stages: delirium tremens (DTs)
*Disorientation to time, place, and person
*Impaired attention
*Agitation
*Hallucinations (visual, tactile, and or auditory)
*Potential seizures
59
alcohol withdrawal peaks within
24-48 hours after last drink
60
when are grand mal seizures possible during alcohol withdrawal
*7 to 48 hours after last drink
61
alcohol withdrawl may be described as
*Irritability and "shaking inside"
62
withdrawl delirium peaks...
*2 to 3 days after cessation or reduction of alcohol intake, is a MEDICAL EMERGENCY
63
withdrawl delirium s/s
*Autonomic hyperactivity
*Sensorial and perceptual disturbances
*Fluctuating level of consciousness (LOC)
*Delusions (paranoid)
*Agitated behaviors
*Body temperature 100° F or higher
64
CAGE Screening Tool
Screening Assessment to determine if further work-up for Alcohol Abuse is warranted
C: Have you ever felt the need to Cut down on your drinking?
A: Have people Annoyed you by criticizing your drinking?
G: Have you ever felt bad or Guilty about your drinking?
E: Eye-opener? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
65
how many positive answers indicates further assessment after the CAGE test
≥ 2 positive answers is a Positive test and warrants further assessment for Alcohol Abuse
66
Clinical Institute Withdrawal Assessment (CIWA-AR) is used for..
Used to assess the need for alcohol detoxification.
67
alcohol detox s/s
*Nausea/vomiting
*Tremors
*Anxiety
*Agitation
*Paroxysmal Sweats
*Orientation
*Tactile Disturbances
*Auditory Disturbances
*Visual Disturbances
*Headaches
68
medications for alcohol use disorder
*benzodiazepines
*anticonvulsants
*beta-blockers
*magnesium, thiamine (vitamin B1), folic acid, and multivitamins
69
vitamins used for alcohol use disorder
magnesium, thiamine (vitamin B1), folic acid, and multivitamins
70
what are the first like drugs fro sedation and seizure prevention/control
benzodiazepines
71
benzodiazepine examples
*chlordiazepoxide
*lorazepam
*diazepam
72
diazepam has..
anticonvulsive qualities, Not metabolized in the liver*
73
diazepam needs to be
*Gradually taper and discontinue benzodiazepines once detox is complete
74
*Other drugs used for seizure prevention/control
*carbamazepine
*valproic acid
*magnesium
75
Naltrexone
*Reduces or eliminates alcohol craving
use: withdrawal & relapse prevention
76
Acamprosate
*Reduces alcohol craving
*Reduces unpleasant symptoms of abstinence (anxiety, tension, and dysphoria)
*Mitigates withdrawal symptoms
use: relapse prevention
77
benefits of Acamprosate are seen after
30-90 days
78
disulfiram
if you drink taking this, you will get sick (that is the point of the medicaton)
*Alcohol ingestion results in unpleasant physical effects (nausea, vomiting, headache, and flushing)
use: aversion, maintenance, relapse prevention
79
individual needs to be alcohol free for how many days inorder to take disulifram
*Must be alcohol-free for at least 14 days to avoid this reaction when starting (or restarting) disulfiram
80
treatment options for alcohol use disorder
*Inpatient
*Partial Hospitalization
*Residential Treatment
*Outpatient
*Self-Help
*Support Groups
*12 Step Programs (self-help groups)
81
Long-Term Residential Treatment
Lengths of stay between 6 and 12 months in a non-hospital setting.
82
Short-Term Residential Treatment
a 3-6 week hospital based inpatient treatment setting
83
Outpatient Treatment Programs
Vary in the intensity and forms of services offered. Such treatment often is more suitable for individuals who are employed or who have extensive family and/or community support.
84
conventional treatment for alcohol use disorder
*Psychotherapy
*Group therapy
*Cognitive behavioral therapy (CBT)
*Motivational incentives
*Motivational interviewing
85
12-Step Programs
*AA, NA, Al-Anon, Ala-Teen
86
SMART
self-management and recovery training
87
*Important aspect of recovery in Alcoholics Anonymous (AA) and other recovery modalities
*Spirituality practices are related to improved outcomes.
*Higher spiritual levels often correlate with:
*Sense of purpose
*Gratitude
*Forgiveness
88
Cross Tolerance
This occurs when tolerance to the effects of a certain drug results in tolerance to a similar drug.
For instance, someone habitually using opioids may develop a tolerance to not just their drug of choice but also to other opioids.
89
Physical Dependence
This is when the body adapts to a drug and becomes reliant on it, leading to withdrawal symptoms when the drug is not used.
For example, a person dependent on caffeine might experience headaches and fatigue if they suddenly stop drinking coffee.
90
Abuse
This refers to the misuse of substances in a way that is harmful or risky.
An example is someone drinking alcohol to the point of blacking out or using prescription medication more frequently or in higher doses than prescribed.
91
Addiction
This is a chronic disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.
For example, someone addicted to nicotine may continue smoking despite developing health issues like lung disease.
92
Wernicke’s Encephalopathy
This is a neurological disorder caused by a thiamine (vitamin B1) deficiency, often seen in chronic alcoholics. Symptoms can include confusion, loss of muscle coordination, and vision changes.
93
Korsakoff’s Psychosis
Often following Wernicke's encephalopathy, this chronic memory disorder is also linked to severe thiamine deficiency. It's characterized by memory loss, confabulation (making up stories), and hallucinations.
94
Blood Alcohol Level (BAL)
This is a measure of the concentration of alcohol in one's bloodstream, expressed as a percentage.
95
Schedule I drugs
a high potential for abuse and have no acceptable medical use.
Examples: Heroin, LSD, GHB, Bath Salts, MDMA, Weed, Peyote
96
Schedule II drugs
a high potential for abuse, are considered dangerous and are available only by prescription.
Examples include methadone, meperidine (Demerol), oxycodone, cocaine, Fentanyl, Adderall, methylphenidate (Ritalin).
97
Schedule III drugs
a low to moderate potential for misuse and are available only by prescription.
Examples are testosterone, steroids, ketamine, acetaminophen/codeine (Tylenol with codeine), and buprenorphine (Suboxone).
98
Schedule IV drugs
low-risk drugs and are available by prescription.
Examples: benzos, Ambien, Tramadol, and propoxyphene/acetaminophen (Darvocet).
99
Schedule V drugs
limited quantities of certain narcotics for the treatment of diarrhea, coughing, and pain.
Examples are atropine/diphenoxylate (Lomotil), guaifenesin and codeine (Robitussin AC), and pregabalin (Lyrica), available OTC
100
PCP Intoxication
a medical emergency
s/s: belligerent, assaultive, impulsive, and unpredictable
cannot be talked down and may require restraint;
tx: benzo IV/IM and mechanical cooling for hyperthermia
101
important to note of inhalant use disorder...
“Sudden sniffing death” from cardiac arrhythmias may occur with inhalants, particularly with butane and propane.
102
opioid intoxication s/s
miosis (pinpoint pupils) and decreased bowel sounds. Reduced RR & BP and HR are normal to low; track marks from injection sites
103
opioid OD s/s
Three main symptoms—coma, pinpoint pupils, and respiratory depression—are strongly suggestive of overdose.
others: unresponsiveness, hypothermia, hypotension, and bradycardia.
104
opioid withdrawal s/s
mood dysphoria, N/V/D, muscle aches, fever, and insomnia. Others: lacrimation (watery eyes), rhinorrhea (runny nose), pupillary dilation, yawning, gooseflesh skin
105
Methadone
used to decrease the painful symptoms of opiate withdrawal. It also blocks the euphoric effects of opiate drugs
Once a day dosing is adequate; needs to be tapered
- reduce cravings in maintenance therapy.
106
Clonidine
antihypertensive, is often used to reduce the symptoms of opioid withdrawal
clonidine eases sweating, hot flashes, watery eyes, anxiety, and restlessness
107
Buprenorphine (Subutex/Suboxone)
this drug is used only after abstaining from opioids for 12 to 24 hours and in the early stages of opioid withdrawal
- reduce cravings in maintenance therapy.
108
Naltrexone
an opioid antagonist that prevents intoxication; blocks the activation of opioid receptors and prevents opioid drugs from producing rewarding effects
(Vivitrol) is a once a once-a-month IM injection; site reactions are common
109
Sedative/hypnotic/antianxiety intoxication s/s
slurred speech, incoordination, unsteady gait, nystagmus, and impaired thinking. Coma is a dangerous possibility
110
Sedative/hypnotic/antianxiety OD Tx
gastric lavage, activated charcoal, and careful VS monitoring; PTs kept awake to avoid loss of consciousness; endotracheal tube may be required and/or mech ventilation
111
Sedative/hypnotic/antianxiety withdrawal s/s
ANS hyperactivity, tremor, insomnia, psychomotor agitation, anxiety, and grand mal seizure
Tx: taper benzos to prevent seizure
112
tobacco withdrawal s/s
at least 4 of the following: irritability, anxiety, depression, difficulty concentrating, restlessness, and insomnia
113
tobacco use Tx
Nicotine replacement therapies in the form of gum, lozenges, nasal sprays, inhalers, and patches are highly successful treatments.
114
tobacco cessation: 2 main drugs
Bupropion (Zyban) reduces the cravings for nicotine and withdrawal symptoms [same name, different drug]
Varenicline (Chantix) is a nicotinic receptor partial agonist that mimics the effects of nicotine, thereby reducing cravings and withdrawal.
115
Binge drinking
too much, too quickly;
W: 4+ w/i 2hr // M: 5+ w/i 2hr
116
Heavy drinking
too much, too often;
W: 8+ a wk // M: 14+ a wk
117
Alcohol withdrawal, greatest concerning timeframe
first 24-72hrs
"When was your last drink?"
118
Shakes/jitters/tremors occur within...
6-8hrs after last drink
Chlordiazepoxide (Librium) used for tremors and mild to moderate agitation
119
psychotic/perceptual s/s occur within...
8-10hrs after last drink
monitor for psychosis = MEDICAL EMERGENCY
risk: uncon., seizure, delirium
Tx: Lorazepam or Chlordiazepoxide (Librium)
120
withdrawal seizures occur within...
12-24hrs after last drink
Tx: Diazepam; d/t rapid onset, ctrl of acute/severe seizures
121
DTs occur within...
72hrs after last drink
MEDICAL EMERGENCY
Prevention of "Alcohol withdrawal delirium/DTs" is the goal
Tx: Diazepam (Valium): agitation, tremor, impending or acute DTs, and hallucinosis
Chlordiazepoxide (Librium): tremors & mild-modderate agitation
Lorazepam (Ativan): once delirium appears, tx severe s/s
122
Carbamazepine
anticonvulsant and mood stabilizer
use: tremors, agitation, anxiety, and seizures
Monitor for hyponatremia/take 2nd OCA
