TOPIC 10 - substance abuse Flashcards
cross tolerance
developing tolerance for more than one drug in the same class
includes intense rush followed by intense lows
difficulty of success with nicotine cessation attempts
abstinence syndrome :
strong cravings, irritability, impatience, increased appetite
risk of marijuana use
long term effects = lethargy, anhedonia, difficulty concentrating, loss of memory, amotivational syndrome
current US substances most often used
alcohol, marijuana, nicotine, opioids, prescription abuse
common classes of prescription drugs
painkillers, sedatives, stimulants
common classes of prescription drugs
painkillers, sedatives, stimulants
opioid examples
hydrocodone, oxycodone, hydromorphone, morphine, codeine
hydrocodone uses
commonly prescribed for variety of painful conditions
morphine uses
before and after surgical procedures to alleviate severe pain
codeine uses
mild pain, relieve coughs and diarrhea
heroin overdoses
suppression of breathing (decrease amount of oxygen reaching brain = hypoxia)
feelings after injection of heroin
euphoria
dry mouth
warm flushing of skin
heaviness of extremities
clouded mental functioning
what follows the feeling of euphoria after heroin injection
alternating wakeful and drowsy state
what happens in the brain with dependence and addiction
the brain tricks itself into believing that the drug is as necessary for survival as basic needs
“turns volume down” to compensate for vicious highs and lows that occur during repeated opioid use and opioid withdrawal by reducing the number of opioid receptors in the brain
physical dependence s/s
restless, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, involuntary leg movements
what happens to white matter of the brain due to heroin use
affects decision making abilities, ability to regulate behavior, and responses to stressful situation
influences and risk factors
psychological, societal, cultural, gender, religious and societal
difference in men and women with substance use
men have higher tolerance than women but women can get addicted quicker
4 C’s of addiction
craving, compulsive behavior, chronic relapsing, cognitive impairment
what receptor is involved in the feelings of euphoria that patients are likely to keep seeking and lead to addiction
dopamine
alcohol and CNS depressants act on
GABA
assessment for substance abuse
Clarify presenting signs
Assess for withdrawal
Assess for overdose
Assess for self-harm potential
Evaluate physiologic response
Explore individual’s interest in taking action
Assess knowledge of community resources
Med History
Psychiatric History
Psychosocial Issues
what are patients who abuse substance and have other mental illnesses likely to suffer from
depression and suicidal ideation
what age poses clients at a greater risk for addiction if they started drinking at this age
under 14 (since the brain is not developed - affects brain development)
alcohol use and pregnancy
alcohol is the most teratogenic
FAS - long lasting effects both physically and mentally
breastfeeding considerations
impairs fetus ability to receive oxygen
alcohol use and aging
tolerance is decreased due to slowed gastric emptying, slower metabolism, increased sensitivity, decline mass, liver damage
changes in response to alcohol include : headache, reduction in mental abilities, memory loss, feelings of malaise
antidepressants and alcohol
ingestion of both together = affects are potentiated and toxicity of other drugs is enhanced by alcohol associated malnutrition and reduced stores of detoxifying substances
do older adults have a higher or lower BAL than younger people
higher
physiologic effects of alcohol
change in motor coordination, temp regulation, sleep, mood, cognitive impairment, sleep disturbance, anxiety, depression, short attention span, coma
how to treat hepatic encephalopathy
lower ammonia levels
comorbid medical issues with alcoholism
hepatic encephalopathy, fetal alcohol syndrome, cardiomyopathy, arrhythmia, stroke, hypertension, cirrhosis, jaundice, ascites, varices, hepato or splenomegaly, edema, anemia, pancreatitis
wernickes enecephalopathy
confusion, abnormal eye movements and unsteady gaits
korsakoffs psychosis
chronic condition
consequence of untreated wernickes
inability to learn new information, short and long term memory loss
wernicke - korsakoff syndrome
thiamine deficient
need B1, mag sulfate, and folic acid, and multivitamin supplement
how long does it take the liver to detoxify 1 oz of alcohol
1 hr
what is BAL
determines level of intoxication tolerance
effects of 1-2 drinks
change in mood and behavior, impaired judgement
effects of 5-6 drinks
Legal level of intoxication in most states. Clumsiness in voluntary motor activity
effects of 10-12 drinks
Depressed function of entire motor area of the brain, causing staggering and ataxia; emotional lability
effects of 15-19 drinks
confusion and stupor
effects of 20-24 drinks
coma
effects of 25-30 drinks
death by resp depression
mild alcohol withdrawl stages
Anxiety
Tremors (feeling ‘shaky’)
Insomnia
Headache
Palpitations
Gastrointestinal disturbances (cramping)
Orientation remains intact
moderate and severe alcohol withdrawl stages
Diaphoresis
Elevated systolic blood pressure
Tachypnea
Tachycardia
Confusion
Mild hyperthermia
Hallucinations (visual, tactile, and or auditory)
Orientation remains intact
delirium tremens stage of alcohol withdrawl
Disorientation to time, place, and person
Impaired attention
Agitation
Hallucinations (visual, tactile, and or auditory)
Potential seizures
time of peak for alcohol withdrawl symptoms
24-48 hr after last drink
screening tools
CAGE, AUDIT
withdrawl delirium peak
2-3 days after cessation or reduction of alcohol intake
CAGE
cut down
annoyed
guilty
eye opener
CIWA-AR
used to assess need for alcohol detoxification
medications for alcohol withdrawl
benzos, anticonvulsants, beta blockers, mag sulfate, thiamine, folic acid, multivitamins
first line med for sedation and seizure prevention
benzos
examples of benzos
chlordiazeproxide
dizepam
considerations for benzos
gradually taper off once detox is complete
other drugs for seizure prevention and control
carbamazepine (Tegretol)
valproic acid (Depakote)
magnesium sulfate
use of naltrexone
reduce or eliminate alcohol craving
acamprosate
reduce alcohol craving, reduce unpleasant symptoms of abstinence, prolong withdrawl symptoms
when do you see benefits of acamprosate
30-90 days
disulfiram use
alcohol ingestion with disulfiram = unpleasant physical effects (nausea, vomiting, headache, flushing)
when would there not be a disulfiram reaction if someone had alcohol
14 days
types of treatment
psychotherapy, group therapy, CBT, motivational incentives, motivational interviewing, 12 step program, SMART, program types (residential, intensive outpatient, outpatient drug free, employee assistance)
what do AA 12 step programs focus on related to spirituality
sense of purpose, gratitude, forgiveness
