TOPIC 10 - substance abuse Flashcards by Emily Lash

cross tolerance

developing tolerance for more than one drug in the same class
includes intense rush followed by intense lows

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difficulty of success with nicotine cessation attempts

abstinence syndrome :
strong cravings, irritability, impatience, increased appetite

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risk of marijuana use

long term effects = lethargy, anhedonia, difficulty concentrating, loss of memory, amotivational syndrome

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current US substances most often used

alcohol, marijuana, nicotine, opioids, prescription abuse

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common classes of prescription drugs

painkillers, sedatives, stimulants

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common classes of prescription drugs

painkillers, sedatives, stimulants

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opioid examples

hydrocodone, oxycodone, hydromorphone, morphine, codeine

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hydrocodone uses

commonly prescribed for variety of painful conditions

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morphine uses

before and after surgical procedures to alleviate severe pain

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codeine uses

mild pain, relieve coughs and diarrhea

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heroin overdoses

suppression of breathing (decrease amount of oxygen reaching brain = hypoxia)

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feelings after injection of heroin

euphoria
dry mouth
warm flushing of skin
heaviness of extremities
clouded mental functioning

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what follows the feeling of euphoria after heroin injection

alternating wakeful and drowsy state

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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

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physical dependence s/s

restless, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, involuntary leg movements

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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

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influences and risk factors

psychological, societal, cultural, gender, religious and societal

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difference in men and women with substance use

men have higher tolerance than women but women can get addicted quicker

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4 C’s of addiction

craving, compulsive behavior, chronic relapsing, cognitive impairment

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what receptor is involved in the feelings of euphoria that patients are likely to keep seeking and lead to addiction

dopamine

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alcohol and CNS depressants act on

GABA

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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

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what are patients who abuse substance and have other mental illnesses likely to suffer from

depression and suicidal ideation

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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)

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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