TOPIC 11 - substance abuse and addictive disorders (pt 2) Flashcards

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1
Q

mandating for reporting substance abuse

A

reporting an impaired colleague is a peer responsibility
clean documentation is crucial and mandatory

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2
Q

who’s responsibility if intervention of substance abuse

A

nurse manager and administrators

If an impaired nurse remains in the practice situation and no action is taken by the nurse manager, the information must be taken to the next level in the chain of command

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3
Q

benefits of reporting an impaired colleague

A

improve safety of patients
protect healthcare professionals future ability to practice
improved physical health
improved or saved personal relationships
may save professional care

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4
Q

ten classes of psychoactive substances

A
  1. alcohol
  2. caffeine
  3. marijuana
  4. hallucinogens
  5. inhalants
  6. opioids
  7. sedatives
  8. hypnotics
  9. anxiolytics
  10. stimulants, tobacco, and other substances
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5
Q

marijuana

A

most commonly used illicit drug in the USA

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6
Q

nicotine addiction rates

A

addiction is high in all groups of people with substance dependence as well as those with psychiatric mental health issues

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7
Q

examples of CNS depressants

A

barbiturates
benzos
alcohol

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8
Q

intoxication symptoms of CNS depressants

A

Slurred speech
Incoordination
Unsteady gait
Drowsiness
Hypotension
Sexual or aggressive disinhibition
Impaired judgement
Impaired social or occupational function
Impaired attention or memory

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9
Q

CNS depressants overdose symptoms

A

Cardiovascular or respiratory depression, coma, shock, convulsions, death

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10
Q

CNS depressants overdose treatment

A

If awake, keep awake *
Induce vomiting
Administer activated charcoal (absorption of drug)
Check vitals every 15 minutes

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11
Q

CNS depressants coma interventions

A

Clear airway, insert endotracheal tube
Administer IV fluids
Gastric lavage with activated charcoal
Frequent vital sign checks continue after patient is stable (potential remains for shock and cardiac arrest)
Implement seizure precautions
Hemodialysis may be needed
Administer flumazenil (Romazicon) IV for benzodiazepine overdose

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12
Q

benzo antidote

A

flumazenil

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13
Q

examples of opiates

A

Morphine
Heroin
Codeine
Fentanyl
Methadone
Meperidine

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14
Q

opiate intoxication effects

A

Constricted pupils *
Decreased respiration
Decreased blood pressure
Slurred speech
Drowsiness
Psychomotor retardation
Initial: euphoria
Later: dysphoria
Impaired: concentration, judgment, memory

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15
Q

opiate withdrawl effects

A

Yawning
Insomnia
Irritability
Rhinorrhea
Panic
Diaphoresis
Cramps
Nausea and vomiting
Muscle aches
Chills and fever
Lacrimation
Diarrhea

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16
Q

pregnancy and heroin

A

do not abruptly stop use

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17
Q

opiates overdose effects triad symptoms

A

coma, pinpoint pupils, respiratory depression

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18
Q

other overdose effects of opiates

A

Cardiac arrest
Shock
Convulsions
Death

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19
Q

opiate overdose treatment

A

naloxone

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20
Q

important parts to naloxone

A

Quickly reverses CNS depression caused by opioid drugs
Short half-life
May need to repeat dose

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21
Q

examples of long term pharmacologic management of opioid use disorders

A

methadone, buprenorphin, maltrexone, clonidine

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22
Q

methadone

A

Opioid agonist that blocks the craving for opioids
Also used for detoxification
Most effective

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23
Q

which is the most effective long term management of opioid use disorder

A

methadone

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24
Q

buprenorphin

A

Opioid agonist-antagonist
Blocks the signs and symptoms of opioid withdrawal

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25
Q

naltrexone

A

Opioid antagonist that blocks the euphoric effects of opioids.

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26
Q

what combination with clonidine is effective

A

with naltrexone

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27
Q

examples of CNS stimulants

A

Cocaine & crack
Methamphetamine
Caffeine
Nicotine

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28
Q

intoxication effects of CNS stimulants

A

Dilation of the pupils*
Dryness of the oronasal cavity
Excessive motor activity
Dilated pupils
Tachycardia
Increased blood pressure
Nausea & vomiting
Insomnia

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29
Q

withdrawl effects of CNS stimulants

A

Depression
Paranoia
Anxiety *
Lethargy
Insomnia
Nausea
Vomiting
Sweating
Chills
Fatigue
Agitation
Apathy
Disorientation
Lethargy
Craving
Sleepiness

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30
Q

overdose effects of CNS stimulants

A

Respiratory distress
Hyperpyrexia
Convulsions
Coma
Stroke
MI
Death

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31
Q

psychological/perceptual effects of CNS stimulants

A

Assaultiveness
Impaired judgement
Euphoria

32
Q

withdrawl treatment for CNS stimulants

A

desipramine (TCA)
bromocriptine (Parlodel)

33
Q

overdose treatment for CNS stimulants

A

antipsychotics
ambient cooling (for hyperpyrexia)
diazepam (for convulsions)

34
Q

which overdose treatment is used for hyperpyrexia

A

ambient cooling

35
Q

which overdose treatment is used for convulsions

A

diazepam

36
Q

3 phases of cocaine and crack withdrawl

A

crash phase
second phase
third phase

37
Q

what happens in the crash phase of cocaine and crack withdrawl

A

anxiety, depression, craving peaks, agitation. (4 days)

38
Q

what happens in the second phase of cocaine and crack withdrawl

A

no motivation, anhedonia (10 weeks) Relapse is more likely

39
Q

what happens in the third phase of cocaine and crack withdrawl

A

intermittent craving (undetermined length of time)

40
Q

treatment for cocaine and crack withdrawl

A

Antidepressants such as desipramine (Norpramin)
Dopamine agonist such as bromocriptine (Parlodel)

41
Q

class of nicotine

A

can be a stimulant, depressant, or tranquilizer

42
Q

importance of addiction and nicotine

A

highly toxic and addictive
high dependence

43
Q

withdrawl symptoms of nicotine

A

strong cravings
irritability
impatience
increased appetite

44
Q

drugs available to break nicotine addiction

A

bupropion (Zyban, same chemical structure as Wellbutrin)
varenicline (Chantix)
nicotine patches, gum, lozenges, nasal spray/inhalant

45
Q

complications of smoking/chewing

A

Cancer: lung, mouth, throat, stomach, bladder
-Cardiovascular disease

46
Q

proposed benefits of e cigarettes

A

long term smokers may smoke less

47
Q

risks with e cigarettes

A

does not prevent people from starting to use cigarettes
increased death related to lung and brain injury

48
Q

ingredients in e cigarettes

A

formaldehyde, risk for cancer
nicotine : leads to cigarette use & addiction
THC, use of some form of THC products prior to vaping

49
Q

how much caffeine is needed for positive effects

A

250 MG OR LESS

50
Q

how much caffeine is needed for fatality

A

5 grams = fatal

51
Q

positive effects of caffeine

A

Increased alertness/decreased fatigue, lower risk of cardiovascular disease, lower risk of diabetes, increased metabolic rate

52
Q

negative effects of caffeine

A

Increased BP, tachycardia, heartburn, irregular bowel movements, excess urination

53
Q

active ingredient in marijuana

A

tetrahydrocannabinol (THC)

54
Q

properties in marijuana

A

both depressant and hallucinogenic

55
Q

desired effects of marijuana

A

euphoria, detachment, relaxation

56
Q

long term effects of marijuana

A

lethargy, anhedonia, difficulty concentrating, loss of memory, amotivational syndrome

57
Q

direct or indirect intentional inhalation of noxious substances results in

A

anoxia, seizures, irreversible brain damage, death

58
Q

anoxia definition

A

The act of inhaling these noxious chemicals deprives the brain of oxygen

59
Q

club drugs

A

MDMA
MDA
MDE
Bath salts
Flakka

60
Q

what club drug can cause excited delirium

A

flakka

61
Q

effects of simulated amphetamines (MDMA, MDA, MDE)

A

Cause serotonin surge (also norepinephrine) and other neurochemical effects
Euphoria, heightened sociability, lowered inhibitions, increased self-confidence and energy
After … deep depressive state is common, due to lack of serotonin after the surge
Hyperthermia, hyponatremia, rhabdomyolysis, heart failure, kidney failure

62
Q

bath salts effects

A

hallucinogenic-delusional properties, dissociation, extreme agitation, and feelings of superhuman strength and combativeness) and have the hyperaddictive qualities of cocaine and methamphetamines.

63
Q

symptoms of excited delirium

A

violent behavior + hallucinations + body temp increases up to 106°F + muscle breakdown (rhabdomyolysis, which can lead to kidney failure) + extreme tachycardia (↑ risk of stroke or heart attack)

64
Q

hallucinogens examples

A

Lysergic acid diethylamide (*LSD, ‘acid’)
mescaline (peyote)
psilocybin (‘magic mushroom’)

65
Q

dissociative drugs

A

Phencyclidine piperidine (*PCP, angel dust, horse tranquilizer, peace pill)
Ketamine (Special K)
Salvia

66
Q

what agonizes the kappa opioid receptors

A

salvia

67
Q

LSD effects

A

Abusers also may have traumatic experiences and emotions that can last for many hours. Some short-term effects can include increased body temperature, heart rate, and blood pressure; sweating; loss of appetite; sleeplessness, dry mouth, and tremors

68
Q

interventions for clients who took LSD

A

Low stimulus environment
Minimal light and sounds
1-to-1 interaction reassures the client on LSD. Attempt to ‘talk the client down’
Speak slowly and clearly in low tones

69
Q

medications for anxiety and tension related to LSD

A

diazepam or chloral hydrate

70
Q

interventions for clients who took PCP

A

Give cranberry juice or ascorbic acid
Minimal environmental stimulus
DO NOT attempt to ‘talk client down’
Speak slowly and clearly in low tones
Avoid touch if possible. If touching client is necessary, involve additional staff (client may have impulsive, bizarre, aggressive behaviors)

71
Q

medications for PCP interventions

A

diazepam, haloperidol
(never give a phenothiazine antipsychotic to a client on PCP)

72
Q

conventional treatments for substance abuse treatment

A

Psychotherapy
Group therapy
Cognitive behavioral therapy (CBT)
Motivational incentives
Motivational interviewing
12 step programs

73
Q

what role does the rescuer have within the chemically dependent family

A

Often steps in to save the addict, bails the addict out, makes excuses or fills in for the addict. Shielding the addict from consequences of substance abuse makes it easier for the addict to continue using.

74
Q

what role does the hero have within the chemically dependent family

A

Tries to divert attention away from the problem by being too good to be true, secretly hoping that exemplary behavior will somehow make it easier for the addict to stop using. High achievers who do everything to assure that the addict has as little responsibility as possible, minimizing the possibilities for trouble to occur.

75
Q

what role does the adjuster have within the chemically dependent family

A

Behaves apathetically to distance self from pain; passively withdraw from upsetting situations; hurting but attempts to avoid feeling the pain by refusing to confront the addiction or its consequences.

76
Q

what role does the scapegoat have within the chemically dependent family

A

Draws attention away from the family’s primary problem of dependency through delinquency or other misbehavior; reacts to feeling trapped by the situation at home by poor school performance, hostility and other behavior problems.

77
Q

what role does the mascot have within the chemically dependent family

A

Also draws attention away from the family by trying to please, by acting in a humorous way; the clown.