TOPIC 11 - substance abuse and addictive disorders (pt 2) Flashcards
mandating for reporting substance abuse
reporting an impaired colleague is a peer responsibility
clean documentation is crucial and mandatory
who’s responsibility if intervention of substance abuse
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
benefits of reporting an impaired colleague
improve safety of patients
protect healthcare professionals future ability to practice
improved physical health
improved or saved personal relationships
may save professional care
ten classes of psychoactive substances
- alcohol
- caffeine
- marijuana
- hallucinogens
- inhalants
- opioids
- sedatives
- hypnotics
- anxiolytics
- stimulants, tobacco, and other substances
marijuana
most commonly used illicit drug in the USA
nicotine addiction rates
addiction is high in all groups of people with substance dependence as well as those with psychiatric mental health issues
examples of CNS depressants
barbiturates
benzos
alcohol
intoxication symptoms of CNS depressants
Slurred speech
Incoordination
Unsteady gait
Drowsiness
Hypotension
Sexual or aggressive disinhibition
Impaired judgement
Impaired social or occupational function
Impaired attention or memory
CNS depressants overdose symptoms
Cardiovascular or respiratory depression, coma, shock, convulsions, death
CNS depressants overdose treatment
If awake, keep awake *
Induce vomiting
Administer activated charcoal (absorption of drug)
Check vitals every 15 minutes
CNS depressants coma interventions
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
benzo antidote
flumazenil
examples of opiates
Morphine
Heroin
Codeine
Fentanyl
Methadone
Meperidine
opiate intoxication effects
Constricted pupils *
Decreased respiration
Decreased blood pressure
Slurred speech
Drowsiness
Psychomotor retardation
Initial: euphoria
Later: dysphoria
Impaired: concentration, judgment, memory
opiate withdrawl effects
Yawning
Insomnia
Irritability
Rhinorrhea
Panic
Diaphoresis
Cramps
Nausea and vomiting
Muscle aches
Chills and fever
Lacrimation
Diarrhea
pregnancy and heroin
do not abruptly stop use
opiates overdose effects triad symptoms
coma, pinpoint pupils, respiratory depression
other overdose effects of opiates
Cardiac arrest
Shock
Convulsions
Death
opiate overdose treatment
naloxone
important parts to naloxone
Quickly reverses CNS depression caused by opioid drugs
Short half-life
May need to repeat dose
examples of long term pharmacologic management of opioid use disorders
methadone, buprenorphin, maltrexone, clonidine
methadone
Opioid agonist that blocks the craving for opioids
Also used for detoxification
Most effective
which is the most effective long term management of opioid use disorder
methadone
buprenorphin
Opioid agonist-antagonist
Blocks the signs and symptoms of opioid withdrawal
naltrexone
Opioid antagonist that blocks the euphoric effects of opioids.
what combination with clonidine is effective
with naltrexone
examples of CNS stimulants
Cocaine & crack
Methamphetamine
Caffeine
Nicotine
intoxication effects of CNS stimulants
Dilation of the pupils*
Dryness of the oronasal cavity
Excessive motor activity
Dilated pupils
Tachycardia
Increased blood pressure
Nausea & vomiting
Insomnia
withdrawl effects of CNS stimulants
Depression
Paranoia
Anxiety *
Lethargy
Insomnia
Nausea
Vomiting
Sweating
Chills
Fatigue
Agitation
Apathy
Disorientation
Lethargy
Craving
Sleepiness
overdose effects of CNS stimulants
Respiratory distress
Hyperpyrexia
Convulsions
Coma
Stroke
MI
Death
psychological/perceptual effects of CNS stimulants
Assaultiveness
Impaired judgement
Euphoria
withdrawl treatment for CNS stimulants
desipramine (TCA)
bromocriptine (Parlodel)
overdose treatment for CNS stimulants
antipsychotics
ambient cooling (for hyperpyrexia)
diazepam (for convulsions)
which overdose treatment is used for hyperpyrexia
ambient cooling
which overdose treatment is used for convulsions
diazepam
3 phases of cocaine and crack withdrawl
crash phase
second phase
third phase
what happens in the crash phase of cocaine and crack withdrawl
anxiety, depression, craving peaks, agitation. (4 days)
what happens in the second phase of cocaine and crack withdrawl
no motivation, anhedonia (10 weeks) Relapse is more likely
what happens in the third phase of cocaine and crack withdrawl
intermittent craving (undetermined length of time)
treatment for cocaine and crack withdrawl
Antidepressants such as desipramine (Norpramin)
Dopamine agonist such as bromocriptine (Parlodel)
class of nicotine
can be a stimulant, depressant, or tranquilizer
importance of addiction and nicotine
highly toxic and addictive
high dependence
withdrawl symptoms of nicotine
strong cravings
irritability
impatience
increased appetite
drugs available to break nicotine addiction
bupropion (Zyban, same chemical structure as Wellbutrin)
varenicline (Chantix)
nicotine patches, gum, lozenges, nasal spray/inhalant
complications of smoking/chewing
Cancer: lung, mouth, throat, stomach, bladder
-Cardiovascular disease
proposed benefits of e cigarettes
long term smokers may smoke less
risks with e cigarettes
does not prevent people from starting to use cigarettes
increased death related to lung and brain injury
ingredients in e cigarettes
formaldehyde, risk for cancer
nicotine : leads to cigarette use & addiction
THC, use of some form of THC products prior to vaping
how much caffeine is needed for positive effects
250 MG OR LESS
how much caffeine is needed for fatality
5 grams = fatal
positive effects of caffeine
Increased alertness/decreased fatigue, lower risk of cardiovascular disease, lower risk of diabetes, increased metabolic rate
negative effects of caffeine
Increased BP, tachycardia, heartburn, irregular bowel movements, excess urination
active ingredient in marijuana
tetrahydrocannabinol (THC)
properties in marijuana
both depressant and hallucinogenic
desired effects of marijuana
euphoria, detachment, relaxation
long term effects of marijuana
lethargy, anhedonia, difficulty concentrating, loss of memory, amotivational syndrome
direct or indirect intentional inhalation of noxious substances results in
anoxia, seizures, irreversible brain damage, death
anoxia definition
The act of inhaling these noxious chemicals deprives the brain of oxygen
club drugs
MDMA
MDA
MDE
Bath salts
Flakka
what club drug can cause excited delirium
flakka
effects of simulated amphetamines (MDMA, MDA, MDE)
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
bath salts effects
hallucinogenic-delusional properties, dissociation, extreme agitation, and feelings of superhuman strength and combativeness) and have the hyperaddictive qualities of cocaine and methamphetamines.
symptoms of excited delirium
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)
hallucinogens examples
Lysergic acid diethylamide (*LSD, ‘acid’)
mescaline (peyote)
psilocybin (‘magic mushroom’)
dissociative drugs
Phencyclidine piperidine (*PCP, angel dust, horse tranquilizer, peace pill)
Ketamine (Special K)
Salvia
what agonizes the kappa opioid receptors
salvia
LSD effects
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
interventions for clients who took LSD
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
medications for anxiety and tension related to LSD
diazepam or chloral hydrate
interventions for clients who took PCP
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)
medications for PCP interventions
diazepam, haloperidol
(never give a phenothiazine antipsychotic to a client on PCP)
conventional treatments for substance abuse treatment
Psychotherapy
Group therapy
Cognitive behavioral therapy (CBT)
Motivational incentives
Motivational interviewing
12 step programs
what role does the rescuer have within the chemically dependent family
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.
what role does the hero have within the chemically dependent family
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.
what role does the adjuster have within the chemically dependent family
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.
what role does the scapegoat have within the chemically dependent family
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.
what role does the mascot have within the chemically dependent family
Also draws attention away from the family by trying to please, by acting in a humorous way; the clown.
