UNIT 2 SUBSTANCE USE DISORDER Flashcards
1
Q
What is substance abuse disorder?
A
A cluster of cogntive havior and physiolofical symptoms indicating that the individual continues using the substance despite significant substance-related problems
2
Q
What is amotivational syndrome
A
chronic psychiatric disorder characterized by a variety of changes in personalility, emotions and cognitive function.
3
Q
What is cross tolerance?
A
long term exposure to one drug often results in the developement of tolerance to the effects of other structually simular drugs in the same pharmacologic class
4
Q
What is dual dx?
A
- Term used when a person has a substance abuse disorder and another mental health disorder.
5
Q
What are goals for substance use disorder treatment
A
- Recognition of acute toxicity
- Facilitation of withdrawl
- Diagnois and treatment of medical complication of substance use
- Education/counseling/therapy to sustain sobriety and long-term
6
Q
What are 10 classifications of substances
A
- caffeine
- alcohol
- nicotine
- cannabis
- sedatives/hypnotics/anxiolytics
- opiods
- stimulants
- hallucinogens
- inhalants
- Other
7
Q
What is abuse?
A
- Habitual use of a substance which falls outside of medical necessity or societal acceptance
- Used solely for the purpose of altering mood emotion or state of consciousness
8
Q
What is addiction
A
- Chronic/relapsing disease
- Complusive substance seeking behaviors motivated by cravins, despite harmful consequences
- Long-lasting changes in the brain
- May include development of tolerance and withdrawl symptoms
9
Q
DS5 Criteria for substance use disorders
A
- susbstance taken in larger amounts and/or over a longer period than intended
- One or more unsuccessful efforts made to cut down or control use
- Craving to use substance
- Failure to fulfill major role obligations
- Persistent or recurrent social problems caused by substance use
- social/occupational recreational activites negatviely affected
- Substance use continued despite physical/psychological problems
- Recurrent use in physically hazardous situations
- Tolerance
10
Q
What is the DS5 creteria for tolerance?
A
Markedly: Increased amounts used to achieve intoxication/desired effect
Diminished effect with continued use of the same amount
11
Q
What are psycholoical risk factors for SUD
A
- low frustration levels
- Poor impulse control
- Lack of meaningful relationships
- Childhood trauma
- Low self esteem
- Propensity for risk taking behaviors
12
Q
What are some social risk factors of SUD
A
Peer influences
Family acceptance
13
Q
What are some gender risk factors of SUD
A
Males at greater risk
14
Q
What are genetic risk factors for SUB
A
member of family in which SUD prevalent
15
Q
What is the patho of SUD
A
- Brain reward system-reinforcement of behaviors and production of memories/limbic system
- Neurobiology and neurotransmitters- substances of abuse affet neurotransmitters
- Genetic- increased risk associated with genetic markers
16
Q
What complications can present when a person uses IM/SubQ as there route in SUD
A
- scaring
- lesions
- abscesses
- infections
17
Q
What complications can present when a person uses IV as there route in SUD
A
- infections
- venous sclerosis
- Disease transmission
- Track marks around inj site– darker pigmintation usually seen in ac, legs, or anywhere they can find a vein
18
Q
What complications can present when a person uses intranasal route in SUD
A
- Chornic sinusitis
- Perfortated nasal septum
19
Q
What complication can present when a person uses smoking as their route in SUD
A
Respiratory problems
20
Q
What are types of CNS depressants
A
- Alcohol
- Barbituates
- Benzodiazepines
21
Q
What is the MOA of Alcohol ETOH use disorder
A
- CNS depressant- binds with GABA receptors and glutamate receptors
- Activation of the reward circuit- binds with 5ht3 receptors
- Diuretic- inhibits the release of ADH
22
Q
How much ETOH is too much?
A
Heavy or “at risk” use
1. Men >4 standard drinks on any 1 day or more than 14 in any one week
2. Women >3 standard drinks on any 1 day or more than 7 in any one week
23
Q
Blood alcohol concentration of mother = ______
A
milk alcohol concentration
24
Q
Comparing BAC with behavior can tell us…
A
tolerance. High BAC with few intoxication symtoms= high toleracne vs. versa
25
What are life threatening signs of alcohol poising
1. Inability to wake up
2. Vomiting
3. Slow breathing- less than 8 breaths per min
4. Irregular breathing 10 seconds or more between breaths
5. Seizures
6. Hypothermia - low body temp, blue in color, paleness
26
1- 2 (0.05mg) drinks start effecting...
1. mood and behavior,
2. impaired judgement
27
5-6 (0.08mg%) drinks starts effecting
1. Legal level of intoxication in most states.
2. clumsiness in voluntary motor activity
28
10-12 (0.20mg%) drinks starts effecting
1. Depressed function of entire motor area of the brain causing staggering and ataxia; emotional lability
29
15-19 drinks (0.30mg%) starts effecting
confusion, stupor
30
20-24 drinks (0.40mg%) starts effecting...
coma
31
25-30 drinks (0.50mg%) starts effecting...
dealth caused by resp. depression
32
clinical institute withdrawl assessment looks at....
1. N/V: ask "do you feel sick to your stomach" have you vomited
2. Tactile disturbances: ask "have you any itching, pins and needs, burning, numbness, feeling of bugs on your skin"
3. Auditory distrubances: Ask: are you sensitive to sound/hearing things you know are not there?
4. Visual distrubances: Ask: are you sensitive to light/seeing things you know are not there
5. Anxiety: Ask Do you feel nervous
6. Headache/fullness in head: Ask does your head feel different/like there is a band around it?
7. Orientation: Ask "what day is it? where are you? who am i? What is 3+4
8. Tremor: Observe: Arms extended, fingers spread apart; stick tongue out
9. Paraoxymal sweats: Observe
10. Agitation: Observe
33
True or false: Tongue tremors are hard to fake?
true
34
What medications are commonly prescribed in a CIWA order?
Lorazepam & Diazepam
35
What should we know about alcohol withdrawal
1. Early signs within a few hours
2. peaks within 24-48 hours
3. Rapidly and dramatically diappears unless it progresses to delirium
4. Irritability and "Shaking" inside
5. Grand mal seizures possible in 7-48 hours agter stopping
6. Illusions
36
What should we know about delirium tremens
1. Possible death
2. Peaks 2-3 days after cessation and reduction
3. autonomic hyperactivity (MONITOR VS)
4. Sensorial and preceptual distrubances
5. Fluctuating LOC
6. Delusions (paranoid)
7. Agitated behaviors
8. most serious form of alcohol withdrawl
37
What do we need to know about post acute withdrawl syndrome (PAWS)
Episodic- days to weeks occur up to 2 years
Features- Mood swings, anxiety, Irritability, tiredness, variable energy, low enthusiasm, variable ability to concentrate, distrubed sleep
Risks- distressing, RELAPSE
38
What are some effects of chronic alcohol use?
1. CV damage (cardiomyopathy)
2. Liver damage (hepatitis, cirrhosis)
3. Erosive gastritis
4. GI bleed
5. Esophageal carices
6. ascities
7. acute pancretitis
8. thiamine deficiency
9. peripheral neurpahty
10. increased risk of cancer
11. thromboxytobenia
12. damage to the brain
13. dilation of cutaneous blood vessels
14. hypertension
15. testicular atrophy,
16. impotence sterility & breast enlargement in men
39
What is wernickies encephalopathy?
Infalmmatory, hemorrhagic degerative conditon of the brain caused by thiamine deficeincy from poor diet and alcohol-induced supression of thiamine aborption
REVERSIBLE WITH THIAMINE
40
What is korsakoff's psychosis?
Irreversible form of amnesia characterized by
2. Short-term memory loss
3. Long- term memory loss
4. inability to learn
Notable behavior
confusion & amnesia
41
What pharmacolgical interventions may we used to help with ETOH withdrawl
1. Benzos Lorazepam- cross toelrance taper
2. Barbituates- Phenobarbital- If benzos arent effective
3. Anticonvulsants- Gabapentin- Lower anxiety, prevent seizure
4. Betablockers- Propanolol- autonomic symptoms, elevated vitals
5. Alphablockers- clondine- autonomic symptoms, elevated vitals
6. Thiamine- prevent wernicke-korsakoff syndrome, correct high-output heart failure
7. Folic acid b12- correct megaloblastic anemia, heart peripheral neuropathy
42
What medication may be given to help with alcohol sobriety?
Think “dang” I’m sober
1. Naltrexone (VIVITROL)
2. Acamprostate (CAMPRAL)
3. Disulfiram (ANTABUSE)
4. Gabapentin (NEURONTIN)
43
What is the MOA of naltrexone
Opiod antagonist: blocks opiod receptors involved in reward/craving
reduces relapse
44
What is the MOA of disulfiram (antabuse)
1. Interferes with breakdown of alcohol leading to unpleasant reactions such as flushing, n/v
2. stays in system up to 14 days
45
What is the MOA of gabapentin?
1. Works on GABA to clam down the brain and mitagate hyper-aroused state
2. reduces cravings by lowering anxiety
46
What are signs of benzodiazepine toxcity?
1. Severe confusion
2. Drowsiness
3. lack of coordination/weakness
4. lightheadness
5. memory loss
6. fainting
47
Overdose of benzodiazepine....
Usually occurs with concomitant use of ETOCH, opiates, TCAs or CNS depressants
48
What are withdrawal symptoms of benzodiazepines?
1. body pain
2. muscle tension
3. cramping
4. insomnia
5. vomiting
6. tremors
7. sweating
8. seizures
9.
49
What is the reversal agent for benzos
flumazenil
50
What are examples of opiates?
1. opium
2. oxycodone
3. fentanyl
4. heroin
5. meperidine
6. morphine
7. codeine
8. methadone
9. hydromorphone
51
What do we need to know about HEROIN
1. High lipid solubitiy- Easily enters cells-- making it highly addictive
2. Crosses the blood brain barrier easily- then converts to active form of morphine
3. Effects fast & intense- IV: 7-8 seconds for effects to be felt, smoked or snorted: 10-15 mins for effects to be felt
4. Popular street drug because it easy and cheap to find
52
What should we know about oxycodone?
1. Controlled release formula similar to morphine
2. Chewed or crushed and snorted or injected into IV
3. esp. risk for OD if tolerance isnt high
4. Orignal formulation had OC, Currently OP
This drug is esp. dangerous for those who have built a tolerance and quit taking. If they relapse and decisde to take drug at the same level as they did when they quit it often lethal.
53
What should we know about meperidine?
1. Effective when taken orally0 can get effects without obvious signs of IV drug use
2. Minimal effects on smooth muscle- less cosntipating and less urinary retention
3. Produces less pupillary contrsiction than other opiods
54
What are signs of intoxication of opiates?
1. Contricted pupils
2. decreased respirations
3. sedation
4. decreased bp
5. slurred speech
6. psychomotor retardation
55
What are signs of toxicity triad symptoms in opiate use
1. Pinpoint pupils
2. resp. depression
3. coma
4. Overdose can lead to death r/t
- shock
- seizures
- cardiac arrest
56
Signs of opiod withdrawl includes?
1. yawning
2. insomnia
3. irritability
4. rhinorrhea, lacrimation
5. panic
6. diaphoresis
7. cramps
8. n/v/d
9. muscle aches
10. bone pain
11. chills/fever
12. increased r/r and hr
57
Opiate toxicity triad of symptoms
1. pinpoint pupils
2. coma
3. resp depression
58
How do we tx opiate toxicity treatment?
1. Emergecny care- airway management & adequate oxygenation
2. Medcation- opiod antagonist
- Short-acting naloxone/narcan
- longer-acting- nalmefene revex
59
What should we know about Naloxone (narcon)
1. Reverses s/s opiod overdose
2. can precipitate withdrawl symptoms
3. short-acting
- potential for violent reaction when patient revives
- shorter half life opiods
60
What should we know about nafelmene (revex)
1. Longer-acting
2. longer half-life
3. can precipate prolonged withdrawl
61
Opiod withdrawl begins, peaks, lasts...
1-12 hours after last use
Peaks 3-5 days
Last 1-4 weeks
62
Post acute withdrawal lasts and symptoms include?
1. Last up to 2 years
2. mood swings
3. anxiety
4. depressive symptoms
5. insomnia
Presistent vomiting is a big problem that can cause hypernatremia... relsiten
63
What medication can we use for opiod withdrawl?
Methadone & Clonidine
64
What do we need to know about about methadone and its use for opiod withdrawl
1. Long-acting opiod
2. replace substance of abuse
65
What do we need to know about clondine and its use for opiod withdrawl
Helps with autonomic s/s
66
What medication can we use to help with opiod sobriety
1. Methadone maintence
2. Buprenophine (subutex)
3. Naltreone
4. Suboxone
67
What do we need to know about methadone maintence used for opiod sobriety maintence?
1. Long-term
2. Decreases craving, relapse
3. daily dosing
68
What do we need to know about buprenorphine (Subutex)
1. Reduces cravings, relapse
2. Milder neonatal withdrawl
3. Dosing 1-3 times/week
69
What is the MOA of naltreoxne that is used to help opiod sobriety
Blocks the euphoric effects
70
What is the MOA of suboxone used to tx opioid sobriety
Prevents high from opioids
71
What are some short acting CNS stimulants
Cocaine
Crack
72
What are some long-acting CNS stimulants
Amphetamines
Methamphetamines
73
what is the MOA of cocaine?
Increases dopamine and norepinephrine
74
What are two forms of cocaine?
1. Cocaine hydrochloride- powder;snorted or uncommonly IV
2. Cocaine base- aka crack, crystal & rock; smoked aka freebasing
75
What are s/s of cocaine intoxication?
1. Euphoria
2. Dilated pupils
3. elevated bp & hr
4. N/V
5. Insomnia
6. Grandiosity
7. Impaired judgement
76
what are s/s of cocaine overdose?
1. Respiratory distress
2. ataxia
3. hyperpyrexia
4. convulsions
5. hemorrhagic stroke
6. ventricular dysrthymias
7. MI
8. coma
9. Death
77
What are s/s of cocaine withdrawl
1. fatigue, lethargy, sleepiness
2. Anxiety, agitation, insomnia
3. disorientation
4. apathy
5. craving
6. depression
7. s/i
78
What are long-term adverse effects of cocaine?
1. Atrophy of the nasal muscosa
2. loss of smell
3. injury to lungs (from free-basing)
79
What are adverse cocaine effects if used in preganancy?
1. Crosses the placenta barrier
2. can result in
- Early delivery
- smaller head
- decreased birth weight
- long term effects may include deficits in attention and memory & language development
80
What is the MOA of methamphetamines?
Increases release of norepi and dopamine
Reduces uptake of norepi and dopamine
81
What are other names of Methamphetamine
1. speed
2. chalk
3. ice
4. meth
5. crystal
6. crank
7. blue glass
8. rocket fuel
9.
82
Methamphetmies dissolve easily in______ and easy to manufacture
water
83
What are s/s of meth intoxication?
Short term
1. dilated pupils
2. increased energy
3. increased respirations
4. hyperthermia
5. euphoria
long term
1. paranoia w/delusions
2. hallucinations
3. anxiety
4. potential for violence
84
What are s/s of overdose of meth
1. resp distress
2. ataxia
3. hyperpyrexia
4. convulsions
5. hemorrhagic stroke
6. ventricular dysrthymias
7. mi
8. coma
9. death
85
What are s/s of meth withdrawl
1. Fatigue, lethargy, sleepiness
2. ANxiety, agitation, insomnia
3. disorientation
4. apathy
5. craving
6. depression
7. SI
86
What are long term adverse effects of meth
1. parkinsonian symptoms
2. cracked teeth
3. skin infections
4. HTN
5. stroke
6. angina
7. dysrthymias
8. resp damage
9. renal and hepatic damage
87
88
What are adverse effects of meth use in preganacy
1. preterm birth
2. hypertension
3. placental abruption
4. IUGR
5. neonatal death
89
How do we treat CNS stimulant overdose?
1. Maintain ABC's
2. Provide O2
3. Benzos
- sedation
- prevention of seizures
4. Cooling measures
5. IV antihypertensives
90
CNS stimulant withdrawl tx includes?
1. Modafinil- excessive lethargy
2. Diphenhydramine/Trazodone- agitation and sleeplessness
3. Analgesics- minor pain
4. Benzos- sedatives
91
What are examples of club drugs?
Ecstasy (MDMA)
Gamma-hydroxybutryate (GHB)
Rohypnol
92
What are signs of ecstasy intoxication?
1. Euphoria
2. Disinhibition
3. Increased sensuality, empathy, closeness
93
What are signs of ecstasy overdose?
1. Hyperthermia
2. seizures
3. hypertensive crises
4. cardiac dysrhythmias
5. serotonin syndrome
6. neuro effects- confusion, delirum, paranoia,
7. cognitive
94
What is the antidote for ecstacy?
NOne
94
What are signs of ecstasy withdrawl?
1.Profound depression
2.confusion
3.sleep roblems
4.anxiety cravings
95
How do we tx an ecstasy overdose?
1. activated charcoal
2. comprehensive chemistry panel
3. Symptom management
- ABCs
- cooling measures
- clam queit environment
- sedation with benzodiazepines
95
What are s/s of GHB intoxicaiton
1. euphoria
2. disinhibiton
3. impaired judgement
4. feeling drunk
5. amenesia
6. loss of control over movement
7. dissiness
8. confusion
9. sedation
10. n/v
96
What are s/s GHB overdose?
1. Cheyne-stokes respirations
2. seizures
3. slow breathing
4. low heart rate
5. low body temp
6. coma
7. death
97
What are s/s of GHB withdrawl
1. Tremors
2. insomnia
3. anxiety
98
What are s/s of Rohypnol (roofies) intoxication
1. euphoria
2. disinhibiton
3. imparied judgment
4. feeling drunk
5. amnesia
6. loss of control over movement
7. dizziness
8. confusion
9. sedation
10. n/v
99
What are s/s of rohypnol aka roofies overdose?
1. cheyne-strokes respirations
2. seizures
3. slow breathing
4. lowheart rate
5. low body temp
6. coma
7. death
100
what are s/s of rohypnol roofies witdrawl
1. seizures
2. headache
3. muscle pain
4. delirum
5. anxiety
101
How do we treat GHB and Rohypnol overdose?
1. Antidote
- None for GHB
- Flumazenil for rohypnol
2. Activated charcoal
3. Symptom management
- ABCs
- cooling measures
- calm quiet environment
- sedation with benzos
102
What are examples of dissociative drugs?
1. Phenylcyclohexyl piperdine (PCP)
2. Ketamine
3. Salvia
103
What are s/s of PCP intoxicaiton?
Physical
1. Impervious to pain
2. Elevated VS
3. ataxia
4. assaultive
5. impulsive
6. impaired judgement
Severe effects
1. Hallucinations
2. paranoia
3. bizarre behavior
4. regressive
5. violent behavior
104
What are s/s PCP overdose?
1. Psychosis
2. hypertensive crisis
3. Stroke
4. respiratroy arrest
5. Hyperthermia
6. seizures
105
What are some potential treatments of PCP
1. Acidify urine
2. safe environment
3. reduce stimulation
4. speech- low clear slow
5. drugs- benzo, haloperidol
6. medical support
- hyperthermia
- htn
- resp distress
106
What are s/s of ketamine intoxication?
1. Floating sensation
2. out of body experience
107
what are s/s of ketamine overdose
1. Amenesia
2. consfusion
3. htn
4. acute resp distress
108
What are the potential treatments for ketamine
1. medical support
2. HTN
3. Resp distress
109
What are s/s of salvia divnorium intoxication?
1. Hallucinations
2. Dissociation
3. Derealization
4. Depersonalization
110
111
What are different types of hallucinogens?
1. Lysergic acid diethlaminde (LSD)
2. Mescaline (peyote)
3. Psilocybin
112
What are s/s of intoxication with hallucinogens
Physical
1. Dialated pupils
2. tachycardia
3. diaphoresis
4. palpitations
5. tremors
6. discoordination
7. elevated vs
Psychological
1. Hallucinations
2. Synesthesia
3. fear
4. paranoia
5. anxiety
113
What are s/s of overdose in hallucinogens?
1. psychosis
2. can trigger other psychiatric disorder
114
What are treatment options for hullucinogen overdose?
1. low-stimulation environment
2. safety
3. speech- low clear slow
4. Meds- benzo, haloperidol
115
What are examples of cathinoes
1. bath
2. k2
3. spice
116
What are s/s of intoxication of cathinones?
1. Hallucination
2. dissociation
3. disinhibiton
4. increased sex-drive
5. extreme agitation
117
What are s/s of overdose of cathinones?
1. excited delirium
2. dehydration
3. rhabdomyolysis
4. renal failure
5. chest pain
118
What are s/s of withdrawl of cathinones?
1. depression
2. anxiety
3. insonia
4. paranoia
119
What are examples of inhalants?
Volitile solvents
1. Paint thinner
2. glues
3. gas
4. nail polish remover
5. dry cleaner fluid
Gasses
1. Butane
2. Propane
3. nitrous oxide
Nitrates
1. Isoamyl
2. Isobutyl
Aerosols
1. Spray paint
2. keyboard cleaner
3. cooking oil
120
What are s/s of intoxication of inhalants?
1. Slurred speech
2. disinhibition
3. euphoria
4. dizziness
121
what are s/s of overdose of inhalants?
1. resp. arrest
2. suffocation
3. brain damage
4. liver damage
5. heart failure
6. myelin sheath damage
7. Muscle spasms
8. tremors
9. ataxia
10. hearing loss
11. coma
122
How do we treat inhalant overdose?
1. Medical support
2. b12 and folate
123
What is s/s of nicotine toxcity?
1. N/v/d
2. salivation
3. cold sweats
4. visual and auditory distrbance
5. confusion
6. syncope
7. rapid weak pulse
8. death r/t resp
124
what are s/s of nicotine withdrawl?
1. Cravings
2. impaired concentration
3. nervousness
4. increased appetite
125
What are some pharmacologic aids for nicotine withdrawl
Nicotine
1. patches
2. gum
3. lozenges
4. nasal sprays
5. inhalers
6. varenicline (chantiz)
7. bupropion (zyban)
126
What are commeon uses of cannabis?
1. anxiety
2. fibromayalgia
3. ms
4. neuropathy
5. seizure disprder
6. glaucoma
7. antiemetic
8. appetite stimulant
9. muscle spasm
10. bronchodilater
127
What are some pharmacologic versions of cannabis
1. Sativex
2. dronabinol (marinol)
3. Nabilone (cesamet)
128
What are s/s of intoxication of cannabis?
1. euphoria
2. detachment
3. relaxation
4. increased appetitie
5. talkativeness
6. slowed perception of time
129
What are s/s of overdose from cannabis?
1. Paranoia
2. anxiety
3. N/v
130
what are long term effects of cannabis?
1. cannabis hypermesis syndrome
- severe vomiting
- abdominal discomfort
- acute dehydration
- renal failure
131
History of patient substance abuse should include....
1. age of first use
2. name of substances used
3. periods of sobriety
4. history of substance use
5. hx of withdrwl
6. hx of overdose
7. family hx
8. level of insight
131
What assessment labs should we look for with SUD
Urine drug screen
Blood toxicology
BAC
131
Many people will underreport substance use
yes
132
What is SUD nursing diagnosis?
Risk for
1. Injury
2. dehydration
3. delirium/confusion
4. loneliness
5. suicide
Impaired
1. cognition
2. sleep
3. self care
4. coping
5. role performance
6. family coping
Other
1. denial
2. craving
3. shame
4. spirtual distress
5. distorted thinking process
6. hallucinations
7. hopelessness
8. lack of family support
133
What are patient outcomes for SUD patient
1. Demonstrate- increased insight and accountability & coping strategies
2. Attend- treatment programs, relapse prevention groups, AA, group theory
3. Identify triggers- stress social situations, habits
