UNIT 2 SUBSTANCE USE DISORDER Flashcards
What is substance abuse disorder?
A cluster of cogntive havior and physiolofical symptoms indicating that the individual continues using the substance despite significant substance-related problems
What is amotivational syndrome
chronic psychiatric disorder characterized by a variety of changes in personalility, emotions and cognitive function.
What is cross tolerance?
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
What is dual dx?
- Term used when a person has a substance abuse disorder and another mental health disorder.
What are goals for substance use disorder treatment
- 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
What are 10 classifications of substances
- caffeine
- alcohol
- nicotine
- cannabis
- sedatives/hypnotics/anxiolytics
- opiods
- stimulants
- hallucinogens
- inhalants
- Other
What is abuse?
- 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
What is addiction
- 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
DS5 Criteria for substance use disorders
- 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
What is the DS5 creteria for tolerance?
Markedly: Increased amounts used to achieve intoxication/desired effect
Diminished effect with continued use of the same amount
What are psycholoical risk factors for SUD
- low frustration levels
- Poor impulse control
- Lack of meaningful relationships
- Childhood trauma
- Low self esteem
- Propensity for risk taking behaviors
What are some social risk factors of SUD
Peer influences
Family acceptance
What are some gender risk factors of SUD
Males at greater risk
What are genetic risk factors for SUB
member of family in which SUD prevalent
What is the patho of SUD
- 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
What complications can present when a person uses IM/SubQ as there route in SUD
- scaring
- lesions
- abscesses
- infections
What complications can present when a person uses IV as there route in SUD
- infections
- venous sclerosis
- Disease transmission
- Track marks around inj site– darker pigmintation usually seen in ac, legs, or anywhere they can find a vein
What complications can present when a person uses intranasal route in SUD
- Chornic sinusitis
- Perfortated nasal septum
What complication can present when a person uses smoking as their route in SUD
Respiratory problems
What are types of CNS depressants
- Alcohol
- Barbituates
- Benzodiazepines
What is the MOA of Alcohol ETOH use disorder
- CNS depressant- binds with GABA receptors and glutamate receptors
- Activation of the reward circuit- binds with 5ht3 receptors
- Diuretic- inhibits the release of ADH
How much ETOH is too much?
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
Blood alcohol concentration of mother = ______
milk alcohol concentration
Comparing BAC with behavior can tell us…
tolerance. High BAC with few intoxication symtoms= high toleracne vs. versa
What are life threatening signs of alcohol poising
- Inability to wake up
- Vomiting
- Slow breathing- less than 8 breaths per min
- Irregular breathing 10 seconds or more between breaths
- Seizures
- Hypothermia - low body temp, blue in color, paleness
1- 2 (0.05mg) drinks start effecting…
- mood and behavior,
- impaired judgement
5-6 (0.08mg%) drinks starts effecting
- Legal level of intoxication in most states.
- clumsiness in voluntary motor activity
10-12 (0.20mg%) drinks starts effecting
- Depressed function of entire motor area of the brain causing staggering and ataxia; emotional lability
15-19 drinks (0.30mg%) starts effecting
confusion, stupor
20-24 drinks (0.40mg%) starts effecting…
coma
25-30 drinks (0.50mg%) starts effecting…
dealth caused by resp. depression
clinical institute withdrawl assessment looks at….
- N/V: ask “do you feel sick to your stomach” have you vomited
- Tactile disturbances: ask “have you any itching, pins and needs, burning, numbness, feeling of bugs on your skin”
- Auditory distrubances: Ask: are you sensitive to sound/hearing things you know are not there?
- Visual distrubances: Ask: are you sensitive to light/seeing things you know are not there
- Anxiety: Ask Do you feel nervous
- Headache/fullness in head: Ask does your head feel different/like there is a band around it?
- Orientation: Ask “what day is it? where are you? who am i? What is 3+4
- Tremor: Observe: Arms extended, fingers spread apart; stick tongue out
- Paraoxymal sweats: Observe
- Agitation: Observe
True or false: Tongue tremors are hard to fake?
true
What medications are commonly prescribed in a CIWA order?
Lorazepam & Diazepam
What should we know about alcohol withdrawal
- Early signs within a few hours
- peaks within 24-48 hours
- Rapidly and dramatically diappears unless it progresses to delirium
- Irritability and “Shaking” inside
- Grand mal seizures possible in 7-48 hours agter stopping
- Illusions
What should we know about delirium tremens
- Possible death
- Peaks 2-3 days after cessation and reduction
- autonomic hyperactivity (MONITOR VS)
- Sensorial and preceptual distrubances
- Fluctuating LOC
- Delusions (paranoid)
- Agitated behaviors
- most serious form of alcohol withdrawl
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
What are some effects of chronic alcohol use?
- CV damage (cardiomyopathy)
- Liver damage (hepatitis, cirrhosis)
- Erosive gastritis
- GI bleed
- Esophageal carices
- ascities
- acute pancretitis
- thiamine deficiency
- peripheral neurpahty
- increased risk of cancer
- thromboxytobenia
- damage to the brain
- dilation of cutaneous blood vessels
- hypertension
- testicular atrophy,
- impotence sterility & breast enlargement in men
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
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
What pharmacolgical interventions may we used to help with ETOH withdrawl
- Benzos Lorazepam- cross toelrance taper
- Barbituates- Phenobarbital- If benzos arent effective
- Anticonvulsants- Gabapentin- Lower anxiety, prevent seizure
- Betablockers- Propanolol- autonomic symptoms, elevated vitals
- Alphablockers- clondine- autonomic symptoms, elevated vitals
- Thiamine- prevent wernicke-korsakoff syndrome, correct high-output heart failure
- Folic acid b12- correct megaloblastic anemia, heart peripheral neuropathy
What medication may be given to help with alcohol sobriety?
Think “dang” I’m sober
- Naltrexone (VIVITROL)
- Acamprostate (CAMPRAL)
- Disulfiram (ANTABUSE)
- Gabapentin (NEURONTIN)
What is the MOA of naltrexone
Opiod antagonist: blocks opiod receptors involved in reward/craving
reduces relapse
What is the MOA of disulfiram (antabuse)
- Interferes with breakdown of alcohol leading to unpleasant reactions such as flushing, n/v
- stays in system up to 14 days
What is the MOA of gabapentin?
- Works on GABA to clam down the brain and mitagate hyper-aroused state
- reduces cravings by lowering anxiety
What are signs of benzodiazepine toxcity?
- Severe confusion
- Drowsiness
- lack of coordination/weakness
- lightheadness
- memory loss
- fainting
Overdose of benzodiazepine….
Usually occurs with concomitant use of ETOCH, opiates, TCAs or CNS depressants
What are withdrawal symptoms of benzodiazepines?
- body pain
- muscle tension
- cramping
- insomnia
- vomiting
- tremors
- sweating
- seizures
9.
What is the reversal agent for benzos
flumazenil
What are examples of opiates?
- opium
- oxycodone
- fentanyl
- heroin
- meperidine
- morphine
- codeine
- methadone
- hydromorphone
What do we need to know about HEROIN
- High lipid solubitiy- Easily enters cells– making it highly addictive
- Crosses the blood brain barrier easily- then converts to active form of morphine
- Effects fast & intense- IV: 7-8 seconds for effects to be felt, smoked or snorted: 10-15 mins for effects to be felt
- Popular street drug because it easy and cheap to find
What should we know about oxycodone?
- Controlled release formula similar to morphine
- Chewed or crushed and snorted or injected into IV
- esp. risk for OD if tolerance isnt high
- 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.
What should we know about meperidine?
- Effective when taken orally0 can get effects without obvious signs of IV drug use
- Minimal effects on smooth muscle- less cosntipating and less urinary retention
- Produces less pupillary contrsiction than other opiods
What are signs of intoxication of opiates?
- Contricted pupils
- decreased respirations
- sedation
- decreased bp
- slurred speech
- psychomotor retardation