Unit 9 Substance Abuse Disorder Alcohol & Opioid Chapter 22

Question 1

What are the commonly abused substances

Answer 1

Commonly Abused Substances Include:
-Alcohol
-Caffeine
-Cannabis
-Hallucinogen
-Inhalant (paint thinner)
-Opioids
-Sedative-hypnotics (benzodiazepines, barbiturates)
-Stimulants (pseudoephedrine, Adderall, cocaine,
-Tobacco

Question 2

What is Addiction

Answer 2

Addiction
-Unable to consistently abstain from a substance or activity.

-Ultimately, without treatment, addiction is progressive and often results in disability or premature death.

Question 3

What is intoxication

Answer 3

Intoxication

When people are in the process of using a substance to excess, they are experiencing intoxication.

-“under the influence”, “high”
-What the person experiences when using the substance excess.

Question 4

What is Tolerance

Answer 4

Tolerance
When a person no longer responds to the drug as they initially did.

Question 5

What is withdrawal

Answer 5

Withdrawal
Physiological symptoms that occur when a person stops using a substance

-Can be specific to the substance, mild – life-threatening
-The more severe the symptoms the more likely the person is to continue to use the substance

Question 6

During initial assessment of a patient with a history of alcohol abuse and is currently experiencing withdrawals, What is the PRIORITY question for the nurse to ask?

A. When was your last alcoholic drink?
B. Do you abuse heroin as well?
C. What other drugs do you abuse?
D. What type of alcohol did you consume?

Answer 6

A. When was your last alcoholic drink?

This is the priority question due to the stages of alcohol withdrawal which can lead to death.

Question 7

Opiod intoxication
hint; down

Answer 7

-Bradycardia (slow pulse)

-Hypotension (low blood pressure)
-Hypothermia (low body temperature)
-Sedation
-Miosis (pinpoint pupils)
-Hypokinesis (slowed movement)
-Slurred speech
-Head nodding
-Euphoria
-Analgesia (the inability to feel pain)
-Calmness

Question 8

Opiod withdrawal s/s

Answer 8

Tachycardia (fast pulse)

Hypertension (high blood pressure)

Hyperthermia (high body temperature)

Insomnia
Mydriasis (enlarged pupils) Hyperreflexia (abnormally heightened
reflexes)
Diaphoresis (sweating)
Piloerection (gooseflesh)
Increased respiratory rate Lacrimation (tearing), yawning Rhinorrhea (runny nose)
Muscle spasms
Abdominal cramps, nausea, vomiting,
diarrhea
Bone and muscle pain Anxiety

Question 9

TX for opioid withdrawal

Answer 9

-increase iv fluids
-decrease stimulation
-keep patient safe
-decrease risk for falls

Question 10

Opiod Overdose s/s

Answer 10

• Death is usually attributed to respiratory
  arrest
• Unresponsiveness
• Slow respirations
• Coma
• Hypothermia
• Hypotension
• Bradycardia
• Pinpoint pupils

Question 11

Which of the following medications are used for opioid overdose

A. naloxone
B.haloperidol
C.clozapine
D. acetaminophen

Answer 11

A. naloxone

Question 12

Risk factors for Alcoholic abuse

Answer 12

-Genetics
-Dopamine and GABA have been linked
-Environmental
-Poverty
-Lack of parental supervision
-Impaired support systems
-Peer influence
-Sociocultural
-Some cultures accept consuming alcohol
Illegal in some countries
Religion – “Sin”

Question 13

Pharmacological Drug tx for Opioid Abuse

Answer 13

Methadone
Buprenorphine
Naltrexone

Question 14

What is the action of Methadone?

Answer 14

Methadone (Dolophine, Methadose) is a synthetic narcotic opioid. It is used to decrease the painful symptoms of opiate withdrawal.

It also blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semisynthetic opioids like oxycodone and hydrocodone.

REPORT TO PROVIDER
Patients should be instructed to seek medical care if they experience difficulty breathing or shallow breathing, feel light- headed or faint, or experience chest pain or a fast or pounding heartbeat. Hives, rash, or swelling of the face, lips, tongue, or throat could also be serious

DISCONTINUATION OF METHADONE MUST OCCUR SLOWLY , TAPER OFF

Question 15

What is the action for clonidine?

Answer 15

Clonidine (Catapres), an alpha agonist antihypertensive, is often used to reduce the symptoms of opioid withdrawal. By blocking neurotransmitters that trigger sympathetic nervous system activity, clonidine eases sweating, hot flashes, watery eyes, and restlessness. This drug also decreases anxiety and may even shorten the detox process.

Question 16

What is the action of Buprenorphine

Answer 16

Buprenorphine is also used to help people reduce or quit opiates.

Buprenorphine is an opioid partial agonist. Like opioids, it produces effects such as euphoria or respiratory depres- sion, but these effects are weaker than those of drugs such as heroin and methadone.

s/e
Side effects of buprenorphine include nausea, vomiting, con- stipation, muscle aches and cramps, insomnia, irritability, and fever.

This drug is used only after abstaining from opioids for 12 to 24 hours and in the early stages of opioid withdrawal.

Question 17

What is the action of Naltrexone?

Answer 17

An injectable long-acting form of naltrexone, Vivitrol, is given intramuscularly once a month.

Patient needs to be opiate free 10 days before initiation of medication.

Blocks euphoric and sedative effects – if they use an opioid

• Long acting injectable

It has FDA approval for the prevention of relapse to opioid dependence following opioid detoxification.

s/e

GI distress, muscle cramps, dizziness, sedation, and appetite disturbances

weakness, tiredness, insomnia, increased thirst, anxiety,
nervousness, restlessness, irritability, muscle and joint aches, decreased sex drive

Question 18

S/s of caffeine intoxication

Answer 18

Caffeine intoxication is characterized by behavioral symptomssuch as
-restlessness,
-nervousness,
-excitement,
-agitation,
-rambling speech, and inexhaustibility.

overdose
Caffeine overdose is characterized by fever, tachycardia or bradycardia, and hypertension

Physical symptoms of intoxication are
-flushed face,
-diuresis,
-gastrointestinal distur- bance, stomach ache
-muscle twitching,
-tachycardia, or
-cardiac arrhythmia.

Question 19

S/s of caffeine Withdrawal

Answer 19

-headache,
-drowsiness,
- irritability, and
-poor concentration
- flu-like symptoms, such as
-nausea, vomiting, and.
-muscle aches.

Question 20

Cannabis Intoxication s/s

Answer 20

• brighter color
• time seems to go more slowly
  - conjunctival injection (red eyes from vessel dilation)
• increased appetite
  -dry mouth,
  tachycardia
  Hallucinations with intact reality testing may occur, or auditory, visual, or tactile illusions may occur in the absence of delirium.

Question 21

Cannabis withdrawal

Answer 21

-occurs within 1 week of cessation

-irritability,
-anger,
-aggression,
-anxiety,
-restlessness, and
-depressed mood.
-insomnia
-weightloss
-abdominal pain, -shakiness,
-sweating,
-fever,
-chills, or
-headache.

Question 22

Hallucinogen intoxication s/s

Answer 22

-Paranoia,
-impaired judgment,
-intensification of perceptions,
-depersonalization, and
-derealization
-pupillary dilation,
-tachycardia,
-sweating,
-palpitations,
-blurred vision,
-tremors, and -incoordination.

Question 23

tx for hallucinogen. hint-mileu

Answer 23

Treatment. Treatment for hallucinogen intoxication includes talking the patient down. This refers to reassurance that the symptoms are caused by the drug and that the symptoms will subside

Patient and provider safety are essential goals. Physical restraint may be necessary. In severe cases, an antipsychotic such as haloperidol (Haldol) or a benzodiazepine such as diazepam (Valium) can be used in the short term.

Question 24

Phencyclidine intoxication. PCP s/s

Answer 24

-nystagmus (involuntary eye movements), -hypertension,
-tachycardia,
-diminished response to pain,
-ataxia (loss of voluntary muscle control), -dysarthria (unclear speech),
-muscle rigidity,
-seizures,
-coma, and
-hyperacusis (sensitivity to sound).
-Hyperthermia and
-seizure activity may also occur.

Question 25

Inhalant intoxication. s/s

Answer 25

Inhalant intoxication. Small doses of inhalants result in disinhibition and euphoria. High doses can cause fearfulness, illusions, auditory and visual hallucinations, and a distorted body image. Apathy, diminished social and occupational functioning, impaired judgment, a

Question 26

Sedative, hypnotic, and antianxiety medication

Answer 26

slurred speech, incoordination, unsteady gait, nystagmus, and impaired thinking. Coma is a dangerous possibil- ity with this class of drugs. Inappropriate aggression and sexual behavior, mood fluctuation, and impaired judgment may also be side effects.

Question 27

Sedative, hypnotic, and antianxiety medication withdrawal

Answer 27

hyperactivity, tremor, insomnia, psychomotor agitation, anxiety, and grand mal seizures. The degree and timing of the withdrawal syndrome depends on the specific substance. Half-life is an important predictor of time.

Question 28

Stimulation intoxication

Answer 28

Stimulant intoxication. People feel superhuman while using stimulants. They feel elated, euphoric, and sociable. Unfortunately, they are also hypervigilant, sensitive, anxious, tense, and angry. Physical symptoms include two or more of the following: chest pain, cardiac arrhythmias, high or low blood pressure, tachycardia or bradycardia, respiratory depression, dilated pupils, perspiration, chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, weakness, confusion, seizures, or coma.

Question 29

Stimulation withdrawal

Answer 29

Withdrawal symptoms begin within a few hours to several days. Symptoms include tiredness, vivid nightmares, increased appetite, insomnia or hypersomnia, and psychomotor retardation or agitation. Functionality is impaired during this withdrawal process. Depression and suicidal thoughts are the most serious side effects of stimulant withdrawal.

Question 30

Is alcohol a stimulant or sedative?

Answer 30

Although alcohol is a sedative, it creates an initial feeling of euphoria.

Question 31

What is Binge Drinking

Answer 31

Excessive drinking is described by two different terms.

Binge drinking refers to drinking too much alcohol quickly.

For women, this amount is four or more drinks within 2 hours; for men, this amount is five or more drinks within 2 hours.

Question 32

What is Heavy Drinking

Answer 32

Heavy drinking is characterized by drinking too much, too often. Eight or more drinks in a week constitutes heavy drinking in women.
Men who drink more than 14 drinks in a week are considered heavy drinkers.

Question 33

6-8 Hours of Cessation from Alcohol
-signs and symptoms

Answer 33

. The classic sign of alcohol with- drawal is tremulousness, commonly called the shakes or the jit- ters, which begins 6 to 8 hours after alcohol cessation (Sadock et al., 2015). Mild to moderate alcohol withdrawal includes agi- tation, lack of appetite, nausea, vomiting, insomnia, impaired cognition, and mild perceptual changes. Both systolic and dia- stolic blood pressure increases, as does pulse and body tempera- ture.

Question 34

8-10 Hours of Cessation from Alcohol
Signs and symptoms

Answer 34

Psychotic and perceptual symptoms may begin in 8 to 10 hours. If your patient is undergoing withdrawal to the point of psychosis, it should be considered a medical emergency because of the risks of unconsciousness, seizures, and delirium. The ben- zodiazepines lorazepam (Ativan) or chlordiazepoxide (Librium) can be given either orally or intramuscularly and tapered over the following 5 to 7 days.

Question 35

12 to 24 Hours of Cessation from Alcohol
(Withdrawal seizures)
signs and symptoms

Answer 35

Withdrawal seizures may occur within 12 to 24 hours after alcohol cessation. These seizures are generalized and tonic- clonic. Additional seizures may occur within hours of the first seizure. Diazepam (Valium) given intravenously is a common treatment for withdrawal seizures.

Question 36

Anytime in the first 72 hours of cessation of alcohol
S/s
(Alcohol withdrawal delirium)

Answer 36

. Alcohol withdrawal delirium may happen anytime in the first 72 hours.

Autonomic hyper-activity may result in tachycardia, diaphoresis, fever, anxiety, insomnia, and severe hypertension. Delusions and visual and tactile hallucinations are common in alcohol withdrawal delirium.

-Delusions and hallucinations may result in unpredictable behaviors as patients try to protect themselves from what they believe are genuine dangers. Patients on any medical floor are at risk for this condition after cessation of heavy drinking for 3 days and are a danger to themselves and others.

Serious physical illness such as hepatitis or pancreatitis may increase the likelihood of alcohol withdrawal delirium.

Question 37

Tx for delerium tremors

Answer 37

Prevention of alcohol withdrawal delirium is the goal. Oral diazepam (Valium) may be useful in the symptomatic relief of acute agitation, tremor, impending or acute DTs, and halluci- nosis. Chlordiazepoxide (Librium) may keep your patient out of danger.

-However, once delirium appears, intravenous loraze- pam (Ativan) is used to treat these severe symptoms. Seclusion may be necessary. Dehydration, often exacerbated by diaphore- sis and fever, can be corrected with oral or intravenous fluids.

Question 38

Which of the following is a complication of Alcohol abuse disorders?

A. hematuria
B.hemptyopsis
C.Wernicke-Korsakoff encephalopathy
D. Hypotensive Encephalopathy

Answer 38

C.Wernicke-Korsakoff

Question 39

What is Wernicke-Korsakoff encephalopathy

Answer 39

-One memory- reducing problem is Wernicke’s (alcoholic) encephalopathy, an acute and reversible condition.

-ACUTE AND REVERSIBLE-

Cause thiamine deficiency

FROM BOOK
The pathophysiological connection between the two problems is a thiamine deficiency, which may be caused by poor nutrition associated with alcohol use or by the malabsorption of nutrients.

Question 40

S/s of Wernicke-Korsakoff encephalopathy

Answer 40

-altered gait,
-vestibular dysfunction,
-confusion,
-several ocular motility
-abnormalities (horizontal nystagmus, lateral orbital palsy, and gaze palsy).

^These eye-focused signs are bilateral but not necessarily symmetrical.

Sluggish reaction to light and anisocoria (unequal pupil size) are also symptoms.

Wernicke’s encephalopathy may clear up within a few weeks or may progress into Korsakoff ’s syndrome, the more severe and chronic version of this problem.

Question 41

Can Wernicke’s encephalopathy clear up in a few weeks?

A. yes
B. no

Answer 41

A. yes

Wernicke’s encephalopathy may clear up within a few weeks

or may progress into Korsakoff ’s syndrome, the more severe and chronic version of this problem.

Question 42

Treatment for Wernicke’s encephalopathy

Answer 42

Wernicke’s encephalopathy responds rapidly to large doses of intravenous thiamine two to three times daily for 1 to 2 weeks.

-IV HYDRATION
-THIAMINE

Treatment of Korsakoff ’s syndrome is also thiamine for 3 to 12 months. Most patients with Korsakoff’s syndrome never fully recover, although cognitive improvement may occur with thiamine and nutritional support.

Question 43

Can Wernicke’s encephalopathy progress into Korsakoff ’s syndrome?

A.No
B. Yes

Answer 43

B. Yes

Wernicke’s encephalopathy may clear up within a few weeks
or may progress into Korsakoff ’s syndrome, the more severe and chronic version of this problem.

Question 44

Pathophsiology to wernike

Answer 44

• Pathophysiology
• Thiamine Deficiency due to:
• Poor Nutrition
• Malabsorption of Nutrients

Question 45

What is Korsakoff ’s syndrome?

Answer 45

chronic on 20% recover

Question 46

ALCOHOL ABUSE DEPENDENCE
INTERVENTIONS

Answer 46

Manage symptoms (Comfort) * Nutritional/Hydration Status * Encourage Self-Care (hygiene) * Provide education related to recovery, resources, risk factors * Pharmacotherapy * Rehabilitation * Therapy * Support Groups – Alcoholic Anonymous * Motivational Interviewing
* Person-centered approach to strengthen motivation for change

Question 47

MEDICATIONS USED FOR ALCOHOL ABUSE DISORDER (NOT USED DURING WITHDRAWAL PHASE)

Answer 47

Disulfiram (Antabuse)
* Relapse prevention
* Aversion Therapy
* Teaching: intense nausea/vomiting, headache, seating, flushed skin, confusion and respiratory difficulties if alcohol ingested/smelled (cough syrup, aftershave etc…)

• Naltrexone (Vivitrol)
• Tx Withdrawal and/or Relapse prevention
  -10 day of abstinence begin tx
• Decrease pleasurable feelings of cravings
• Oral or long-acting injection (qmonth)
• Nausea usually goes away after first month *

Acamprosate calcium (Camprel)
* Relapse prevention
* Begin on 5th day of abstinence tx
* GI upset, appetite loss, dizziness, anxiety and difficulty sleeping
* Contraindicated in patient with renal impairment
^KNOW KIDNEY FUNCTION LABS^

Question 48

Relapse prevention

Answer 48

To maintain long-term sobriety, each individual must prepare for and anticipate the possibility of relapse. This includes identi- fying potential triggers to substance use, learning skills to regain abstinence in the event of use, and adopting healthy coping, identity, and stress management skills to address triggers before they threaten sobriety. Advances in technology have expanded options for maintaining long-term sobriety. Applications for smartphones, for example, offer a way to monitor behavioral patterns for relapse clues.

Individual must prepare for the possibility of relapse * Identify triggers * Skills to regain abstinence * Adopting healthy coping mechanism * Address things that threaten sobriety