Unit III Flashcards
abuse
refers to the habitual use of a substance that falls outside of medical necessity or social acceptance and is used for the single purpose of altering one’s mood, emotion or LOC
results in adverse effects to the abuser or others
addiction
the 4 C's compulsive behavior(finding and taking the substance) cravings chronic, relapsing brain disorder cognitive impairment
DSM-5: substance use disorder
10 classes of psychoactive substances: alcohol caffeine cannabis hallucinogen inhalants opioids sedatives, hypnotic or anxiolytics stimulants tobacco other/unknown
pathological gambling use disorder
4-6% of gamblers become PG’s
PG and major depression often co-occur
opportunities can double prevalence of PG and problem gamblers
youths(11-19) show 4-7% prevalence rate of problem gambling
internet gambling has increased access to all ages and led to financial ruin
compulsive shopping and spending
pattern of chronic, repetitive purchasing that becomes difficult to stop and results in harmful consequences
6% prevalence rate
“high” caused by increase in endorphins and dopamine
coexist in people with mood disorders, substance abuse or eating disorders
compulsive internet use
provides high that person needs to feel normal
5-10% are compulsive users
50%+ that are addicted also suffer from other addictions(drugs, sex, alcohol, and smoking)
cyber porn, sexual encounters, internet gambling, auctions, excessive emailing
compulsive sexual behaviors
19-24 million Americans compulsive masturbation anonymous sex with mult partners multiple afffairs computer sex sexting co-occurs with other addictive behaviors
prevalence - alcohol
Alcohol use disorder- most common
marijuana - most common illicit drug (Wash and Col legal)
club drugs on the rise
prescription drugs - middle school and high school
anabolic-androgenic steroids: 10th-12th grade mostly male
nicotine- most common chemical dependence
comorbidity
psychiatric: dual dx of subs abuse and psych disorder suicide high risk medical: chronic pain psoriasis cardiovascular respiratory vessel weakening:aneurysm diabetes
3 areas of brain necessary for life - sustaining functions
brainstem- basic functions(HR, breathing, sleeping)
limbic- reward circuit(pleasure)
cerebral cortex- info processing(seeing, hearing etc.)
neurobiology
dopamine regulates pleasure and pain and plays a major role in all addictions
drugs of use affect the limbic system
first time use releases a large amount of dopamine
intense pleasure results
neurons unable to regulate dopamine
dopamine unable to stimulate limbic system
more of a drug is used to increase levels
cycle of tolerance begins
dependence and addiction occurs
genetic contributions
account for between 40-60% of vulnerability to addiction
psychological observations
people who use 2+ substances simultaneously are more likely to reports an unstable childhood and self-medicate than those who use alcohol alone
societal and cultural considerations
if family uses, children more likely
more susceptible to peer pressure if lack close bond with parents
Asian - low prevalence
alcohol and pregnancy
negative physical, mental and behavioral consequences
neurotoxic and interferes with ability of fetus to receive O2 and nourishment
FAS: mental retardation, delayed growth and development, facial abnormalities
end of first trimester most vulnerable time for fetus
nicotine and pregnancy
twice as likely to have low birth weight increased risk development issues congenital abnormalities resp tract problems increased risk SIDS opiates: intrauterine fetal death and infant death, babies addicted at birth
healthcare reporting
safety of patients future ability to practice physical health personal relationships save colleagues professional career or life
alternative to discipline (ATD) programs
up to 20% RN’s addicted
students vulnerable
reporting is peer responsibility
clear documentation by co-workers is crucial
intervention is managers and administrators responsibility
if impaired RN stays in situation with no action, move up chain of command
enabling
could allow RN to endanger lives Excused/ignored behaviors Never told supervisor Accepted responsibility for unfinished work Believed there is not a problem Liked to use drugs or alcohol myself Exonerated a peer's irresponsible behavior Defended colleague
overresponsible/codependent behaviors
control someone else drug use covering up bailing addicted person out of financial or legal problems making threats elicit promises for change walking on eggshells
intoxication
transient condition following the admin of alcohol or other psychoactive substance resulting in disturbances in the LOC, cognition, perception, affect or behavior or other psychological functions and responses
dual dx
coexistence of a substance use/abuse along with one or more other mental health disorders
tolerance
need for higher and higher doses of a substance to achieve the desired effect and or to prevent withdrawal symptoms
withdrawal
occurs after a long period of continued use and signifies a physical dependence
flashbacks
transitory recurrences or perceptual disturbance caused by a persons earlier hallucinogenic drug use
occur during persons drug free state
visual distortions, time expansion, loss of ego boundaries, and intense emotions reported
common in PTSD
codependence
cluster or behaviors originally identified through research involving the families of alcoholic patients
synergistic effects
when some drugs taken together, the effect of either or both drugs in intensified or prolonged
many deaths come from this
antagonistic effects
many people combine drugs to weaken or inhibit the effect of one of the drugs
intoxication assessment - CNS depressants
slurred speech incoordination unsteady gait drowsiness decreased BP disinhibition of sexual or aggressive drives impaired judgment impaired social or occupational function impaired attention or memory irritability
CNS depressants
benzo’s
glutethemide
alcohol(ETOH)
overdose assessment - CNS depressants
cardiovascular or respiratory depression or arrest(mostly barbiturates) coma shock convulsions death
OD tx - CNS depressant
if awake: keep awake induce vomiting give activated charcoal to aid absorption of drug check VS q 15mins coma: clear airway - intubate IV fluids gastric lavage with activated charcoal check VS frequently seizure precautions possibly perfrom HD or peritoneal dialysis flumazenil (Romazicon) IV
withdrawal assessment - CNS depressant
cessation of prolonged heavy use: N/V tachycardia diaphoresis anxiety/irritability tremors in hands, fingers, eyelids marked insomnia grand mal seizures 5-15 years use: delirium
BAL
.05% 1-2drinks .08 5-6 drinks .2 10-12 drinks .3 15-19 drinks .4 20-24 drinks .5 25-30 drinks
psychopharmacology to maintain sobriety
disulfiram(antabuse): used after sober for a few months, motivational aid. DO NOT mix with alcohol
naltrexone(ReVia, Vivitrol) reduces desired pleasant feelings by blocking endorphins , blocks drug craving
acamprosate(Camprol) reducing some of the unpleasant symptoms of abstinence such as anxiety, tension, dysphoria, helps pt abstain
topiramate(Topamax) works to decrease alcohol cravings
alcohol withdrawal delirium drugs - sedatives
benzos:
chlordiazepoxide(Librium)- safe withdrawal and anti-convulsant effects
diazepam (valium) - anticonvulsant
oxazepam(serax) - not metabolized in liver
lorazdepam (Ativan) - not metabolized in liver
alcohol WD drugs - seizure control
carbamazepine (tegretol/Depakote) - reduce symptoms and risk of seizures
mag sulfate - increase effect of vit B1 and reduce postwithdrawal seizures
thiamine(vit B1) - IM or IV before glucose loading to prevent wernickes encephalopathy
alcohol WD drugs - alleviation of ANS
beta blockers(propranolol) or alpha blockers(clonidine) - help reduce ANS hyperactivity (tremor, tachy, inc BP, diaphoresis)
folic acid - effective in short time
mulitvitamins - malabsorption due to heavy long term alcohol abuse
psychopharmacology opiate addiction
naloxone (narcan) - dramatically reverse the signs of OD. short acting, and must be readministered every few hours
nalmefene(revex) - longer half life, less doses, prolonged withdrawal
detox first step
methadone - long acting opiod, substituted for opioid of addiction and then titrated downward.
opioid toxicity
coma
pinpoint pupils
respiratory depression
methadone maintenance
most effective tx of heroin and other illicit opioids
opiates
morphine heroin codeine fentanyl methadone meperidine
opiate intox effects
constricted pupil dec resp dec BP slurred speech drowsiness psychomotor retardation initial:euphoria later: dysphoria impaired: concentration, judgment, memory
opiate withdrawal effects
yawning insomnia irritability rhinorrhea panic diaphoresis cramps N/V muscle aches chills and fever lacrimation diarrhea
buprenorphine maintenance(subutex)
similar to methadone maintenance
longer duration of action\
pharmacologic therapy opioid addiction
methadone(dolophine) - synthetic opiate that blocks craving and effects of heroin
L-x-acetylmethadol(LAAM) - alternative to methadone
naltrexone(ReVia) - antagonist that blocks the euphoric effects of opioids
clonidine(Catapres) - effective somatic tx when combined with naltrexone
buprenorphine(Subutex) - blocks the signs and symptoms of opiois withdrawal
CNS stimulants common signs of stimulant abuse
pupil dilation
oronasal dryness
excessive motor activity
examples of CNS stimulants
cocaine/crack
methamphetamine
caffeine
nicotine
cocaine and crack
extracted from the leaf of a coca bush smoked - 4-6seconds for effects; after 5-7 minutes = "high" two main effects - anesthetic - stimulant produce imbalance in neurotransmitters
cocaine and crack withdrawal symptoms
depression paranoia lethargy anxiety insomnia N/V sweating chills apathy agitation fatigue craving
methamphetamine use
highly addictive neurotoxic effects - destroy dopamine and serotonin visual hallucination delusions paranoia
reduced levels of dopamine
Parkinson-like symptoms occur
prolong use of methamphetamines
cracked teeth skin infections stroke lung disease kidney liver damage birth defects death
marijuana(cannabis)
indian hemp plant which THC is the main/active ingredient
usually smoked
euphoria, sedation, hallucinations
adolescence to young adulthood
illegal
long term effects:
lethargy, anhedonia, diff concentrating, loss of memory
amotivational syndrome
chronic use of cannabis leading to: apathy loss of achievement motivation decrease productivity difficulty with learning and memory impaired concentration lack of personal hygiene preoccupation with drug
rave/club drugs
MDMA(Ecstasy) gamma hydroxybutyrate(GBA) - fantasy, GBH, liquid ecstasy, cherry meth, flunitrazepam - rohypnol - date rape bath salts ketamine - date rape
effects of date rape drugs
disinhibition
relaxation of voluntary muscles
anterograde amnesia
hallucinogens
lysergic acid diethylamide (LSD or acid)
mescaline (peyote)
psilocybin (magic mushroom)
phenycyclidine piperidine(PCP, angel dust, horse tranquilizer, peace pill)
hallucinogen intox effects
pupil dilation tachy diaphoresis palpitations tremors incoordination elevated temp, pulse, resp fear of going crazy paranoid ideas marked anxiety, depression synesthesia(colors are heard, sounds are seen) depersonalization hallucinations grandiosity
hall OD effects
psychosis
brain damage
death
hall. tx
keep in room, low stim
1:1 - reassure and talk down pt
speak slow and clear in low voice
diazepam or chloral hydrate for anxiety or tension
inhalants
spray paint glue cigarette lighter fluid propellant gases used in aerosols age 13-17 accessable!
assessnents for substance use
history of use
medical hx
psych hx
psychosocial issues
