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FMHN > WEEK 7: DA DA DA DRUGS!!!!! AKA LIL PUMPS BREKKIE > Flashcards

WEEK 7: DA DA DA DRUGS!!!!! AKA LIL PUMPS BREKKIE Flashcards

1
Q

TOLERANCE

A
  • An acquired desensitization to a drug, characterised by a diminishing potency of response to the substance
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2
Q

WITHDRAWAL

A
  • A cluster of symptoms that arise in response to the cessation of a drug. Symptoms vary for each drug.
  • Common symptoms include nausea, vomiting, intense psychological discomfort, physical pain, restlessness, anxiety, seizures
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3
Q

DEPENDENCE/ ADDICTION

A
  • A state in which physiological and or psychological functioning is dependent on the presence of a substance
  • The absence of the substance may result in withdrawal and subsequent irrational and/or self destructive behaviour
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4
Q

WHY SHOULD WE CARE ABOUT DRUG USE?

A
  • Substance use disorders account for the third most common group of mental disorders in Australia
  • Drug use carries substantial economic and social implications
  • Nurses frequently care for people engaged in substance use, across a range of settings; ED, community, inpatient medical/surgical wards, mental health wards etc
  • Caring for people with substance use disorder, or a history of substance use disorder, is challenging: blood borne infections, aggressive behaviour, absconding, surreptitious behaviour, discharging against medical advice, complications of withdrawal and drug use
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5
Q

TYPES OF DRUGS

A
  • Tobacco (stimulant/depression)
  • Alcohol (depressant)
  • Heroin (opioid)
  • Ecstasy (Stimulant/hallucinogen)
  • Cocaine (stimulant)
  • LSD (hallucinogen)
  • Methamphetamine (stimulant)
  • Steroids (PEDs)
  • Synthetic drugs (bath salts)
  • Marijuana (depressant hallucinogen)
  • Prescription drugs: opiods (oxycodone, codeine)
  • Benzodiazepines (valium)
  • Caffeine- caffeine can be fatal (lethal dose estimated to be 150 to 200 million per kilogram of body mass (75-100 cups of coffee for a 70 kilogram adult)
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6
Q

DEPPRESSANTS

A 
Alcohol 
Benzos
Barbiturates
Low dose marijuana (also hallucinogen) 
Volatile substances (inhalants) 
Ketamine, GHB etc (often a mixture of depressant, hallucinogen)
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7
Q

STIMULANTS

A 
Nicotine 
Cocaine
Ritalin/ Dexamphetamine
Amphetamine (ICE) 
Ecstasy (also in hallucinogens)
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8
Q

HALLUCINOGENS

A 
LSD
Mescaline/ Peyote
Psilocybin (magic mushrooms) 
High dose marijuana
Ecstasy 
Ketamine
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9
Q

WHY DO PEOPLE USE DRUGS

A
  • Social
  • Curiosity/ Experimental
  • Peer pressure
  • To relax
  • Temporary relief from mental health issues, stress
  • Escape reality
  • To supplement physical or cognitive capacity
  • Management of physical/psychological pain
  • Dependent to avoid withdrawal
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10
Q

THE REWARD PATHWAY

A
  • Reward system activated when individuals experience something pleasurable such as taking an addictive drug
  • Pathway→ Mesolimbic Pathway
  • Neurotransmitter→ Dopamine
  • Doesn’t explain all issues in dependence→ other physiological, cognitive and psychological factors are involved
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11
Q

AUSTRALIA’S NATIONAL DRUG STRATEGY - 3 PILLARS OF HARM MINIMISATION

A
  • Demand Reduction
  • Supply Reduction
  • Harm Reduction
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12
Q

AUSTRALIA’S NATIONAL DRUG STRATEGY - 3 PILLARS OF HARM MINIMISATION: Demand Reduction

A
  • Preventing the uptake and/or delaying the onset of use of alcohol, tobacco and other drugs
  • Reducing the misuse of alcohol, tobacco and other drugs in the community
  • And supporting people to recover from dependence through evidence informed treatment
  • E.g. Health promotion, TV ads, Plain packaging, Healthy Harold
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13
Q

AUSTRALIA’S NATIONAL DRUG STRATEGY - 3 PILLARS OF HARM MINIMISATION: Supply Reduction

A
  • Preventing, stopping, disrupting or otherwise reducing the production and supply of illegal drugs
  • And controlling, managing and/or regulating the availability of legal drugs
  • E.g. Border control, Laws governing alcohol, tobacco, drug distribution. - Lockout laws
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14
Q

AUSTRALIA’S NATIONAL DRUG STRATEGY - 3 PILLARS OF HARM MINIMISATION: Harm Reduction

A
  • Reducing the adverse health, social and economic consequences of the use of drugs, for the user, their families and the wider community
  • E.g. Methadone program, injection room, needle/ syringe exchange programs, lockout laws
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15
Q

HOW DO WE KNOW IF SOMEONE ABUSES ALCOHOL?

A
  • Alcohol use is socially sanctioned and there are guidelines available that detail its safe use
  • We therefore need to exercise judgement in how we classify use, whether use is safe or unsafe
  • Tools:
    Index of suspicion (Informal Screening)
  • AUDIT scale (Screening)
  • Alcohol Withdrawal Scale (AWS) (used for continuous monitoring of at-risk persons)
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16
Q

THE INDEX OF SUSPICION

A
  • Has the patient had a regular intake of 80 grams (8 drinks for males) or 60 grams (6 drinks for females) of alcohol or more per day?
  • Has the patient used alcohol in conjunction with other CNS depressants?
  • Has the patient had previous episodes of alcohol withdrawal
  • Is the patients current admission for an alcohol related reason
  • Does the patients physical appearance indicate chronic alcohol use (e.g. parotid swelling, cushingoid face, facial telangiectasia, eyes reddened or signs of liver disease- ascites, jaundice, limb muscle wasting)?
  • Does the patients pathology results show raised GGT (Gamma- Glutamyl Transference) and/or raised mean corpuscular volume (MCV) LFT, BAC?
  • Does the patient display symptoms such as anxiety, agitation, tremor, sweating or early morning retching, which might be due to an alcohol withdrawal syndrome?
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17
Q

AUDIT (ALCOHOL USE DISORDER IDENTIFICATION TEST)

A
  • Consists of 10 questions, designed to identify people at risk of alcohol related substance use disorder
  • A numeric score is developed to identify the severity of risk
  • Does not rate the degree of withdrawal
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18
Q

ALCOHOL WITHDRAWAL

A
  • Patients admitted to hospitals or presenting to the ED should undergo screening at admission to identify those at risk of alcohol withdrawal
  • Anyone who reports alcohol consumption in excess of recommended levels should be considered at risk of withdrawal. They should be asked about features of dependence, particularly previous withdrawal, and they should be monitored in hospital with an alcohol withdrawal rating scale
  • Onset of alcohol withdrawal is usually 6-24 hours after the last drink. Usually withdrawal resolves after 2-3 days without treatment; occasionally withdrawal may continue for up to 10 days
  • Seizures affect about 5% of patients, occurring early (usually 7-24 hours after the last drink) they are grand mal in type (i.e. generalised, not focal) and usually (though not always) occur as a single episode
  • Delirium tremens (‘the DTs’) is the most severe form of alcohol withdrawal and is a medical emergency. It usually develops 2-5 days after stopping or significantly reducing alcohol consumption. The usual course is 3 days, but can be up to 14 days
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19
Q

AWS- ALCOHOL WITHDRAWAL SCALE

A
  • Instrument designed to enable healthcare professionals to monitor the severity of withdrawals from alcohol
  • Supposed to be used on a continuous basis, as people’s status may vary sharply over time
  • Combines the diagnostic value of physiological and psychological features of withdrawal
  • Crucial for determining the pharmacological needs of people withdrawing from alcohol
  • The AWS assesses against a range of indicators: Nausea and vomiting, tremor, paroxysmal sweats, anxiety/agitation, tactile hallucinations, auditory hallucinations, visual hallucinations, orientation and vital signs
20
Q

PHARMACOLOGICAL MANAGEMENT OF ALCOHOLISM: Diazepam (Valium)

A
  • Pharmacotherapy of choice for withdrawal
  • Best initiated early in the course of withdrawal, to prevent progression to more severe withdrawal
  • Diazepam loading is recommended for inpatient settings, and tapering diazepam for outpatient settings
  • Diazepam inhibits seizure activity, associated with alcohol withdrawal
  • Can be located in the emergency trolley
21
Q

PHARMACOLOGICAL MANAGEMENT OF ALCOHOLISM: Vit B

A
  • All people being treated for alcohol withdrawal should routinely receive thiamine for prophylaxis against Wernicke’s encephalopathy
  • Thiamine should initially be given intramuscularly or intravenously
  • Vitamin B is safe to administer in large doses, as it is a water soluble vitamin
22
Q

PHARMACOLOGICAL MANAGEMENT OF ALCOHOLISM: Analgesia

A

PRN as prescribed

23
Q

OTHER TREATMENT CONSIDERATIONS: DIET

A
  • Due to hepatic impairment, people with alcoholism have very high caloric needs
  • Alcoholism often leads to pancreatitis which interferes with appetite and absorption
24
Q

OTHER TREATMENT CONSIDERATIONS: SEIZURE CHART

A
  • A seizure chart may be necessary for someone experiencing withdrawal
25
Q

OTHER TREATMENT CONSIDERATIONS: ASCITES

A
  • Due to hepatic impairments, people with alcoholism may have large fluid deposits in their abdomen that require drainage and special care
26
Q

OTHER TREATMENT CONSIDERATIONS: BREATHALYSERS

A
  • In some workplaces, nurses are required to breathalyse consumers regularly (such as after a period of leave
27
Q

OPIODS THE AUSTRALIAN CONTEXT

A
  • Many people addicted to opiods use legitimate medications: Oxycodone, tramadol, morphine and fentanyl
  • Opiods are involved in the deaths of hundreds of Australians each year
  • The harms of addiction to opiods has resulted in the close control of once over-the-counter drugs: codeine
  • People using opiods develop tolerance and dependence rapidly
  • Nurses are involved in treating addiction itself, as well as complications of use (injections, injuries and illnesses)
28
Q

OPIODS: DESIRABLE EFFECTS

A

Comfort , instant pain relief, relaxation, emotional detachment and euphoria

29
Q

OPIODS: SIDE EFFECTS

A

Constipation, pinpoint pupils, drowsiness, respiratory depression, itchiness, nausea/vomiting

30
Q

WITHDRAWAL FROM OPIODS

A
  • Anorexia
  • Nausea, vomiting and diarrhoea
  • Tachycardia
  • Restlessness/tremor
  • Yawning
  • Abdominal pain
  • Hot and cold flushes
  • Sweating
  • Runny nose and or tearing
  • Bone/joint/muscle pain
  • Anxiety and irritability
  • Dilated pupils
  • Goosebumps
31
Q

HOW DO NURSES WORK WITH CONSUMERS ENGAGED IN OPIOID USE? SUPERVISED INJECTION ROOMS

A
  • There is no evidence to suggest that injection rooms induce harm
  • To the contrary; injection rooms reduce death and infection
32
Q

HOW DO NURSES WORK WITH CONSUMERS ENGAGED IN OPIOID USE? METHADONE PROGRAM

A
  • Methadone is provided to consumers to assist their overall abstinence
33
Q

HOW DO NURSES WORK WITH CONSUMERS ENGAGED IN OPIOID USE? REHABILITATION

A

Inpatient rehabilitation and detox available (although this is typically only available for private patients)

34
Q

HOW DO NURSES WORK WITH CONSUMERS ENGAGED IN OPIOID USE? NEEDLE EXCHANGE

A

Gives consumers the opportunity to get new needles, reducing the incidence of blood borne diseases

35
Q

BE AWARE OF SURREPTITIOUS BEHAVIOUR: Drug Seeking Behaviour

A
  • People addicted to drugs may present to EDs and behave within each other wards in such a way that seeks to obtain drugs.
  • This often involves vague or non-excludable complaints of physical pain (non-specific abdominal pain, non-specific back pain)
36
Q

BE AWARE OF SURREPTITIOUS BEHAVIOUR: Manipulation of Med Charts

A
  • Inpatient setting→ may attempt to write their own drugs orders in medication charts
  • This means that med charts should be stored away from access in certain circumstances
37
Q

BE AWARE OF SURREPTITIOUS BEHAVIOUR:

Monitoring Medication Room and Supply Rooms

A
  • May investigate medication or supply rooms for equipment that is of use for drug administration (such as needles or water for injection)
38
Q

OTHER CONSIDERATIONS FOR THE MANAGEMENT OF OPIOID ADDICTION

A
  • Strict adherence to PPE: HIV, Hep C
  • Complications from blood borne illness: AIDS and Ascites
  • Use of naloxone
  • Methadone routines
  • Remember DRSABCD
39
Q

MOTIVATIONAL INTERVIEWING

A
  • To purposefully create a conversation around change, without attempting to convince the person of the need to change or instructing them about how to change
  • Motivation to change is inspired through dialogue, not dictation
  • It recognises that the consumer is the person that has to make decisions and have the power to do so
40
Q

MOTIVATIONAL INTERVIEWING : Involves 5 principles

A
  • Avoid argumentation→ Avoiding conflict and confrontations
  • Express empathy→ Letting them feel heard and understood
  • Support self efficacy: recognising the capacity to change
  • Roll with resistance: Resistance is not to be encountered by the therapist, but given back to the consumer to address
  • Develop discrepancy: Assisting consumers to recognise discrepancies in their current situation and their desired future
41
Q

STAGES OF CHANGE: PRE CONTEMPLATION

A
  • People in this stage are not seriously thinking about changing and tend to defend their current AOD use patterns
  • May not see their use as a problem
  • The positives or benefits of the behaviour outweigh any costs or adverse consequences so they are happy to continue using
42
Q

STAGES OF CHANGE: CONTEMPLATION

A
  • People in this stage are able to consider the possibility of quitting or reducing AOD use but feel ambivalent about taking the next step
  • On the one hand AOD use is enjoyable, exciting and a pleasurable activity
  • On the other hand, they are saying to experience some adverse consequences (which may include personal, psychological, physical, legal social or family problems)
43
Q

STAGES OF CHANGE: PREPARATION

A
  • Have usually made a recent attempt to change using behaviour in the last year
  • Sees the cons of continuing as outweighing the pros and they are less ambivalent about taking the next step
  • They are usually taking some small steps towards changing behaviour
  • They believe that change is necessary and that time for change is imminent
  • Equally some people at this stage decide not to do anything about their behaviour
44
Q

STAGES OF CHANGE: ACTION

A
  • Actively involved in taking steps to change their using behaviour and making great steps towards significant change
  • Ambivalence is still very likely at this stage
  • May try several different techniques and are also at greatest risk of relapse
45
Q

STAGES OF CHANGE: MAINTENANCE

A
  • Able to successfully avoid any temptations to return to using behaviour.
  • Have learned to anticipate and handle temptations to use and are able to employ new ways of coping
  • Can have a temporary slip, but don’t see it as failure

FMHN (7 decks)

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