Week 9; Substance Abuse Flashcards
Core concept:
ADDICTION IS A COMPULSION AND IS SO
STRONG AS TO GENERATE DISTRESS
(EITHER PHYSICAL OR PSYCHOLOGICAL IF
LEFT UNFULFILLED.
INTOXICATION –
A PHYSICAL AND MENTAL STATE OF MENTAL STATE
OR EXHILARATION AND EMOTIONAL FRENZY OR LETHARGY AND STUPOR WHILE UNDER THE INFLUENCE OF THE SUBSTANCE
WITHDRAWAL –
THE PHYSIOLOGICAL AND MENTAL READJUSTMENT
THAT ACCOMPANIES THE DISCONTINUATION F AN ADDICTIVE SUBSTANCE. THIS CAN OCCUR WITH CESSATION OR ABRUPT DECREASE OF A SUBSTANCE USED REGULARLY OVER A PROLONGED PERIOD.
Substance addiction consists of
PHYSICAL DEPENDENCE; NEED FOR INCREASING AMOUNTS TO PRODUCE THE DESIRED EFFECTS
PSYCHOLOGICAL DEPENDENCE; OVERWHELMING DESIRE TO REPEAT THE USE OF A PARTICULAR DRUG TO PRODUCE PLEASURE OR AVOID DISCOMFORT
Other components of substance abuse disorder
*USE OF THE SUBSTANCE INTERFERES WITH ABILITY
TO FULFILL ROLE OBLIGATIONS
*ATTEMPTS TO CUT DOWN OR CONTROL USE FAIL
*INTENSE CRAVING FOR THE SUBSTANCE
*EXCESSIVE AMOUNT OF TIME SPENT TRYING TO
PROCURE THE SUBSTANCE OR RECOVER FROM ITS USE
* USE OF THE SUBSTANCE CAUSES THE PERSON DIFFICULTY WITH INTERPERSONAL RELATIONSHIPS OR TO BECOME SOCIALLY ISOLATED
*ENGAGES IN HAZARDOUS ACTIVITIES WHEN IMPAIRED
BY THE SUBSTANCE
*TOLERANCE DEVELOPS AND THE AMOUNT REQUIRED TO ACHIEVE THE DESIRED EFFECT INCREASES
*SUBSTANCE-SPECIFIC SYMPTOMS OCCUR UPON DISCONTINUATION OF USE
SUBSTANCE INTOXICATION
*DEVELOPMENT OF A REVERSIBLE SYNDROME OF SYMPTOMS FOLLOWING EXCESSIVE USE OF A SUBSTANCE
* DIRECT EFFECT ON THE CENTRAL NERVOUS SYSTEM
* DISRUPTION IN PHYSICAL AND PSYCHOLOGICAL FUNCTIONING
* JUDGMENT IS DISTURBED AND SOCIAL AND OCCUPATIONAL FXN IMPAIRED
SUBSTANCE WITHDRAWAL
*DEVELOPMENT OF SYMPTOMS THAT OCCURS UPON ABRUPT REDUCTION
OR DISCONTINUATION OF A SUBSTANCE THAT HAS BEEN USED
*SYMPTOMS ARE SPECIFIC TO THE SUBSTANCE THAT HAS BEEN USED.
*DISRUPTION IN PHYSICAL AND PSYCHOLOGICAL FUNCTIONING
Biological factors
GENETICS: APPARENT HEREDITARY FACTOR, PARTICULARLY WITH ALCOHOLISM
* BIOCHEMICAL: ALCOHOL MAY PRODUCE MORPHINE-LIKE SUBSTANCES IN THE BRAIN THAT ARE RESPONSIBLE FOR ALCOHOL ADDICTION.
SOCIOCULTURAL FACTORS
- SOCIAL LEARNING: CHILDREN AND ADOLESCENTS ARE MORE LIKELY TO USE SUBSTANCES WITH PARENTS WHO PROVIDE MODEL FOR SUBSTANCE USE.
- USE OF SUBSTANCES MAY ALSO BE PROMOTED WITHIN PEER GROUP.
CONDITIONING: PLEASURABLE EFFECTS FROM SUBSTANCE USE ACT AS A POSITIVE REINFORCEMENT FOR CONTINUED USE OF SUBSTANCE.
According to the NI of alcohol abuse disorder
- DRINKERS WHO EXPERIENCE BLACKOUTS TYPICALLY DRINK TOO MUCH AND TOO QUICKLY, WHICH CAUSES THEIR BLOOD ALCOHOL LEVELS TO RISE VERY
RAPIDLY. - COLLEGE STUDENTS MAY BE AT PARTICULAR RISK FOR EXPERIENCING A BLACKOUT, AS AN ALARMING NUMBER OF COLLEGE STUDENTS ENGAGE IN BINGE DRINKING.
- BINGE DRINKING, FOR A TYPICAL ADULT, IS DEFINED AS CONSUMING FIVE OR MORE DRINKS IN ABOUT 2 HOURS FOR MEN, OR FOUR OR MORE DRINKS FOR WOMEN.
ALCOHOL USE DISORDER
* PHASE I -
PRE-ALCOHOLIC PHASE: CHARACTERIZED BY
USE OF ALCOHOL TO RELIEVE EVERYDAY STRESS AND
TENSIONS OF LIFE
ALCOHOL USE DISORDER
* PHASE II
EARLY ALCOHOLIC PHASE: BEGINS WITH BLACKOUTS—BRIEF PERIODS OF AMNESIA THAT OCCUR DURING OR IMMEDIATELY FOLLOWING A PERIOD OF DRINKING; ALCOHOL IS NOW REQUIRED BY THE PERSON.
ALCOHOL USE DISORDER
* PHASE III -
THE CRUCIAL PHASE: PERSON HAS LOST CONTROL; PHYSIOLOGICAL DEPENDENCE IS CLEARLY EVIDENT.
ALCOHOL USE DISORDER
* PHASE IV -
THE CHRONIC PHASE: CHARACTERIZED BY EMOTIONAL AND PHYSICAL DISINTEGRATION. THE PERSON IS USUALLY INTOXICATED MORE OFTEN THAN SOBER.
EFFECTS OF ALCOHOL ON THE BODY
*PERIPHERAL NEUROPATHY, CHARACTERIZED BY:
- PERIPHERAL NERVE DAMAGE
- PAIN
- BURNING
- TINGLING
- PRICKLY SENSATIONS OF THE EXTREMITIES
ALCOHOLIC MYOPATHY:
THOUGHT TO RESULT FROM SAME B VITAMIN DEFICIENCY THAT CONTRIBUTES TO PERIPHERAL NEUROPATHY
* ACUTE: SUDDEN ONSET OF MUSCLE PAIN, SWELLING,
AND WEAKNESS; REDDISH TINGE TO THE URINE; RAPID
RISE IN MUSCLE ENZYMES IN THE BLOOD
* CHRONIC: GRADUAL WASTING AND WEAKNESS IN
SKELETAL MUSCLES
WERNICKE’S ENCEPHALOPATHY:
MOST SERIOUS FORM OF THIAMINE DEFICIENCY IN ALCOHOLIC PATIENTS. SYMPTOMS INCLUDE PARALYSIS OF OCULAR MUSCLES, DIPLOPIA, ATAXIA, SOMNOLENCE, STUPOR.
KORSAKOFF’S PSYCHOSIS:
SYNDROME OF CONFUSION, LOSS OF RECENT MEMORY, AND CONFABULATION IN ALCOHOLIC PATIENTS
WERNICKE-KORSAKOFF SYNDROME
- IN THE UNITED STATES, THE TWO DISORDERS ARE USUALLY CONSIDERED TOGETHER AND ARE CALLED WERNICKE-KORSAKOFF SYNDROME. TREATMENT IS WITH PARENTERAL OR ORAL THIAMINE REPLACEMENT.
ALCOHOLIC CARDIOMYOPATHY:
EFFECT OF ALCOHOL ON THE HEART IS AN ACCUMULATION OF LIPIDS IN THE MYOCARDIAL CELLS, RESULTING IN ENLARGEMENT AND A WEAKENED CONDITION.
GASTRITIS:
EFFECTS OF ALCOHOL ON THE STOMACH INCLUDE INFLAMMATION OF THE STOMACH LINING CHARACTERIZED BY EPIGASTRIC DISTRESS, NAUSEA, VOMITING, AND DISTENTION
PANCREATITIS
*ACUTE: USUALLY OCCURS 1 OR 2 DAYS AFTER A BINGE
OF EXCESSIVE ALCOHOL CONSUMPTION. SYMPTOMS
INCLUDE CONSTANT, SEVERE EPIGASTRIC PAIN; NAUSEA
AND VOMITING; AND ABDOMINAL DISTENTION.
*CHRONIC: LEADS TO PANCREATIC INSUFFICIENCY
RESULTING IN STEATORRHEA, MALNUTRITION, WEIGHT
LOSS, AND DIABETES MELLITUS
ALCOHOLIC HEPATITIS
- CAUSED BY LONG-TERM HEAVY ALCOHOL USE
- SYMPTOMS: ENLARGED, TENDER LIVER; NAUSEA AND
VOMITING; LETHARGY; ANOREXIA; ELEVATED WHITE
BLOOD CELL COUNT; FEVER; AND JAUNDICE. ALSO
ASCITES AND WEIGHT LOSS IN SEVERE CASES.
CIRRHOSIS OF THE LIVER
CIRRHOSIS IS THE END-STAGE OF ALCOHOLIC LIVER DISEASE AND IS BELIEVED TO BE CAUSED BY CHRONIC
HEAVY ALCOHOL USE. THERE IS WIDESPREAD
DESTRUCTION OF LIVER CELLS, WHICH ARE REPLACED BY FIBROUS (SCAR) TISSUE. COMPLICATIONS OF CIRRHOSIS OF THE LIVER CAN INCLUDE:
* PORTAL HYPERTENSION
* ASCITES
* ESOPHAGEAL VARICES
* HEPATIC ENCEPHALOPATHY
LEUKOPENIA:
IMPAIRED PRODUCTION, FUNCTION,
AND MOVEMENT OF WHITE BLOOD CELLS
THROMBOCYTOPENIA:
PLATELET PRODUCTION AND SURVIVAL ARE IMPAIRED AS A RESULT OF THE TOXIC EFFECTS OF ALCOHOL.
SEXUAL DYSFUNCTION
- IN THE SHORT TERM, ENHANCED LIBIDO AND FAILURE OF ERECTION ARE COMMON.
*LONG-TERM EFFECTS INCLUDE GYNECOMASTIA, STERILITY, IMPOTENCE, AND DECREASED LIBIDO.
FAS
- ALCOHOL USE DURING PREGNANCY CAN RESULT IN FETAL ALCOHOL SPECTRUM DISORDERS (FASDS).
*FETAL ALCOHOL SYNDROME (FAS): PROBLEMS WITH LEARNING, MEMORY, ATTENTION SPAN, COMMUNICATION, VISION, AND HEARING - ALCOHOL-RELATED NEURODEVELOPMENTAL
DISORDER
*ALCOHOL-RELATED BIRTH DEFECTS
*NO AMOUNT OF ALCOHOL DURING PREGNANCY IS
CONSIDERED SAFE
ALCOHOL INTOXICATION:
OCCURS AT BLOOD ALCOHOL LEVELS BETWEEN 100 AND 200 MG/DL
* LEGAL LIMIT IS 0.08 – PEOPLE REACT DIFFERENTLY!
ALCOHOL WITHDRAWAL:
OCCURS WITHIN 4 TO 12 HOURS OF CESSATION OF OR REDUCTION IN HEAVY AND PROLONGED ALCOHOL USE
* ALCOHOL WITHDRAWAL CAN BE LIFE THREATENING
* COMMON SYMPTOMS: INCREASED BP, INCREASED PULSE, DIAPHORESIS, INCREASED ANXIETY OR AGITATION
* COMPLICATED WITHDRAWAL MAY PROGRES TO ALCOHOL WITHDRAWAL DELIRIUM
* THIS DELIRIUM USUALLY OCCURS ON 2ND OR 3RD DAY
Alcohol withdrawal s/s
- TREMORS, SHAKES
- DIAPHORESIS
- INCREASING BP
- INCREASING ANXIETY
- N/V
- IRRITABILITY
- HALLUCINATIONS AND/OR ILLUSIONS
- INSOMNIA
- DELIRIUM TREMENS – ALCOHOL WITHDRAWAL DELIRIUM
- SEIZURES, DEATH
Treatment indications for alcohol withdrawal
- R/O ALTERNATIVE DIAGNOSIS
- SYMPTOM CONTROL AND MANAGEMENT
- LABS (CBC, CHEM PANEL, UA, LIVER PANEL)
- VS Q 4 HOURS – BP IS A GOOD INDICATOR
- I&0
- ASSESSMENTS
- BENZODIAZEPINE – DIAZEPAM (VALIUM), LORAZEPAM
(ATIVAN), CHLORDIAZEPOXIDE LIBRIUM), OR OXAZEPAM
(SERAX) - IV IF SEIZURES
TRIGGERED APPROACH –
CIWA-AR CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL.
*CLOSE MONITORING NEEDED
*LIFE THREATENING
SEDATIVE/HYPNOTIC USE DISORDER EFFECTS ON THE BODY
- EFFECTS ON SLEEP AND DREAMING
- RESPIRATORY DEPRESSION
- CARDIOVASCULAR EFFECTS
- RENAL FUNCTION
- HEPATIC EFFECTS
- BODY TEMPERATURE
- SEXUAL FUNCTIONING
SEDATIVE/HYPNOTIC USE DISORDER: A PROFILE OF THE SUBSTANCE
- BARBITURATES (EXAMPLES PHENOBARBITAL,
SECONAL) - NON-BARBITURATE HYPNOTICS
- ANTIANXIETY AGENTS – BENZODIAZEPINES (LIFE
THREATENING WITHDRAWAL) - CLUB DRUGS
SEDATIVE/HYPNOTIC-INDUCED DISORDER
- INTOXICATION
- WITH THESE CENTRAL NERVOUS SYSTEM (CNS) DEPRESSANTS, EFFECTS CAN RANGE FROM DISINHIBITION AND AGGRESSIVENESS TO COMA
AND DEATH (WITH INCREASING DOSAGES OF THE DRUG). - WITHDRAWAL
- ONSET OF SYMPTOMS DEPENDS ON THE HALF-LIFE OF THE DRUG FROM WHICH THE PERSON IS WITHDRAWING.
- SEVERE WITHDRAWAL FROM CNS DEPRESSANTS CAN BE LIFE THREATENING.
STIMULANT USE DISORDER SUBSTANCES INCLUDE:
- AMPHETAMINES
- SYNTHETIC STIMULANTS
- MDMA 3,4-METHYLENEDIOXY-METHAMPHETAMINE (MDMA) IS A SYNTHETIC DRUG THAT ALTERS MOOD AND PERCEPTION (AWARENESS OF SURROUNDING OBJECTS AND CONDITIONS). IT IS CHEMICALLY SIMILAR TO BOTH STIMULANTS AND HALLUCINOGENS, PRODUCING FEELINGS OF INCREASED ENERGY, PLEASURE, EMOTIONAL WARMTH, AND DISTORTED
SENSORY AND TIME PERCEPTION (NIDA, 2021). - NON-AMPHETAMINE STIMULANTS
- COCAINE
- CAFFEINE
- NICOTINE
STIMULANT USE DISORDER EFFECTS ON THE BODY
- CNS EFFECTS
- CARDIOVASCULAR EFFECTS
- PULMONARY EFFECTS
- GASTROINTESTINAL AND RENAL EFFECTS
- SEXUAL FUNCTIONING
- AMPHETAMINE AND COCAINE INTOXICATION PRODUCE EUPHORIA,
IMPAIRED JUDGMENT, CONFUSION, AND CHANGES IN VITAL SIGNS (EVEN COMA OR DEATH, DEPENDING ON AMOUNT CONSUMED). - CAFFEINE INTOXICATION USUALLY OCCURS FOLLOWING CONSUMPTION IN EXCESS OF 250 MG. RESTLESSNESS AND INSOMNIA ARE THE MOST COMMON SYMPTOMS.
STIMULANT-INDUCED DISORDERS (CONT’D)
WITHDRAWAL
- AMPHETAMINE AND COCAINE WITHDRAWAL MAY RESULT IN DYSPHORIA, FATIGUE, SLEEP DISTURBANCES, AND INCREASED APPETITE.
- WITHDRAWAL FROM CAFFEINE MAY INCLUDE HEADACHE, FATIGUE, DROWSINESS, IRRITABILITY, MUSCLE PAIN AND STIFFNESS, AND NAUSEA AND VOMITING.
- WITHDRAWAL FROM NICOTINE MAY INCLUDE DYSPHORIA, ANXIETY, DIFFICULTY CONCENTRATING, IRRITABILITY, RESTLESSNESS, AND INCREASED APPETITE.
INHALANT USE DISORDER
- FUELS, SOLVENTS, ADHESIVES, AEROSOL
PROPELLANTS, AND PAINT THINNERS - CNS EFFECTS
- RESPIRATORY EFFECTS
- GASTROINTESTINAL EFFECTS
- RENAL SYSTEM EFFECTS
- CAN CAUSE SERIOUS, IRREVERSIBLE BRAIN
DAMAGE
INTOXICATION - DEVELOPS DURING OR SHORTLY AFTER USE OF OR
EXPOSURE TO VOLATILE INHALANTS - SYMPTOMS INCLUDE: DIZZINESS, ATAXIA, MUSCLE WEAKNESS, EUPHORIA, EXCITATION, DISINHIBITION, SLURRED SPEECH, NYSTAGMUS, BLURRED OR DOUBLE VISION, PSYCHOMOTOR RETARDATION, HYPOACTIVE REFLEXES, STUPOR OR COMA
OPIOID USE DISORDER
- EFFECTS ON THE BODY
- CNS EFFECTS
- GASTROINTESTINAL EFFECTS
- CARDIOVASCULAR EFFECTS
- SEXUAL FUNCTIONING
- EUPHORIA
- MOOD CHANGES
- MENTAL CLOUDING
- DROWSINESS AND PAIN REDUCTION
- ANTITUSSIVE RESPONSE IS DUE TO SUPPRESSION OF THE COUGH CENTER WITHIN THE MEDULLA
- PERISTALTIC ACTIVITY OF THE INTESTINES IS DIMINISHED.
*DECREASED SEXUAL FUNCTION AND DIMINISHED LIBIDO
*SEVERE OPIOID INTOXICATION CAN LEAD TO
RESPIRATORY DEPRESSION, COMA, AND DEATH.
FENTANYL CRISIS
- HIGH POTENCY
- HIGHLY ADDICTING
- IT IS AN ADDITIVE TO OTHER DRUGS
- SOME PEOPLE TAKE IT UNKNOWINGLY
- MANUFACTURED ILLEGALLY, UNCONTROLLED POURING OVER OUR BORDERS
- VERY RISKY TO LAW ENFORCEMENT, EMS, AND NURSES – CAN BE ACCIDENTALLY INHALED OR INHALED
ANTIDOTE FOR OPIATE OVERDOSE
- NALOXONE (NARCAN)
- MANY DRUG DEALERS MIX THE CHEAPER FENTANYL WITH OTHER DRUGS LIKE HEROIN, COCAINE, MDMA AND METHAMPHETAMINE TO
INCREASE THEIR PROFITS, MAKING IT OFTEN DIFFICULT TO KNOW WHICH DRUG IS CAUSING THE OVERDOSE. - NALOXONE CAN TREAT A FENTANYL OVERDOSE WHEN GIVEN RIGHT AWAY.
- IT RAPIDLY BINDS TO OPIOID RECEPTORS AND BLOCKS THE EFFECTS OF OPIOID DRUGS.
- NOTE: FENTANYL IS STRONGER THAN OTHER OPIOID DRUGS LIKE MORPHINE AND MIGHT REQUIRE MULTIPLE DOSES OF NALOXONE
OPIOID WITHDRAWL
- FROM SHORT-ACTING DRUGS (E.G., HEROIN)
- SYMPTOMS OCCUR WITHIN 6 TO 8 HOURS, PEAK WITHIN 1 TO 3 DAYS,
AND GRADUALLY SUBSIDE IN 5 TO 10 DAYS. - FROM LONG-ACTING DRUGS (E.G., METHADONE)
- SYMPTOMS OCCUR WITHIN 1 TO 3 DAYS, PEAK BETWEEN DAYS 4 AND 6,
AND SUBSIDE IN 14 TO 21 DAYS. - FROM ULTRA-SHORT-ACTING MEPERIDINE (DEMEROL)
- SYMPTOMS BEGIN QUICKLY, PEAK IN 8 TO 12 HOURS, AND SUBSIDE IN 4 TO 5 DAYS.
S/S: - DYSPHORIA
- MUSCLE ACHES, NAUSEA/VOMITING
- LACRIMATION OR RHINORRHEA
- PUPILLARY DILATION
- PILOERECTION, SWEATING
- ABDOMINAL CRAMPING, DIARRHEA
- YAWNING, FEVER, AND INSOMNIA
DISSOCIATIVE DRUGS
- PCP (PHENCYCLIDINE) - DEVELOPED IN THE 1950S AS A GENERAL ANESTHETIC FOR
SURGERY, NO LONGER USED FOR THIS PURPOSE DUE TO SERIOUS SIDE EFFECTS. PCP
CAN BE FOUND IN A VARIETY OF FORMS, TABLETS OR CAPSULES; LIQUID AND WHITE
CRYSTAL POWDER ARE THE MOST COMMON. SLANG NAMES, SUCH AS ANGEL
DUST, HOG, LOVE BOAT, AND PEACE PILL. - KETAMINE - USED AS A SURGERY ANESTHETIC FOR HUMANS AND ANIMALS. MUCH
OF THE KETAMINE SOLD ON THE STREETS COMES FROM VETERINARY OFFICES. SELLS
AS A POWDER OR AS PILLS. ALSO AVAILABLE AS AN INJECTABLE LIQUID. KETAMINE IS
SNORTED OR SOMETIMES ADDED TO DRINKS AS A DATE-RAPE DRUG. SLANG NAMES
INCLUDE SPECIAL K AND CAT VALIUM. - DEXTROMETHORPHAN (DXM) IS A COUGH SUPPRESSANT AND MUCUS-CLEARING
INGREDIENT IN SOME OVER-THE-COUNTER COLD AND COUGH MEDICINES (SYRUPS,
TABLETS, AND GEL CAPSULES). ROBO IS A COMMON SLANG NAME FOR DXM. MUST
BE 18 AND OVER IN CA AND OR TO PURCHASE WITHOUT A RX
HALLUCINOGENS: EFFECTS ON THE BODY
- PHYSIOLOGICAL
- NAUSEA/VOMITING
- CHILLS
- PUPIL DILATION
- INCREASED BLOOD PRESSURE,
PULSE - LOSS OF APPETITE
- INSOMNIA
- ELEVATED BLOOD SUGAR
- DECREASED RESPIRATIONS
- PSYCHOLOGICAL
- HEIGHTENED RESPONSE TO
COLOR, SOUNDS - DISTORTED VISION
- SENSE OF SLOWED TIME
- MAGNIFIED FEELINGS
- PARANOIA, PANIC
- EUPHORIA, PEACE
- DEPERSONALIZATION
- DEREALIZATION
- INCREASED LIBIDO
HALLUCINOGEN-INDUCED INTOXICATION
*OCCURS DURING OR SHORTLY AFTER USING THE
DRUG
*SYMPTOMS INCLUDE PERCEPTUAL ALTERATION,
DEPERSONALIZATION, DEREALIZATION,
TACHYCARDIA, AND PALPITATIONS.
*SYMPTOMS OF PHENCYCLIDINE INTOXICATION
INCLUDE BELLIGERENCE AND ASSAULTIVENESS, AND
MAY PROCEED TO SEIZURES OR COMA.
EXCITED DELIRIUM
- A SEVERE, LIFE-THREATENING STATE OF AGITATED DELIRIUM AND AUTONOMIC DYSREGULATION.
- THIS SYNDROME IS CHARACTERIZED BY SYMPATHETIC HYPERAROUSAL (E.G., HYPERTHERMIA, VITAL SIGN ABNORMALITIES, METABOLIC ACIDOSIS), DELIRIUM (ALTERED CONSCIOUSNESS WITH DIMINISHED
AWARENESS OF ONE’S ENVIRONMENT), RHABDOMYOLYSIS, AND AGITATED OR VIOLENT BEHAVIOR. - PATIENTS ARE OFTEN INCOHERENT AND COMBATIVE.
SOME PATIENTS MAY STRIP NAKED, REFLECTING THE COMBINED HYPERTHERMIA AND ALTERED MENTAL STATUS
MORE ON EXCITED DELIRIUM
- STIMULANT TOXICITY RESULTING IN EXCITED DELIRIUM SYNDROME HAS BEEN DESCRIBED WITH MDMA, COCAINE, AMPHETAMINE, AND MORE RECENTLY, NOVEL PSYCHOACTIVE SUBSTANCES SUCH AS CATHINONES AND CANNABIMIMETICS.
- THE HYPER-DOPAMINERGIC STATE ASSOCIATED WITH INTOXICATION WITH THESE DRUGS OVERLOADS DOPAMINE CIRCUITRY WITH ELECTROCHEMICAL SIGNALING, TRIGGERING A SURGE IN EXTREME
MOTOR HYPERACTIVITY, DELIRIUM, AGITATION, AND VIOLENT BEHAVIOR. - ACTION PATHWAYS LEAD TO PERIPHERAL SYMPATHOMIMETIC STIMULATION THAT PREDISPOSES TO CARDIAC ARRHYTHMIA AND CARDIOMYOPATHY, AND SUDDEN DEATH.
HYPERTHERMIA CONTRIBUTES TO EXCITED DELIRIUM-ASSOCIATED MORBIDITY AND MORTALITY AND PRIMARILY RESULTS FROM:
AGITATION THAT DRIVES MUSCULAR HYPERACTIVITY,
RHABDOMYOLYSIS, AND RENAL FAILURE. EVEN WITH PATIENT SURVIVAL OF AN INITIAL CARDIAC ARREST, PERSISTENT HYPERTHERMIA CONTRIBUTES TO THE DEVELOPING COAGULOPATHY, RHABDOMYOLYSIS, AND MULTISYSTEM ORGAN FAILURE
CANNABIS INDUCED DISORDER
INTOXICATION
* SYMPTOMS INCLUDE IMPAIRED MOTOR COORDINATION, EUPHORIA, ANXIETY, SENSATION OF SLOWED TIME, AND IMPAIRED JUDGMENT.
* PHYSICAL SYMPTOMS INCLUDE CONJUNCTIVAL INJECTION, INCREASED APPETITE, DRY MOUTH, AND TACHYCARDIA.
* IMPAIRMENT OF MOTOR SKILLS VARY DEPENDING ON
QUANTITY, FORM, AND PERSON: CAN LAST FOR 8 TO 12
HOURS.
WITHDRAWL: *SYMPTOMS INCLUDE IRRITABILITY, ANGER, AGGRESSION, ANXIETY, SLEEP
DISTURBANCES, DECREASED APPETITE, DEPRESSED MOOD, STOMACH PAIN, TREMORS, SWEATING, FEVER, CHILLS, OR HEADACHE.
SUBSTANCE USE ASSESSMENT
- VARIOUS ASSESSMENT TOOLS ARE AVAILABLE FOR
DETERMINING THE EXTENT OF THE PROBLEM A CLIENT HAS WITH SUBSTANCES. - DRUG HISTORY AND ASSESSMENT
- CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT OF
ALCOHOL SCALE - MICHIGAN ALCOHOLISM SCREENING TEST (MAST)
- CAGE QUESTIONNAIRE
- SIGNS OF INTOXICATION
- SYMPTOMS OF WITHDRAWAL
CAGE QUESTIONNAIRE
- HAVE YOU EVER FELT YOU SHOULD CUT DOWN ON
YOUR DRINKING? - HAVE PEOPLE ANNOYED YOU BY CRITICIZING YOUR
DRINKING? - HAVE YOU EVER FELT BAD OR GUILTY ABOUT YOUR
DRINKING? - HAVE YOU EVER HAD A DRINK FIRST THING IN THE
MORNING TO STEADY YOUR NERVES (EYE-OPENER)?
NURSING IMPLICATIONS/INTERVENTIONS -
ETOH
- MONITORING VS
- ASSESS FOR SYMPTOMS OF WITHDRAWAL
- SAFETY
- MEDICATION ADMIN
- MEDICATION TEACHING
- EVALUATION
DUAL DIAGNOSIS
- CLIENTS WITH A COEXISTING SUBSTANCE DISORDER AND MENTAL DISORDER MAY BE ASSIGNED TO A SPECIAL PROGRAM THAT TARGETS THE DUAL DIAGNOSIS.
- PROGRAM COMBINES SPECIAL THERAPIES THAT TARGET BOTH PROBLEMS.
THE TEXT REFERS TO INDEPENDENT INTERVENTIONS:
- PROMOTE COMMUNICATION
- LIMIT SETTING AND BOUNDARY VIOLATIONS
- PROMOTE ADEQUATE NUTRITION
- PROMOTE PARTICIPATION IN TREATMENT
CLIENT/FAMILY EDUCATION
NATURE OF THE ILLNESS
*EFFECTS OF (SUBSTANCE) ON THE BODY
*WAYS IN WHICH USE OF SUBSTANCE AFFECTS LIFE
MANAGEMENT OF THE ILLNESS
1. ACTIVITIES TO SUBSTITUTE FOR (SUBSTANCE) IN TIMES
OF STRESS
2. RELAXATION TECHNIQUES
3. PROBLEM-SOLVING SKILLS
4. ESSENTIALS OF GOOD NUTRITION
SUPPORT SERVICES
* FINANCIAL ASSISTANCE
* LEGAL ASSISTANCE
* ALCOHOLICS ANONYMOUS (OR OTHER SUPPORT GROUP SPECIFIC TO ANOTHER SUBSTANCE)
* ONE-TO-ONE SUPPORT PERSON
CODEPENDENCY
- DEFINED BY DYSFUNCTIONAL BEHAVIORS THAT ARE
EVIDENT AMONG MEMBERS OF THE FAMILY OF A
CHEMICALLY DEPENDENT PERSON, OR AMONG FAMILY
MEMBERS WHO HARBOR SECRETS OF PHYSICAL OR
EMOTIONAL ABUSE, OTHER CRUELTIES, OR
PATHOLOGICAL CONDITIONS - CODEPENDENT PEOPLE SACRIFICE THEIR OWN NEEDS
FOR THE FULFILLMENT OF OTHERS TO ACHIEVE A SENSE
OF CONTROL. - DERIVES SELF-WORTH FROM OTHERS
- FEELS RESPONSIBLE FOR THE HAPPINESS OF OTHERS
- COMMONLY DENIES THAT PROBLEMS EXIST
- KEEPS FEELINGS IN CONTROL
- OFTEN RELEASES ANXIETY IN THE FORM OF STRESS-
RELATED ILLNESSES, OR COMPULSIVE BEHAVIORS SUCH AS EATING, SPENDING, WORKING, OR USE OF SUBSTANCES
THE CODEPENDENT NURSE CLASSIC CHARACTERISTICS
- CARETAKING
- PERFECTIONISM
- DENIAL
- ALTERED COMMUNICATION
- NEED TO BE IN CONTROL
- DOESN’T TAKE CARE OF SELF
- PUTS OTHERS FIRST
TREATING CODEPENDENCE
- SURVIVAL STAGE – LET GO OF DENIAL
- RE-IDENTIFICATION STAGE – GLIMPSE THEIR REAL SELVES THROUGH BREAK IN DENIAL, ACCEPT LABEL OF
CODEPENDENT - CORE ISSUES STAGE – FACE THE FACT THAT
RELATIONSHIPS CANNOT BE MANAGE BY FORCE OF
WILL, EACH PARTNER MUST BE INDEPENDENT - REINTEGRATION STAGE – SELF ACCEPTANCE,
WILLINGNESS TO CHANGE AND RELINQUISH POWER
OVER OTHERS THAT WAS NOT RIGHTFULLY THEIRS,
RECLAIM PERSONAL POWER, CONTROL IS ACHIEVED
THROUGH SELF-DISCIPLINE AND SELF-CONFIDENCE
TREATMENT OF ACUTE ALCHOL WITHDRAWAL
ALCOHOL: BENZODIAZEPINES **FIRST LINE DRUG, ANTICONVULSANTS, MULTIVITAMIN THERAPY, THIAMINE
* DETERRENT THERAPY: DISULFIRAM (ANTABUSE)
* “DETOX” PROGRAM
ALCOHOLICS ANONYMOUS (AA)
- A MAJOR SELF-HELP ORGANIZATION FOR THE
TREATMENT
OF ALCOHOLISM - BASED ON THE CONCEPT OF:
- PEER SUPPORT
- ACCEPTANCE
- UNDERSTANDING FROM OTHERS WHO HAVE
EXPERIENCED THE SAME PROBLEM
TREATMENT MODALITIES FOR SUBSTANCE-
RELATED DISORDERS (CONT’D) - ALCOHOLICS ANONYMOUS (CONT’D)
- THE 12 STEPS THAT EMBODY THE PHILOSOPHY OF
AA PROVIDE SPECIFIC GUIDELINES ON HOW TO
ATTAIN AND MAINTAIN SOBRIETY. - TOTAL ABSTINENCE IS PROMOTED AS THE ONLY
CURE; THE PERSON CAN NEVER SAFELY RETURN TO
SOCIAL DRINKING.TREATMENT MODALITIES FOR SUBSTANCE-
RELATED DISORDERS (CONT’D) - ALCOHOLICS ANONYMOUS (CONT’D)
- THE 12 STEPS THAT EMBODY THE PHILOSOPHY OF
AA PROVIDE SPECIFIC GUIDELINES ON HOW TO
ATTAIN AND MAINTAIN SOBRIETY. - TOTAL ABSTINENCE IS PROMOTED AS THE ONLY
CURE; THE PERSON CAN NEVER SAFELY RETURN TO
SOCIAL DRINKING.
More substance abuse treatment
- VARIOUS SUPPORT GROUPS PATTERNED AFTER AA
BUT FOR INDIVIDUALS WITH PROBLEMS WITH
OTHER SUBSTANCES - COUNSELING
- GROUP THERAPY
PHARMACOTHERAPY FOR ALCOHOLISM (DIFFERENT
THAN TREATMENT FOR WITHDRAWAL)
- DISULFIRAM (ANTABUSE)
- OTHER MEDICATIONS
- NALTREXONE (REVIA)
- NALMEFENE (REVEX)
- SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRIS)
OPIOID WITHDRAWAL
- SYMPTOMS OCCUR TYPICALLY WITHIN 6-8 HOURS AFTER LAST DOSE
- PEAK WITHIN 1-3 DAYS
- SUBSIDE OVER A PERIOD OF 5-10 DAYS
- WITH LONGER ACTING DRUGS SUCH AS METHADONE, SYMPTOMS
BEGIN WITHIN 1-3 DAYS, OVER WITHIN 14-21 DAYS - WITH SHORTER ACTING SUBSTANCES SUCH AS MEPERIDINE
(DEMEROL) – REACHES A PICK WITHIN 8-12 HOURS AND COMPLETE
WITHIN 4-5 DAYS
NURSING IMPLICATIONS OPIATE
WITHDRAWAL
- MONITORING VS
- ASSESS FOR SYMPTOMS OF WITHDRAWAL
- DYSPHORIC MOOD
- GENERALIZED MALAISE, “FLU”
- PUPILLARY DILATION
- PILOERECTION
- DIAPHORESIS
- N/V, DIARRHEA
- YAWNING
- FEVER
- INSOMNIA
- HYDRATION
- MEDICATION ADMINISTRATION AND TEACHING
- MEDICATIONS FOR WITHDRAWAL TREAT SYMPTOMS
- FOR EXAMPLE, MEDS FOR N/V AND DIARRHEA
- EVALUATION OF NURSING CARE PLAN
- SAFETY
Medications that treat opioid withdrawal
- METHADONE AND SUBOXONE ARE THE TWO LEADING MEDICATIONS USED IN THE TREATMENT OF OPIOID ADDICTION.
- METHADONE HAS BEEN UTILIZED IN OPIOID TREATMENT IN THE UNITED STATES SINCE THE LATE 1960’S.
OPIOID WITHDRAWAL - MEDS
METHADONE IS A FULL OPIOID AGONIST WHICH MEANS IT IS SOMEWHAT
STRONGER THAN SUBOXONE.
* SUBOXONE IS A PARTIAL OPIOID AGONIST AND CONSEQUENTLY IS
CONSIDERED SOMEWHAT SAFER THAN METHADONE. BOTH MEDICATIONS
ARE PRESCRIBED BY A PHYSICIAN.
* IN ADDICTION TREATMENT, METHADONE IS PROVIDED IN A CLINIC SETTING
AND ADMINISTERED BY A NURSE (USUALLY TAKEN ORALLY ON SITE BY THE
PATIENT). SUBOXONE IS OFTEN PRESCRIBED IN A DOCTOR’S OFFICE AND MAY
BE TAKEN AT HOME.
* METHADONE IS OFTEN GIVEN IN LIQUID FORM AND IS SWALLOWED.
SUBOXONE IS A THIN FILM THAT IS PLACED UNDER THE TONGUE WHERE IT
DISSOLVES.
* A PATIENT RECEIVING METHADONE IN A TREATMENT PROGRAM CAN EARN
TAKE HOME MEDICATION PRIVILEGES AFTER A PERIOD OF TIME STABLE ON
THE MEDICATION.
Suboxone
- SUBOXONE DOES OFFER THE CONVENIENCE OF IMMEDIATE TAKE HOME AVAILABILITY, OPIOID USERS WITH AN EXTENSIVE DRUG USE HISTORY MAY FIND THAT SUBOXONE IS NOT SUFFICIENTLY STRONG ENOUGH TO ELIMINATE THEIR DAILY OPIOID WITHDRAWAL.
- SUBOXONE (BUPRENORPHINE AND NALOXONE) SUBLINGUAL FILM IS NOT APPROVED BY THE FDA FOR USE AS A PAIN RELIEF MEDICATION. SUBOXONE IS ONLY APPROVED TO TREAT NARCOTIC (OPIATE) ADDICTION (OPIOID USE DISORDER). ONLY SINGLE AGENT BUPRENORPHINE (WITHOUT NALOXONE) IS APPROVED TO TREAT PAIN.
- SUBOXONE IS A COMBINATION OF TWO DRUGS: BUPRENORPHINE AND NALOXONE. BUPRENORPHINE IS THE PARTIAL OPIOID AGONIST (ACTIVE INGREDIENT) THAT BINDS TO OPIOID RECEPTOR SITES AND PROVIDES RELIEF FROM WITHDRAWAL. NALOXONE IS AN ADDITIVE THAT DETERS THE INJECTION USE OF SUBOXONE.
- MOST RECIPIENTS OF METHADONE OR SUBOXONE ARE REQUIRED TO RECEIVE REGULAR COUNSELING IN ADDITION TO THEIR DAILY MEDICATION. THIS COUNSELING IS TO HELP THE INDIVIDUAL DEVELOP
IMPROVED COPING SKILLS AND THE ABILITY TO REDUCE OR PREVENT RELAPSE.
BENZODIAZEPINE WITHDRAWAL
- LIFE THREATENING
- SIMILAR TO ALCOHOL WITHDRAWAL
- WITHDRAWAL FROM NORMAL DOSAGE
REBOUND OR WITHDRAWAL SYNDROME APPEARANCE DELAY VARIES FROM HOURS TO FEW DAYS ACCORDING MOSTLY TO COMPOUNDS ELIMINATION HALF-LIFE. - MEDICAL DETOXIFICATION FROM BENZODIAZEPINES OFTEN INVOLVES TAPERING DOWN FROM THE DRUG. TAPERING DOWN CAN MEAN REDUCING THE DOSE OR PRESCRIBING A LESS POTENT BENZO. THE STRATEGY USED IS DETERMINED BY THE SEVERITY OF ADDICTION AND THE TYPE OF DRUG THAT WAS ABUSED.
- BENZOS USED FOR DETOX MAY INCLUDE DIAZEPAM (VALIUM) OR CLONAZEPAM (KLONOPIN). THESE DRUGS ARE USED FOR TAPERING DOWN BECAUSE THEY ARE LONG-ACTING AND LESS POTENT THAN OTHER BENZOS. THESE DRUGS KEEP WITHDRAWAL SYMPTOMS AT BAY WHILE THE USER REDUCES THEIR DOSE.
S/S OF BENZO WITHDRAWL
BENZODIAZEPINE TREATMENT CAN RESULT IN A NUMBER OF SYMPTOMATIC PATTERNS. THE MOST
COMMON IS A SHORT-LIVED “REBOUND” ANXIETY AND INSOMNIA, COMING ON WITHIN 1-4 DAYS OF DISCONTINUATION,
* SLEEP DISTURBANCE, IRRITABILITY, INCREASED TENSION AND ANXIETY, PANIC ATTACKS, HAND TREMOR, SWEATING, DIFFICULTY IN CONCENTRATION, DRY WRETCHING AND NAUSEA, SOME WEIGHT LOSS, PALPITATIONS, HEADACHE, MUSCULAR PAIN AND STIFFNESS AND A HOST OF PERCEPTUAL CHANGES
* HALLUCINATIONS, SEIZURES, COMA, DEATH
BENZO DETOX MEDICATIONS
- ONE OPTION IS GRADUAL REDUCTION IN DOSE UNTIL IT’S SAFE TO STOP TAKING THE DRUG ALTOGETHER.
- THERE ARE ALSO MEDICATIONS THAT CAN HELP RELIEVE WITHDRAWAL SYMPTOMS DURING THE DETOX PERIOD.
Benzo detox med: Buspirone
- PEOPLE WITH GENERALIZED ANXIETY DISORDER WHO HAVE A HISTORY OF SUBSTANCE ABUSE ARE OFTEN PRESCRIBED BUSPIRONE. THIS DRUG DOESN’T CAUSE PHYSICAL DEPENDENCE AND CAN RELIEVE THE EMOTIONAL EFFECTS OF WITHDRAWAL.
- THE ONLY DOWNSIDE IS THAT BUSPIRONE TAKES 2-3 WEEKS BEFORE IT BEGINS TO TAKE EFFECT. PATIENTS IN DETOX MAY BEGIN TAKING BUSPIRONE AS THEY TAPER DOWN THEIR BENZO DOSES.
Benzo detox med: FLUMAZENIL
- THIS DRUG IS PRIMARILY USED TO TREAT BENZODIAZEPINE OVERDOSES, BUT HAS SHOWN SOME SUCCESS IN REDUCING WITHDRAWAL SYMPTOMS OF LONG-ACTING BENZOS. FLUMAZENIL IS ABLE TO BLOCK THE EFFECTS OF BENZOS AND RELIEVE WITHDRAWAL SYMPTOMS BECAUSE IT ATTACHES TO THE SAME PLEASURE CENTERS IN THE BRAIN AS BENZODIAZEPINES.
- IT MAY ALSO BE USED FOR RAPID DETOX AS THE DRUG FORCES BENZODIAZEPINES OUT OF THE BODY. THIS DRUG SHOULD BE USED WITH CAUTION AS RAPID DETOX CAN MAKE WITHDRAWAL WORSE
TOPICS OF EDUCATION BENZO ADDICTION/WITHDRAWL
- NATURE OF THE ILLNESS
- EFFECTS ON THE BODY
- WAYS THE SUBSTANCE EFFECTS LIFE
- MANAGEMENT OF THE ILLNESS
- ACTIVITIES TO SUBSTITUTE IN TIMES OF STRESS
- RELAXATION
- PROBLEM SOLVING
- GOOD NUTRITION
- SUPPORT SERVICES – FINANCIAL, LEGAL, AA, SUPPORT PERSON
THE CHEMICALLY IMPAIRED NURSE
- THE AMERICAN NURSES ASSOCIATION ESTIMATES THAT 6 - 8 PERCENT OF NURSES USE ALCOHOL OR DRUGS TO THE EXTENT SUFFICIENT TO IMPAIR THEIR PROFESSIONAL PERFORMANCE AND COULD POSE A RISK TO THE PUBLIC.
- OTHERS ESTIMATE 10 TO 15 PERCENT OF NURSES SUFFER FROM THE DISEASE OF CHEMICAL DEPENDENCY
NATIONWIDE. - ALCOHOL IS THE MOST WIDELY ABUSED DRUG, FOLLOWED CLOSELY BY NARCOTICS.
- EARLY REPORTING AND TREATMENT OF ADDICTION AS A DISEASE, WITH FOCUS ON PUBLIC SAFETY AND REHABILITATION OF THE NURSE SIGNS AND SIMPTOMS
- HIGH ABSENTEEISM MAY BE PRESENT IF THE PERSON’S SOURCE IS OUTSIDE THE WORK AREA.
- OR, THE PERSON MAY RARELY MISS WORK IF THE SUBSTANCE SOURCE IS AT WORK.
State board response for chemically impaired nurses
THEY WILL CONDUCT AND INVESTIGATION.
*MAY DENY, SUSPEND, OR REVOKE A LICENSE BASED
ON A REPORT OF CHEMICAL ABUSE BY A NURSE
*DIVERSIONARY LAWS ALLOW IMPAIRED NURSES TO
AVOID DISCIPLINARY ACTION BY AGREEING TO SEEK
TREATMENT.
* DISMISS THE CASE IF NO VIOLATION OF THE NPA IS DETERMINED.
* DISCIPLINE THE LICENSE OF THE NURSE OR NURSING ASSISTANT.
FREQUENTLY, THE LICENSE IS PLACED ON PROBATION. THIS REQUIRES THE
NURSE TO FULFILL THE REQUIREMENTS OF THE PROBATION ORDER IN ORDER
TO MAINTAIN THEIR LICENSE. THIS DISCIPLINE IS A PUBLIC DOCUMENT AND IS
POSTED ON THE OSBN WEBSITE.
* ALLOW THE NURSE TO ENTER THE ALTERNATIVE-TO-DISCIPLINE PROGRAM IN OREGON, KNOWN AS THE HEALTH PROFESSIONALS’ SERVICES PROGRAM (HPSP). IN OREGON, THE HPSP PROGRAM IS IMPLEMENTED BY A THIRD-PARTY VENDOR. PARTICIPATION IN THE HPSP IS NOT CONSIDERED DISCIPLINE AND, IF THE NURSE SUCCESSFULLY COMPLETES THE PROGRAM, IT
WILL NOT BE A PUBLIC DOCUMENT. CURRENTLY, HPSP IS ONLY AVAILABLE TO ADVANCED PRACTICE NURSES, RNS, AND LPNS.
A NURSE MAY BE REQUIRED TO DO ANY OF THE
FOLLOWING:
- SUCCESSFUL COMPLETION OF AN INPATIENT, OUTPATIENT, GROUP, OR INDIVIDUAL COUNSELING TREATMENT PROGRAM
- EVIDENCE OF REGULAR ATTENDANCE AT NURSE SUPPORT GROUPS OR 12-STEP PROGRAM
- RANDOM NEGATIVE DRUG SCREENS
- EMPLOYMENT OR VOLUNTEER ACTIVITIES
when working with chemically impaired nurse
- CONFRONTATION WILL UNDOUBTEDLY RESULT IN
HOSTILITY AND DENIAL - CONFRONTATION SHOULD OCCUR WITH A SUPERVISOR OR OTHER NURSE OR LEAVE UP TO MANAGEMENT
- OFFER ASSISTANCE IN SEEKING TREATMENT
- REPORT TO STATE BOARD – FACTUAL OF SPECIFIC EVENTS AND ACTIONS, NOT A DIAGNOSTIC STATEMENT
- SERIOUS ACCUSATION – REFER TO SUPERVISOR
