Weeks 14, 15

Question 1

BLOOD ALCOHOL LEVEL

Answer 1

Question 2

CAGE

Answer 2

CAGE questions (2 or more positive)

1. Have you ever felt the need to CUT back on your drinking or drug use?
2. Have you ever felt ANNOYED by another’s criticism of your drinking or drug use?
3. Have you ever felt GUILTY about your drinking or drug use?
4. Have you ever had to have an EYE-OPENER in the morning to avoid withdrawal symptoms?

Question 3

ALCOHOL WITHDRAWAL

Answer 3

Withdrawal

• “Hangover” is mild form of withdrawal
• Early signs a few hours after decreasing alcohol
• Signs peak after 24 to 48 hours then rapidly disappear
• Signs and symptoms
• Hyper-alertness
• Jerky movements
• Irritability
• Easily startled
• “Shaking inside”

Question 4

ALCOHOL WITHDRAWL DELIRIUM

Answer 4

Withdrawal delirium

• A medical emergency that can result in death
• Delirium usually peaks at 2 to 3 days (can be 7-9 days) after cessation of alcohol and lasts 2 to 3 days
• Signs and symptoms:
• Tachycardia, diaphoresis, elevated blood pressure
• Disorientation and clouding of consciousness
• Visual or tactile hallucinations
• Range from hyper-excitability to lethargy
• Paranoid delusions, agitation
• Fever (100° F to 103° F)

Question 5

Medical ComorbidityL

ALCOHOL

Answer 5

• CNS related
• Wernicke’s encephalopathy
• Korsakoff’s psychosis
• Gastrointestinal system
• Esophagitis
• Gastritis
• Pancreatitis
• Alcoholic hepatitis
• Cirrhosis of the liver

Question 6

Tolerance vs. Withdrawal

Answer 6

Tolerance

The need for higher and higher doses to achieve the desired effect

Withdrawal

After a long period of continued use, stopping or reducing drug results in specific physical and psychological signs and symptoms

Question 7

Characteristics associated with substance abuse

Answer 7

DENIAL

Depression

Anxiety

Dependency

Hopelessness

Low self-esteem

Question 8

Narcotics (Opiates)

Answer 8

• Heroin
• Morphine
• Opium
• Codeine
• Methadone

Question 9

Narcotic Addiction

Answer 9

• Tolerance develops; increases expense of drug & likelihood of committing crimes
• Narcotic overdose can rapidly lead to coma, respiratory depression, death
• Accidental overdoses among narcotic addicts possible with uncertainty of drug’s strength
• Drugs usually cut with inert (sometimes toxic) substances before sale, resulting in varied strengths available on the streets
• Narcotic withdrawal rarely life threatening but is very uncomfortable

Question 10

Opiate Withdrawal

Answer 10

• Anxiety, restlessness, insomnia, irritability, impaired attention, often physical illness
• Treatment alleviates symptoms by substituting methadone (opiate agonist), then tapering dose slowly
• Clonidine or librium to manage withdrawal symptoms
• Clinical Institute Narcotic Assessment or similar tool used for assessment, monitoring
• Opiate withdrawal usually not life threatening but very uncomfortable

Question 11

Psychopharmacology:
Treatment of Alcoholism

Answer 11

Trexan, Revia (naltrexone)

• Blocks opiate receptors
• Interferes with mechanism of reinforcement
• Reduces or eliminates alcohol craving

Campral (acamprosate)

• Helps client abstain from alcohol
• Mechanism not well understood
• Cleared by kidneys

Antabuse (disulfiram)

• Works on classical conditioning principle (negative reinforcement)
• Alcohol+disulfiram causes unpleasant physical effects (vomiting)
• Antabuse taken with alcohol can lead
• to respiratory and cardiac collapse, unconsciousness, convulsions, and death
• Antabuse should never be given without the patient’s stated willingness to comply

Question 12

Alcohol Detoxification

Answer 12

• Long-acting benzodiazepines are drugs of choice
  
  • Usually chlordiazepoxide (Librium), diazepam (Valium), or lorazepam (Ativan)
• Monitor for toxicity of benzodiazepines
  
  • Ataxia: difficulty walking
  • Nystagmus: involuntary eyeball movement
• Thiamine and vitamin B12 may help prevent Wernicke encephalopathy, Korsakoff psychosis

Question 13

Psychopharmacology:
Treatment of Opioid Addiction

Answer 13

Dolophine (methadone)

• Synthetic opiate blocks craving for and effects of heroin
• Only medication currently approved to treat pregnant opioid addict

Naltrexone (Trexan, Revia)

• Antagonist that blocks euphoric effects of opioids

Clonidine (Catapres)

• Non-opioid suppressor of opioid withdrawal symptoms
• Effective somatic treatment when combined with naltrexone

Question 14

Recovery and Relapse

Answer 14

• Rare for addicted person to suddenly stop substance use forever
• Most addicted people try at least once and usually several times to use drug in controlled way
• Tell patient to return to treatment promptly after relapses
• Patients can learn from what they did to try to prevent further relapses
• Recidivism rate can be as high as 90%

Question 15

Dangerous Withdrawal

Answer 15

• Substances with potentially life-threatening courses of withdrawal include alcohol, benzodiazepines, and barbiturates
• The possibility of seizures should always be anticipated

Question 16

Withdrawal Issues

Answer 16

• For patients who are experiencing drug withdrawal, the highest priority is given to patient safety
• This involves stabilizing the patient’s physiological status until the crisis of withdrawal has subsided.
• Once safety needs are met, abstinence and support system issues must be addressed
• PCP users may become violent toward themselves or others

Question 17

Addiction During Pregnancy

Answer 17

• Taking drugs can cause congenital abnormalities, other health risks to developing baby
• May be born physically dependent on drugs
• Safest pregnancy is totally drug and alcohol free—exception is pregnant women addicted to heroin
• Methadone maintenance safer for fetus than acute detoxification

Question 18

ANOREXIA NERVOSA

Answer 18

• usually younger in age
• fear of gaining weight; distorted body image
• hunger denied; obsession with food
• need to control
• sexually inactive
• obessional and perfectionistic
• amenorrhea (an abnormal absence of menstruation)
• death by starvation, suicide or medical complication

Question 19

BULIMIA

(BINGE/PURGE)

Answer 19

• Binges are planned 2000-3000 calories in 30 minutes
• can be normal or overweight
• usually begins after a period of dieting for weight loss
• frequent vomiting and laxative use after eating binges
• irregular or absent menses; GI problems; cardiac arrythmias
• avoidant, dependent, obssional or borderline features
• distoted body image
• feels out of control, ashamed, low self-esteem
• death from hypokalemia or suicide

Question 20

ANORESIA NERVOSA

INTERVENTION

Answer 20

Psychopharmacology

• Prozac
• Zyprexa

Psychotherapy

• CBT (Cognitive behavioral therapy)
• psychodynamic
• psychotherapy

Milieu Therapy

• Precise meal times and menus
• Observation during and after meals
• Regularly scheduled weighing
• Forced feeding is frightening
• Set weight goal together

Question 21

RE-FEEDING SYNDROME

Answer 21

Potentially fatal

• shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial re-feeding
• Hormonal and metabolic changes may cause serious clinical complications
• Can see other disturbances in electrolytes, glucose, fat and protein metabolism

Question 22

BULIMIA NERVOSA

INTERVENTION

Answer 22

• Interrupt binge-purge cycle (wait 20-30 min for urge to pass)
• Prevent disordered eating behaviors
• Psychotherapy: CBT (cognitive-behavioral therapy)
• Psychopharmacology: Fluoxetine (Prozac)