Weeks 14, 15 Flashcards
1
Q
BLOOD ALCOHOL LEVEL
A
2
Q
CAGE
A
CAGE questions (2 or more positive)
- Have you ever felt the need to CUT back on your drinking or drug use?
- Have you ever felt ANNOYED by another’s criticism of your drinking or drug use?
- Have you ever felt GUILTY about your drinking or drug use?
- Have you ever had to have an EYE-OPENER in the morning to avoid withdrawal symptoms?
3
Q
ALCOHOL WITHDRAWAL
A
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”
4
Q
ALCOHOL WITHDRAWL DELIRIUM
A
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)
5
Q
Medical ComorbidityL
ALCOHOL
A
- CNS related
- Wernicke’s encephalopathy
- Korsakoff’s psychosis
- Gastrointestinal system
- Esophagitis
- Gastritis
- Pancreatitis
- Alcoholic hepatitis
- Cirrhosis of the liver
6
Q
Tolerance vs. Withdrawal
A
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
7
Q
Characteristics associated with substance abuse
A
DENIAL
Depression
Anxiety
Dependency
Hopelessness
Low self-esteem
8
Q
Narcotics (Opiates)
A
- Heroin
- Morphine
- Opium
- Codeine
- Methadone
9
Q
Narcotic Addiction
A
- 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
10
Q
Opiate Withdrawal
A
- 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
11
Q
Psychopharmacology:
Treatment of Alcoholism
A
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
12
Q
Alcohol Detoxification
A
- 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
13
Q
Psychopharmacology:
Treatment of Opioid Addiction
A
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
14
Q
Recovery and Relapse
A
- 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%
15
Q
Dangerous Withdrawal
A
- Substances with potentially life-threatening courses of withdrawal include alcohol, benzodiazepines, and barbiturates
- The possibility of seizures should always be anticipated
