withdrawal Flashcards
substance withdrawal
physiological s that occur when stop using
specific to each substance, mild or life threatening
more intense s = more likely to start using again
time after OH (or benzo)
usually over in 3-5 days, peek ~48 hr
6-12: insomnia, tremor, mild anx, GI upset, HA, diaphoresis, palpitations, anorexia
12 - 24: hallucinations: visual, auditory, tactile
24 - 48: withdrawal seizures (tonic clonic), potentially life threatening
48 - 72: OH withdrawal delirium tremens, hallucinations (visual), disorientation, tachy, htn, low grade fever, agitation, diaphoresis
CIWA
sedative (benzo) hyponotive/OH withdrawal
usually q4 hr
n/v, tremors (tongue, finger), anx, agitation, paroxysmal sweats, orientation, HA, tactile disturbance (bugs crawling), audio and visual disturbances
manage OH withdrawal
control agitation, decrease r/o seizure, decrease morbidity and mortality
benzos first line for seizure (long acting better)
CIWA > 8 -> chlordiazepoxide, diazepam, lorazepam
thiamine replacement daily before IV dextrose to prevent wernicke’s syndrome
schedules and prn dosing for breakthrough s/s
clonidine to decrease BP
delirium tremens
48 - 72
can cause death
risk increases with hepatitis or pancreatitis
rate in those with good health
delirium tremens - s/s
agitation, anx, confusion and disorientation, coarse tremors, seizures, delusions, hallucinations, paranoia, autonomic hyperactivity (tachy, diaphoresis, fever, anx, insomnia, htn)
danger of mis dx as psych disorder
delirium tremens - tm
prevent, med/sedate adequately, monitor, listen and respond to pt report of symptoms, treat comp, give thiamine and other nutrients
labs (electrolytes), hydrate, VS, meds
treat seizures with anticonvulsants: phenytoin or phenobarbital
oral diazepam: agitation, tremos, impending/acute DTS, hallucinations -> IV once delirium appears
haloperidol prn
clonidine for htn
dehydration exacerbation by diaphoresis and fever -> oral/IV fluids
opioid withdrawal: cows - assess
resting pulse rate, sweating, restless, pupil size (good lighting, 3 = normal), bone/joint ache, runny nose or tearing, GI upset, tremor, yawn, anx/irritable, gooseflesh skin (hallmark, inner forearm), muscle twitch (abd, tongue)
opioid: tm - non pharm
non pharm before prn meds, give methadone on time
n: crackers, ginger ale, tea, flat warm coke
muscle ache: hot showers, warm compress
anx reduction: distract, relax, talk
opioid: tm pharm - n/v
n/v -> need to assess vom thickness, color, etc (dont flush)
ondansetron, promethazine oral or rectal suppository (avoid IM d/t rush effect)
opioid: tm pharm - anx, lacrimation, rhinorrhea
hydroxyzine, avoid benzodiazepine
opioid: tm pharm - insomnia
insomnia -> trazadone
opioid: tm pharm - aches and pain
aches and pain: acetaminophen (long term OH may have esophageal varices or gastric ulcers, avoid); NSAIDs
opioid: tm pharm - d
kaopectorate prefered
avoid loperamide -> sedate
opioid: tm pharm - decrease cravings and control withdrawal s/s
methadone: no ceiling effect, monitor closely, works like opioids but slower, decrease euphoric highs and lows, decrease withdrawal s, taper slow bc it is still an opioid
opioid: tm pharm - emergency tm
naloxone
injection or nasal mist, quickly reverse OD effects
opioid: tm pharm - natrexone
block opioid affect, OHor opioid, decrease cravings, dont treat withdrawal, cant have opioids w/n 10-14 days before bc it speeds up withdrawal and will make v sick
opioid: tm pharm - disulfuram
prevent breakdown of acetylaldehide v sick if drink or in close proximity to OH - perfume, tonor, mouthwash, OTC; does not decrease cravings
opioid: tm pharm - clonidine
decrease bp and hr
opioid: tm pharm - acamprosate
decrease cravings (OH)
opioid: tm psychologic
individual therapy, behavioral, cbt, social skills training, support group (NA), residential -> structure, need to be highly motivated
combo is best!
wernicke korsakoff s
neuro disorder from low thiamine
wernicke encephalopathy and korsacoffs = stages
OH abuse and malN: decreased abs thiamine -> poor nut, ED, chronic infection, sx (bariatric)
wernicke’s encephalopathy
s/s: confusion, ataxia (positive balance tremor), nystagmus, double vision, eyelid droop
acute and reversible: may clear in few weeks or progress
tm: thiamine (IV, 2-3x/day for 1-2wk), increase nutrition
korsakoff s
chronic and debilitating -> not reversible
s/s = WE + severe irreversible mem impairment (forming and recalling), confabulation, hallucinations, repetitious speech and actions, problems with decision making
tm: thiamine 3 - 12 mo, s/s presentation -> mem, hallucinations, etc.
