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CH 25
Mr. D's substance-related disorders
| Question | Answer |
|---|---|
| The DSM-IV-TR identifies substance abuse as a | maladaptive pattern of substance use |
| substance abuse is manifested by | recurrent and significant adverse consequences related to repeated use of the substance |
| Which Axis are addictions considered? | Axis 1 |
| In DSM V substance addiction is considered a | mental illness. |
| Abuse | To use wrongfully in a harmful way. Improper treatment or conduct that may result in injury. |
| Dependence | A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled. |
| Prefrontal Cortex | Makes voluntary decisions. |
| Amygdala | Senses fear. Emotional memory of initial rush/high (sights, sounds, smell). |
| Children of alcoholics are ___ times more likely than other children to become alcoholics. | 3 |
| Substance abuse has been associated with | antisocial and depressive PDs |
| Alcohol acts as a | disinhibitor |
| Risk factors for substance abuse: | low self-esteem, loneliness, loses and failure (loss of job, house, spouse), low tolerance for emotional pain |
| Death rates from alcoholism among Native Americans are more than ___ the national average. | twice |
| The incidence of alcohol dependence is higher among _______ Europeans than _______ Europeans | Northern; Southern |
| EtOH | Alcohol |
| Alcohol exerts a depressant effect on the | CNS |
| The depression of the CNS, caused by alcohol, changes | behavior and mood |
| Most states consider that an individual is legally intoxicated with a blood alcohol level of | 0.08%-0.10% concentration |
| How fast is alcohol metabolized by the liver? | 10-15ml per hour (pure alcohol) |
| How much alcohol is in a 12oz beer? | 15ml (0.5oz) |
| Alcohol is responsible for __% of all E.R. admissions. | 25% |
| Alcohol is responsible for __% of all suicides. | 33% |
| Alcohol is responsible for __% of all domestic violence cases. | 50% |
| The two most common defense mechanisms used by individuals with alcoholism are | rationalization and denial |
| Dual Diagnosis | This is when a person has a substance disorder and a mental illness. |
| Antisocial behavior has a ____% increased risk for substance abuse. | 10%-15% |
| Schizophrenia has a ___% increased risk for substance abuse. | 5%-10% |
| Most dual diagnosis programs take a | more supportive and less confrontational approach. |
| Peer support groups are an ______ part of treatment. | important |
| Individuals with dual diagnosis should be encouraged to attend | 12-step recovery programs such as A.A. or N.A. |
| Most abused benzodiazepine | Xanex |
| Benzodiazepine drugs | Xanex, Vlium, Ativan, Klonopin |
| Benzodiazepine intended effects: | lower anxiety, sedation |
| Benzodiazepine toxic effects: | respiratory depression, disorientation, vomiting, agitation |
| Benzodiazepine withdrawal sx: | anxiety, insomnia, possible psychotic sx, hypertension |
| Marijuana intended effects: | euphoria, sedation, pain management, hallucinations (trip) |
| Medicinal value for legalizing marijuana? | chronic pain relief |
| Marijuana toxic effects: | lung cancer, chronic bronchitis, apathy, lower sperm count |
| Marijuana withdrawal sx: | possible depression, mild |
| Is cocaine cheap or expensive? | expensive |
| Cocaine intended effects: | rush of euphoria and pleasure, increased energy |
| Cocaine toxic effects: | irritable, chest pain, tachycardia, hallucinations |
| Cocaine withdrawal sx: | can occur within 1 hour to several days after last fix, depression, insomnia, unpleasant dreams, craving |
| Nicotine intended effects: | relaxation, decreased anxiety |
| Nicotine toxic effects: | hypertension, irreversible emphysema, respiratory disease, stroke, irritation of oral mucous membranes |
| Nicotine withdrawal sx: | nervousness, restlessness, increased appetite, insomnia, craving |
| Alcohol intended effects: | relaxation, decreased social anxiety, coping with stress |
| Alcohol toxic effects: | altered judgement, decreased motor skill, decreased level of consciousness |
| Alcohol chronic use: | liver damage (fatty liver to cirrhosis), acute pancreatitis, cardiovascular damage |
| Alcohol withdrawal effects start within | 4-12 hours of last drink |
| Alcohol withdrawal delirium may occur in | 2-3 days after last drink |
| Alcohol withdrawal sx: | cramping, vomiting, tremors, inability to sleep, tonic-clonic seizures, increased heart rate, hallucinations |
| Antabuse | disulfiram |
| 1st FDA approved med' for alcohol abuse and dependence? | Antabuse |
| Antabuse is prescribed to help people who want to quite drinking by causing a | negative reaction if the person drinks while they are taking Antabuse. |
| Alcohol is metabolized by the body into | acetaldehyde |
| acetaldehyde | a very toxic substance that causes many hangover symptoms |
| Usually the body continues to oxidize acetaldehyde into | acetic acid, which is harmless |
| Antabuse STOPS the production of | acetaldehyde |
| Antabuse PREVENTS the oxidation of | acetaldehyde into acetic acid |
| Antabuse will cause a build up of acetaldehyde that is | 5-10 times greater than normal when drinking alcohol |
| Name 4 medications for alcohol withdrawal symptoms: | diazepam, lorazepam, carbamezapine, revia |
| Drug class and purpose: diazepam and lorazepam | benzodiazepines lower agitation and lowers anxiety |
| Drug class and purpose: carbamezapine | anticonvulsant and mood stabilizer |
| Drug class and purpose: revia | opioid receptor antagonist (blocks good feelings caused by alcohol) |
| 1st choice for alcohol treatment | most severe alcohol addictions need IN-PATIENT facility |
| 2nd choice for alcohol treatment | HOSPITAL based programs |
| 3rd choice for alcohol treatment | (short or long term) RESIDENTIAL programs |
| 4th choice for alcohol treatment | OUT-PATIENT |
| 5th choice for alcohol treatment | 12-STEP program |
| ___ of recovering alcoholics will relapse | 2/3 |
| ___ of recovering alcoholics will not respond favorably | 1/3 |
| Nsg Dx: Rationalization. S & Sx | "I don't have a problem with alcohol. I can quit any time I want to." |
| Nsg Dx: Rationalization. Nsg Ax | Accept client. Identify ways alcohol cause problems. Don't allow client to blame others for alcohol problems. |
| Nsg Dx: Rationalization. Outcomes | Talk about link between alcohol use and problems. Accept responsibility. |
| Nsg Dx: Ineffective Coping. S & Sx | Alcohol use to cope |
| Nsg Dx: Ineffective Coping. Nsg Ax | Set limits on manipulation. Use non-alcoholic coping. + feedback |
| Nsg Dx: Ineffective Coping. Outcomes | Use of non-alcoholic coping strategies. |
| Nsg Dx: Imbalanced Nutrition. S & Sx | dry skin, pale, underweight, malnourished |
| Nsg Dx: Imbalanced Nutrition. Nsg Ax | Consult dietician. Monitor I&O, weight, protein intake. Restrict sodium intake. Provide small, frequent, and nonirritating meals. |
| Nsg Dx: Imbalanced Nutrition. Outcomes | Vitals normal. Verbalize importance of adequate nutrition. |
| What drug is used to help recovering heroine addicts. | methadone |
| Is meth cheap or expensive to make? | Cheap |
| Meth drug action? | CNS stimulant |
| Meth destroys | tooth enamel |
| Meth can cause (mental disorder) | psychosis |
| Enabling | The tolerance, approval, giving, and or financing of drug use. |
| Enabling sabotages the | recovery of the patient. |
| Reasons ppl enable: | 1 Control. 2 Rationalization. 3 Minimizing. 4 Waiting or hoping that things will get better on their own. |
| The recovery addict must first ___ that they have a drug problem. | admit/accept |
| A patient in _____(hint: a river in Egypt) can't be helped | denial |
| DSM IV says that there must be at least __ of 7 characteristics to be considered substance dependent. | 3 |
| 7 characteristics of substance dependence: | Tolerance. Withdrawal. Larger doses and time used. Persistent uncontrollable desire. Lots of time get-n, use-n, or recov-rn from drug. Social or occupation reduced. Use continues despite knowledge of problems it causes. |
| Patient sent to hospital cause of binge drinking. Heavy drinking for years. Lab reports blood alcohol level of 250 mg/dL. Placed on chemical dependency unit for detox. The 1st signs of alcohol withdrawal should be expected at what time? | Several hours after the last drink. |
| Symptoms of Alcohol withdrawal include: | Diaphoresis, nausea and vomiting, and tremors. |
| Which medication is the physician most likely to order for a patient with alcohol withdrawal syndrome? | Chlordiazepoxide (Librium) |
| Dan has been admitted to alcohol rehab' after being fired for drinking on the job. Dan says "I don't have a problem with alcohol. I can handle booze better than any one else. My boss is a jerk." What is the best response? | "You are here because your drinking was interfering with your work, Dan." |
| Dan has been admitted to alcohol rehab' after being fired for drinking on the job. Dan says "I don't have a problem with alcohol. I can handle booze better than any one else. My boss is a jerk." The defense mechanism that Dan is using is? | Denial |
| Dan has been admitted to alcohol rehab' after being fired for drinking on the job. Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. What is the best intervention? | Send a urine specimen from Dan to the lab for drug screening. |
| Dan, begins attendance at AA meetings. What statement reflects the purpose of this organization? | They claim they will help me stay sober. |
| Symptom of a chronic cocaine user. | Red, irritated nostrils. |
| Heroin addict withdrawal symptom. | nausea and vomiting, diarrhea, and diaphoresis. |
| A polysubstance abuser says. "The green and whites do me good after speed." What drug(s) is he abusing? | The client is abusing amphetamines and anxiolytics. |
Created by:
Sanctus Verus
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