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MH PP Addiction

Continued use despite related problems Substance abuse
A severe condition, a disease. Characterized by physical problems and disruption in work, family, and social life. An addiction Substance dependence
Coexistence of substance abuse and psychiatric disorder at the same time Dual diagnosis
Abuse of multiple substances at the same time Polydepence
Tolerance and withdrawal symptoms Physical dependence
More of the substance is needed for the same effect Tolerance
A biological need that develops when the body becomes adapted to having the substance in the system Withdrawal symptoms
Medication that decreases effect of another Antagonist
Either drug potentiates (enhances) the effect of the other (barbs + ETOH) Synergistic
Behaviors that exist separately from addiction, but in dysfunctional relationship with Addicts (Overinvolvement, control their behavior, need for approval, sacrifices for abuser) Co-dependence
Experiments. Starts with ETOH & smoking. Gateway drug, Adolescents
Wernicke encephalopathy (CNS), Korsakoff psychosis. G.I. Esophagitis. Gastritis. Pancreatitis. Cirrhosis. TB. AA. Homicides. Fetal alcohol syndrome Alcohol medical comorbidities
Have you ever felt you ought to 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 study your nerves or get rid of CAGE screening tool
Strausse/relax. Escape. Disinhibition. Relieve depression/sleep. Change mood. Fun/social. Illness-sleep and pain. Religious/culture. Peer pressure Drugs/ETOH reasons for use
Loss of control over substance ingestion. Substance use despite consequences. Tendency to relapse. Addiction
Intolerance of frustration and pain. Lack of success in life. Lack of affection and meaningful relationships. Low self-esteem. Risk taking propensity Psychological theory
Denial. Projection (responsibility for behavior). Rationalization. Minimization (that is bad is gamma not as much as) Defensive coping
Anxiety. Insomnia. Hyper alert. Irritability. Nausea. Vomiting. Anorexia. Tremors. Jerky movement. Startled easily. Poor formed hallucinations. Increased BP & pulse Alcohol W/D. Early sign (24--48 hours)
Tachycardia. Disorientation. Diaphoresis. Clouding of consciousness. Visual and textile hallucinations. Paranoid delusions. Fever 100-103°F Alcohol W/D delirium. Emergency. Peaks 2-3 days (48 to 72 hours)
Alcohol abuse. Alcohol dependence. Alcohol intoxication. Alcohol withdrawal. Ineffective individual coping Nursing diagnosis
Detox-life-threatening. Closely monitor. Maintain quiet, calm environment (decrease CNS irritability). Maintain orientation-clock, calendar Interventions 1
Give benzodiazepines-not PRN. Maintain hydration. Seizure precautions. Give thiamine (prevents Wernicke disease) Interventions 2
Q 1 hrs , Q 2 hrs. Use clinical Institute withdrawal assessment (CIWA-AR). Keep in safety zone Alcohol WD assessment
Aim is self responsibility. So what type of Tx (inpatient/outpatient) Interventions
Remember behaviors: manipulative, dysfunctional anger, impulsive, grandiose. Develop warm excepting manner. Self-awareness. Knowledge of addiction. Alcohol Communication guidelines 1
Ability to form caring relationships. Capacity to tolerate depression and anxiety. Persistence and patience. Capacity to listen. Aniston alcohol Communication guidelines 2
Expect abstinence/sobriety. Individual goals and interventions. Set limits and behavior and cond. Where tx will cont. Support & redirect defenses (don't remove). Recognize their progress is carried out is slow stages. Look for therapeutic leverage Interventions Alcohol
Acceptance facilitates change. Ambivalence is normal Motivational interviewing Alcohol
Express empathy. Develop discrepancy. Avoid arguments. Roll with resistance. Support self Efficacy Alcohol motivational interviewing
Anatabuse disliram. Antabuse diet Stays in system 14 days Rxn in 15 mins
Antabuse Thiamine-(__1__) Multivits Pyroxidine (__2__) Acromprosate Naltrexone 1. B1 carb metabolism 2. B6 l glycogen release from the liver
Alcohol . Benzo's. Barbiturates withdrawls are? Life-threatening
____Receptors are down regulated with benzodiazepines, barbiturates, and alcohol GABA General depressant withdrawal syndrome
Dependent on the half-life of the substance The___of the half-life of the substance the___the withdrawal Severity and length of what what what drawl. Longer. Shorter
__1_Is highly addictive, illegal opiate. ⬆️⬆️Use with young PT, sniffed or smoked. __(___) can't be crushed and injected. Popular in rule areas ___Is a cocaine powder mixed with __1__ Heroin. OxyContin (Perodan) Speedball
Changes the brain so users only purpose is to get more drug. Inj. X 4 q day Opioids
Scarred and collapsed veins. Abscesses. Bacterial infections (TB & pneumonia). Liver and kidney disease (powder). Damage from inhalation (depressed resp). Decreased immune response. Hepatitis B and C. HIV 39 Opioids-long-term consequences
Warm and flushed. Dry mouth. Heavy feeling in extremities. N, V. Severe itch. Anxiety. Impaired cognition. Sense of floating. Hypertonic. Anorexia. Pinhole pupils Opioids intoxication. S/S
Unconscious. Coma. Respiratory depression. Cardiac &/ or respiratory arrest. Treatment? Opioid overdose. Narcan
WD in few hours. Peaks 24-48 hours. Last about one week. Not fatal (except to a fetus) Opioid withdrawal
craving, runny nose, dilated pupils, tearing, sweating and yawning Initial Opiate WD
Increased BP, T, P, R, insomnia, muscle twitching, diarrhea, chills, spontaneous erection and ejaculation, N, V, ABD PAIN 12 hrs Opiate WD
Muscle aches, hyper sensitive to light and sound, headache. 72 hrs opiate WD
TX. Monitor VS remain with. Offer fluids and light foods. Keep the environment calm. Sometimes small doses of___wean Opiate WD. Methadone
Stimulant. (_1_). Smokeless form. Gives general sense of (__2__). High energy-used to (__3__). Used to prevent sleep and increase alertness. Initially-rush (state of agitation imay become violent) Amphetamine 1. Crank 2. Lose wt
⬆️⬆️ P & BP, Heart rhythm irregularities. __1_ Damage to small vessels in the brain==____ Amphetamines S/S
Anxiety, confusion, insomnia, paranoid, auditory and visual hallucinations, labial moon, SI and HI, out-of-control rages Amphetamines S/S. Chronic use
Observation. Calm environment. Benzodiazepines. Antipsychotics. Withdrawal-maintain safety NSG Interventions-amphetamine high
Fever. Convulsions. Life-threatening Tx= Amphetamine overdose Ice bath. Anticonvulsants
LSD and PCP are? Hallucinogens and dissociative
B, B/P, dizzy, anorexia, dry mouth, sweating, nausea, numbness, tremors, labial mood, sensory perceptual alterations, hallucinations LSD high S/S
Persistent psychosis and hallucinogens persisting disorder (HPPD) Often starts in elementary school as tattoos Longer effects of LSD
First develop as surgical anesthetic-never used humans PCP
Panting, elevated T, P, BP Low dose PCP S/S
Dangerously elevated B/P, P, R, nausea, blurred vision, dizzy, decreased awareness of pain, and muscle contractions Moderate dose PCP S/S
Convulsions, coma, hyperthermia, death High does PCP
Memory loss, the speech problems, depression may last one year WD PCP
Antidepressants can help reduce HPPD. Assist in developing appropriate problem-solving. Referred to narcotics anonymous (NA). Help to deal with long-term impairments. Women assess for rape trauma syndrome PCP nursing TX
Ectasy MDMA 3,4 methyldioxymethamphetamine has Stimulant and associative properties
Hi last 3 to 6 hours. Elevated heart rate and BP. Alertness. Paranoia. Malignant hyperthermia Ectasy signs and symptoms of high
Lowered inhibitions. Increased perceptual awareness. Confusion. Hallucinations. Depression. Sleep problems. Drug craving. Increased anxiety Ectasy signs and symptoms of high
HA. Chills. I twitching. Job clenching. Blurred vision. Nausea Ectasy WD. S/S
____Is inexpensive and inhalant form of cocaine Cocaine
Smoked response in 10 seconds. High last five minutes when smoked. High last 30 minutes when snorted Cocaine
Tolerance. Becomes more sensitive to anesthetic and convulsant effects without increased dose Cocaine. Chronic use
Constricted blood vessels. Dilated pupils. Increased temp, P, BP. Euphoric, sociable, mentally alert. Alert to sight, sound in touch. Decreased need for food and sleep. Enhance perception of physical ability. Heart rhythm changes-chest pain Cocaine. Intoxication S/S
Respiratory failure. Seizures. Headache. Stroke. Coma. ABD pain--N Cocaine. Intoxication (S/S Cont)
At loss-malnourished. Tremors-Redigo-muscle twitches. Paranoia. Restlessness, irritability, High anxiety. Sudden death Cocaine. Chronic cues. S/S
Binge use>>>>___ hallucinations. __Loss of smell, nosebleeds, problem swelling, horse, constant runny nose. Ingestion>>>____. Injection infection (____) Auditory. Snorting. Bowel gangrene. HIV, Hep Cocaine, chronic use S/S
Small birthweight, small head circumference, shorter lenght. Children have difficult time bonding and later blocking out distractions Cocaine. Chronic use. Fetal exposure
Cocaine + alcohol == Cocaethylene
Longer duration. More ataxic then either drug alone. Most common to drug combination resulting in death Cocaethylene
Depression. Fatigue. Agitation. Suicidal thoughts. Paranoia. Insomnia or hypersomnia Cocaine WD
Monitor VS. ✅✅ SI. Promote sleep. Admin antiDe. Remain w/disoriented or frightened. Orient to reality. Refer to Cocaine Anomonymous (CA). Important--cues can trigger memories and memories and cravings (___) Cocaine Nursing Tx (Change environment)
Gateway drug. Marijuana
Peak 10 min. Intoxification 2--3 hrs. Effects 24 hrs Marijuana
N w/chemo. Appetite stimulant w/AIDS Marijuana
⬇️⬇️Birth wt & risk nonlymphoblastic leukemia. Emphysma &/or cancer. Risk for infection D/T ⬇️Immune system. (Asperilla or salmonella, HIV) risky sexual behavior Marijuana
Red eyes. Dry mouth. ⬆️⬆️Appetite. Increased pulse. Decreased reflexes. Panic reaction. Mild euphoria. Reduce inhibition Marijuana Use S/S
Safe environment. Monitor. Increased fluids. Marijuana Tx
Toxic psychosis Marijuana OD
Safety for WD. May last for days Marijuana Tx
Irritability, insomnia, anorexia, agitation,mrestlessness, tremors, depression Marijuana WD S/S,
Safety & psychological needs w/depression. Recovery: pulmonary damage, reproductive hormones.(__1__) early recovery deterrent drug. Assist pt to identify as problem. Assist developing problem solving strategies. Refer to narcotics anonymous (NA) Marijuana Tx
No single tx appropriate for all Pts. Tx readily available. Effective tx attends the MULTIPLE NEEDS of pt. Continually assess & modify tx & services as needed ensuring that the plan meets Pts chaning needs Principles of effective drug addiction tx
For Effective tx it is critical that pt remain in tx adequate amt of time. Counseling (1:1, group, behavioral therapies) CRITICAL for effective tx. Medications important element of tx Principles of effective drug addiction tx
Methadone Heroin
Naltrexone (Trexan or ReVia) Opiate
Opiate agonist, blocks opiate WD & S/S Buprenorphine
SR 141716 Marijuana
Disulfiram (Antabuse) Alcohol
Calms glutamate receptors for alcohol Acomprosate
Non-opioid suppressor of opiate WD Symptoms (high b/p med) Clonidine
Tx underlying depression AntiDe
Dual dx Integrated tx
Created by: srchilds