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EXAM 2 MENTAL HEALTH

Alcohol & Substance Abuse/Withdrawal

QuestionAnswer
Professional Response to impaired College Ethical responsibility to report suspicious behavior to a supervisor, and in some states, a legal obligation as defined in the state's Nurse Practice Act. General warning signs are poor work performance, frequent absenteeism, unusual behavior/slurred speech, isolation from peers.
Biological Risk Factors in Substance Abuse Disorders Having parents with substance abuse disorder, Twins (if one has it, the other often does too), Adoption (Studies show sons and their biological sons have increased risks)
Psychological Risk Factors in Substance Abuse Disorders Family dynamics, lack of remodels, maladaptive coping, stormy relationships
Social & Environmental Risk Factors in Substance Abuse Disorders Social attitudes, cultural factors, peer behaviors, laws, cost, and availability
DT's Safeguarding the Patient Usually beings 2-5 days after last drink. May need to be treated in ICU as it can be lethal if severe.
Management of Withdrawal Opiates Includes the use of opioid receptor agonists, opioid receptor partial agonists, opioid receptor antagonists, and adrenergic receptor agonist
Opioid Receptor Agonists Medications that attach to receptors in the brain to block withdrawal symptoms and cravings. Includes Methadone (Dolophine, Methadose)
Opioid Receptor Partial Agonists Medications attach to and partially activate opioid receptors in the brain to ease withdrawal symptoms and cravings. Includes Buprenorphine (Sublocade)
Opioid Receptor Antagonists Medications block activity of opioid receptors in the brain to prevent euphoric effects (the high) of opioids and alcohol and help reduce cravings. Includes Naltrexone (Vivitrol) & Naloxone (Narcan)
Adrenergic Receptor Agonists A medication that attaches to and activates adrenergic receptors in the brain and helps alleviate withdrawal symptoms. Includes Lofexidine (Lucemyra)
Methadone (dolophine) Powerful drug used for pain relief and treatment of drug addiction, it is an opioid receptor agonist
Naltrexone (Vivitrol or Revia) Help decrease cravings, can only be used after opioid withdrawal has taken place, it is an opioid antagonist
Lofexidine (Lucemyra) Historically used for high BP but helps with physical withdrawal symptoms
Narcan (naloxone) Treats narcotic overdose in emergency situations, it is an opioid receptor antagonist
Opioid Withdrawal Symptoms Occurs after a marked decrease or discontinue of use. Symptoms initially show anxiety, restlessness, aching back and legs, and cravings. Later symptoms include nausea and vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia
Alcohol Withdrawal Symptom Onset Peaks on the 2nd day, over in about 5 days but can last up to 1-2 weeks. Number #1 goal is a safe withdrawal, normally a hospital stay of 3-5 days. Treatment is with Benzodiazepines, assessment is done with CIWA-AR
Relapse Prevention Strategies Complete abstinence and high level of motivation. Healthy nurturing, supportive living environments. Help with fundamental life changes, such as finding a job, abstinent friends. Connections with other recovering people, treatment of comorbid conditions
Nursing Implications in Patients with Addiction Encourage patients to identify problem areas in their lives. Explore ways that their substance use may have intensified them. Ensure the patient knows that sobriety will not make life problems go away, but will assist them in thinking about problems clearly. Redirect the client's attention to his or her behavior. Do not allow clients to focus on external events
Benzodiazepines Commonly Used in Alcohol Withdrawal Lorazepam (Ativan), Diazepam, Chlordiazepoxide (Librium). Provide adequate sedation, significant anticonvulsant effects, and promotes ability to participate in rehab programs. Can be given around the clock. Given as PRN.
Medications Used to Suppress Craving in Alcohol Withdrawal Naltrexone (ReVia, Trexan) - May cause headache, restlessness, or irritability. Acamprosate (Campral) - Also decreases physical and emotion discomfort (sweating, anxiety, sleep disturbances), Monitor for diarrhea, vomiting, flatulence, and pruritis
Vitamins Given in Alcohol Withdrawal Folic Acid (Folate) - to treat nutritional deficiencies, may turn urine dark. Thiamine (Vitamin B1) - prevents or treats Wernicke/Korsakoff Syndrome in alcoholism - Cyanocobalamin (Vitamin B12) - treats nutritional deficiencies
When are Barbiturates Used in Alcohol Withdrawal When Benzodiazepines are ineffective
Disulfiram (Antabuse) Promotes/Maintains the abstinence from alcohol. The patient experiences flushing, throbbing headaches, sweating, extreme nausea, vomiting, and GI upset if alcohol is ingested. Teach patients to avoid all products containing alcohol (Cough syrup, mouthwash, lotions, etc.). Symptoms can last up to 2 weeks.
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