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N126-U5-SUB ABUSE
#5-Dobrisky-Substance Abuse
| Question | Answer |
|---|---|
| Physical dependence | a characteristic that is present when withdrawal of the drug results in physiological disruptions |
| Withdrawal symptoms | biological need that develops when body adapts to having the drug in the system; a substance specific syndrome |
| Tolerance | with continued use, more of the substance is needed to produce the same effect |
| Substance abuse | A maladaptive pattern of substance use leading to clinically significant impairment or distress |
| Substance dependence | Similar definition but involves tolerance and withdrawal |
| Polysubstance abuse | simultaneous or sequential use of more than one substance |
| Cross-tolerance | increasing need for drugs of similar composition |
| Dual diagnosis | When a person has two identified primary psychiatric diagnosis—most commonly used when one dx is drug or alcohol related |
| Gateway drugs | Substances implicated as forerunners topolysubstance use or drug dependence |
| Individual risk factors | age, ethnicity, genetic predisposition; co-morbidities; stress |
| situational risk factors | peer influence; social norms; family influences; support system |
| environmental risk factors | access to and cost of substance; severity of punishment |
| neurobiologic basis of addiction is | rapid release of neurotransmitters, followed by a reduced-from-baseline level |
| dopamine levels change how when drugs are used? | increase |
| glutamate is associated with | addiction |
| which cultures and ethnic groups is substance abuse more prevelant? | found in all cultures and ethnic groups |
| substance abuse is viewed differently depending on... | the substance being used, the person using it and the setting in which it is used |
| when people are displaced from their original cultures what happens to their risk for abuse? | it rises |
| barbiturates, benzodiazepines and alchohol are all | depressants |
| hypnotics are | cns depressants |
| all prescription sleeping medications, antianxiety medications, and barbiturates are considered to be | cns depressants: hypnotics |
| what is the major cause of overdose death? | barbiturates |
| barbiturates produce excessive drowsiness with an initial response of | euphoria |
| dependence & tolerance develop how with barbiturate use? | rapidly |
| epilepsy is often treated with what type of drug? | barbiturates |
| name six barbiturates | barbital, amobarbital, phenobarbital, pentobarbital, secobarbital, and butabarbital |
| the names of barbiturates all end in | barbital |
| what was the preferred treatment for anxiety in the 1960's? | benzodiazepines |
| which is safer: benzo's or barbiturates? | benzos |
| are benzos addictive | they can be |
| withdrawal of benzodiazepines is similar to withdrawal of | alcohol |
| rapid discontinuation of alcohol and benzos may result in | seizures |
| the symptoms of benzos are different from those of barbiturates how? | benzos are longer acting and less intense |
| which is longer acting: benzos or barbiturates? | benzos |
| which is less harmful in case of overdose? benzos or barbiturates? | benzos |
| GHB is an | illegal CNS depressant |
| GHB is used with | alcohol |
| GHB is considered to be a | designer drug |
| GHB affects are | intoxicating, sedating, euporic |
| GHB has the same effect as what and builds muscle | growth hormone |
| GHB affects heart rate and respirations by | decreasing them |
| What drug is considered to be the forget-me pill? | Rohypnol |
| this drug is a benzo, it's illegal in the US and is used as a date rape drug | Rohypnol |
| the Rohypnol pill is accelerated by | alcohol |
| Rohypnol can be ingested | without knowing |
| why is rohypnol easily given without the victim knowing? | tasteless, odorless, dissolves quickly |
| which is the most widely used and most abused substance? | alcohol |
| any amount of alcohol is considered to be harmful to | fetuses, children, adolescents, recovering alcoholics and those with poor health |
| the ability to metabolize alcohol is predetermined by | genetics |
| alcohol is known chemically as | ehtanol (ETOH) |
| alcohol produces mind and mood | altering effects |
| alcohol content is expressed as | proof |
| in the US proof is how much the ethanol concentration? | twice |
| blood alcohol level measures the degree of | ethanol intoxication |
| the concentration of alcohol depends on what? | the rate of absorption, transportation into CNS, redistribution to other parts of the body, metabolism and elimination |
| alcohol is absorbed through | the mouth, stomach and small intestine |
| what varies depending upon the presence of food, the drinker's emotional state and the drinker's body size? | the rate of absorption |
| does alchohol cross the placenta? | yes |
| alcohol is oxidated in the | liver |
| oxidation in the liver eliminates what percent of the alcohol absorbed by the body? | 90 |
| does the excretion of alcohol vary or does it take place at a fixed rate? | fixed rate |
| the healthy liver can metabolize how much alcohol in an hour | one ounce |
| alcohol that is not metabolized in the liver | circulates in the blood |
| what type of dependence is developed with alcohol use? | physical and psychological |
| BAC stands for | blood alcohol concentration |
| BAL stands for | blood alcohol level |
| a BAC of 20 is equivilant to a BAL of | 0.02 |
| effects of a BAL of 0.02 | light and moderate drinkers begin to feel some effect |
| at a BAL of 0.04 most people begin to feel | relaxed |
| at what BAL is judgment mildly impaired and the ability to make rationale decisions is declined? | 0.06 |
| at what BAL is driving impaired, speech slurred, and ataxia and decreased sensory function evident? | 0.08 |
| at a BAL of 0.10 there is a clear deterioration in | reaction time |
| at what BAL is the person considered to be legally intoxicated in most states? | 0.10 |
| at 0.15 the BAL there is increased impairment and the alcohol level is equivalent to | a half pint of whiskey in the bloodstream |
| at 0.30 what can happen? | potential cardiovascular and respiratory collapse and loss of consiousness |
| at what BAL is cardiovascular and respiratory collapse a potential complication? | 0.30 |
| at what BAL is there a potential to lose consciousness? | 0.30 |
| neurological sydromes resulting from etoh abuse include | wernicke-korsakoff syndrome, marchiafava bignami disease, alcoholic blackouts, mood changes, confusion, hallucinations and peripheral neuropathy |
| wernicke-korsakoff syndrome is inflammatory | degeneration of brain |
| wernicke-korsakoff syndrome effects the brain how | inflammatory degeneration |
| inflammatory degeneration of the brain, as in wernicke-korsakoff syndrome, causes | memory loss and cognitive changes |
| wernicke-korsakoff syndrome is caused by a deficit of what? | thiamine |
| marchiafava bignami disease is | brain atrophy with dysarthria and impaired consiousness |
| alcoholic blackouts cause | anterograde amnesia |
| what drugs are considered to be the foremost gateway drugs? | alcohol, cigarretes and marijuana |
| what ethnicities experience more adverse effects from alcohol use? | chinese, japanese and korean |
| addiction causes a rapid release of neurotransmitters followed by a reduced-from-baseline level that | never fully returns to pre-drug level |
| barbituates, sleeping aids and anti-anxiety medications are all | cns depressants |
| barbituates are the major cause of | overdose deaths |
| what form of alcohol is actually considered to be good for you in moderate amounts? | red wine |
| what health benefits are gained by moderate consumption of red wine? | increased HDL, decreased LDL, decreased diabetic complications and decreased blood sugar levels |
| the standard drink size for spirits is? | one ounce |
| the standard drink size for wine is | five ounces |
| the standard drink size for beer is | twelve ounces |
| breathing can potentially stop at what blood alcohol level? | 0.45 |
| 80% proof is equal to what % alcohol? | 40 |
| the absorption rate of alcohol | varies |
| the metabolism rate of alcohol is | 1 ounce per hour |
| the excretion rate of alcohol is | fixed |
| alcohol is metabolized by the | liver |
| the kansas legal limit for alcohol is | 0.08 BAL or 80 BAC |
| alcohol affects thiamine absorption how? | inhibits absorption |
| a decreased level of thiamine may lead to what syndrome? | wernicke-korsakoff |
| wernicke-korsakoff-->brain... | inflammation |
| wernicke-korsakoff-->brain inflammation resulting in | memory loss and cognitive changes |
| if a person that abuses alcohol is suffering from memory loss and cognitive changes, what syndrome may they have? | wernicke-korsakoff |
| wernicke-korsakoff | that's a long name to REMEMBER...memory loss... |
| brain atrophy is associated with | marchiafava bignami |
| brain atrophy... | big nami |
| marchiafava bignami is indicated when the brain is affected how? | brain atrophy |
| what clinical manifestations may result from brain atrophy related to marchiafava bignami | impaired speech and LOC |
| a common clinical manifestation of "march-i-a-fava big-nami" is | impaired speech |
| BP, LDL and Triglycerides are all affected how by etoh abuse? | all increased |
| the risk for what complications r/t bleeding increase with etoh abuse | hemorrhagic stroke |
| alcohol abuse affects Ca & Mag in what way? | decrease |
| the cardiovascular systemic effects of alcohol abuse are | elevates bp, triglycerides, ldl and increases the risk for hemorrhagic stroke, cardiomyopathy |
| what effect does alcohol abuse have on the immune system? | decreased WBC production, increased size of RBC, impaired production of clotting factors and platelets |
| what happens to WBC when alcohol is abused | production is decreased |
| what happens to platelets when alcohol is abused | decreased production |
| what happens to the RBCs when alcohol is abused? | increase in size |
| when RBCs are increased in size what else is changed? | MCV |
| the systemic effects on the liver from etoh abuse include | fatty liver, cirrhosis, varices & ascites |
| accumulation of fats in liver cells leads to | fatty liver |
| chronic hepatic inflammations lead to | cirrhosis |
| what develops as a result of impaired liver circulation | varices & ascites; hepatic encephalopathy |
| alcohol abuse damages the GI tract because of | increased gastric secretions that promote bacterial growth |
| ulcers, gastritis, pancreatitis, esophageal varices are all GI tract disorders potentially caused by | alcohol abuse |
| alcohol abuse impairs the function of the pancrease to | respond to insulin |
| the sleep cycle disturbance caused by etoh abuse is also referred to as | sleep fragmentation |
| how does alcohol decrease calcium & magnesium in the blood? | by reducing parathyroid hormone release |
| the leading cause of birth defects is | etoh consumption during pregnancy |
| hormonal changes due to etoh abuse include changes in prolactin, growth hormone, cortisol and | ACTH |
| what elevated liver enzyme indicates alcohol has been consumed recently? | GGT |
| what is the normal range for GGT | 2-30 |
| GGT...gin gin tequila | liver enzyme that shows recent etoh use |
| is a ggt level accurate in the 15-30yo age range? | no |
| Large RBCs indicate | anemia |
| what are some lab tests used to determine etoh abuse? | GGT, RBC size, MCV, uric acid, triglycerides, AST, Urea and carbohydrate deficient transferring |
| how long will etoh be present in the urine? | 12-24 hours from last drink |
| what is AWS? | alcohol withdrawal syndrome |
| how common is AWS | 40% of hospitalized pt have potential to experience it |
| early symptoms of AWS can start within | 6-12 hrs after BAC drops |
| symptoms of AWS will peak in | 24-48 hours |
| when will AWS symptoms decrease | 4-5 days |
| what time frame is a seizure more likely to occur with AWS | 7-48 hours after last drink |
| what changes in the HR are seen in AWS? | above 100, tachy |
| seizures can occur within | 7-48hrs after last drink |
| AWS peaks | 24-48hrs after last drink |
| AWS symptoms decrease | 4-5days after last drink |
| is AWS the same as the DTs? | no |
| early etoh w/drawal symptoms include | n/v, anxiety, tremor |
| what type of psychosis do AWS patients experience | visual, auditory or tactile hallucinations |
| what is different about the hallucinations in AWS patients? | the patient knows they aren't real when they are having them |
| alcohol withdrawal delirium is also referred to as | DTs (delirium Tremens) |
| which is the most serious form of alcohol withdrawal? | DTs |
| how common is DT? | occurs in less than 10% of those with AWS |
| what clinical manifestation may characterize impending DT? | disorientation |
| the DTs are often accompanied by | liver failure, pneumonia, and head trauma |
| disorientation is often the first sign of what type of etoh withdrawal? | DTs |
| what assessment tools are used to determine if a patient may have an substance abuse problem? | the CAGE questionnaire, DAST and AUDIT |
| CAGE stands for | Cut down, Annoyed, Guilty and Eye-opener |
| what score on the CAGE questionnaire indicates potential etoh abuse? | 2 answers of yes out of the 4 questions |
| the CAGE assessment refers to what type of abuse? | alcohol |
| The DAST is | a brief drug abuse screening tool |
| what DAST score suggests a significant drug abuse problem? | score greater than 6/28 |
| what is an AUDIT | alcohol use disorders identification test |
| an AUDIT identifies what type of substance abuse? | drug and etoh |
| if screening tests shows that problems might exist what type of questions with the nurse follow up with? | withdrawal symptoms, tolerance, work history, legal/social complications |
| when eliciting history of substance abuse how should questioning start? | from etoh, nicotine, mj, and then on to cocaine etc |
| along with assessing for a substance abuse problem what else should be assessed? | readiness to change |
| key assessment items include | age of first use, heaviest lifetime use, patterns of use, binges &/or blackouts, last use and family hx, abuse hx and risk for suicide |
| arcus senilis is | an opage grayish ring around the eyes |
| what causes arcus senilis? | alcohol abuse |
| how might the hands be affected by alcohol abuse? | red palms, shaky, cigarette burns, decreased sensation |
| in addition to red palms what else may be red? | face |
| facial redness is known as | acne rosacea |
| an enlarged liver may cause what clinical manifestation? | upper abdominal pain |
| a positive stool _______ may indicate gi bleed | guaiac |
| the hr and bp of an alocholic will be | increased |
| is arcus senilis or cardiac arrhythmia a clinical manifestation of drug abuse? | cardiac arrhythmia |
| a patient presents with conjuctivitis, you suspect what type of substance abuse? | drug abuse |
| how are the eyes affected by drug abuse? | the pupil size changes |
| cardiac arrhythmias, needle tracks, cellulites, conjunctivitis, poor dentition, rapid weight loss and changes in pupil size are indicative of | drug abuse |
| jaundice, arcus senilis, acne rosacea, palmar erthema, upper abdominal pain, cigarett burns on fingers/clothing, decreased sensation in feet hands, positive stool guaiac, HTN & tachycardia and tremor are all indicative of | alcohol abuse |
| what is the most effective pharmaceutical for treating withdrawal and detoxification? | benzos |
| benzo dosing should be | tapered down |
| patients in withdrawal that have liver failure or impaired cognition should be given what type of benzos? | short-acting: Ativan |
| the pt with severe withdrawal will more than likely be taking which type of benzo? | librium, long-acting |
| Ativan is a | short acting benzo |
| ativan is used when | the w/drawal pt has liver or cognition issues |
| librium is | a long acting benzo |
| when is librium prescribed for withdrawal? | when it is severe |
| which is preferred, symptoms-triggered dosing or fixed schedule? | symptoms-triggered dosing |
| what is the concern with fixed schedule dosing? | may over medicate patient |
| what tool is used to assist in symptom triggered dosing? | CIWA scale |
| what is the antidote for benzos? | romazicon (benZo-->romaZicon) |
| what is the antidote for opiates? | narcan |
| if symptoms of withdrawal do not progress in a predictable manner what tool is then used? | CIWA-R |
| the accuracy of the CIWA-R is decreased when the pt has | co-morbidities and psychiatric illnesses |
| how often should CIWA-R be repeated if the patient is actively detoxing | every 1-2 hours |
| if the CIWA-R score is <5 | discontinue the CIWA |
| if the CIWA-R scoring is 9 or less what does that indicate? | the absent or mild withdrawal |
| what dosing changes are made if there is a CIWA-R score of 9 or less? | discontinue medications for withdrawal |
| a CIWA score of 10-19 indicates | moderate withdrawal |
| a CIWA score of greater than 20 indicates | severe withdrawal |
| it is important to maintain fluid & electrolyte balance during | withdrawal with delirium |
| history or presence of seizures is vital to asses so that the patient can be | treated with anti-seizure medication |
| what Vitamins are often needed during withdrawal? | B |
| what are the B vitamins needed during withdrawal? | Thiamine, Folic Acid and Vitamin B12 |
| besides thiamine, folic acid and vitamin b12 what is also needed | slow mag |
| what treatment is used as an alcohol teterrent by interupting the metabolism of ETOH | antabuse |
| what common ADL items should be avoided when taking antabuse? | aftershave lotion and mouthwashes |
| what common food or bakery ingredients should be avoided in the patient taking antabuse | vanilla extract & vinegar |
| what over the counter medications should be avoided in the pt taking antabuse? | cough-medicines |
| what reaction will a patient have if they drink etoh while taking antabuse | they will become violently ill |
| campral is used to treat what in early sobriety | cravings |
| to prevent relapse for alcoholics that have a "slip" | Revia |
| high-dose withdrawal of cns depressants substitutes medication | from the same drug class for gradual tapering |
| low dose withdrawal depends on | symptoms |
| insomnia, anxiety, elevated temp, pulse and respiratory rate, fine tremors, GI upset, muscle aches, diaphoresis and a labile BP indicate withdrawal from | cns depressants |
| what are the nursing priorities in acute situations of withdrawal? | maintain patent airway, monitor VS, intervene with hemorrhage, seizure and respiratory/cardiac arrest and maintain safety for client and others |
| support during withdrawal process includes | observation, meds, emotional & nutritional |
| the drug abuser still needs pain relief, it is best to | avoid drug of abuse when treating pain |
| in order to avoid relapse we should assist the patient to avoid | being hungry, angry, lonely or tired |
| motivational interviewing focuses on listening rather than | telling |
| gently persuade the patient, understand that | changes is up to the patient |
| fatigue, workaholism, cover-ups, exaggerations, rationalizations, self-pity, victim role, frustration vs appropriate anger, impatience and negativism are all signs of | relapse |
| primary prevention is aimed at | preventing abuse |
| secondary prevention is aimed at | client with mild to moderate problems |
| tertiary prevention is aimed at | decreasing complications of addiction |
| the most important sign of a healthy recovery is when the patient | lets go of toxic people and substances |
Created by:
Lori Dobrisky
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