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Nursing 201 GWCC

Varcarolis chapter 18: Substance Abuse

Helps an addict to continue their self-destructive behavior by rescuing, making excuses, or lying for that person (not reporting…) Enabler
Physiological reaction to a drug decreases with repeated administration of same dose Tolerance
Physiological changes to occur when blood and tissue concentration of a drug decrease (heavy and long-term use. Withdrawal
Transitory recurrences of perceptual disturbance caused by a person’s earlier hallucinogenic drug use when the person’s is in a drug-free state Flashbacks
Potentiated effect of two drugs Synergistic effect
One drug weakening or inhibiting the effect of one of the drugs Antagonistic effect
Cluster of behavior originally identified through research involving the families of alcohol patients; Is a cluster of behaviors that prevent an individual for taking care of his own needs because of preoccupation with the addict Co-dependence
Reusing the drug; it is not a failure but an error to learn from Relapse
Relapse prevention involves? Not falling back into the habits of using alcohol or drugs through integrative programs
A chronic, relapsing brain disease characterized by compulsive drug seeking and use despite devastating consequences Addiction
The process to remove the physiological effects of the addictive substances. Detoxification
Alcohol and other CNS depressants act on GABA receptors and increase bio-availability of? glutamate, norepinephrine, and dopamine.
Addictive substances that directly activate _________ transmission or induced neural sensitization cause person who are addicted to become cue-sensitive dopamine
Incentive ________ is responsible for the craving of a substance when not currently using the substance. Salience
Biological factors for etiology of addiction are drugs that have specific effects on neurotransmitter systems
Psychological factors for etiology of addiction are lack of tolerance for frustration and pain; lack of success in life; lack of affectionate and meaningful relationships; low self-esteem; lack of self-regard; risk taking propensity
Sociocultural factors for etiology of addiction are social and cultural norms; socioeconomic stress
Women are generally diagnosed with substance use at _______ rates than men lower
Psychological changes that are associated with substance abuse a. Denial b. Anxiety c. Dependency d. Hopelessness e. Low self-esteem f. Depression
Which two questions are asked to determine the substance use problems in the clinical setting? a. In the last year, have you ever drunk or used drugs more than you mean to? b. Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?
What other details about drug questionnaire include? a. Names of drugs used b. Routes c. Quantity d. Time of last use e. Usual pattern of use
Alarming responses when asked about drug use are a. Rationalization b. Automatic responses c. Slow, prolonged responses
Alcohol intoxication is defined by checking for blood alcohol level In most states blood level of 0.08mg (5-6 drinks)
Alcohol poisoning can result in death from aspiration of emesis or a shutdown of body systems caused by severe CNS depression
Signs of alcohol poisoning a. Inability to arouse b. Cool or clammy skin c. Respirations less than 10 per minutes d. Cyanosis e. Emesis while semiconscious or unconscious
Treatment of alcohol poisoning a. If awake i. induce vomiting ii. Give activated charcoal to aid absorption of drug iii. Every 15minutes check the VS
Treatment of alcohol poisoning b. If coma i. Clear airway; endotracheal tube ii. Give intravenous IVF iii. Gastric lavage with activated charcoal iv. Check shock and cardiac arrest after pt is stable v. Initiate seizure precautions vi. Hemodialysis or peritoneal dialysis vii. flumazenil IV
Alcohol withdrawal S&S develop in few hours after
alcohol withdrawal peaks in at 24-48 hours
Early signs of alcohol withdrawal a. Hyper-alert b. Jerky movements c. Irritability d. Startle easily e. “shaking inside” f. N/V g. Tachycardia h. Diaphoresis i. Marked insomnia
Late sign of alcohol withdrawal a. Grand al seizures (7-48hrs) with hx of seizures b. Delirium
Treatment of withdrawal a. Careful titration b. Detoxification with similar drug
Nursing consideration of pt with alcohol withdrawal a. Provide careful assessment b. Consistent and frequent orientation to time and place. c. Encourage family support. d. Clarifying reality from illusions.
Alcohol withdrawal delirium is also known as “delirium tremors(DTs)
alcohol withdrawal delirium (this situation is) is “emergency”
alcohol withdrawal delirium peak at 48-72 hours after cessation of alcohol
alcohol withdrawal delirium can result in death if untreated
Death from alcohol withdrawal delirium is usually due to a. Sepsis b. Myocardial infarction c. Fat embolism d. Peripheral vascular collapse e. Electrolyte imbalance f. Aspiration pneumonia g. Suicide
Features of alcohol withdrawal delirium a. Anxiety b. Insomnia c. Anorexia d. Delirium e. Autonomic hyperactivity (BP and HR up, diaphoresis) f. Severe disturbance in sensorium g. Perceptual disturbances h. Fluctuating levels of consciousness i. Delusions – agitated behaviors and fever
Central Nervous System Stimulants: examples of drugs a. Cocaine b. Amphetamines (long-acting) c. Dextroamphetamine d. Methamphetamine ice e. Caffeine and nicotine
Common symptoms of CNS stimulant abuse a. Dilation of the pupils b. Dryness of the oronasal cavity c. Excessive motor activity
In chronic cocaine users you may observe i. Depression ii. Paranoia iii. Lethargy iv. Anxiety v. Insomnia vi. N/V vii. Seating and chills viii. Intense craving
Signs and symptoms of intoxication of cocaine i. Tachycardia ii. Dilated pupils iii. Elevated blood pressure iv. N/V v. Insomnia
Severe effects of cocaine use i. State resembling paranoid ii. Schizophrenia iii. Paranoia with delusions iv. Psychosis v. Visual, auditory, and tactile hallucination vi. Potential for violence
Psychological effect of cocaine i. Assaultiveness ii. Grandiosity iii. Impaired judgment iv. Impaired social and occupational functioning v. Euphoria vi. Increased energy
Signs and symptoms of overdose central nervous system stimulants a. Respiratory distress b. Ataxia c. Hyperpyrexia d. Convulsions e. Coma f. Stoke g. Myocardial infarction h. Death
Effects of withdrawal of cocaine a. Fatigue b. Depression c. agitation d. Apathy e. Anxiety f. Sleepiness g. Disorientation h. Lethargy i. Craving
Cocaine blocks the reuptake of norepinephrine, dopamine, and serotonin
Cocaine is extracted from the leaf of the ___________, and crack is a cheap, widely available, ____________________. coca bush; alkalinized form of cocaine
When it is smoked, it takes effect in _________, producing a fleeing high (5-7 minutes) followed by a period of deep depression that reinforces addictive behavior patterns in 4-6 seconds
Possible treatment for withdrawal of cocaine a. Antidepressants (desipramine) b. Dopamine agonist c. bromocriptine
Opiates/opioids Examples of drugs that are included  Opium  Morphine  Heroine  Codeine  Fentanyl  Methadone  Meperidine  Percocet
physical S&S of opiate intoxication 1. constricted pupils 2. decreased respiration 3. drowsiness 4. decreased blood pressure 5. slurred speech 6. psycho-motor retardation
Psychological-perceptual S&S of opiate intoxication 1. initial euphoria followed by dysphoria 2. impairment of attention 3. impairment of judgment 4. impairment of memory
S&S of opiate overdose 1. possible pupil dilation d/t anoxia 2. respiratory depression/arrest 3. coma 4. shock 5. convulsion 6. death
Possible treatments for overdose 1. Narcotic antagonist to reverse CNS depression
What are example of narcotic antagonist? Narcan
Effects of opiate withdrawal 1. yawning 2. insomnia 3. irritability 4. runny nose 4. panic 6. diaphoresis 7. cramps/ bone pain/ N/V/D 8. chills/fever 9. lacrimation
Possible Treatments for opiate withdrawal 1. Methadone tapering 2. Clonidine-naltrexone detoxification 3. Buprenophine substitution
Buprenophine medication used to treat opiate withdrawal
Narcan used to treat narcotic overdose
Methadone tapering medication used to treat opiate withdrawal
diazepam used to possibly treat hallucinogen overdose (LSD and PCP)
Clonidine-naltrexone used to possibly treat opiate withdrawal
Blood alcohol level that changes in mood and behavior; impaired judgment 0.05mg%/1-2 drinks
Blood alcohol level that cause clumsiness in voluntary motor activity; legal level of intoxication in most states 0.10 mg%/5-6 drinks
Blood alcohol level that cause depressed function of entire motor area of the brain, causing staggering and ataxia; emotional lability 0.20 mg%/10-12 drinks
Blood alcohol level that can cause confusion, stupor 0.30 mg%/ 15-18 drunks
Blood alcohol level that can cause coma 0.40 mg%/20-24 drinks
Blood alcohol level that can cause death due to respiratory depression 0.50mg%/ 25-30 drinks
examples of CNS stimulants 1. cocaine, crack (short acting) 2. amphetamines (long-acting) 3. dextroamphetamine 4. methamphetamine ice
cocaine and crack is short acting if snorted the feeling of high is reached in; if injected; if smoked 3 minutes; 30sec; 4-6 seconds
Examples of hallucinogens are 1. lysergic acid diethylamide (LSD) 2. mescaline (peyote) 3. psilocybin
meperidine (demerol)is example of opiates
Methadone (Dolophine)is example of opiates
LSD is example of Hallucinogens
amphetamine is example of long-acting CNS stimulant
phencyclidine piperidine (PCP) is example of which type of drug? hallucinogen
dextroamphetamine is example of which class of drug? CNS stimulant
physical effects of LSD intoxication 1. pupil dilation 2. tachycardia 3. diaphoresis 4. palpitations 5. tremors 6. incoordination 7. elevated T, P, R
Physical effects of PCP intoxication 1. vertical or horizontal nystagmus 2. increased BP, P, T 3. ataxia 4. muscle rigidity 5. seizures 6. blank stare 7. chronic jerking 8. agitated, repetitive movements 9. belligerence 10. impaired judgment, social and occupational functioning
nystagmus Rapid involuntary movements of the eyes
ataxia The loss of full control of bodily movements
psychological-perceptual effects of hallucinogen (LSD) intoxication 1. fear of going crazy 2. paranoid ideas 3. marked anxiety, depression 4. synesthesia - “a loud perfume.” ? 5. depersonalization 6. hallucination 7. grandiosity
Effects of hallucinogen (LSD) overdose 1. psychosis 2. brain damage 3. death
Psychological-perceptual effects of PCP intoxication (severe effects) 1. hallucination 2. paranoia 3. bizarre behavior (barking, repetitive chanting) 4. regressive behavior 5. violent behavior 6. very labile behavior; easily altered
effects of PCP overdose 1. psychosis 2. possible hypertensive crisis 3. respiratory arrest 4. hyperthermia 5. seizures
Possible treatment of LSD overdose 1. low stimuli, minimal light, sound, activity 2. have one person stay with patient; reassure patient, "talk down" patient 3. speak slowly and clearly in low voice 4. give diazepam or chloral hydrate for extreme anxiety or tension
Possible treatment of PCP overdose If alert: 1. caution: gastric lavage can lead to laryngeal spasms or aspiration ** 2. acidify urine (cranberry juice, ascorbic acid) 3. In acute stage: ammonium chloride acidifies urine to help excrete drug from body 4. put in room with minimal stimuli
Possible treatment of PCP overdose: If alert continued 5. do not attempt to talk down. speak slowly, clearly, and in a low voice 6. administer diazepam, haloperidol may be used for behavioral disturbance 7. treat hyperthermia, high BP and respiratory distress, HTN
what are two main effects of cocaine and crack on the body 1. anesthetic 2. stimulant
fentanyl is under which class? opiates
Marijuana comes from which plant Indian hemp plant
what is the active ingredient found in the flowering tops and leaves of the cannabis plant? Tetrahydrocannabinol (THC)
desired effects of marijuana are 1. euphoria 2. detachment 3. relazation 4. talkativeness 5. slowed perception of time 6. inappropriate hilarity 7. heightened sensitivities to external stimuli 8. anxiety or paranoia
long-term use of marijuana causes what? 1. lethargy 2. anhedonia 3. difficulty concentration 4. loss of memory
Inability to feel pleasure anhedonia
marijuana and withdrawal symptoms occur rarely other than cravings
what are some medical indications for use of marijuana? 1. control of chemotherapy-induced nausea 2. reduction of intraocular pressure in glaucoma 3. appetite stimulation in AIDS
PCP is also known as angel dust, horse tranquilizer peace pill
mescaline (peyote)is type of LSD-like drug
PCP produces a generalized... anesthesia that lessens the sensations of touch and pain
mescaline (peyote) is also used in (cultural) religion ceremony in native Americans
side effects/overdose of organic solvents (toluene, gasoline, lighter fluid, paint thinner, nail-polish remover, acetone) chronic use is toxic to heart, liver, and kidney toxicity may result in sudden death from anoxia, vagal stimulation, respiratory depression, and dysrhythmia
Treatment of inhalant (organic solvents) no antidote; support affected systems
neuropathy may be treated with... B12
examples of club drugs ecstasy; also called MDMA, Adam, Yaba and XTC
Ecstasy includes substituted amphetamines with MDA (love) and MDE (eve)
ecstasy produces effects similar to those of stimulants and hallucinogens
MDMA causes release of the neurochemicals: 1. serotonin 2. dopamine 3. norepinephrine
The MDMA causes which specific effects? 1. strong empathy towards others 2. good feeling about others 3. introspection about oneself 4. extreme sensitivity to senses 5. hyperactive 6. dilated pupils with impaired reaction to light 7. elevated T, P, BP 8. dystonia, diaphoresis, tremors 8
Consideration taken for ecstasy users 1. drink a lot of water to prevent hyperthermia and dehydration 2. watch out for depression d/t depletion of serotonin because levels do not return to normal in 3-4 days
Date Rape Drugs are frequently used to facilitate a sexual assault (rape)
Commonly used date rape drugs are 1. flunitrazepam (roofies, Rohypnol)- fast acting benzodiazepine 2. GHB
Characteristics of Date Rape Drugs 1. colorless 2. tasteless 3. odorless
effects of date rape drugs 1. unconsciousness 2. disinhibition 3. relaxation of voluntary muscles 4. anterograde amnesia 5. alcohol potentiates their effects
Created by: eunjine
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