Substance Abuse
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| With substance abuse, what is first thing to get altered? | judgement
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| What are some physical s/s of withdrawal w/d? | flu-like s/s: tachycardia, hypertension, diaphoresis, abd. cramps
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| What defines substance dependence? | 3 or more of the following:
tolerance - need for more to get effect
withdrawal - physical/cognitive changes when no substance
compulsive use
persistent desire to cut down/control
lots of effort to obtain
decline activities, continue despite health p
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| what is tolerance break? | situation from a small amt of substance taken that intoxicates person after bout of heavy use
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| What is most common defense mechanism with substance abuse? | denial and alcoholics tend to stay in denial
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| What are the roles of children in dysfx fam? | hero/martyr- caretaker,overachiever
troublemaker/scapegoat- acts out
lost child-3rd, lonely, shy
mascot- baby, clowns, underachiever
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| Physiologic effects of alcohol long term use | heart failure, Wernicke's encephalopathy, Korsakoff's psychosis, pancreatitis, esophagitis, hepatitis, cirrhosis, ascites
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| S/s of W/D of alcohol when does hangover appear? | hand tremors, diaphoresis, tachy, htn, insomnia, anxiety, N/V..peaks 2d, end 5d
Severe: hallucinations, seizures, delirium tremens (DTs)
Hangover 4-12h
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| what drugs are usually given with alcohol w/d whether it's tapered or symptom triggered | benzos: (lorazepam(Ativan) 2-4mg q2-4h
Diazepam(Valium)- long half life
clorazepate(Tranzene) 15-30mg, q2-4h
chlordiazepoxide(Librium) 50-100 mg, q2-4h
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| what is legal toxication in TN? | .08
1oz of whiskey about q 90m depending on size/wt
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| what deficiency is common in alcoholics? what is the disease that can occur? | thiamine, B1(100mg/day) adn B-12(25-250mcg/day) deficiency
Wernicke-Korsakoff syndrome
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| What is Korsakoff's psychosis? Wernicke's Encephalopathy? | 1. form of amnesia(lie to self), not treatable
2. inflammatory hemmorhage w/ clouding consciousness, nystagmus(eyes bounce) from thiamine def
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| Terms for brain damage r/t alcohol Marchiafava dis? central pontine myelinosis? cerebellar degeneration? alcohol amblyopia? | 1. demyelination of corpus callosum, agitated
2. myelinosis, affect brain stem, resp center
3. lose coordination, posture/balance
4. dim vision
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| Effects on heart from alcohol | ht enlarge, hypokalemia/Mg, hyperlipidemia, narrow pulse pressure, incr diastolic pressure, tacy, Afib, htn
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| What is CAGE | C-cut down
A-annoyed by people asking to cut down
G-guilty about drinking
E-eye opener, need drink in morn
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| List from least to greatest on addiction: barbituates, heroin, codein, alcohol | 1. codein
2. alcohol
3. barbituates
4. heroin
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| Sedatives/anxiolytics/hypnotics examples? W/D s/s? | benzos, barbituates, soma(stops first pass effect)
w/d: tachy, htn, tachypnea, fever, insomnia, anxiety, hand tremor...need to taper with barbituates
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| Stiumlants: | amphetamines, cocaine- euhoric, hyperactivity, anger, dilated pupils
overdose: seizure, coma
w/d: unpleasant dreams, incr appetite, agitation, crashing(suicidal watch)....no drugs needed
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| Marijuana? Hashish? | upper leaves and tops
dried resin from leaves
Gives euphoria, alert awareness, no W/D
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| Opiods s/s intoxication and overdose and withdrawal substition therapy drugs? | intox: contricted pupils, slurred speech, drowsy, resp depression
overdose tx: narcan 0.4-0.8mg IV q 5-15m
Naloxone: til opiod level drops
Naltrexone: prevent opiate overdose/alcohol cravings
W/d: yawning rhinorrhea
methadone, subutex/suboxone, cloni
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| Hallucinogens intoxication, overdose, w/d | anxiety, depression, paranoid ideation, ideas of reference
PCP: Safety #1, decr stimuli
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| Pharm tx Levomethadyl? Subutex? suboxone? Clonidine? | 1. tx heroin addiction
2. substitute therapy
3. used for sustitute instead of methadone
4. htn, suppress effects of opiate w/d
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| How to talk to psychotic/intoxicated ind | Use broad openings
point out beh
seek clarification
avoid blaming
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