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Psych > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

1
Q

Addiction

A

repeated harm from use

pt needs our care, like w/ any other chronic medical conditions

relapsing and remitting pattern

chronic brain disease

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2
Q

Urine Drug Testing

A

results may not be confirmed

interpret w/ caution

there are false positives (poppyseeds)

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3
Q

Addiction: Etiology

A

unknown

biologic/genetic: family hx w/ alcohol use = higher risk

environmental: cultural factors, social attitudes, peer influence, laws, cost, and availability
psychological: family dynamics, poor role modeling
neurotransmitter: drugs increase dopamine in the brain (reward center specifically)

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4
Q

Addiction: Cultural Considerations

A

attitudes/physiological differences to substances vary by culture by

ex: flushing reaction among people of asian ancestry

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5
Q

Intoxication

A

use of a substance resulting in maladaptive behavior

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6
Q

Withdrawal

A

is the physiological reactions that occur when a substance is stopped or dramatically tapered

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7
Q

What Classes of Meds Require Detox?

A

alcohol
opioids
benzos

could be stimulants but usually there isn’t a life-threatening withdrawal

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8
Q

Detoxification

A

referred to as medically supervised withdrawal

is the process for safely withdrawing from a substance

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9
Q

Tolerance

A

the process that occurs when the body no longer responds to a drug the way they did when it was first started

it takes a higher dose of the drug to achieve the same effect

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10
Q

Dependence

A

not the same thing as addicted

it means that when a person stops using a drug, their body goes through a withdrawal

ex: life threatening withdrawal from alcohol, benzos, barbiturates

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11
Q

Co-Dependence

A

level of dependence exceeds what is healthy-learned behavior

characteristics: poor relationship skills, excessive anxiety, compulsive behaviors, resistance to change

type: enabling
- may seem helpful but it perpetuates the substance use
- calling the job to report sickness when person is hungover

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12
Q

Behavioral Addictions

A 
gambling
sex
spending money
overeating
gaming
food

the act is no longer a source of pleasure, it becomes ingrained so that the person continues to perform it despite negative consequences

*gambling disorder is the only condition in the DSM “Non-substance-related disorder”

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13
Q

Alcohol Intoxication (ethanol)

A

-CNS depressant
-blood alcohol test measures alcohol in the blood (BAL)
-absorbed in the bloodstream and processed by the liver
-process one drink per hour
(12oz beer, 5oz wine, 1.5oz whiskey)

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14
Q

Alcohol Intoxication/Overdose

A

risk of:

  • vomiting
  • unconsciousness
  • respiratory depression (can cause aspiration pneumonia, pulmonary obstruction)
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15
Q

Alcohol Withdrawal

A

onset: 4-12 hours after last drink
peak: 24 hours
duration: five days (variable) - 96 hours!

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16
Q

Alcohol Withdrawal: Tx

A
  • benzodiazepines (diazepam)
  • anticonvulsant to decrease benzodiazepine load (Gabapentin - extra seizure precautions)
  • seizure precautions
  • fluids (dehydration, malnourished, etc.)
  • electrolyte
  • symptom triggered: providing meds when client has symptoms, CIWA (to help assess sx), schedule developed based on CIWA score, lorazepam, diazepam
  • fixed-schedule dosing
  • front loading approach (10mg qhr for 4 doses for the first day they are admitted)
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17
Q

CIWA-AR

A

Clinical Institute Withdrawal Assessment

  • n/v
  • tremor
  • diaphoresis
  • anxiety
  • agitation
  • tactile disturbances
  • auditory distrubances
  • visual disturbances
  • headache
  • sensorium (LOC)
18
Q

Alcoholic Hallucinosis

A

not delirium tremens (DT)
-12-24 hours after incidence and are gone w/in 48 hours

visual
clear sensorium (know they are hallucinating, are uncomfortable, not disoriented)
19
Q

DT

A

delirium tremens

  • hallucinations
  • disorientation
  • autonomic hyperactivity
  • agitation
  • diaphoresis
  • 48-96 hours after last drink
20
Q

Alcohol Withdrawal: Seizure and DT

A

generalized tonic/clonic w/in 12-24 hours

day 3-4: at risk for DT

21
Q

Thiamine and Folate

A

Banana bag: IV infusion of thiamine, folate, MVI

prevention of wernicke encephalopathy

neurological symptoms caused by thiamine deficiency

22
Q

Physiological Effects of Long-Term Alcohol Ise

A 
cardiac myopathy
pancreatitis
esophagitis
hepatitis
cirrhosis
leukopenia
thrombocytopenia
ascites
23
Q

Cannabis

A

Cannabis induced hyperemesis

cannabis and psychosis: transient acute psychosis

  • substance induced psychosis
  • exacerbation of sx w/ schizophrenia
24
Q

Synthetic Cannabis

A

spike, K2, spice

hallucinations, delirium, seizures

inhalation of adulterated herbs

won’t show up on a urine drug screen

25
Q

Vaping

A

Evali: form of acute lung injury (vaping associated lung disease)

Inhalation of aerosol created by a liquid or wax (Nicotine/THC)

26
Q

What are Opioids?

A

an opiate is derived from the opium poppy plant, while opioids are substances that act on the opiate receptors/manmade

the poppy plant is the source of all natural opiates (morphine, diacetylmorphine), whereas synthetic opioids are made in a lab (oxycodone, methadone)

opioid receptors are located in the brain, spinal cord, and gut

27
Q

How Opioids Cause Overdose

A

in OD, there is an excessive effect on the portion of the brain regulating respiratory rate, resulting in respiratory depression and death

28
Q

OD Risk Factors

A
  • reduced tolerance
  • mixing drugs
  • using alone
  • fentanyl/adulterants
  • injection or inhalation of the opioid
  • prior overdose
  • use w/ other CNS depressants (Gabapentin, ETOH, benzos, etc.)
29
Q

Signs of OD

A
  • over sedation is a sign of impeding OD
  • OD is not always immediate
  • Fentanyl related ODs can be fatal w/in minutes
  • blue lips/nails
  • dizziness/confusion
  • choking/gurgling/snoring sounds
  • slow/diminished/no breathing
  • drowsiness/difficulty remaining awake
30
Q

What is naloxone?

A
  • it displaces opioids off the opioid receptor and blocks the receptor (antagonist)
  • opioid receptor is blocked for 30-90 minutes
  • given most often as nasal spray
  • can be given as injection or IV
  • restores breathing w/in 1-4 minutes
31
Q

Opioid Withdrawal: Sx

A 
resting pulse
sweating
restlessness
pupil size - dilated
bone/joint aches
runny nose or tearing
GI upset
tremor
yawning
anxiety or irritability
piloerection (goosebumps)
32
Q

Clinical Opiate Withdrawal Scale

A

COWS

33
Q

Opioid Use Disorder: Tx

A

naltrexone: pure opioid antagonist (vivitrol - like Nalaxone)

Buprenorphine: partial opioid agonist/antagonist (ceiling effect)
-special license to prescribe w/ restrictions

Methadone: full opioid agonist (very long duration of action)
-only available via OTP’s (opioid treatment programs “methadone clinic”)

34
Q

Buprenorphine

A

brand names:

  • suboxone (has naloxone) - usually prescribed
  • subutex (no naloxone)

absorbed directly into the blood by the veins under the tongue

do not swallow or it will be destroyed by stomach acid

do not use nicotine products before use as it causes vasoconstriction, decreasing the surface area of blood vessels that absorb the med

continue while NPO

nursing: monitor the pt for the full 3 minutes that it takes for med to be absorbed

35
Q

Buprenorphine: Pt Education

A

SE: HA, dizziness, nausea, constipation, sexual dysfunction, urinary retention

storage of the med: safe/locked box, careful w/ children

understand that discontinuing buprenorphine increases risk of accidental OD/death

not recommended to combine alcohol/benzos or other CNS depressants

plan for procedures

36
Q

Harm Education

A

it’s not condoning use, rather it is valuing life w/o judgement

people have the right to continue using substances

Harm reduction strategies:

  • don’t use alone
  • fentanyl test strips
  • naloxone
  • peer support
37
Q

Hallucinogens/Inhalants

A

feeling of detachment from body

  • mostly ingested
  • dextromethorphan (paranoia), LSD, PCP, Ketamine

inhalant of chemical vapors that create an altered mental state

38
Q

Tobacco Use Disorder

A

Varenicline
NRT
Bupropion

39
Q

Why Use the 12-Steps?

A

while meds are important in recovery, don’t teach and practice:

  • responsibility
  • honesty
  • respect for others
  • 12 step programs not only promote model recovery
  • 12 step members from a new, sober, social group for guidance and support
  • free
  • available to help people stay sober
  • meetings are currently easier than ever to access
40
Q

Motivational Interviewing

A
  • type of therapy utilized in substance use tx
  • goal is to feel less frustrated and be more effective in helping people change
  • guiding style of communication
  • focus on the language of change
  • evoking in the person their own reasons for change
41
Q

Dual Diagnosis

A

substance use + another psychiatric illness

~50% of people w/ substance use disorder have a mental health diagnoses

Psych (18 decks)

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