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NSG 322 > Topic 10 & 11: Substance Abuse & Addiction > Flashcards

Topic 10 & 11: Substance Abuse & Addiction Flashcards

1
Q

alcohol is often…

A

*used in combination with other substances

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2
Q

marijuana

A

*Recreational use
*Legalized in some states
*Medicinal use
*Legalized in several states
*Use remains federally prohibited

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3
Q

nicotine

A

*Historic trends continue:
*cigarettes
* pipes
*chewing tobacco
*Newer trend:
*e-Cigarettes (“vaping”)

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4
Q

opioids

A

*Includes prescription pain relievers & heroin
*Opioid overdose is at epidemic levels (A leading cause of death in the U.S.)
*Women dying of heroin overdose has tripled

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5
Q

prescription abuse

A

*Opioids
*Sedatives (e.g., benzodiazepines)
*Stimulants

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6
Q

medications that fall under the opioid class

A

*hydrocodone (e.g., Vicodin),
*oxycodone (e.g., OxyContin, Percocet),
*Hydromorphone (Dilaudid)
*morphine (e.g., Kadian, Avinza),
*codeine, and related drugs.

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7
Q

Dependence/Addiction and changes in the brain

A

The most important structural or architectural change takes place in the circuitry of the brain — particularly in the wiring of the reward pathway

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8
Q

withdrawal symptoms may occur if drug use is suddenly reduced or stopped are…

A

restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements.

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9
Q

the 4 Cs of addiction

A

*Compulsive behavior (finding & taking the substance)
*Cravings
*Chronic, relapsing brain disorder
*Cognitive impairment

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10
Q

How do drugs work in the brain to produce pleasure?

A

Most drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.

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11
Q

Alcohol and other CNS depressants act on what NT

A

GABA

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12
Q

tolerance can lead to

A

dependence, then addiction, then overdose

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13
Q

Client -Centered Care:Assessment for Substance Abuse

A

1.Clarify presenting signs
2.Assess for withdrawal
3.Assess for overdose
4.Assess for self-harm potential
5.Evaluate physiologic response
6.Explore individual’s interest in taking action
7.Assess knowledge of community resources

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14
Q

Since the brain is not fully developed until the mid-20s…

A

early drug abuse negatively impacts brain development.

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15
Q

Identification & Reporting in Healthcare

A

-Reporting an impaired colleague is a peer responsibility (mandated reporter)
-Clear documentation by co-workers is crucial & mandatory

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16
Q

you as the nurse can repot alcohol abuse about a colleague, but interventions is the responsibility of

A

the nurse manager and administrators

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17
Q

If an impaired nurse remains in the practice situation and no action is taken by the nurse manager, the information must be…

A

taken to the next level in the chain of command

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18
Q

alternative-to-discipline (ATD) programs

A
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19
Q

Alcohol is the most teratogenic substance during

A

pregnancy

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20
Q

*Fetal alcohol syndrome (FAS)

A

*Life-long effects (mental retardation, delayed growth and development, and distinctive facial abnormalities)

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21
Q

breastfeeding considerations for alcoholics

A
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22
Q

alcohol and aging

A

tolerance for alcohol is DECREASED due to:
*Slower emptying of stomach
*Slower metabolism (including hepatic)
*Increased sensitivity to alcohol in the brain

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23
Q

Decline in lean muscle mass and increased fatty tissue contribute to…

A

increased blood alcohol levels (BALs).

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24
Q

*Changes in the response to alcohol include: (older adults)

A

*Headaches
*Reduction in mental abilities
*Memory losses or lapses
*Feelings of malaise instead of well-being

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25
Q

older adults have decreased liver enzymes which

A

decrease the ability or break down alcohol, making higher BAL than in younger people

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26
Q

alcohol should not be mixed with

A

Antidepressants and tranquilizers because they further depress the CNS

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27
Q

Toxicity of other drugs (e.g., acetaminophen (Tylenol)) is enhanced by

A

alcohol-associated malnutrition.

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28
Q

Physiologic Effects of Alcohol

A

*Brain Function
*Fetal Alcohol Syndrome (FAS)
*Alcoholic Cardiomyopathy
*Arrhythmias
*Hypertension

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29
Q

Alcohol can cause your neurotransmitters to relay information too slowly, so you feel..

A

extremely drowsy

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30
Q

Alcohol related disruptions to the neurotransmitter balance also can trigger mood and behavioral changes, including…

A

depression, agitation, memory loss, and even seizures.

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31
Q

what NT is susceptible to even small amounts of alcohol, and what does it affect

A

glutamate
-glutamate affects memory

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32
Q

what NT does alcohol affect that sparks feeling of relaxation and euphoria

A

serotonin

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33
Q

alcohol damages liver function which can lead to

A

hepatic encephalopathy

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34
Q

s/s of hepatic encephalopathy

A
  • Sleep disturbances
  • Mood and personality changes
  • Anxiety
  • Depression
  • Shortened attention span
  • Coordination problems, including asterixis, which results in hand shaking or flapping
  • Coma
  • Death
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35
Q

Doctors can help treat hepatic encephalopathy with

A

compounds that lower blood ammonia concentrations and with devices that help remove harmful toxins from the blood.

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36
Q

Fetal Alcohol Syndromes

A

a medical condition in which body deformation or facial development or mental ability of a fetus is impaired because the mother drank alcohol while pregnant

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37
Q

Alcoholic Cardiomyopathy

A

Long term heavy drinking weakens the heart muscle, causing a condition called alcoholic cardiomyopathy. A weakened heart droops and stretches and cannot contract effectively. As a result, it cannot pump enough blood to sufficiently nourish the organs.

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38
Q

Symptoms of cardiomyopathy include

A

shortness of breath and other breathing difficulties, fatigue, swollen legs and feet, and irregular heartbeat. It can even lead to heart failure

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39
Q

Arrhythmias

A

Both binge drinking and long term drinking can affect how quickly a heart beats.

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40
Q

Strokes

A

A stroke occurs when blood cannot reach the brain.
Both binge drinking and long term heavy drinking can lead to strokes even in people without coronary heart disease

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41
Q

Hypertension

A

Chronic alcohol use, as well as binge drinking, can cause high blood pressure, or hypertension.

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42
Q

Alcohol affects all organ systems

A

*Alcohol is a CNS depressant
*Wernicke’s Encephalopathy
*Korsakoff’s Psychosis
*Esophagitis
*Pancreatitis
*Alcohol-induced hepatitis
*Fetal Alcohol Syndrome (FAS)

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43
Q

*Wernicke’s Encephalopathy

A

*Confusion, abnormal eye movement (nystagmus) and unsteady gait (ataxia)

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44
Q

*Korsakoff’s Psychosis

A

*Chronic condition

*Inability to learn new information, short-term and long-term memory problems

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45
Q

*Consequence of untreated Wernicke’s encephalopathy is

A

Korsakoff’s Psychosis

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46
Q

late effects of alcoholism

A

*Cirrhosis
*Jaundice
*Esophageal varices
*Ascites
*Hepatomegaly
*Splenomegaly
*Edema
*Spider angiomas
*Anemia/Thrombocytopenia
*Coagulation disorders
*Peripheral neuropathy

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47
Q

*thiamine (B1) deficiency is caused by

A

*Wernicke-Korsakoff’s syndrome

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48
Q

treatment for thiamine (B1) deficiency

A

*thiamine for B1 replacement, magnesium sulfate, folic acid & multivitamin

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49
Q

how long does it take for the liver to detox 1oz of alcohol

A

1 hour

50
Q

Blood alcohol level (BAL):

A

*determines level of intoxication and tolerance

51
Q

BAL of 0.05% (1-2 drinks)

A

changes in mood and behavior; impaired judgment

52
Q

BAL of 0.08% (5-6 drinks)

A

legal level of intoxication in most states. clumsiness in voluntary motor activity

53
Q

BAL of 0.20% (10-12 drinks)

A

memory blackout, N/V

54
Q

BAL of 0.30% (15-19 drinks)

A

dec. RR, hypothermia, hypotension, drowsy

55
Q

BAL of 0.40% (20-24 drinks)

A

impaired VS and even death

56
Q

alcohol withdrawal stages: mild

A

*Anxiety
*Tremors (feeling ‘shaky’)
*Insomnia
*Headache
*Palpitations
*Gastrointestinal disturbances (cramping)
*Orientation remains intact

57
Q

alcohol withdrawal stages: moderate/severe

A

*Diaphoresis
*Elevated systolic blood pressure
*Tachypnea
*Tachycardia
*Confusion
*Mild hyperthermia
*Hallucinations (visual, tactile, and or auditory)
*Orientation remains intact

58
Q

alcohol withdrawal stages: delirium tremens (DTs)

A

*Disorientation to time, place, and person
*Impaired attention
*Agitation
*Hallucinations (visual, tactile, and or auditory)
*Potential seizures

59
Q

alcohol withdrawal peaks within

A

24-48 hours after last drink

60
Q

when are grand mal seizures possible during alcohol withdrawal

A

*7 to 48 hours after last drink

61
Q

alcohol withdrawl may be described as

A

*Irritability and “shaking inside”

62
Q

withdrawl delirium peaks…

A

*2 to 3 days after cessation or reduction of alcohol intake, is a MEDICAL EMERGENCY

63
Q

withdrawl delirium s/s

A

*Autonomic hyperactivity
*Sensorial and perceptual disturbances
*Fluctuating level of consciousness (LOC)
*Delusions (paranoid)
*Agitated behaviors
*Body temperature 100° F or higher

64
Q

CAGE Screening Tool

A

Screening Assessment to determine if further work-up for Alcohol Abuse is warranted

C: Have you ever felt the need to Cut down on your drinking?
A: Have people Annoyed you by criticizing your drinking?
G: Have you ever felt bad or Guilty about your drinking?
E: Eye-opener? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

65
Q

how many positive answers indicates further assessment after the CAGE test

A

≥ 2 positive answers is a Positive test and warrants further assessment for Alcohol Abuse

66
Q

Clinical Institute Withdrawal Assessment (CIWA-AR) is used for..

A

Used to assess the need for alcohol detoxification.

67
Q

alcohol detox s/s

A

*Nausea/vomiting
*Tremors
*Anxiety
*Agitation
*Paroxysmal Sweats
*Orientation
*Tactile Disturbances
*Auditory Disturbances
*Visual Disturbances
*Headaches

68
Q

medications for alcohol use disorder

A

*benzodiazepines
*anticonvulsants
*beta-blockers
*magnesium, thiamine (vitamin B1), folic acid, and multivitamins

69
Q

vitamins used for alcohol use disorder

A

magnesium, thiamine (vitamin B1), folic acid, and multivitamins

70
Q

what are the first like drugs fro sedation and seizure prevention/control

A

benzodiazepines

71
Q

benzodiazepine examples

A

*chlordiazepoxide
*lorazepam
*diazepam

72
Q

diazepam has..

A

anticonvulsive qualities, Not metabolized in the liver*

73
Q

diazepam needs to be

A

*Gradually taper and discontinue benzodiazepines once detox is complete

74
Q

*Other drugs used for seizure prevention/control

A

*carbamazepine
*valproic acid
*magnesium

75
Q

Naltrexone

A

*Reduces or eliminates alcohol craving
use: withdrawal & relapse prevention

76
Q

Acamprosate

A

*Reduces alcohol craving
*Reduces unpleasant symptoms of abstinence (anxiety, tension, and dysphoria)
*Mitigates withdrawal symptoms
use: relapse prevention

77
Q

benefits of Acamprosate are seen after

A

30-90 days

78
Q

disulfiram

A

if you drink taking this, you will get sick (that is the point of the medicaton)
*Alcohol ingestion results in unpleasant physical effects (nausea, vomiting, headache, and flushing)
use: aversion, maintenance, relapse prevention

79
Q

individual needs to be alcohol free for how many days inorder to take disulifram

A

*Must be alcohol-free for at least 14 days to avoid this reaction when starting (or restarting) disulfiram

80
Q

treatment options for alcohol use disorder

A

*Inpatient
*Partial Hospitalization
*Residential Treatment
*Outpatient
*Self-Help
*Support Groups
*12 Step Programs (self-help groups)

81
Q

Long-Term Residential Treatment

A

Lengths of stay between 6 and 12 months in a non-hospital setting.

82
Q

Short-Term Residential Treatment

A

a 3-6 week hospital based inpatient treatment setting

83
Q

Outpatient Treatment Programs

A

Vary in the intensity and forms of services offered. Such treatment often is more suitable for individuals who are employed or who have extensive family and/or community support.

84
Q

conventional treatment for alcohol use disorder

A

*Psychotherapy
*Group therapy
*Cognitive behavioral therapy (CBT)
*Motivational incentives
*Motivational interviewing

85
Q

12-Step Programs

A

*AA, NA, Al-Anon, Ala-Teen

86
Q

SMART

A

self-management and recovery training

87
Q

*Important aspect of recovery in Alcoholics Anonymous (AA) and other recovery modalities

A

*Spirituality practices are related to improved outcomes.
*Higher spiritual levels often correlate with:
*Sense of purpose
*Gratitude
*Forgiveness

88
Q

Cross Tolerance

A

This occurs when tolerance to the effects of a certain drug results in tolerance to a similar drug.
For instance, someone habitually using opioids may develop a tolerance to not just their drug of choice but also to other opioids.

89
Q

Physical Dependence

A

This is when the body adapts to a drug and becomes reliant on it, leading to withdrawal symptoms when the drug is not used.
For example, a person dependent on caffeine might experience headaches and fatigue if they suddenly stop drinking coffee.

90
Q

Abuse

A

This refers to the misuse of substances in a way that is harmful or risky.
An example is someone drinking alcohol to the point of blacking out or using prescription medication more frequently or in higher doses than prescribed.

91
Q

Addiction

A

This is a chronic disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.
For example, someone addicted to nicotine may continue smoking despite developing health issues like lung disease.

92
Q

Wernicke’s Encephalopathy

A

This is a neurological disorder caused by a thiamine (vitamin B1) deficiency, often seen in chronic alcoholics. Symptoms can include confusion, loss of muscle coordination, and vision changes.

93
Q

Korsakoff’s Psychosis

A

Often following Wernicke’s encephalopathy, this chronic memory disorder is also linked to severe thiamine deficiency. It’s characterized by memory loss, confabulation (making up stories), and hallucinations.

94
Q

Blood Alcohol Level (BAL)

A

This is a measure of the concentration of alcohol in one’s bloodstream, expressed as a percentage.

95
Q

Schedule I drugs

A

a high potential for abuse and have no acceptable medical use.
Examples: Heroin, LSD, GHB, Bath Salts, MDMA, Weed, Peyote

96
Q

Schedule II drugs

A

a high potential for abuse, are considered dangerous and are available only by prescription.
Examples include methadone, meperidine (Demerol), oxycodone, cocaine, Fentanyl, Adderall, methylphenidate (Ritalin).

97
Q

Schedule III drugs

A

a low to moderate potential for misuse and are available only by prescription.
Examples are testosterone, steroids, ketamine, acetaminophen/codeine (Tylenol with codeine), and buprenorphine (Suboxone).

98
Q

Schedule IV drugs

A

low-risk drugs and are available by prescription.
Examples: benzos, Ambien, Tramadol, and propoxyphene/acetaminophen (Darvocet).

99
Q

Schedule V drugs

A

limited quantities of certain narcotics for the treatment of diarrhea, coughing, and pain.
Examples are atropine/diphenoxylate (Lomotil), guaifenesin and codeine (Robitussin AC), and pregabalin (Lyrica), available OTC

100
Q

PCP Intoxication

A

a medical emergency
s/s: belligerent, assaultive, impulsive, and unpredictable
cannot be talked down and may require restraint;
tx: benzo IV/IM and mechanical cooling for hyperthermia

101
Q

important to note of inhalant use disorder…

A

“Sudden sniffing death” from cardiac arrhythmias may occur with inhalants, particularly with butane and propane.

102
Q

opioid intoxication s/s

A

miosis (pinpoint pupils) and decreased bowel sounds. Reduced RR & BP and HR are normal to low; track marks from injection sites

103
Q

opioid OD s/s

A

Three main symptoms—coma, pinpoint pupils, and respiratory depression—are strongly suggestive of overdose.
others: unresponsiveness, hypothermia, hypotension, and bradycardia.

104
Q

opioid withdrawal s/s

A

mood dysphoria, N/V/D, muscle aches, fever, and insomnia. Others: lacrimation (watery eyes), rhinorrhea (runny nose), pupillary dilation, yawning, gooseflesh skin

105
Q

Methadone

A

used to decrease the painful symptoms of opiate withdrawal. It also blocks the euphoric effects of opiate drugs
Once a day dosing is adequate; needs to be tapered
- reduce cravings in maintenance therapy.

106
Q

Clonidine

A

antihypertensive, is often used to reduce the symptoms of opioid withdrawal
clonidine eases sweating, hot flashes, watery eyes, anxiety, and restlessness

107
Q

Buprenorphine (Subutex/Suboxone)

A

this drug is used only after abstaining from opioids for 12 to 24 hours and in the early stages of opioid withdrawal
- reduce cravings in maintenance therapy.

108
Q

Naltrexone

A

an opioid antagonist that prevents intoxication; blocks the activation of opioid receptors and prevents opioid drugs from producing rewarding effects
(Vivitrol) is a once a once-a-month IM injection; site reactions are common

109
Q

Sedative/hypnotic/antianxiety intoxication s/s

A

slurred speech, incoordination, unsteady gait, nystagmus, and impaired thinking. Coma is a dangerous possibility

110
Q

Sedative/hypnotic/antianxiety OD Tx

A

gastric lavage, activated charcoal, and careful VS monitoring; PTs kept awake to avoid loss of consciousness; endotracheal tube may be required and/or mech ventilation

111
Q

Sedative/hypnotic/antianxiety withdrawal s/s

A

ANS hyperactivity, tremor, insomnia, psychomotor agitation, anxiety, and grand mal seizure
Tx: taper benzos to prevent seizure

112
Q

tobacco withdrawal s/s

A

at least 4 of the following: irritability, anxiety, depression, difficulty concentrating, restlessness, and insomnia

113
Q

tobacco use Tx

A

Nicotine replacement therapies in the form of gum, lozenges, nasal sprays, inhalers, and patches are highly successful treatments.

114
Q

tobacco cessation: 2 main drugs

A

Bupropion (Zyban) reduces the cravings for nicotine and withdrawal symptoms [same name, different drug]
Varenicline (Chantix) is a nicotinic receptor partial agonist that mimics the effects of nicotine, thereby reducing cravings and withdrawal.

115
Q

Binge drinking

A

too much, too quickly;
W: 4+ w/i 2hr // M: 5+ w/i 2hr

116
Q

Heavy drinking

A

too much, too often;
W: 8+ a wk // M: 14+ a wk

117
Q

Alcohol withdrawal, greatest concerning timeframe

A

first 24-72hrs
“When was your last drink?”

118
Q

Shakes/jitters/tremors occur within…

A

6-8hrs after last drink
Chlordiazepoxide (Librium) used for tremors and mild to moderate agitation

119
Q

psychotic/perceptual s/s occur within…

A

8-10hrs after last drink
monitor for psychosis = MEDICAL EMERGENCY
risk: uncon., seizure, delirium
Tx: Lorazepam or Chlordiazepoxide (Librium)

120
Q

withdrawal seizures occur within…

A

12-24hrs after last drink
Tx: Diazepam; d/t rapid onset, ctrl of acute/severe seizures

121
Q

DTs occur within…

A

72hrs after last drink
MEDICAL EMERGENCY
Prevention of “Alcohol withdrawal delirium/DTs” is the goal
Tx: Diazepam (Valium): agitation, tremor, impending or acute DTs, and hallucinosis
Chlordiazepoxide (Librium): tremors & mild-modderate agitation
Lorazepam (Ativan): once delirium appears, tx severe s/s

122
Q

Carbamazepine

A

anticonvulsant and mood stabilizer
use: tremors, agitation, anxiety, and seizures
Monitor for hyponatremia/take 2nd OCA

NSG 322 (12 decks)

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