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Psych > 30. Addiction and Substance Abuse > Flashcards

30. Addiction and Substance Abuse Flashcards

(75 cards)

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1
Q

what must nurses be aware of when caring for a pt w/ substance abuse

A
  • self awareness

- countertransference

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2
Q

continued use despite adverse consequences

A

addiction

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3
Q

ingestion, smoking, sniffing, or injecting of mind-altering substances

A

use

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4
Q

one or more drugs needed to function

A

dependence

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5
Q

use for purposes of intoxication, beyond intended use, can lead to dependence

A

abuse

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6
Q

sxs occurring when substance no longer used

A

withdrawal

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7
Q

process for safe withdrawal

A

detoxification

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8
Q

recurrence

A

relapse

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9
Q

what type of substance is alcohol

A

CNS depressant

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10
Q

immediate effects of alcohol

A
  • disinhibition
  • euphoria
  • sedating
  • CNS depressant
  • potentially fatal in excess
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11
Q

long term effects of using alcohol

A
  • harmful changes in liver, GI, bone density, muscles, and immune system
  • permanent brain damage
  • dementia (Wernicke’s encephalopathy and Korsakoff’s syndrome)
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12
Q

alcohol effect caused by a thiamine deficiency; causes vision impairment, ataxia, hypotension, and confusion

A

Wernicke’s encephalopathy

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13
Q

alcohol effect that causes heart, vascular, nervous system involvement; difficulty acquiring new info and retrieving memories -> causes them to make up new memories (confabulation)

A

Korsakoff’s syndrome

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14
Q

difference between Wernicke’s encephalopathy and Korsakoff’s syndrome

A
  • Wernicke’s: comes on suddenly and needs to be treated immediately (thiamine replacement)
  • Korsakoff’s: long-term ongoing problem
  • Wernicke’s can lead to Korsakoff’s
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15
Q

effects of alcohol on the body

A
  • peripheral neuropathy
  • alcoholic neuropathy
  • alcoholic cardiomyopathy (weakness heart muscle)
  • esophagitis
  • gastritis
  • pancreatitis
  • alcoholic hepatitis and cirrhosis
  • leukopenia
  • thrombocytopenia
  • sexual dysfunction
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16
Q

use of alcohol during pregnancy leads to problems w/ learning, memory, attention span, communication, vision, and hearing

A

fetal alcohol syndrome (FAS)

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17
Q

manifestations of fetal alcohol syndrome (FAS)

A
  • small for gestational size
  • facial abnormalities
  • poor coordination
  • hyperactive behavior
  • learning disabilities
  • low IQ
  • problems w/ daily living
  • vision/hearing problems
  • poor judgement and reasoning
  • heart and kidney defects
  • abnormal size and shape of brain
  • risk for psych disorders
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18
Q

theories for alcohol dependence

A
  • genetics
  • biochemical: may produce morphine-like substances in the brain -> causes addition
  • developmental factors
  • certain personality traits play part in both development and maintenance of alcohol dependence
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19
Q

phase of alcohol abuse where it is used to relieve everyday stress and tensions of life

A

phase I: pre-alcoholic phase

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20
Q

phase of alcohol abuse where there are brief periods of amnesia that occur during or immediately following drinking; alcohol is now required

A

phase II: early alcoholic phase (blackouts)

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21
Q

phase of alcohol abuse where control is lost and there is physiological dependence

A

phase III: crucial phase

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22
Q

phase of alcohol abuse where there is emotional and physical disintegration; intoxicated more often than sober

A

phase IV: chronic phase

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23
Q

assessment tools for alcohol use

A
  • Michigan alcoholism screening test (MAST)
  • AUDIT questionnaire
  • CAGE questionnaire (CUT, Annoyed, Guilty, Eye Opener)
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24
Q

usually occurs within 12 hours after abrupt discontinuation of alcohol; may include delirium tremens

A

alcohol withdrawal syndrome

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25
scale used to determine management for alcohol withdrawal
clinical institute withdrawal assessment of alcohol scale (CIWA scale)
26
pharmacology used to ease the alcohol withdrawal period
- benzos (Librium, Ativan, Diazepam) - antidepressants - sleep meds - antipsychotics
27
how to determine which benzos to give for alcohol withdrawal
- Librium and Diazepam have longer half life and are smoother to taper off - Ativan given if pt has liver impairment
28
stage I of alcohol withdrawal syndrome
- increased HR and temp - normal or slightly elevated BP - slight diaphoresis - oriented w/ no confusion or hallucinations - mild anxiety and restlessness - hand tremors w/ no seizures - impaired appetite and nausea
29
stage II of alcohol withdrawal syndrome
- HR 100-120 - systolic BP and temp elevated - obvious diaphoresis - intermittent confusion and transient hallucinations - painful anxiety and restlessness - insomnia and nightmares - visible tremors and rare seizures - anorexia, N/V
30
stage III of alcohol withdrawal syndrome
- HR 120-140 - BP and temp elevated - marked diaphoresis - marked disorientation, confusion, disturbing visual and auditory hallucinations, and delusions - delirium tremens - extreme restlessness and panic states - unable to sleep - gross uncontrollable tremors and seizures common - reject all fluid and food
31
complications of alcohol withdrawal
- withdrawal seizures - alcoholic hallucinosis (12-24 hours after last drink; resolve in 24-48 hours - delirium tremens (DTs) - most severe form of alcohol withdrawal
32
describe withdrawal seizures
generalized tonic-clonic confusions usually 12-48 hours after last drink - may occur within 2 hours - 30-40% w/ seizures progress to delirium tremens
33
manifestations of delirium tremens (DTs)
occurs 3-10 days following last drink - agitation - global confusion - disorientation - hallucinations - fever - HTN - tachycardia
34
most common conditions leading to death in pts w/ DTs
respiratory failure and cardiac arrhythmias
35
treatment of DTs
- adequate nutrition - medication - multivitamin therapy - thamine
36
3 medications used for DTs
- Disulfiram (Antabuse) - Naltrexone - Acamprosate
37
MOA of Disulfiram
- inhibits aldehyde dehydrogenase (ETOH oxidation) - build up of acetaldehyde - causes sickness if taken w/ alcohol
38
MOA of Natrexone
binds to opioid receptor and inhibits action of opioid drugs -> may prevent high feeling from using alcohol and decrease cravings
39
MOA of Acamprosate
reduces cravings by rebalancing glutamate and GABA NTs
40
how to prevent alcohol relapse
- psychosocial interventions - cognitive behavioral interventions (examine thinking process that leads to alcohol use) - motivational approaches (motivational interview -> very effective)
41
describe alcoholic anonymous (AA)
- major self-help organization that gives peer support, acceptance, and understanding from those who have experienced same problem - 12 steps provide specific guidelines on how to obtain and maintain sobriety
42
T/F: total abstinence is the only cure for alcoholism; pt can never socially drink again
True
43
describe harm reduction programs
- ran by professionals to reduce consumption and work towards abstinence - not required to turn over recovery to a higher power
44
describe sedatives, hypnotics, and anxiolytics
- sedatives: have calming effects on CNS - hypnotics: induce sleep - anxiolytics: anti-anxiety meds
45
found in coffee, tea, chocolate, energy drinks, diet pills, and headache remedies
caffeine
46
effects of caffeine
- increase person's perceived level of energy alertness | - increase BP and may lead to increase production of cortisol
47
psychoactive substance found in cigarettes
nicotine
48
effects of nicotine
- stimulates release of adrenaline (NE) | - increases BP, HR, and RR
49
signs of nicotine withdrawal
- anxiety - irritability - depression - difficulty concentrating - sleep disturbances - headaches - increased appetite
50
2 medications used to help people quit smoking
- Zyban | - Chantix
51
types of inhalants
- volatile solvents - aerosols - gases - nitrates
52
effects of inhalants
- euphoria - sedation - emotional lability - impaired judgement - chronic neurologic syndrome possible for long-term use
53
intoxication of inhalants
- respiratory depression - stupor - coma - risk for "sudden sniffing death" -> suffocation or cardiac arrhythmias
54
what type of substance is cocaine
CNS stimulant - increases dopamine (euphoria and psychotic sxs) - increases NE (tachycardia, HTN, dilated pupils, and elevated temp) - increased serotonin (sleep disturbances and anorexia)
55
effect of cocaine
sudden burst of mental alertness and energy; feelings of self-confidence and being in control
56
how long does the cocaine rush lasts
about 10-20 minutes followed by intense let-down effect that causes irritability, depression, tiredness, and craving more drug
57
effects of amphetamines
- CNS stimulant | - blocks reuptake of NE and dopamine w/ lesser effect on serotonin; also has peripheral nervous system effects
58
list of CNS stimulants
- cocaine - amphetamines (includes ADHD meds) - methamphetamine - MDMA (Ecstasy) - Rohypnol GHB, Ketamine
59
effects of methamphetamine
- CNS stimulant - release of excess dopamine - highly additive - used in a binge and crash pattern
60
effects of MDMA (Ecstasy)
- increase serotonin and excess dopamine release - causes hallucinations, confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia - possible malignant hyperthermia
61
what drug is also know as the date rape drug
Ketamine (odorless, tasteless, and colorless) | - when mixed w/ alcohol -> incapacitated w/ sedated euphoric effect and produces anterograde amnesia
62
effects of cannabis on body
- CV effects - respiratory effects - reproductive effects - CNS effects - sexual functioning
63
what is Marinol
FDA approved drug w/ THC in it that is given to chemo patients to stimulate appetite
64
effects of hallucinogens
- euphoria or dysphoria - altered body image - distorted or sharpened visual and auditory perception - confusion and incoordination - impaired judgement and memory
65
severe reactions to hallucinogens
- paranoia - fear of losing one's mind - depersonalization - illusions - delusions - hallucinations
66
type of hallucinogens
more than 100 different types - psilocybin (mushroom) - D-lysergic acid diethyl amide (LSD) - mescaline - numerous amphetamine derivatives
67
types of opioids
- oxycodone - hydrocodone - morphine - fentanyl - codeine - heroin (type of opioid)
68
side effects of opiods
- constipation - dulled senses - slowed HR and RR - euphoria/confusion - dependency/addiction - urinary retention
69
effects of repeated activation of opioid receptor
- euphoria - physical dependence - analgesia - depression - respiratory depression (common cause of death) - sedation
70
signs of opioid overdose
- extreme sleepiness - slow shallow breathing - fingernails or lips turn blue-purple - small pinpoint pupils - slow HR and BP
71
what is used to treat opioid addiction
- Methadone - given over 21 days and tapered down; reduces craving and withdrawal sxs - Naltrexone/Vivitrol (injectable form) - used for opioids and alcohol addiction
72
pt education after treatment for opioid addiction
- after tx -> tolerance is reduced | - if they resume using after tx -> not be able to use same amount as before -> could be lethal
73
management of substance use disorder
- activities to substitute substances int times of stress - relaxation techniques - problem solving skills - harm reduction strategies - 12 step programs
74
signs of chemical dependency in nurses
- mood swings and inappropriate behavior at work - noncompliance w/ acceptable policies and procedures - deteriorating appearance and job performance - sloppy illegible charting - alcohol on breath - forgetfulness and poor judgement - lying - high achievement - volunteering for OT or extra duties - onset after prescription after sx or chronic illness - FHx of alcoholism or addiction
75
describe gambling addiction
- non-substance related disorder - preoccupied w/ gambling and experience aroused euphoric state during actual betting - highly competitive, energetic, restless, and easily bored - more likely to commit suicide and less likely to seek mental health tx - staff education and family involvement are important

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