6 Substance Disorders Flashcards Preview

PSYCH > 6 Substance Disorders > Flashcards

Flashcards in 6 Substance Disorders Deck (183):
1

Illicit drug use is __.
Mostly due to __ use.

increasing
marijuana

2

First time users start in their __

teens

3

__% of the 2.8 million new users in 2013 were under 18

54

4

Drug use is highest among people in their __ and __

teens, 20's

5

Around 1 in __ 25 year olds reported using an illicit substance in the past month

5

6

Drug use is increasing among people in their __'s

50's

7

Dependence is the repeated use of a substance, with or without __ dependence

physical, an example is cocaine. It has psychological dependence but no physical dependence

8

Physical dependence indicates an altered __ state caused by repeated administration of a substance

physiologic

9

Cessation of a substance causes a __ __

specific syndrome

10

Cocaine has a __ dependence, but not a __ dependence

psychological
physical

11

What three substances are life threatening when you withdraw?

Benzos
Barbituates
Alcohol

12

Why does someone who is an alcoholic need a higher dose of benzodiazepines?

b/c they have a cross tolerance with CNS depressants

13

Drugs in the __ __ can create a cross tolerance

same class

14

What does this describe?
After repeated administration, a given dose of drug produces a decreased effect or increasingly larger doses must be administered to obtain the desired effect

tolerance

15

what is cross-tolerance?

it is the ability of one drug to be substituted for another. For example: alcohol and benzo. They both depress the CNS so in order for benzo to work, its dose must increase to overcome those from the alcohol.

16

What is codependence?

It refers to family members, significant others affected by or influencing the behavior of the substance abuser.

17

How does the codependence family member facilitate the abuser's addictive behaviors? (2)

denial and providing money or drugs.

18

____ is an ____ part of substance dependence.

denial, integral

19

What does denial do to the substance abuser's situation? (2)

fuels the addiction, and minimizes the problem.

20

what is substance use disorder?

Pathological pattern of behaviors related to the use of a substance

21

In substance use disorder, the underlying change in brain circuits caused what 2 things?

Repeated relapses
Intense drug craving

22

Substance use disorder occur in a broad range of ...

a broad range of severity from mild to severe

23

Substance interferes with what?

an individual’s ability to fulfill role obligations

24

what happen to patient with substance use disorder?

the individual would like to cut down or control use but cannot

25

what is one characteristic of substance abuser?

Excessive amount of time spent procuring the substance or recovering from effects

26

what is an addiction?

tolerance develops and increased amounts are necessary

27

what is intoxication?

Development of a reversible substance-specific syndrome due to the ingestion of a substance

28

what is withdrawal?

it occurs upon abrupt reduction or discontinuation of a substance.

29

What are the 9 classes of psychoactive substances?

Alcohol
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedative-hypnotics
Stimulants
Tobacco

30

what are the 7 predisposing factors for a person to develop substance abuse?

Genetics
Biochemical
Developmental influences
Personality factors
Social learning
Conditioning
Cultural and ethnic influences

31

how many percentage of American aged 12 and over reported using alcohol in the US?

52.2%

32

what percentage of those 12 and over are binge drinkers?

22.9%

33

What percentage of the US population is 18-25 year olds binge drinker?

37.9%

34

What is the percentage rate of alcohol use in 12 – 17 year olds?

11.6%

35

alcohol equivalencies: 12 fl oz of regular beer has how many percentage of alcohol?

5%

36

alcohol equivalencies: 8-9 fl oz of malt liquor has how many percentage of alcohol?

about 7%

37

alcohol equivalencies: 5 fl oz of table wine has how many percentage of alcohol?

about 12%

38

alcohol equivalencies: 1.5 fl oz shot of 80-proof spirits (hard liquor) has how many percentage of alcohol?

about 40%

39

what are the 3 types of alcohol- related disorders?

alcohol use disorder
alcohol intoxication
alcohol withdrawal

40

what is an alcohol use disorder?

It is a problematic pattern of alcohol use leading to clinically significant impairment or distress

41

What are the cluster of behavioral and physical symptoms of alcohol use disorder? (3)

1. Withdrawal (develops 4-12 hours after reduction of intake)
2. Tolerance
3. Craving

42

what is 12 month prevalence rate of alcohol use disorder among 12 - 17?

4.6%

43

what is 12 month prevalence rate of alcohol use disorder among adults 18 and over?

8.5%

44

rates of alcohol use disorder is higher or lower in adult males compared to adult females?

higher, male is 12.4% and female is 4.9%

45

Does the prevalence rate of alcohol use disorder varies markedly across race and ethnic subgroups?

yes

46

What are 4 things about the course of alcohol use disorder?

1.Variable course periods of remission and relapse
2. First episode of intoxication likely to occur in mid-teens
3. Most people develop disorder before 40
4. 10% have later onset

47

what are 4 genetic factors of alcohol use disorder?

1. Alcohol use disorders run in families
2. Rates 3-4 times higher in close relatives
3. 4-fold increased risk in children
4. Low risk phenotypes

48

what are the 5 phychological theories related to the use of alcohol?

1. To reduce tension
2. Increase feelings of power
3. Decrease effects of psychological pain
4. Decreases feelings of anxiety
5. Helps to cope with stress

49

what are the 2 socio-cultural factors of alcohol use disorder?

1. Social learning (effects of modeling, imitation, identification)
2. Factors within the individual’s culture help to establish patterns of use

50

about what percentage of individuals aged 12 and over report being current alcohol users?

50%

51

what percentage of the US population binge drink?

23%

52

alcohol use is the ___ leading cause of preventable deaths

third

53

Heavy alcohol use contributes to the 3 leading causes of death. What are the 3 diseases?

heart disease, cancer and stroke

54

Alcohol induces a _____ of the CNS

general, nonselective reversible depression

55

___ of a single dose of alcohol is absorbed ____ into the bloodstream

20%, immediately

56

Blood carries the alcohol directly to the brain’s _____

central control areas

57

Moments after alcohol is consumed it can be found in ____.

all tissues, organs and secretions of the body

58

Absorption of alcohol is influenced by ____

food, rate of drinking, type of alcohol

59

Chronic alcohol abuse results in ____ impairments

multi-system

60

What are the 5 Peripheral Neuropathy related to alcohol pathologies?

1. Peripheral nerve damage
2. Result of deficiencies in B vitamins particularly Thiamine
3. Result of poor nutrition
4. Toxic effects of alcohol result in mal-absorption of nutrients
5. Process reversible with abstinence

61

What are the 6 symptoms of alcoholic myopathy?

1. Acute or chronic
2. Muscle pain, swelling, weakness
3. Reddish tinge in urine caused by myoglobin break down
4. Lab studies show elevated CPK, LDH, AST
5. Thought to be a result of vitamin B deficiency
6. Improvement with abstinence and nutrition and vitamin supplements (Thiamine)

62

what is Wernicke’s Encephalopathy?

Most serious thiamine deficiency in alcoholics

63

What are the symptoms of Wernicke's encephalopathy?

paralysis of ocular muscles, diplopia, ataxia, somnolence, stupor

64

What is the treatment of Wernicke’s Encephalopathy?

Thiamine replacement therapy necessary to avoid death

65

What is Korsakoff’s Psychosis?

It is the psychotic state encountered in individuals recovering from Wernicke’s

66

What are the symptoms of Korsakoff’s Psychosis?

Confusion, recent memory loss and confabulation

67

What is the treatment for Korsakoff’s Psychosis?

parenteral or oral thiamine replacement

68

What is Alcoholic Cardiomyopathy?

Alcohol causes an accumulation of lipids in the myocardial cells

69

What results due to Alcoholic Cardiomyopathy?

heart enlargement, CHF, arrhythmia

70

What are the symptoms of Alcoholic Cardiomyopathy?

decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, non-productive cough

71

What will the lab of a pt with Alcoholic Cardiomyopathy show?

Labs show an elevation in CPK, AST, ALT, LDH

72

What is the treatment for Alcoholic Cardiomyopathy?

abstinence

73

What is one esophagus condition caused by drinking?

Esophagitis inflammation and pain in the esophagus, result of frequent vomiting

74

What happen to the stomach due to drinking?

alcohol breaks down the stomach’s protective mucosal barrier

75

What can happen to the pancreas due to drinking?

pancreatitis

76

What can happen to the liver due to drinking? (3)

Alcoholic Hepatitis
Cirrhosis
Hepatic encephalopathy

77

Prenatal exposure to alcohol can result in ____

fetal alcohol spectrum disorders

78

what is the most common fetal problem due to the pregnant mother's drinking?

Fetal Alcohol Syndrome (have low IQ)

79

what are the symptoms of Alcohol Intoxication?

disinhibition, mood lability, impaired judgment, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, flushed face

80

Alcohol Intoxication usually occurs at what blood alcohol level?

levels between 100 and 200mg/dL

81

What blood alcohol level is lethal?

levels ranging from 400 – 700mg/dL

82

what 3 drugs/chemical is life threatening when you withdrew them too quickly?

benzos, barbituates, and alcohol

83

what is DT?

delirium tremor. it is a type of life threatening seizure.

84

When does alcohol withdrawal happen?

4-6 hours after last drink. It may progress to DT’s (delirium tremor) in 2-3 days

85

What are some signs and symptoms of alcohol withdrawal?

Autonomic hyperactivity (sweating or pulse rate greater than 100 bpm)
Increased hand tremor
Insomnia
Nausea or vomiting
Transient visual, tactile or auditory hallucinations or illusions
Psychomotor agitation
Anxiety
Generalized tonic-clonic seizures

86

what is one treatment for alcohol withdrawal?

Substitution therapy: to reduce life threatening effects of alcohol withdrawal... use benzo and Lithium together

87

what are some medication used in substitution therapy for alcohol withdrawal?

Benzodiazepines: most widely used group of drugs for substitution therapy
1.Librium Chlordiazepoxide)
2. Serax (Oxazepam)
3. Ativan (Lorazpeam)
4. Valium (Diazpeam)

88

Treatment of Alcohol Withdrawal usually start with ____ and reduce by _____ each day. And why?

high doses, 20 -25%
This is to boost up the affect at the beginning.

89

The substitution therapy is given how often?

every 4-6 hours

90

Sometimes, the substitution therapy is given with additional doses, why?

for breakthrough symptoms

91

Substitution therapy: when individuals with liver disease, what medications are used instead?

shorter acting Ativan (Lorazepam) and Serax (Oxazepam)

92

When treating for alcohol withdrawal, if a pt has tremulousness and mild to moderate agitation, what med is used?

Oral Librium 25 -100mg Q 4- 6 hours

93

When treating for alcohol withdrawal, if a pt has hallucinosis, extreme agitation, what meds are used? (2)

1. Oral Valium 5-20mg Q 4-6 hours or Ativan 2-10mg Q 4-6 hours
2. IV Librium 0.5mg/kg at 12.5mg/min until patient is calm

94

When treating for alcohol withdrawal, if a pt has withdrawal seizures, DT’s, what two meds are used?

1. IV Valium 0.15,g/kg at 2.5mg/min
2. IV Ativan 0.1mg?kg at 2.0mg/min

95

what are the nursing interventions for alcohol withdrawal? (7)

1. Specialized detox units
2. Monitor vital signs every 4 hours
3. Administer substitution therapy
4. Monitor for break through symptoms
5. Monitor intake and output
6. Ensure safety patient
7. Thiamine replacement

96

What are the 4 treatments for alcoholism?

1. Alcoholic Anonymous
2. Counseling
3. Group Therapy
4. Pharmacotherapy

97

The pharmacotherapy of alcoholism, what 4 meds would you use?

1. Antabuse
2. Naltrexone
3. SSRI’s mixed results
4. Campral

98

What should the nurse self assess when working with clients with alcohol dependence? (3)

1. Examination of one’s own feelings about working with clients with alcohol dependence
2. Can you be empathetic
3. Self assessment around one’s own patterns of alcohol use

99

what are the 5 assessment tools for alcoholism?

1. Clinical Institute Withdrawal Assessment of Alcohol
2. Michigan Alcoholism Screening Test
3. CAGE
4. AUDIT - C
5. SBIRT

100

__#?__ persons __%?__ of the population smoke cigarettes

55.8 million, 21.3%

101

smoking is the____ cause of preventable death in the US

Leading

102

Smoking accounts for more than __#?__ deaths each year

480,000

103

__#?__ American suffer from a disease caused by ____

16 million, smoking

104

Smoking: annual costs __#?__ medical expenses, __#?__ in lost productivity

$96 billion, $97 billion

105

Nicotine is ____
and affects the ___

psychoactive, CNS

106

__%?__ of nicotine inhaled reaches the bloodstream and reaches the ___ in 15 seconds

25%, brain

107

Nicotine activates the ____ pathways

dopaminergic

108

What are the 5 health consequences of tobacco use?

1. Lung and other cancers
2. Cardiovascular disease
3. Pulmonary disease
4. Adverse reproductive outcomes
5. Exacerbation of chronic conditions

109

What are the 3 health consequences of second hand smoke in children?

1. Middle ear disease
2. Respiratory symptoms
3. Sudden Infant Death

110

What are the 4 health consequences of second hand smoke in adults?

1. Nasal irritation
2. Coronary heart disease
3. Lung cancer
4. Reproductive effects

111

What are 4 prevention and treatment for smoking?

1. Education
2. Individual, group or telephone counseling
3. Nicotine replacement (nicotine patches)
4. Pharmacologic agents

112

The Pharmacologic agents for treating smoking are (2):

1. Zyban (Buproprion SR)
2. Chantix (Varenicline)

113

What 4 class of drugs are used for sedative hypnotic or anxiolytic use disorder?

1. Benzodiazepines
2. Non-barbiturate hypnotics
3. Barbiturates
4. Club drugs

114

What are some examples of benzodiazepines? (8)

1. Xanax (Alprazolam)
2. Librium (Chlordiazepoxide)
3. Klonipin (Clonazepam)
4. Tranxene (Clorazepate)
5. Valium (Diazepam)
6. Ativan (Lorazepam)
7. Serax (Oxazepam)
8. Miltown (Meporbamate)

115

Which of the benzodiazepines is most commonly abused?

Xanax (Alprazolam)

116

What are some examples of Barbiturates? (5)

1. Amytal (Amobarbital)
2. Nembutal (Pentobarbital)
3. Seconal (Secobarbital)
4. Butisol (Butabarbital)
5. Phenobarbital

117

What are some examples of Non-Barbiturate Hypnotics? (10)

1. Chloral hydrate
2. Estazolam
3. Flurazepam
4. Restoril (Temazepam)
5. Halcion (Triazolam)
6. Doral (Quasepam)
7. Lunesta (Eszoplicone)
8. Rozerem (Ramelteon)
9. Sonata (Zaleplon)
10. Ambien (Zolpidem)

118

What are 2 examples of club drugs?

1. Rohypnol (Flunitrazepam)
2. GHB (Gamma hydroxybutyric acid)

119

What are the 3 CNS Depressant Principles?

1. Effects are additive with one another and with the behavioral state of the user
2. Capable of producing physiological and psychological addiction
3. Cross-tolerance and cross dependence exist between various CNS depressants

120

__%?__ of people in the US have had a benzo prescribed

15%

121

__%?__ of adults over __#?__ have used prescription ___ in the past month

4%, 20, sleep aids

122

12 month prevalence of sedative hypnotic or anxiolytic use disorder: __%?__ among __#?__ year olds, __%?__ among ____

0.3%, 12-17
0.2%, adults

123

What are some physiological effects of barbiturates? (9)

1. General depressant effect
2. Produce all levels of CNS depression from mild sedation to death
3. Decrease amount of time spent dreaming
4. Inhibition of the reticular activating system, depressing respirations
5. Hypotension
6. Suppress urine function
7. Produce jaundice
8. Decrease body temperature
9. Sexual dysfunction

124

What are 3 things about Sedative, Hypnotic or Anxiolytic Withdrawal?

1. Life threatening
2. Short acting
3. Longer acting

125

What are the "short acting" drugs, peak intensity, and subside time for Sedative, Hypnotic or Anxiolytic Withdrawal?

- Xanax and Ativan in 12 -24 hours
- Peak intensity 24-72 hours
- Subside 5-10 days

126

What are the "longer acting" drugs, peak intensity, and subside time for Sedative, Hypnotic or Anxiolytic Withdrawal?

- Librium, Valium Phenobarbital in 2-7 days
- Peak 5-8th day
- Subside 10-16 days

127

What are some of the Sedative, hypnotic or Anxiolytic Withdrawal Symptoms? (8)

1. Autonomic hyperactivity (sweating, pulse rate greater than 100)
2. Hand tremor
3. Insomnia
4. Nausea or vomiting
5. Transient visual, tactile or auditory hallucinations or illusions
6. Psychomotor agitation
7. Anxiety
8. Grand mal seizures

128

What are 4 things about Treatment of Withdrawal from Sedative, Hypnotic or Anxiolytics?

1. Gradual reduction of dosage
2. Switch to long acting agent if appropriate
3. Barbiturates probably need hospitalization
4. Nursing interventions same for alcohol withdrawal

129

What is Stimulant Use Disorder?

It is a pattern of amphetamine-type substance, cocaine or other stimulant use leading to clinically significant impairment or distress

130

What is Psychomotor stimulants?

augmentation or potentiation of the neurotransmitters norepinephrine, epinephrine or dopamine

131

What are the 2 most prevalent and widely used stimulants?

Caffeine and nicotine

132

What are the 5 Patterns of Use for CNS stimulants?

1. High abuse potential
2. 1.5 million Americans current cocaine users
3. Characterized by episodic, chronic or daily use
4. Binge use common
5. Tolerance develops and amount increases

133

What are 5 physiological effects of stimulants?

1. CNS effects
2. Cardiovascular effects
3. Gastrointestinal effects
4. Renal effects
5. Sexual functioning

134

What are symptoms of stimulant withdrawal? (7)

1. Fatigue
2. Vivid unpleasant dreams
3. Insomnia or hypersomnia
4. Increased appetite
5. Psychomotor retardation or agitation
6. Symptoms peak in 2-4 days
7. Intense dysphoria can occur

135

There's NO __ __ for stimulant withdrawal

REAL TREATMENT

136

Inhalant use disorder features include: __ use of an inhalant despite the individual's knowing the substance is __ __ __

repeated
causing serious problems

137

Prevalence of inhalant use disorder for Americans aged 12-17

0.4%

138

__% of 13 year old American report using an inhalant

10

139

Inhalants can cause: __ and __ damage

CNS/ PNS

140

Opioid use disorder is a problematic pattern of opioid use leading to clinically significant __ or __

impairment or distress

141

12 month prevalence for opioid use disorder for adults age 18+

0.37%

142

12 month prevalence of opioid use disorder for 12-17 y/o

1%

143

Is opioid use disorder higher in males or females?

males

144

What are opioids most effective for?

relief of pain

145

___ current heroin users aged 12+ in the US

200,000

146

What are the 4 methods of opioid administration?

oral
intranasal
smoking
IV

147

There is a dramatic ___ in the past 10 years of ___ ___ ___

increase, prescription pain medication

148

1991: _____ prescriptions of pain meds, now 2011: _____

76 million
219 million

149

There is an increase in ER visits related to ____ or ____ of prescription pain meds, more than doubled in the past decade (475,000 ER visits)

misuse, abuse

150

Drug overdose death involving ___ ____ ___ 9,000 in 1999 to 17,000 in 2010

opioid pain relievers

151

Opioid use/ abuse cost ____ in health care.

$72.5 billion

152

What 3 chemicals are opioids of natural origin?

Opium, morphine, codeine

153

What are some opioids derivatives?(5)

Heroin
Hydromorphone (Dilaudid)
Oxycodone (Percodan)
OxyContin (Oxycontin)
Hydrocodone (Vicodin)

154

What are some synthetic opiate like drugs? (4)

1. Meperidine (Demerol)
2. Methadone, (Dolophine)
3. Pentazocine (Talwin)
4. Fentanyl (Fentora)

155

What are some opioids' CNS effects?

Euphoria, mood changes, mental clouding, drowsiness and pain reduction, pupillary constriction, respiratory depression

156

What are some opioids' GI effects?

Peristalic activity diminished

157

What are some opioids' Cardiovascular effects?

Hypotension

158

What are some opioids' sexual function effects?

Decreased function and libido

159

What happen to one's breathing when he is overdosed on opioid?

Breathing slows to the point where oxygen levels in the blood fall below 86%

160

What happen after one's breathing slows when he is overdosed on opioids?

Person becomes unresponsive
Hypotension
Bradycardia

161

What happen if no treatment is given to one who is overdosed on opioids?

long period of unresponsiveness, sometimes associated with “loud snoring”

162

What is the Opioid overdose triad?

1. Pinpoint pupils
2. Unconsciousness
3. Respiratory depression

163

____ of ___ deaths involve at least ____ other drug

50%, painkiller, one

164

What is one thing about opioid withdrawal?

it is not life threatening but pt feels terrible.

165

What is the main focus of Opioid Overdose treatment?

to address respiration and oxygenation

166

What are the 2 steps of Opioid Overdose treatment? hint: related to medications

1. Administration of Naloxone (Narcan) IM, IV, subcutaneous, nasal
2. Assisted breathing until Naloxone (Narcan) takes effect, typically within 3-7 minutes

167

What are some symptoms of opioid withdrawal? (9)

1. Dysphoric mood
2. Nausea or vomiting
3. Muscle aches
4. Lacrimation or rhinorrhea (watery eyes and nose)
5. Pupillary dilation, piloerection or sweating
6. Diarrhea
7. Yawning
8. Fear
9. insomnia

168

When does Opioid Withdrawal symptoms occur?

within 6-8 hours after last dose peak in the 2nd or 3rd day subside in 5-10 days

169

What are some treatments for Opioid Withdrawal? (4)

1. Rest, nutritional support
2. Methadone substitution
---Maintenance treatment: daily from clinics
3. Buprenorphine
---Can be given in a MD’s office month supply
---Need special certification
4. Clonidine (Catapres) has been given to suppress withdrawal symptoms

170

What are some meds related to Hallucinogen Related Disorders? (8)

Phencyclidine
Ketamine
Mescaline
Psilocybin
Ololiuqui
LSD
MDMA (Ecstasy)
Methylone

171

What are 3 things about Hallucinogen Related Disorders?

1. Use is episodic, some Phencyclidine users are daily users
2. 2.5% of the population has used Phencyclidine
3. Psychologically addictive

172

What are some other names for Cannabis? (4)

1. pot
2. weed
3. marij
4. marijuana

173

____ Americans used cannabis in the ___ ____, ___ of those users were aged _____.

19.8 million
past month
7.5%
12 or older

174

Daily or almost daily use of MJA increased from ____ in 2005-2007 to ____ in 2013

5.1 million
8.1 million

175

Name 3 things about cannabis?

1. Psychologically addictive
2. Controversy about physical addiction
3. Medical marijuana

176

____ of high school seniors used marijuana in the ___ ____

23%
past month

177

___ of high-school students use marijuana ____

6%
daily

178

What are the Cardiovascular effects of Cannabis? (2)

Tachycardia, orthostatic hypotension

179

What are the respiratory effects of Cannabis?

Chronic use can cause obstructive airway diseases

180

What are the reproductive effects of Cannabis? (4)

1. Decrease in sperm
2. Suppression of ovulation
3. menstrual cycle disruption 4. alteration in hormone levels

181

What are the CNS effects of Cannabis? (7)

1. Euphoria
2. relaxation
3. depersonalization
4. derealization
5. panic
6. anxiety
7. long term heavy use lead to amotivational syndrome

182

What are some symptoms of Cannabis Withdrawal?

Irritability, anger or aggression
Nervousness or anxiety
Sleep difficulty
Decreased appetite or weight loss
Restlessness
Depressed mood
These symptoms must cause significant impairment

183

What are the Nursing Diagnoses for Cannabis Withdrawal? (6)

1. Risk for injury
2. Ineffective denial
3. Ineffective coping
4. Detoxification: withdrawal from substances
5. Powerlessness
6. Risk for suicide