Flashcards in 6 Substance Disorders Deck (183):
Illicit drug use is __.
Mostly due to __ use.
First time users start in their __
__% of the 2.8 million new users in 2013 were under 18
Drug use is highest among people in their __ and __
Around 1 in __ 25 year olds reported using an illicit substance in the past month
Drug use is increasing among people in their __'s
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
Physical dependence indicates an altered __ state caused by repeated administration of a substance
Cessation of a substance causes a __ __
Cocaine has a __ dependence, but not a __ dependence
What three substances are life threatening when you withdraw?
Why does someone who is an alcoholic need a higher dose of benzodiazepines?
b/c they have a cross tolerance with CNS depressants
Drugs in the __ __ can create a cross tolerance
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
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.
What is codependence?
It refers to family members, significant others affected by or influencing the behavior of the substance abuser.
How does the codependence family member facilitate the abuser's addictive behaviors? (2)
denial and providing money or drugs.
____ is an ____ part of substance dependence.
What does denial do to the substance abuser's situation? (2)
fuels the addiction, and minimizes the problem.
what is substance use disorder?
Pathological pattern of behaviors related to the use of a substance
In substance use disorder, the underlying change in brain circuits caused what 2 things?
Intense drug craving
Substance use disorder occur in a broad range of ...
a broad range of severity from mild to severe
Substance interferes with what?
an individual’s ability to fulfill role obligations
what happen to patient with substance use disorder?
the individual would like to cut down or control use but cannot
what is one characteristic of substance abuser?
Excessive amount of time spent procuring the substance or recovering from effects
what is an addiction?
tolerance develops and increased amounts are necessary
what is intoxication?
Development of a reversible substance-specific syndrome due to the ingestion of a substance
what is withdrawal?
it occurs upon abrupt reduction or discontinuation of a substance.
What are the 9 classes of psychoactive substances?
what are the 7 predisposing factors for a person to develop substance abuse?
Cultural and ethnic influences
how many percentage of American aged 12 and over reported using alcohol in the US?
what percentage of those 12 and over are binge drinkers?
What percentage of the US population is 18-25 year olds binge drinker?
What is the percentage rate of alcohol use in 12 – 17 year olds?
alcohol equivalencies: 12 fl oz of regular beer has how many percentage of alcohol?
alcohol equivalencies: 8-9 fl oz of malt liquor has how many percentage of alcohol?
alcohol equivalencies: 5 fl oz of table wine has how many percentage of alcohol?
alcohol equivalencies: 1.5 fl oz shot of 80-proof spirits (hard liquor) has how many percentage of alcohol?
what are the 3 types of alcohol- related disorders?
alcohol use disorder
what is an alcohol use disorder?
It is a problematic pattern of alcohol use leading to clinically significant impairment or distress
What are the cluster of behavioral and physical symptoms of alcohol use disorder? (3)
1. Withdrawal (develops 4-12 hours after reduction of intake)
what is 12 month prevalence rate of alcohol use disorder among 12 - 17?
what is 12 month prevalence rate of alcohol use disorder among adults 18 and over?
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%
Does the prevalence rate of alcohol use disorder varies markedly across race and ethnic subgroups?
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
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
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
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
about what percentage of individuals aged 12 and over report being current alcohol users?
what percentage of the US population binge drink?
alcohol use is the ___ leading cause of preventable deaths
Heavy alcohol use contributes to the 3 leading causes of death. What are the 3 diseases?
heart disease, cancer and stroke
Alcohol induces a _____ of the CNS
general, nonselective reversible depression
___ of a single dose of alcohol is absorbed ____ into the bloodstream
Blood carries the alcohol directly to the brain’s _____
central control areas
Moments after alcohol is consumed it can be found in ____.
all tissues, organs and secretions of the body
Absorption of alcohol is influenced by ____
food, rate of drinking, type of alcohol
Chronic alcohol abuse results in ____ impairments
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
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)
what is Wernicke’s Encephalopathy?
Most serious thiamine deficiency in alcoholics
What are the symptoms of Wernicke's encephalopathy?
paralysis of ocular muscles, diplopia, ataxia, somnolence, stupor
What is the treatment of Wernicke’s Encephalopathy?
Thiamine replacement therapy necessary to avoid death
What is Korsakoff’s Psychosis?
It is the psychotic state encountered in individuals recovering from Wernicke’s
What are the symptoms of Korsakoff’s Psychosis?
Confusion, recent memory loss and confabulation
What is the treatment for Korsakoff’s Psychosis?
parenteral or oral thiamine replacement
What is Alcoholic Cardiomyopathy?
Alcohol causes an accumulation of lipids in the myocardial cells
What results due to Alcoholic Cardiomyopathy?
heart enlargement, CHF, arrhythmia
What are the symptoms of Alcoholic Cardiomyopathy?
decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, non-productive cough
What will the lab of a pt with Alcoholic Cardiomyopathy show?
Labs show an elevation in CPK, AST, ALT, LDH
What is the treatment for Alcoholic Cardiomyopathy?
What is one esophagus condition caused by drinking?
Esophagitis inflammation and pain in the esophagus, result of frequent vomiting
What happen to the stomach due to drinking?
alcohol breaks down the stomach’s protective mucosal barrier
What can happen to the pancreas due to drinking?
What can happen to the liver due to drinking? (3)
Prenatal exposure to alcohol can result in ____
fetal alcohol spectrum disorders
what is the most common fetal problem due to the pregnant mother's drinking?
Fetal Alcohol Syndrome (have low IQ)
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
Alcohol Intoxication usually occurs at what blood alcohol level?
levels between 100 and 200mg/dL
What blood alcohol level is lethal?
levels ranging from 400 – 700mg/dL
what 3 drugs/chemical is life threatening when you withdrew them too quickly?
benzos, barbituates, and alcohol
what is DT?
delirium tremor. it is a type of life threatening seizure.
When does alcohol withdrawal happen?
4-6 hours after last drink. It may progress to DT’s (delirium tremor) in 2-3 days
What are some signs and symptoms of alcohol withdrawal?
Autonomic hyperactivity (sweating or pulse rate greater than 100 bpm)
Increased hand tremor
Nausea or vomiting
Transient visual, tactile or auditory hallucinations or illusions
Generalized tonic-clonic seizures
what is one treatment for alcohol withdrawal?
Substitution therapy: to reduce life threatening effects of alcohol withdrawal... use benzo and Lithium together
what are some medication used in substitution therapy for alcohol withdrawal?
Benzodiazepines: most widely used group of drugs for substitution therapy
2. Serax (Oxazepam)
3. Ativan (Lorazpeam)
4. Valium (Diazpeam)
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.
The substitution therapy is given how often?
every 4-6 hours
Sometimes, the substitution therapy is given with additional doses, why?
for breakthrough symptoms
Substitution therapy: when individuals with liver disease, what medications are used instead?
shorter acting Ativan (Lorazepam) and Serax (Oxazepam)
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
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
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
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
What are the 4 treatments for alcoholism?
1. Alcoholic Anonymous
3. Group Therapy
The pharmacotherapy of alcoholism, what 4 meds would you use?
3. SSRI’s mixed results
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
what are the 5 assessment tools for alcoholism?
1. Clinical Institute Withdrawal Assessment of Alcohol
2. Michigan Alcoholism Screening Test
4. AUDIT - C
__#?__ persons __%?__ of the population smoke cigarettes
55.8 million, 21.3%
smoking is the____ cause of preventable death in the US
Smoking accounts for more than __#?__ deaths each year
__#?__ American suffer from a disease caused by ____
16 million, smoking
Smoking: annual costs __#?__ medical expenses, __#?__ in lost productivity
$96 billion, $97 billion
Nicotine is ____
and affects the ___
__%?__ of nicotine inhaled reaches the bloodstream and reaches the ___ in 15 seconds
Nicotine activates the ____ pathways
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
What are the 3 health consequences of second hand smoke in children?
1. Middle ear disease
2. Respiratory symptoms
3. Sudden Infant Death
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
What are 4 prevention and treatment for smoking?
2. Individual, group or telephone counseling
3. Nicotine replacement (nicotine patches)
4. Pharmacologic agents
The Pharmacologic agents for treating smoking are (2):
1. Zyban (Buproprion SR)
2. Chantix (Varenicline)
What 4 class of drugs are used for sedative hypnotic or anxiolytic use disorder?
2. Non-barbiturate hypnotics
4. Club drugs
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)
Which of the benzodiazepines is most commonly abused?
What are some examples of Barbiturates? (5)
1. Amytal (Amobarbital)
2. Nembutal (Pentobarbital)
3. Seconal (Secobarbital)
4. Butisol (Butabarbital)
What are some examples of Non-Barbiturate Hypnotics? (10)
1. Chloral hydrate
4. Restoril (Temazepam)
5. Halcion (Triazolam)
6. Doral (Quasepam)
7. Lunesta (Eszoplicone)
8. Rozerem (Ramelteon)
9. Sonata (Zaleplon)
10. Ambien (Zolpidem)
What are 2 examples of club drugs?
1. Rohypnol (Flunitrazepam)
2. GHB (Gamma hydroxybutyric acid)
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
__%?__ of people in the US have had a benzo prescribed
__%?__ of adults over __#?__ have used prescription ___ in the past month
4%, 20, sleep aids
12 month prevalence of sedative hypnotic or anxiolytic use disorder: __%?__ among __#?__ year olds, __%?__ among ____
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
6. Suppress urine function
7. Produce jaundice
8. Decrease body temperature
9. Sexual dysfunction
What are 3 things about Sedative, Hypnotic or Anxiolytic Withdrawal?
1. Life threatening
2. Short acting
3. Longer acting
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
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
What are some of the Sedative, hypnotic or Anxiolytic Withdrawal Symptoms? (8)
1. Autonomic hyperactivity (sweating, pulse rate greater than 100)
2. Hand tremor
4. Nausea or vomiting
5. Transient visual, tactile or auditory hallucinations or illusions
6. Psychomotor agitation
8. Grand mal seizures
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
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
What is Psychomotor stimulants?
augmentation or potentiation of the neurotransmitters norepinephrine, epinephrine or dopamine
What are the 2 most prevalent and widely used stimulants?
Caffeine and nicotine
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
What are 5 physiological effects of stimulants?
1. CNS effects
2. Cardiovascular effects
3. Gastrointestinal effects
4. Renal effects
5. Sexual functioning
What are symptoms of stimulant withdrawal? (7)
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
There's NO __ __ for stimulant withdrawal
Inhalant use disorder features include: __ use of an inhalant despite the individual's knowing the substance is __ __ __
causing serious problems
Prevalence of inhalant use disorder for Americans aged 12-17
__% of 13 year old American report using an inhalant
Inhalants can cause: __ and __ damage
Opioid use disorder is a problematic pattern of opioid use leading to clinically significant __ or __
impairment or distress
12 month prevalence for opioid use disorder for adults age 18+
12 month prevalence of opioid use disorder for 12-17 y/o
Is opioid use disorder higher in males or females?
What are opioids most effective for?
relief of pain
___ current heroin users aged 12+ in the US
What are the 4 methods of opioid administration?
There is a dramatic ___ in the past 10 years of ___ ___ ___
increase, prescription pain medication
1991: _____ prescriptions of pain meds, now 2011: _____
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)
Drug overdose death involving ___ ____ ___ 9,000 in 1999 to 17,000 in 2010
opioid pain relievers
Opioid use/ abuse cost ____ in health care.
What 3 chemicals are opioids of natural origin?
Opium, morphine, codeine
What are some opioids derivatives?(5)
What are some synthetic opiate like drugs? (4)
1. Meperidine (Demerol)
2. Methadone, (Dolophine)
3. Pentazocine (Talwin)
4. Fentanyl (Fentora)
What are some opioids' CNS effects?
Euphoria, mood changes, mental clouding, drowsiness and pain reduction, pupillary constriction, respiratory depression
What are some opioids' GI effects?
Peristalic activity diminished
What are some opioids' Cardiovascular effects?
What are some opioids' sexual function effects?
Decreased function and libido
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%
What happen after one's breathing slows when he is overdosed on opioids?
Person becomes unresponsive
What happen if no treatment is given to one who is overdosed on opioids?
long period of unresponsiveness, sometimes associated with “loud snoring”
What is the Opioid overdose triad?
1. Pinpoint pupils
3. Respiratory depression
____ of ___ deaths involve at least ____ other drug
50%, painkiller, one
What is one thing about opioid withdrawal?
it is not life threatening but pt feels terrible.
What is the main focus of Opioid Overdose treatment?
to address respiration and oxygenation
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
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
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
What are some treatments for Opioid Withdrawal? (4)
1. Rest, nutritional support
2. Methadone substitution
---Maintenance treatment: daily from clinics
---Can be given in a MD’s office month supply
---Need special certification
4. Clonidine (Catapres) has been given to suppress withdrawal symptoms
What are some meds related to Hallucinogen Related Disorders? (8)
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
What are some other names for Cannabis? (4)
____ Americans used cannabis in the ___ ____, ___ of those users were aged _____.
12 or older
Daily or almost daily use of MJA increased from ____ in 2005-2007 to ____ in 2013
Name 3 things about cannabis?
1. Psychologically addictive
2. Controversy about physical addiction
3. Medical marijuana
____ of high school seniors used marijuana in the ___ ____
___ of high-school students use marijuana ____
What are the Cardiovascular effects of Cannabis? (2)
Tachycardia, orthostatic hypotension
What are the respiratory effects of Cannabis?
Chronic use can cause obstructive airway diseases
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
What are the CNS effects of Cannabis? (7)
7. long term heavy use lead to amotivational syndrome
What are some symptoms of Cannabis Withdrawal?
Irritability, anger or aggression
Nervousness or anxiety
Decreased appetite or weight loss
These symptoms must cause significant impairment