Addiction and Aminoglycosides

Question 1

What is the number 1 problem with psychological problems? How do you respond/treat?

Answer 1

Denial

Confront them by pointing out the difference between what they say and what they do

Question 2

What is DABDA?

Answer 2

Denial
Anger
Bargaining
Depression
Acceptance

Question 3

How do you respond differently for denial in loss compared to abuse?

Answer 3

Loss –> support

Abuse –> confront

Question 4

What is dependency vs co-dependency?

Answer 4

Dependency: when the get the significant other to do things or make decisions for them. Therefore the abuser is dependent

Co-dependency: when the significant other derive self-esteem for doing things or making
decisions for the abuser

Question 5

How is dependency/co-dependency treated?

Answer 5

Dependent abuses need to be confronted

Co-dependent need to set limits and ENFORCE them. Say NO. Work on self-esteem

Question 6

What is manipulation? How is it different than co-dependency?

Answer 6

Manipulation is when the abuser gets the significant other to do things or make decisions
that are not in the best interests of the significant other

Manipulation leads to harm of SO and co-dependency is not harmful/dangerous

Question 7

What is Wernicke Korsakoff syndrome? What is the cause?

Answer 7

Wernicke - encephalopathy

Korsakoff - psychosis

Vitamin B1 deficiency

Question 8

What are the s/s of Wernicke Korsakoff syndrome? Treatment?

Answer 8

Amnesia (memory loss) and confabulation (making up stories that they believe are real)

1. Preventable … Take B1
2. Arrestable (stop it from getting worse) … Take B1
3. Irreversible (70%) … Will kill brain cells

Question 9

What is a medication that can be used to help treat alcohol abuse? How does it work?

Answer 9

Antabuse and Revia (disulfiram)

Works by creating a aversion. When taken and mixed with alcohol it creates a unpleasant effect leading to hatred of alcohol

Question 10

How long does it take for disulfiram (antabuse/revia) to start working? Stop working?

What should pt avoid?

Answer 10

2 weeks to start and 2 weeks to stop

Anything with alcohol including mouth wash, cologne, perfume, aftershave, ANY med with name elixir, insect repellant, hand Sani, vanilla extract

Question 11

What drugs are an upper?

Answer 11

Caffeine
Cocaine
PCP/LSD
Methamphetamines
Adderall

Question 12

If a drug is NOT one of the 5 uppers then what is it?

Answer 12

A downer

Question 13

What s/s does an upper cause? Biggest concern?

Answer 13

THINGS GO UP!

Euphoria, seizures, restlessness,
irritability, hyperreflexia (3+, 4+),
tachycardia, increased bowels (borborygmi), diarrhea, spastic

SIEZURES –> suction

Question 14

What s/s does a downer cause? Biggest concern?

Answer 14

THINGS GO DOWN!

Lethargic, respiratory depression/arrest,
constipated, etc.

RESPIRATORY DEPRESSION/ARREST –> intubation/ventilate

Question 15

What does an overdose on an upper look like?

Answer 15

TOO MUCH

Everything goes up?

Question 16

What does an withdrawal on an upper look like?

Answer 16

TOO LITTLE

Everything goes down. Looks like overdose on an downer

Question 17

What does an overdose on a downer look like?

Answer 17

TOO LITTLE

Everything goes down

Question 18

What does an withdrawal on a downer look like?

Answer 18

TOO MUCH

Looks like an overdose on an upper

Question 19

When there is drug abuse in a neonate what does you assume within 24 hours of birth? After 24 hours?

Answer 19

ALWAYS assume intoxication in a newborn less than 24 hours

ALWAYS assume withdrawal in a newborn after 24 hours

Question 20

What will every alcoholic go through ___ hours after they have stopped drinking?

Is it life threatening?

Answer 20

Alcohol withdrawal syndrome occurs 24 hours after drinking stops

NON life threatening (reg diet, semiprivate room anywhere on unit, pt is ad lib, no restraints)

Question 21

Less than 20% of alcoholics in Alcohol withdrawal syndrome will progress to _____ in _____ hours

Answer 21

Less than 20% of alcoholics in Alcohol withdrawal syndrome will progress to DELIRIUM TREMENS in 72 hours

Question 22

Is Delirium Tremens harmful? What changes should occur?

Answer 22

LIFE THREATENING to self and others

NPO/clears d/t seizures
Private room near nurses
Restraints w/ bed rest (2 point lock letter restraints)

Question 23

What do you give both patients with Alcohol Withdrawal Syndrome and Delirium Tremens?

Why these meds?

Answer 23

Anti-HTN meds, Tranquilizer, multivitamin with B1

Anti-HTN and tran - withdrawal on downer so everything goes up
B1 - metabolize alcohol and prevent Wernicke/Korsakoff

Question 24

What do Aminoglycosides treat?

Answer 24

A mean old mycin

A mean and old infection such as TB, sepsis

END in MYCIN

Question 25

What drugs end fun MYCIN but are not Aminoglycosides and how do you know?

Answer 25

Azithromycin, Clarithromycin, Erythromycin ALL have THRO is throw them out

Question 26

What are toxic side effects of Aminoglycosides? How do you remember?

Answer 26

Ototoxic - hearing, tinnitus, balance Nephrotoxic - creatinine MCYIN sound like mice. Mice have big ears. It is toxic to ears and the kidneys look like ears

Question 27

What CN are aminogylcosides toxic to? How often do you administer them? How do you remember?

Answer 27

Toxic to CN8 (ear nerve) Administer every 8 hours MCYIN sound like mice. Mice have big ears. You can easily draw an 8 in the ears

Question 28

Why are mycins given PO? What happens if they are?

Answer 28

They are not absorbed --> no systemic effects If given they sterilize the gut

Question 29

What 2 situations would you sterilize the gut? What meds would you use?

Answer 29

Hepatic encephalopathy/hepatic coma (too much ammonia) Pre-op bowel prep "Who can sterilize my bowel? Neo Kan!" Neomycin and Kanamycin

Question 30

What 2 routes are Aminoglycosides given?

Answer 30

IM or IV

Question 31

When is a trough drawn?

Answer 31

30 minutes before the next dose no matter the route (at medications lowest concentration in blood)

Question 32

When is a peak drawn for SubL?

Answer 32

5-10 minutes after drug dissolved

Question 33

When is a peak drawn for IV?

Answer 33

15-30 minutes after a drug is finished/bag empty

Question 34

When is a peak drawn for IM?

Answer 34

30-60 minutes

Question 35

If there are 2 correct answers regarding a time frame should you big the longer time frame or shorter?

Answer 35

ALWAYS pick the longer time frame For example if an IM med was given and you need to draw peak, pick the answer that says it should be drawn in 60 minutes (30-60 min timeframe) OR For example a patient states they haven been on their antidepressant meds for 1 week and they were told it would work in 2-4 weeks but it still doesn't have any effect you should tell the patient it can take 3 more weeks before seeing effects