Addiction ppt Flashcards
Exam 4 (FINAL) (186 cards)
1
Q
Substance abuse is what kind of abuse?
A
A National health problem
2
Q
What are the detrimental effects of substance abuse?
A
Alcohol-related death is the third leading preventable cause of death in United States.
Absenteeism at work
Prenatal exposure
Increased violence
3
Q
What is the third leading preventing cause of death in the US?
A
Alcohol-related death is the third leading preventable cause of death in United States.
4
Q
Addiction
A
continued use of substances (or reward-seeking behaviors) despite adverse consequences
5
Q
Use:
A
ingestion, smoking, sniffing, or injection of mind-altering substance
6
Q
Abuse
A
use for purposes of intoxication or beyond intended use
7
Q
Withdrawal:
A
symptoms occurring when substance no longer used
8
Q
Detoxification:
A
process for safe withdrawal
9
Q
Relapse:
A
recurrence
10
Q
Onset and Clinical Course: What is the average age for first episode of intoxication?
A
Average age for first episode of intoxication is adolescence.
11
Q
When do episodes of “sipping” occur?
A
Episodes of “sipping” as early as 8 years old
12
Q
Pattern of difficulties with alcohol become more severe when?
A
Pattern of more severe difficulties emerges in mid-20s to mid-30s.
13
Q
For many people substance use is considered what? Why?
A
What? A chronic illness
Why? Remissions and relapses
14
Q
Relapse rates for substance use (ETOH) are:
A
Relapse rates 60% to 90%
15
Q
What will give someone the highest rates of a successful recovery? (ETOH or any drug)
A
Abstinence
High level of motivation
16
Q
Poor outcomes of recovery are associated with:
A
Poor outcomes associated with earlier age at onset
17
Q
Substance abusers have a low tolerance of…
A
Substance abusers have a low tolerance for frustration.
(no coping skills)
18
Q
What do substance users get out of drugs?
A
Need immediate gratification to escape anxiety.
19
Q
Etiology of Addiction
A
Biological factors
Psychological factors
Social and environmental factors
20
Q
Biological factors having to do with addiction
A
Biologic factors
- Genetic vulnerability (no precise genetic marker identified)
21
Q
Psychological factors having to do with addiction
A
Psychological factors
-Family dynamics
-Coping styles
22
Q
Social and environmental factors having to do with addiction
A
Social and environmental factors
Cultural factors, social attitudes, peer behaviors
23
Q
Alcohol intoxication leads to:
A
CNS depressant: relaxation/loss of inhibitions
24
Q
What are the symptoms of Alcohol intoxication
A
Slurred speech, unsteady gait, lack of coordination, and impaired attention, memory, judgmentW
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What kind of behavior is associated with Alcohol intoxication
Aggressive behavior or display of inappropriate sexual behavior; blackout
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What is included in alcohol overdose?
vomiting, unconsciousness, respiratory depression
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What is included in alcohol overdose treatment?
Treatment: gastric lavage or dialysis to remove the drug and support of respiratory and cardiovascular functioning in an intensive care unit
28
When is alcohol withdrawal onset occur/
Onset within 4 to 12 hours after cessation or marked reduction of alcohol intake;
usually peaks on the second day and complete in about 5 days
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When does alcohol withdrawal peak?
Onset within 4 to 12 hours after cessation or marked reduction of alcohol intake; usually peaks on the second day and complete in about 5 days
30
Why is withdrawal considered dangerous?
Withdrawal can be life-threatening.
31
What are the three stages of Alcohol withdrawal?
Stage I: Mild
Stage II: Moderate
Stage III: Severe
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What are the vital signs of someone with MILD withdrawal?
Heart rate, temp. elevated,
normal or slightly elevated systolic BP
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What are the vital signs of someone with MODERATE withdrawal?
Heart rate 100-120, elevated systolic and temp.
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What are the vital signs of someone with SEVERE withdrawal?
Heart rate 120-140, elevated systolic & diastolic pressure
35
What is the level of diaphoresis of someone MILD withdrawal?
Slight
36
What is the level of diaphoresis of someone MODERATE withdrawal?
Obvious
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What is the level of diaphoresis of someone SEVERE withdrawal?
Marked
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How is the Central Nervous System of someone with MILD withdrawal?
Orientated, no confusion, no hallucinations, mild anxiety, restless sleep, hand tremors* shakes, No convulsions
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How is the Central Nervous System of someone with MODERATE withdrawal?
Intermittent confusion, transient visual and auditory hallucinations & illusions, anxiety, motor restlessness, insomnia, nightmares, tremors, rare convulsions
40
How is the Central Nervous System of someone with SEVERE withdrawal?
Marked disorientation, confusion, A & V hallucinations, delusions, delirium tremens*, disturbance in consciousness, agitation, panic, unable to sleep, gross tremors, convulsions
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How is the GI of someone with MILD withdrawal?
Impaired appetite, nausea
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How is the GI of someone with MODERATE withdrawal?
Anorexia, N & V
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How is the GI of someone with SEVERE withdrawal?
Rejecting all food & fluid
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Delirium Tremors is considered:
Medical emergency*
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What is the mortality rate of someone with delirium tremors?
Mortality rate 20%
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What percent of delirium tremors occur in dependent alcoholics?
Occurs in 5% dependent alcoholics
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When do delirium tremors occur?
Occurs usually within 48-72 hours after last drink
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Symptoms of delirium tremors
Symptoms; tremors, fever, tachycardia, hypertension, agitation (also have stupor), & hallucinations (often tactile and/or visual), confusion, disorientation
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Alcohol dose- BAC
Blood Alcohol Content (body wt., gender; women 25% higher r/t gastric metabolism)
50
How is BAC expressed?
Expressed as percentage of alcohol in the blood
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What is legal limit of ETOH?
Legal limit usually 0.08%;
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BAL decreases by what an hour?
BAL decreases by 0.02g/dL/hr
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How does absorption of alcohol occur?
Food in the stomach slows absorption of alcohol, especially high fat food
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What disorder is often associated with alcohol use?
Wernicke’s Encephalopathy
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Symptoms of Wernicke’s Encephalopathy
Symptoms: nystagmus(repetitive eye movements) /diplopia (double vision), gait ataxia & confusion
Encephalopathy
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Encephalopathy
Encephalopathy: Elevated spinal fluid protein levels
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What may prevent Wernicke’s Encephalopathy
May be prevented with thiamine (vitamin B1) & folic acid*
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If not treated immediately, Wernicke’s Encephalopathy can lead to?
If not treated immediately can lead to Korsakoff’s psychosis
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Korsakoff’s psychosis tell tale sign/
The telltale sign is the loss of short-term memory*
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What are other signs of Korsakoff’s psychosis?
The urge to make up stories without knowing it to fill in any gaps
A hard time putting words into context
Trouble understanding or processing information
Hallucinations
Coma & death is rare
61
Chronic effects of Alcohol use/abuse?
Long-term heavy drinking is detrimental to almost every organ system of the body, specifically the brain and the liver
Fetal alcohol syndrome
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What organs specifically does alcohol have detrimental effects for
specifically the brain and the liver
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Fetal Alcohol Syndrome occurs in response to what?
Can occur as a result of excessive alcohol consumption by a woman during pregnancy
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What does fetal alcohol syndrome lead to?
Subsequently, leading to slowed growth; cranial, facial, or neural abnormalities; and developmental disabilities
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What is used the most widely used screening test for alcohol abuse and dependence?
Cage Questionnaire
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Cage Questionnaire- what are the questions?
1. Have you ever felt you should Cut down on your drinking?
2. Do people Annoy you by criticizing your drinking?
3. Do you feel Guilty about your drinking?
4. Do you have an Eye opener first thing on the morning to steady your nerves?
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What is another test (other than CAGE) to assess alcohol use?
The Alcohol Use Disorders Identification Test (AUDIT-C)
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The Alcohol Use Disorders Identification Test (AUDIT-C)
is an alcohol screen that can help identify patients who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence).
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Questions in the Audit-C test?
Q1: How often did you have a drink containing alcohol in the past year?
Q2: How many drinks did you have on a typical day when you were drinking in the past year?
Q3: How often did you have six or more drinks on one occasion in the past year?
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How is the AUDIT-C scored?
The AUDIT-C is scored on a scale of 0-12 (scores of 0 reflect no alcohol use).
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In men, how is AUDIT-C scored?
In men, a score of 4 or more is considered positive;
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In women, how is AUDIT-C scored?
in women, a score of 3 or more is considered positive.
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The higher the AUDIT-C score, what does that mean?
Generally, the higher the AUDIT-C score, the more likely it is that the patient's drinking is affecting his/her health and safety.
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The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR)
is an instrument used by medical professionals to assess and diagnose the severity of alcohol withdrawal.
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What is the most sensitive tool for assessment of the patient experiencing alcohol withdrawal.
The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR)
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How do the score for the The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR) range?
Scores range from 0-67
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What does it mean if a pt scores less than 10 of The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR)?
Patients scoring less than 10 do not usually need additional medication for withdrawal
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The (CIWA-AR) can measure how many alcohol withdrawal symptoms?
The CIWA-AR can measure 10 alcohol withdrawal symptoms
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TheCIWA-AR can measure 10 alcohol withdrawal symptoms including:
Nausea & Vomiting
Tremor
Sweats
Anxiety
Agitation
Tactile disturbances
Auditory disturbances
Visual disturbances
Headache, fullness in head
Orientation
80
What is the cornerstone treatment of alcohol abuse?
Cornerstone of treatment: Benzodiazepines
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Where are the setting of alcohol detoxification where Benzodiazepines are given?
Settings: outpatient, inpatient detox, hospital medical unit
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What route it benzodiazepines are given?
PO, IM, IV, depending on setting & severity
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How does tapering of benzodiazepines effect patient?
Clinical pearl: The slower the medication is tapered, the more comfortable the patient.
84
Administer one of the following medications every hour based on the CIWA-AR score. / How often should the CIWA-AR test be repeated?
Chlordiazepoxide (Librium) 50-100mg*
Diazepam (Valium) 10-20mg
Oxazepam (Serax) 30-60mg
Lorazepam (Ativan) 2-4mg
Repeat the CIWA-AR after every dose to assess the need for further medication
85
What medication is used to treat chronic alcoholism
Disulfiram (Antabuse) is used to treat chronic alcoholism.
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What does Disulfiram medication cause when taken to treat chronic alcoholism?
It causes unpleasant effects* when even small amounts of alcohol are consumed.
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How does disulfiram work?
Inhibits aldehyde dehydrogenase and prevents metabolism of acetaldehyde, alcohol's main metabolite
88
How does disulfiram work in the body?
Inhibits aldehyde dehydrogenase and prevents metabolism of acetaldehyde, alcohol's main metabolite
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How long does disulfiram stay in the body?
Can stay in body up to 14 days after last dose*
90
What should you be cautious of when taking disulfiram?
Caution in use with cologne or aftershave with alcohol, and foods with “Hidden alcohol” *
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Disulfiram three phases?
1. Mild
2. Moderate
3. Severe
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Disulfiram- mild
Mild- facial flushing, sweating, headache
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Disulfiram- moderate
Moderate- nausea, tachycardia, palpitations, hyperventilation, hypotension, dyspnea
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Disulfiram- severe
Severe- vomiting, respiratory depression, CV collapse, arrhythmias, MI, CHF, coma, death
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When do symptoms of disulfiram occur? How do patients feel?
Symptoms start within 5 to 15 minutes and last 30 minutes to several hours.
Clients feel as if they are having a heart attack and are dying.
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Naltrexone
Naltrexone blocks the euphoric of alcohol & opioids such as heroin, morphine, and codeine.
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How specifically does naltrexone work in the body?
Naltrexone binds and blocks opioid receptors, and reduces and suppresses opioid cravings.
98
What is a benefit of naltrexone?
There is no abuse and diversion potential with naltrexone
99
Who is naltrexone NOT to be given to?
Not to be given to people taking opioids*
100
What does naltrexone reduce?
Can Reduce (Water Scenario)
Number of days spent drinking
Amount of alcohol consumed on drinking days
Excessive and destructive drinking
101
Most common side effects of Naltrexone?
Most Common Side Effects :
Nausea, decreased appetite
Headache, fatigue
102
Rare/Serious side effects of naltrexone?
Rare/Serious: Hepatotoxicity/monitor LFTs * Contraindicated in acute hepatitis or liver failure
103
Who is naltrexone contraindicated in?
* Contraindicated in acute hepatitis or liver failure
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When can patients start naltrexone?
* Patient should be opioid free for 7-10 days prior to initiating treatment, as confirmed by a negative urine screen.
105
Acamprosate
Maintains abstinence from alcohol in patients who are abstinent at treatment initiation
106
How is Acamprosate similar to naltrexone?
Similar to naltrexone, reduces drinking by reducing craving
107
Dosing of Naltrexone?
666 mg (two 333 mg tablets) TID (with food)
Do not cut or crush (EC)
Initiate after 7 days abstinence
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Acamprosate most common side effects
Most Common: Nausea & headache
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Who is Acamprosate preferred for?
Preferred for those with significant liver impairment*
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Who is Acamprosate contraindicated in?
Renal excretion: Contraindicated in renal failure
111
What are the 2 other groups of meds used for abuse?
1. Anxiolytic/ Benzodiazepines
2. Hypnotics/Sleep Medications
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Anxiolytic/ Benzodiazepines include:
Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan), Clonazepam (Klonopin)
113
Hypnotics/Sleep Medications include:
Eszopiclone (Lunesta), Zaleplon (Sonata), Zolpidem (Ambien)
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Hypnotics and Anxiolytiscs: What do they do to cause intoxication and overdose?
CNS depressants
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Intoxication symptoms of Hypnotics and Anxiolytics:
Intoxication symptoms: slurred speech, lack of coordination, unsteady gait, labile mood, stupor
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Onset of withdrawal symptoms for Hypnotics and Anxiolytics depend on what?
Onset of withdrawal dependent on half-life of drug
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How to detox from hypnotics and anxiolytics
Detoxification via drug tapering*
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Flumazenil
Flumazenil prescribed to reverse the sedative effects of benzodiazepines after sedation is produced for procedures or overdose*
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Stimulants include:
(Amphetamines, Cocaine)
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Stimulants are what kind of stimulants?
CNS stimulants
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Intoxification and overdose of stimulants lead to what symptoms:
High or euphoric feeling, hyperactivity, hypervigilance, anger; elevated blood pressure, chest pain, confusion
Seizures, coma with overdose
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How long does it take for onset of stimulant withdrawal to occur?
Onset within hours to several days
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Primary symptom of stimulant withdrawal
Primary symptom is marked dysphoria (unease).
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Other symptoms of withdrawal for stimulants
“Crashing” sleeping 12 to 18 hours
Not treated pharmacologically* Supportive in nature
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Cannabis (Marijuana)
Used for psychoactive effects and has medical applications
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Intoxication of Cannabis leads to:
Lowered inhibitions, relaxation, euphoria, increased appetite
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Symptoms of intoxication of cannabis include:
Symptoms of intoxication include impaired motor control*, impaired judgment
Delirium
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Delirium in cannabis
Delirium*, cannabis-induced psychotic disorder
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What is a big danger with marijuana?
Marijuana laced with fentanyl
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What are the withdrawal symptoms of cannabis
No clinically significant withdrawal syndrome
Possible symptoms of insomnia, muscle aches, sweating, anxiety, tremors
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Examples of opoids
Opium
Heroin
Fentanyl
Morphine
Codeine
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Classic triad of opioid overdose?
1. Decreased respirations: <12/minute, shallow respirations
2. Decreased level of consciousness…eventually coma
3. Pinpoint pupils: Miosis
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Miosis
(excessive constriction of the pupil)
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What is the first line of treatment for opioid overdose?
First line treatment for overdose Naloxone (Narcan)*
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Symptoms of withdrawal of opioids:
Nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia
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Symptoms of opioids do not require...
Symptoms cause significant distress, but do not require pharmacologic intervention to support life or bodily functions
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What is the onset of short acting drugs? What is the peaking? When does it subside?
Short-acting drugs (e.g., heroin): onset in 6 to 24 hours;
peaking in 2 to 3 days and
gradually subsiding in 5 to 7 days
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Example of short acting drugs
Heroin
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What is used to treat opioid disorder?
Methadone is used to treat opioid use disorder
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Where is methadone administered?
Only in licensed NTPs (narcotic treatment program) or while on a detox unit
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What does methadone do?
It blocks the high from drugs
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Risks of methadone?
Risks: physical dependence, abuse, diversion, overdose
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When can methadone use be safe and effective?
When taken as prescribed, safe & effective
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How is the overdose of methadone viewed?
Overdose can be fatal
145
Methadone Adverse Effects
Dizziness
Sedation or paradoxic excitement
Nausea
Respiratory depression
Constipation
Miosis (pupils constrict)
Hypotension
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Nursing Considerations of Methadone
Administer in smallest effective dose.
Observe for development of dependence.
Monitor:
Respiratory status.
Vital signs.
Intake and output.
Encourage fluids and high-bulk foods.
147
What should you monitoring for as a nursing consideration for pts using methadone?
Monitor:
Respiratory status.
Vital signs.
Intake and output.
148
Monoproduct buprenorphine; Suboxone is a combination of what?
BUP +naloxone (diversion prevention as naloxone is not absorbed)
149
How is Buprenorphine/ Suboxone similar to methadone?
Equal to methadone in:
Alleviating withdrawal, treatment retention & completion
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Risks of Buprenorphine/ Suboxone:
Risks (reduced): overdose; abuse; toxicity; diversion
151
What other drug can be combined with Methadone or Buprenorphine?
Clonidine – Add On
152
Why does Clonidine have to be combined with Methadone and Buprenorphine?
Combine with Methadone or Buprenorphine because not as effective stand alone treatment*
153
Advantages of Clonidine add on:
Advantages: non-controlled, minimal diversion risk, provider comfort level
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Notable effects of Clonidine add on:
Notable side effects: dry mouth, dizziness, constipation, sedation
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Clonidine add on Amount given for opioid withdrawal
Opioid withdrawal: 0.1mg - 3 times daily (can be higher in a inpatient setting)
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Most commonly abused hallucinogens:
Most commonly abused:Mushrooms, LSD and MDMA (ecstasy)
157
Symptoms of hallucinogens:
Reality distortion; symptoms similar to psychosis including hallucinations (usually visual), depersonalization
158
Physical symptoms caused by hallucinogens:
Cause increased pulse, blood pressure, and temperature; dilated pupils; and hyperreflexia
159
Hallucinogens overdose? A confusing slide....
No overdose; toxic reactions are primarily psychological (anxiety), paranoia, fear, depression
160
What are the withdrawal symptoms of hallucinogens?
No withdrawal syndrome
Some report a craving for the drug
Flashbacks possible for few months up to 5 years
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Inhalants
Found in common household products that produce chemical vapors
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Acute toxicity of inhalants?
Acute toxicity
Anoxia (decreased oxygen), respiratory depression, dysrhythmias
Death possible from bronchospasm, cardiac arrest, suffocation, or aspiration
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Withdrawal or detoxification of inhalants?
No withdrawal or detoxification
Frequent users report cravings
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What is the treatment for inhalant use?
Symptomatic treatment
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Substance Abuse Treatment: Treatment models
1. 12-step program of Alcoholics Anonymous
2. Harm Reduction Strategies Goal is to reduce the potential harm associated with behavior
3. Screening, brief intervention, and referral to treatment (SBIRT)
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12-step program of Alcoholics Anonymous
(peer led with aim toward sobriety)
167
Harm Reduction Strategies
Goal is to reduce the potential harm associated with behavior
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History of someone with substance abuse?
chaotic family life, family history, crisis that precipitated treatment
General appearance and motor behavior
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Mood and affect of someone with substance abuse disorder
Mood and affect: tearful; expressing guilt, remorse; angry; sullen; quiet; unwilling to talk
170
Thought process and content of someone with substance abuse disorder:
Thought process and content: minimize substance use; blaming others; rationalization
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Sensorium and intellectual processes: of someone with substance abuse disorder
intact
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Judgment and insight of someone with substance abuse disorder
poor judgment; impulsivity; may still believe he or she can control substance use
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Self-concept: of someone with substance abuse disorder
low self-esteem; problems identifying and expressing feelings
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Roles and relationships: of someone with substance abuse disorder
Roles and relationships: often strained
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Physiological considerations of someone with substance abuse disorder
Physiological considerations: poor nutrition; sleep disturbances; liver damage; HIV infection; lung damage
176
Outcome identification of substance abuse?
Outcome identification
Abstain from alcohol and drug use
Express feelings openly and directly
Accept responsibility for own behavior
Practice nonchemical coping alternatives
Establish an effective aftercare plan
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A client who abuses substances will commonly state that he or she can control his or her use of the substance. True or False
True
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Substance Abuse and Nursing Process Application: Interventions
Health teaching for client, family
Addressing family issues (codependence, shifting roles)
Promoting coping skills
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Elder Considerations of substance abuse: What percent of elders in treatment began drinking abusively after age 60?
Approximately 30% to 60% of elders in treatment began drinking abusively after age 60.
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Risk factors for late onset substance abuse include:
Risk factors for late-onset substance include chronic illness that causes pain, long-term use of prescription medication, life stress, loss, social isolation, grief, depression, and an abundance of discretionary time and money.
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How do physical problems develop with substance use?
Physical problems associated with substance abuse develop rather quickly.
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Substance Abuse in Health Professionals: What is the role of other providers noticing this?
Ethical and legal responsibility to report suspicious behavior to supervisor
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General warning signs of substance abuse in health professionals
Poor work performance/frequent absenteeism
Unusual behavior/slurred speech
Isolation from peers
May be involved in discrepancies in narcotics counts
Increased client reports
of unrelieved pain or poor sleep
Frequent trips to bathroom.
Offers to medicate co-worker’s clients.
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States treatment of substance abusers who are health professionals?
Most states have a non-disciplinary alternative-to-discipline program that can monitor and treat the nurse, assess for abstinence and help with returning to work.
185
Self-Awareness Issues of substance abuse?
Examine own beliefs about alcohol and drugs.
History of substance use
Recognize that substance abuse is chronic illness with relapses and remissions.
Remain open and objective.
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