Addictions/Substance Use Disorders Flashcards
1
Q
What is ‘addiction’
A
a condition where a person becomes dependent on a substance (like drugs or alcohol) or a behavior (like gambling) and feels a strong urge to use it or do it, even when it causes harm to themselves or others.
2
Q
Repeated use of these substances or frequent substance intoxication can develop into a long-term problem known as
A
substance abuse
3
Q
Abuse typically occurs when an individual consumes the substance for an extended period and develops a__ to the ingested substance
A
tolerance
4
Q
A substance use disorder (SUD) occurs when
A
an individual continues using substances despite cognitive, behavioral, and physiologic symptoms
5
Q
Define:
Abuse of more than one substance
A
Polysubstance abuse
6
Q
4 major groups where symptoms of Substance Use Disorder (SUD) fall into:
A
- Impaired control: Struggling to limit how much or how often you use a substance
- Social impairment: Neglecting responsibilities at work, school, or home due to substance use.
- Risky use: Continuing substance use in dangerous situations (e.g., driving)
- Physical effects: intoxication, tolerance, and withdrawal
7
Q
What is the purpose of the DSM-5 in relation to Substance Use Disorders?
A
Outlines specific criteria for diagnosing Substance Use Disorders (SUDs).
8
Q
A nurse is reviewing the DSM-5 criteria for diagnosing substance use disorders. How many criteria must an individual meet within a 12-month period to be diagnosed with a substance use disorder?
A) One
B) Two
C) Three
D) Four
A
B) Two
2 or more from the DSM-5 List
(if meet 2-3 criteria = mild)
9
Q
DSM-5 Criteria:
Moderate diagnoses is considered
A
if meet 4-5 criteria
10
Q
DSM-5 Criteria:
SEVERE diagnoses is considered
A
if meet 6 or more criteria
11
Q
Substance withdrawal symptoms are specific to
A
the substance used
12
Q
Biological factors:
What role does genetics play in substance use disorders?
A
Some people have a genetic tendency to become addicted to alcohol.
( certain individuals may inherit genes from their parents that make them more vulnerable to addiction)
13
Q
Withdrawal symptoms develop upon __
A
ABRUPT reduction or discontinue of substance that has been used.
14
Q
One of the leading causes of irreversible mental retardation
A
Fetal Alcohol Syndrome (FAS)
15
Q
What impact do parents who model substance use have on their children?
A
children (adolescents) are more likely to use substances if they have parents who provide a model for substance use.
16
Q
What is the primary goal for individuals who have experienced substance abuse?
A
Recover from the abuse
17
Q
Treatment and Recovery of Substanace Use:
Recovery involves a partnership between
List 3 individuals
A
- health care provider
- the individual and
- family
18
Q
A nurse is educating a group of nursing students about the withdrawal process from substance use. Which statement accurately describes the process?
A) Withdrawal symptoms are always life-threatening and require immediate intervention.
B) Detoxification is the first step, followed by the beginning of the recovery process.
C) Recovery can begin without detoxification if the individual is motivated.
D) The withdrawal process does not require medical supervision in all cases.
A
B) Detoxification is the first step, followed by the beginning of the recovery process.
19
Q
A nurse is providing education to a patient in recovery from substance use disorder. Which of the following statements regarding relapse should the nurse emphasize?
A) Relapse is uncommon and indicates that treatment has failed.
B) Relapse is an expected part of the chronic disease of addiction and may occur multiple times throughout recovery.
C) Once a patient achieves sobriety, they will not experience cravings or relapse.
D) Relapse only happens if the individual does not follow the treatment plan strictly.
A
B) Relapse is an expected part of the chronic disease of addiction and may occur multiple times throughout recovery.
(relapse is the PRIMARY concern)
20
Q
A nurse is admitting a patient with a history of alcohol use disorder to the hospital. What is the nurse’s first priority during the initial assessment?
A) Assess the patient’s vital signs and mental status.
B) Determine whether the patient will be withdrawing.
C) Evaluate the patient’s nutritional status and hydration levels.
D) Initiate a referral to a substance use counselor for treatment options.
A
B) Determine whether the pt will be withdrawing
- after pt is NO LONGER in danger of withdrawal symptoms, then the nurse can discuss the use of substance and encourage individual to seek help for the addiction.
21
Q
What is the nurse’s next step after a patient is no longer in danger of withdrawal symptoms?
A
The nurse can discuss the use of substance and encourage the individual to seek help for the addiction
- After ensuring the patient is stable, nurses play a crucial role in facilitating discussions about substance use, helping the individual understand their situation, and encouraging them to seek help. This holistic approach is essential for effective recovery and long-term well-being.
22
Q
Substance Use:
Can a patient be in denial?
A
Yes. It is common and often a priority
23
Q
The 7 categories of addicting Drugs
A
- alcohol
- sedatives/hypnotics
- stimulants
- opioids
- hallucinogens
- inhalants
- cannabis
24
Q
Alcohol contributes to what 3 chronic diseases?
A
- Heart disease
- cancer
- Cerebralvascular Accident (CVA): brain attack
25
What is the **nutritional impact** of ethanol (ETOH) in food
ETOH contains calories but has no nutritional value.
26
At what **blood alcohol level** are individuals considered legally intoxicated in most states?
0.08 - 0.10
27
What type of effect does **alcohol** exert on the central nervous system (CNS)?
**depressant** effect on the CNS
28
Which 2 **tools** are commonly used to screen for: **alcohol use disorders, drinking patterns & behaviors**
1. CAGE Questionnaire
2. Alcohol Use Disorders Identification Test (AUDIT)
29
What is the **INITIAL** effect of ethanol (ETOH), and how does it act on the body?
ETOH is a sedative but **initially** creates a feeling of euphoria.
30
Is alcohol digested?
No.
31
Where does alcohol enter FIRST?
BLOODSTREAM, then travels to every part of the body.
32
What **organ** does **alcohol affect FIRST**?
**BRAIN**
(then kidneys, lungs, and liver)
33
What are some **physical and mental health risks** for **older adults** who drink excessive amounts of alcohol?
* Stroke
* Heart disease
* Cancer
* Depression
* Confusion
* Dementia
34
What does alcohol do to your blood vessels?
Widens (vasodilates)-
* causing blushing, heat loss, decrease in body temp and drop in BP
35
What does receiving 2 "yes" responses on the CAGE screening indicate?
the possibility of **alcoholism** should be investigated further.
36
What are the potential consequences of alcohol overdose?
Can cause **permanent brain damage or death**.
37
What cardiovascular effects can **ACUTE** alcohol intoxication cause?
* Hypotension
* tachycardia
(*due to peripheral vasodilation or fluid loss*)
38
What S/S are commonly associated with a blood alcohol level of **0.08 - 0.1**?
* Impaired driving
* Slurred speech
* Ataxia: lack of muscle coordination
* Reduced sensory function
39
S/S of alcohol blood level of 0.2-0.3
**All** sensory motor function impaired
40
S/S of alcohol blood level of 0.3 and up
* Increase potential cardiovascular and respiratory COLLAPSE
* coma
* death
41
Q: When do symptoms of **alcohol withdrawal** usually **begin**?
A: Symptoms usually start **4-12 hours AFTER** stopping or cutting back on drinking.
42
S/S of **alcohol withdrawal**
* tremors
* sweating
* anxiety
* hyper alertness
* elevated pulse and B/P
* insomnia
* anxiety
* restlessness
* N/V
43
Q: What is required for safe alcohol withdrawal?
A: Alcohol withdrawal needs to be **accomplished under medical supervision.**
44
During alcohol withdrawal, VS should be monitored every
Q 4 hrs.
45
**Medications** to **suppress withdrawal symptoms** include:
**benzo**diazepines: **V**alium, **A**tivan, **L**ibrium
* *REMEMBER: Benzo and VAL*
46
What **assessment tool** is used to assess & manage alcohol WITHDRAWAL symptoms. Used in hospitals to evaluate **severity of withdrawal & guide treatment decisions.**
Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar).
47
What can **complicated alcohol withdrawal syndrome** PROGRESS to?
May progress to **alcohol withdrawal delirium.**
* *Usually happens 48 to 72 hours after the last drink and can cause confusion, hallucinations, severe agitation, tremors, and changes in heart rate and blood pressure. This condition requires immediate medical attention*
48
What is CIWA?
**Clinical Institute Withdrawal Assessment for Alcohol**
* It is a tool used to assess the severity of alcohol withdrawal symptoms in patients.
* It evaluates symptoms such as nausea, tremors, sweating, anxiety, agitation, hallucinations, and orientation.
* Each symptom is rated, and the total score helps guide treatment decisions.
* A higher score indicates more severe withdrawal symptoms.
49
*CIWA*:
**Mild** withdrawal symptoms can be **treated** with
(*score of 7 or below*)
Supportive care such as: *IV fluids* and **close monitoring**
50
*CIWA*:
**Moderate** withdrawal symptoms can be treated with
(*score of 8-15*)
more intensive interventions such as: **IV meds** or **sedation**
51
*CIWA*:
**SEVERE** withdrawal symptoms may require
(*score of 16 or more*)
intensive tx such as an ICU care
52
What nutritional deficiencies can occur with alcohol abuse?
List 3
* Vit. B12
* folic acid
* Thiamine (Vit. B1)
53
What is the purpose of administering a "**banana bag**" to a patient **during alcohol withdrawal**?
* To treat electrolyte imbalances and nutritional deficiencies in **alcohol withdrawal**.
* It typically contains thiamine (B1), folic acid, magnesium, and a multivitamin
54
Which **medications** are commonly prescribed to **suppress ALCOHOL withdrawal symptoms**?
Benzodiazepines:
* **Diazepam** (Valium)
* **Chlordiazepoxide** (Librium)
* **Lorazepam** (Ativan)
55
What is the common **protocol** for **treating a patient experiencing alcohol withdrawal**?
* Thiamine 100 mg IV initially and daily (qd)
* Folic acid (Folate) 1 mg daily (qd)
* Multivitamin (MVI) daily (qd)
* Assess current withdrawal state using the Clinical Institute Withdrawal Assessment for Alcohol (**CIWA**) scale- **then move forward based on score**
56
Define:
Delirium Tremens (DTs)
* **SEVERE** form of **alcohol withdrawal** characterized by confusion, severe agitation, hallucinations, and autonomic instability
* require prompt medical treatment due to the risk of **complications**, including **seizures and death**.
57
7 S/S OF **DELIRIUM TREMENS (DT)**
* **Tachycardia**: *fast HR*
* **tachypnea**: *fast breathing*
* **Increase BP**
* **diaphoresis**
* **Marked tremors**: *noticeable, rhythmic shaking movements*
* **Hallucinations**
* **Paranoia**
* **Grand Mal seizures (possible)**: *seizure that involves a loss of consciousness and body convulsions*
58
Delirium Tremens (DT) may appear
**12 to 36 hours AFTER the last drink**
(*can last from a few hours to several weeks*)
59
**3** types of **alcohol-induced amnestic disorders** (memory impairment)?
1. **Wernicke encephalopathy**
2. **Korsakoff’s amnestic syndrome**
3. **Wernicke–Korsakoff syndrome**
60
What is **Wernicke encephalopathy**?
* degenerative brain disorder caused by **thiamine deficiency**
* often associated with **alcohol misuse**
61
**5** S/S of **Werniche's Encephalopathy**
* **confusion**
* **ataxia**: *poor muscle control*
* **vision impairment**
* **hypotension**
* **coma**
62
What is **Korsakoff’s Amnestic Syndrome**?
* Chronic condition **resulting** from **UNTREATED Wernicke encephalopathy**.
63
S/S of Korsakoff syndrome
* memory deficits
* confabulation (fabricating stories)
* difficulty with learning new information
64
What is **Wernicke–Korsakoff syndrome**?
* They are 2 different disorder- they are generally considered to be **different stages of the same disorder**
* Refers to the **combined effects of Wernicke encephalopathy and Korsakoff’s amnestic syndrome.**
* **Wernicke** encephalopathy representing the **acute** phase
* **Korsakoff** amnestic syndrome the **chronic** phase
65
What is the prognosis of **Wernicke–Korsakoff syndrome**
* Early symptoms can be reversed
* But without **long-term treatment**, the prognosis is poor
66
How does **heavy alcohol use** affect the stomach lining and vitamin absorption?
* Causes inflammation of the stomach lining and digestive tract (gastritis), which **reduces the body's ability to absorb essential vitamins and nutrients.**
* This can lead to nutritional deficiencies, including thiamine (B1), folate, and vitamin B12, contributing to conditions such as Wernicke-Korsakoff syndrome.
67
**Drug** used to **reduce or eliminate alcohol craving**
(*used for narcotic dependents*)
Naltrexone (ReVia)
68
Is Naltrexone a narctoic?
NOPE- works by blocking the effects of narcotics
69
2 benefits of Naltrexone
* It will **NOT** produce any narcotic-like effects or cause mental or physical dependence.
* It will **NOT** prevent you from becoming impaired while drinking alcohol.
70
* DRUG that is used to **help OVERCOME your drinking problem**.
* It is not a cure for alcoholism, but rather will **help you maintain abstinence.**
Acamprosate
71
* DRUG used to **DECREASE alcohol cravings**
* Also used for seizures & migranes
**Topiramate**
* *will NOT CURE epilepsy and will only work to control seizures for as long as you continue to take it*
72
Drug that disrupts the metabolism of alcohol, leading to **unpleasant reactions when alcohol is consumed**.
Disulfiram (Antabuse)
73
physical reaction of Disulfiram + Alcohol can include
* nausea
* flushing
* heart palpitations
74
MOST effective way to treat alcohol use disorder
Alcoholics Anonymous program
75
Important teaching when taking Disulfiram (antabuse)
* Teach to avoid products such as **cough syrups, lotions, colognes, mouthwash**
* ANY product with ETOH in its ingredient.
76
3 Non pharmacological Treatment for Alcohol abuse
* 12 Step Programs (Support Groups- AAA)
* Residential treatment centers
* Cognitive behavior therapy
77
A client is brought to the emergency department. The client is aggressive, has slurred speech, and has impaired motor coordination. Blood alcohol level is 347 milligrams per deciliter. Among the physician’s orders is thiamine. Which is the rationale for this intervention?
A. To prevent nutritional deficits
B. To prevent pancreatitis
C. To prevent alcoholic hepatitis
D. To prevent Wernicke’s encephalopathy
D. To prevent **Wernicke**’s encephalopathy
-*Wernicke’s encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.*
78
What is **one potential danger** of alcohol overdose?
choking on one’s vomit, which can lead to death from lack of oxygen.
79
How does high alcohol intake affect the **gag reflex and airway protection**?
* High levels of alcohol intake can **hinder the gag reflex, resulting in the inability to protect the airway.**
* This impairment increases the risk of choking and aspiration
80
Pt's passed out due to alcohol misues should NEVER __.
be left alone.
81
What **position** should a patient who has passed out due to alcohol use be placed in to ensure safety?
**Partially upright position**
OR
**Rolling them onto one side with an ear toward the ground.**
- *This position helps prevent choking in case of vomiting and ensures that the airway remains clear*
82
Class of medications that **depress the central nervous system (CNS)** to induce sedation or sleep
(*from tranquilizing relief of anxiety to anesthesia, coma, and even death*)
**Sedative**/hypnotic/anxiolitics compounds
83
**Sedative/hypnotics** are generally categorized into **3 main groups**:
* barbiturates
* nonbarbiturate hypnotics
* antianxiety agents
84
What **organ** is primarily **affected** by the use of **sedative/hypnotics**?
LIVER (hepatic damage- jaundice)
85
*Sedative/hypnotic drugs*:
What **factor** influences the **ONSET of withdrawal symptoms**?
depends on the **half-life of the drug** from which the person is withdrawing.
* *short-acting sedative/hypnotics can lead to rapid onset of withdrawal symptoms within hours, while long-acting ones may result in delayed onset, occurring days after the last dose.*
86
What is the **reversal agent** for Benzodiazepines
Flumazenil
87
____ may occur **SECONDARY** to administering Flumazenil.
Seizures
88
If seizures are induced by **flumazenil** administration, patients may require
larger doses of benzodiazepines to control seizures effectively.
89
9 S/S of **Benzo Withdrawal**
* Anxiety
* Weakness
* Elevated heart rate (tachycardia)
* Tremors
* Sweating
* Hyperreflexia (increased reflexes)
* Oversensitivity to stimuli
* Confusion
* Konvulsions (seizures)
'A WET SHOCK'
90
Abrupt stoping of **barbituates** can cause
death.
**know**
91
How do we SAFELY get patients off of Sedative/Hypnotic drugs?
TAPER THEM- slowly decrease
92
6 TYPES OF **STIMULANTS**
* **Amphetamines**- *increase dopamine & Norepi*
* **Synthetic stimulants**: *man-made substances designed to mimic the effects of natural stimulants, such as amphetamines or cocaine*
* **Nonamphetamine stimulants**
* **Cocaine**
* **Caffeine**
* **Nicotine**
93
**Stimulants**-
5 Effects on the body
* Central nervous system effects
* Cardiovascular effects
* Pulmonary effects
* **GI and renal effects**
* **Sexual functioning**
94
At what level of **caffeine** consumption does intoxication usually occur?
250 milligrams
95
2 most common **caffeine intoxication symptoms**
1. Restlessness
2. insomnia
96
What **two S/S** receive **TOP PRIORITY** in **Stimulant-Induced Disorders**?
1. Agitation
2. Hyperthermia
97
S/S of Cocaine Intoxication
* Rapid heart rate (**tachycardia**)
* Sweating (**diaphoresis**)
* **Pupil dilation** (mydriasis)
* Teeth grinding
* dry mouth
* nosebleeds
* rapid speech
* weight loss
98
The withdrawing from Stimulants is called
Crashing.
(feel very high and suddenly feel very low)
99
When **crashing** occurs during **stimulant withdrwal**, #1 thing we need to monitor for is
Suicide
100
Pts may sleep for ___ when use of Stimulants is discontinued
12-18 hrs
(pts are excessively sleepy)
**NCLEX**
101
Opioids:
Fentanyl is __ stronger than Heroin
50 times stronger
*Fentanyl > heroin*
102
Opioids:
Fentanyl is __ stronger than Morphine
100 times stronger
*Fentanyl > heroin > morphine*
103
S/S of **Opioid Intoxication**
* euphoria followed by:
* apathy
* dysphoria
* psychomotor agitation or retardation
* impaired judgment.
104
Opioid antagonist
Naloxone
105
9 Symptoms of **OPIOID withdrawal**
* Dysphoria
* muscle aches
* nausea/vomiting/diarrhea
* **lacrimation or rhinorrhea** **
* pupillary dilation,
* sweating, abdominal cramping,
* **yawning****
* fever
* insomnia
-bold is specific to opioid withdrawals
106
Withdrawal from **short-acting drugs** (for example, heroin) occur, peak and subside in:
* Symptoms occur **within 6 to 8 hours**
* **peak** within **1 to 3 days**
* gradually subside in 5 to 10 days.
107
Withdrawal from **long-acting drugs** (for example, methadone) occur, peak and subside in:
* Symptoms occur within 1 to 3 days
* peak between days 4 and 6
* subside in 14 to 21 days.
108
Withdrawal from **ultra-short-acting meperidine** occur, peak and subside in:
* Symptoms begin quickly
* peak in 8 to 12 hours
* subside in 4 to 5 days
109
How do we get patients off of Opioids>
Taper- gradual decrease of drug
110
S/S of **Opioid OVERDOSE**
* **Unconsciousness or inability to awaken**
* **Pinpoint pupils**
* **Slow, shallow breathing**: *choking sounds or a gurgling/snoring noise from a person who cannot be awakened*
* **Fingernails or lips turning blue or purple**
111
If opioid overdose is suspected, how will you stimulate the person to wake them up?
2 ways
* calling their name
Or
* vigorously grinding one’s knuckles into their sternum.
112
Steps in Treating **Opioid OVERDOSE**
* Recognize signs of Opioid Overdose
* Obtain Emergency Assistance: *911*
* **Provide Rescue Breathing, Chest Compressions, and Oxygen As needed**
* Administer the **First Dose of Naloxone**- WAIT 2-3 mins
* Administer a **Second Dose of Naloxone if the person does not respond**
* Monitor the Person’s Response
113
Pt who is a chronic, long-term use of inhalants experiences ___ withdrawal symtpoms
mild
114
S/S of **Inhalant withrawal**
* restlessness
* nausea
* vomiting
* runny nose
* watery eyes
* poor attention
* concentration
115
Drug that is **often used** in isolated events or episodes rather than using them regularly or daily.
Halluciongens
116
The effects produced by hallucinogens are highly ____.
unpredictable
117
Hallucinogen intoxication occurs ___ after using the drug
shortly
118
Cannabis use decreases ___ count
sperm
119
S/S of **Cannabis Intoxication**
* **impaired motor coordination**
* euphoria
* **anxiety**
* **sensation of slowed time**
* impaired judgment.
120
Cannabis use impairs motor skills for
8-12 hrs
121
**Cannabis withdrawal** symptoms occur
**within a week** following cessation of cannabis use that has **been heavy and prolonged**
122
**Withdrawal** **symptoms** for Cannabis
* irritability
* **anger/aggression**
* **anxiety**
* sleep disturbances
* decreased appetite
* **depressed mood**
123
Which **substance** is the most widely misused among nurses, followed closely by narcotics?
A. Stimulants
B. Alcohol
C. Benzodiazepines
D. Hallucinogens
B. Alcohol
124
A nurse manager is evaluating staff attendance records for signs of substance misuse. Which of the following might indicate that a nurse’s source of substances is outside of the workplace?
A. High absenteeism
B. Volunteering for overtime
C. Frequently offering to medicate patients
D. Spending excessive time in medication rooms
A. High absenteeism
125
A nurse manager is concerned about a nurse's possible substance misuse. Which behavior might suggest that the nurse is obtaining substances from the workplace?
A. Frequent absenteeism
B. Rarely missing work
C. Taking frequent sick days
D. Reluctance to work extra shifts
B. Rarely missing work
-*feels a need to be present to access the drugs*
126
Chemically impaired Nurses are ___ at masking their symptoms
good.
127
A nurse is discussing **diversionary laws** with a colleague. Which statement **accurately reflects the purpose of diversionary laws regarding impaired nurses**?
A. Diversionary laws require mandatory reporting of impaired nurses to law enforcement.
B. Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment.
C. Diversionary laws mandate that impaired nurses be immediately suspended without pay.
D. Diversionary laws prohibit any type of treatment for impaired nurses.
B. Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment.
* *Diversionary laws provide a framework for impaired nurses to enter treatment programs and receive support instead of facing immediate disciplinary action*.
128
What is required for **successful completion of treatment** during the **SUSPENSION PERIOD** for a nurse with substance use issues?
* Successful completion of an inpatient, outpatient, group, or individual counseling treatment program
* Evidence of regular attendance at nurse support groups or 12-step program
* Random negative drug screens
* Employment or volunteer activities
129
**Peer assistance programs** serve to assist **impaired** nurses to:
* Recognize their impairment
* Obtain necessary treatment
* Regain accountability within the profession
130
Who makes up the Peer Assistance Programs
Nurse members of the state associations as well as nurses who are in recovery themselves.
131
Treatment for Gambling disorders
* Behavior therapy
* Cognitive therapy
132
Psychopharmacology Treatment for Gambling
SSRI
133
Which of the following are **effective ways to identify a substance-impaired nurse**? Select all that apply.
1. A nurse who frequently administers medications to other nurses’ clients.
2. High absenteeism if the substance source is outside of the work area.
3. Denial of substance abuse problems.
4. A high incidence of incorrect narcotic counts.
5. Poor concentration and difficulty in meeting deadlines
All of the above!
134
A client receives lorazepam because of a high Clinical Institute Withdrawal Assessment (CIWA) score. What is the rationale for this pharmacological intervention?
1. Lorazepam is a medication that decreases cravings in clients who are experiencing alcohol-induced withdrawal.
2. Lorazepam is a deterrent therapy that helps to motivate clients to maintain alcohol abstinence.
3. Lorazepam is a substitution therapy to decrease the intensity of withdrawal symptoms.
4. Lorazepam is a CNS stimulant that decreases the CIWA score.
3. Lorazepam is a substitution therapy to d**ecrease the intensity of withdrawal symptoms.**
135
What does an increasing **CIWA** score indicate about a client's condition?
* As the CIWA score increases, the client’s potential for serious complications from alcohol withdrawal also increases.
* **CNS** (central nervous system) depressant medications must be administered to **manage withdrawal symptoms** and prevent serious complications.
