Chapter 17 Substance Abuse Flashcards Preview

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Flashcards in Chapter 17 Substance Abuse Deck (42):
1

Physical Dependence

A condition characterized by physiologic reliance on a substance, usually indicated by tolerance to the effects of the substance and development of withdrawal symptoms when use of the substance is terminated

2

Psychologic Dependence

A condition characterized by strong desires to obtain and use a substance

3

Habituation

Development of tolerance to a substance following prolonged medical use but without psychologic or physical dependence(addiction)

4

Addicition

Psychologic or physical dependence on a drug or psychoactive substance

5

Opioids
examples

-heroin
-codeine
-hydrocodone
-hydromorphone
-meperidine
-morphine
-oxycodone

6

Stimulants
examples

-racemic amphetamine
-dextroamphetamine
-methamphetamine
-cocaine, methylphenidate, dextroamphetamine, phenmetrazine, and methamphetamine

7

Depressants

-Benzodiazepines
-Barbiturates
-Marijuana

8

Opioids

-Also known as narcotics
-Intended drug effects: relieve pain, reduce cough, relieve diarrhea, and induce anesthesia
-Abuse and psychological dependency: opioids promote relaxation and euphoria
-Affect areas outside the central nervous system (CNS)
Skin, gastrointestinal tract, genitourinary tract

9

Methadone

-Used to treat opioid dependence
-Goal: reduce the patient’s dosage gradually so that eventually the patient can live permanently drug free
-Relapse rates are often high; the drug can be abused.

10

Opioids: Adverse Effects
Central Nervous System

-Diuresis
-Miosis
-Convulsions
-Nausea, vomiting
-Respiratory depression

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Opioids: Adverse Effects
Non–central nervous system

-Hypotension
-Constipation
-Urinary retention
-Flushing of the face, neck, and upper thorax
-Sweating, urticaria, and pruritus

12

Opioid Drug Withdrawal
Peak Period

1 to 3 days

13

Opioid Drug Withdrawal
Duration

5 to 7 days

14

Opioid Drug Withdrawal Signs

Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated blood pressure (BP) and pulse

15

Opioid Drug Withdrawal Symptoms

Intense desire for drug, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise

16

Opioid Drug Withdrawal: Treatment

-Block opioid receptors so that use of opioid drugs does not produce euphoria
-Naltrexone—an opioid antagonist
-Vivitrol—injectable form of naltrexone
-Naloxone combined with buprenorphine (Subutrex) or used alone (Suboxone)

17

Stimulants

-Elevation of mood
-Reduction of fatigue
-Increased alertness
-Invigorated aggressiveness

18

Stimulants: Adverse Effects Gastrointestinal

Gastrointestinal
Dry mouth
Metallic taste
Anorexia
Nausea
Vomiting
Diarrhea
Abdominal cramps

19

Stimulant Overdose

-Death results from:
Convulsions
Coma
Cerebral hemorrhage
-May occur during periods of intoxication or withdrawal

20

Stimulant Withdrawal Peak Period

1 to 3 days

21

Stimulant Withdrawal Duration

5 to 7 days

22

Stimulant Withdrawal Signs

Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia

23

Stimulant Withdrawal Symptoms

Depression, suicidal thoughts and behavior, paranoid delusions

24

Depressants

-Drugs that relieve anxiety, irritability, and tension when used as intended
-Also used to treat seizure disorders and induce anesthesia
-Two main pharmacologic classes
Benzodiazepines
Barbiturates
-Marijuana (“pot,” “grass,” “weed”)
-Flunitrazepam (“roofies”)

25

Benzodiazepines and barbiturates

increase the action of GABA an amino acid in the brain, which inhibits nerve transmission in the CNS

26

Benzodiazepines

reduce anxiety, induce sleep, to sedate, and prevent seizures

27

Barbiturates

sedatives and anticonvulsants and to induce anesthesia

28

Depressants: Adverse Effects

-CNS: Drowsiness, sedation, loss of coordination,
dizziness, blurred vision, headaches, and
paradoxical reactions
-Gastrointestinal: Nausea, vomiting, constipation, dry mouth, and abdominal cramping
-Pruritus and skin rash
-Marijuana: “amotivational” syndrome

29

Depressants Withdrawal Peak Period

-2 to 4 days for short-acting drugs
-4 to 7 days for long-acting drugs

30

Depressants Withdrawal Duration

-4 to 7 days for short-acting drugs
-7 to 12 days for long-acting drug

31

Depressants Withdrawal signs

Increased psychomotor activity; agitation; hyperthermia; diaphoresis; delirium; convulsions; elevated BP, pulse rate, and temperature; others

32

Depressants Withdrawal Symptoms

Anxiety, depression, euphoria, incoherent thoughts, hostility, grandiosity, disorientation, hallucinations, suicidal thoughts

33

Depressant Withdrawal treatment

involves tapering of the drug over a course of a 7 to 10 or 10 to 14 days

34

Alcohol (Ethanol)

-More accurately known as ethanol (ETOH)
-Causes CNS depression by dissolving in lipid membranes in the CNS
-Few legitimate uses of ethanol and alcoholic beverages
-Used as a solvent for many drugs
-Systemic uses of ethanol: treatment of methyl alcohol and ethylene glycol intoxication (e.g., from drinking automotive antifreeze solution).

35

Ethanol: Drug Effects

-CNS depression
-Respiratory stimulation or depression
-Vasodilation, producing warm, flushed skin
-Increased sweating
-Diuretic effects

36

Effects of Chronic Ethanol Ingestion

-Nutritional and vitamin deficiencies (especially B vitamins):Wernicke’s encephalopathy
Korsakoff’s psychosis
Polyneuritis
Nicotinic acid deficiency encephalopathy
-Seizures
-Alcoholic hepatitis, progressing to cirrhosis
-Cardiomyopathy
-Fetal alcohol syndrome (FAS)

37

Ethanol Withdrawal Signs and Symptoms

-Elevated blood pressure, pulse rate, and temperature
-Insomnia
-Tremors
-Agitation

38

Ethanol Withdrawal Treatment

-Benzodiazepines are the treatment of choice
-Diazepam (Valium), lorazepam (Ativan), or
chlordiazepoxide (Korsakoff’s psychosis)
-Dosage and frequency depend on severity
-For severe withdrawal, monitoring in an intensive care unit is recommended

39

Treatment for Alcoholism

-disulfiram (Antabuse)
Acetaldehyde syndrome
-naltrexone
-acamprosate (Campral)
Newest treatment
-Counseling
Individual
Alcoholics Anonymous

40

Nicotine: Drug Effects

-Transient stimulation of autonomic ganglia
-Followed by more persistent depression of all autonomic ganglia
-CNS and respiratory stimulation followed by CNS depression
-Increased heart rate and BP
-Increased bowel activity

41

Nicotine Withdrawal

-Manifested by cigarette craving
Irritability, restlessness, decreased heart rate and BP
-Cardiac symptoms resolve in 3 to 4 weeks, but cigarette craving may persist for months or years

42

Nicotine Withdrawal Treatment

-Treatments provide nicotine without the carcinogens in tobacco
Nicotine transdermal system (patch)
Nicotine polacrilex (gum)
Inhalers
Nasal spray
-bupropion (Zyban): may be prescribed to aid in smoking cessation
-varenicline (Chantix): Stimulates nicotine receptors