Chapter 22 Substance-related and Addictive Disorders

Question 1

ADDICTION/Substance Abuse

Define

Answer 1

“Primary, chronic disease of brain reward, motivation, memory and related circuitry.”

“Chronic medical condition with roots in the environment, neurotransmission, genetics and life experiences.”

American Society of Addiction Medicine

A disease of dysregulation in the hedonic or reward pathway of the brain.

Question 2

ALCOHOL?

Most common abuser

Answer 2

Men
Young people
Whites
Single

Question 3

ALCOHOL?

What % of US population consumes regularly

Answer 3

2/3

Question 4

ANTAGONISTIC EFFECTS OF DRUGS

Answer 4

When drugs are taken together and the effect of one is inhibited or weakened

IE cocaine with heroin (speedball)
CNS depressant Heroin softens the withdrawal from cocaine
Narcan (Naloxone) give to OD opiates reverses respiratory and CNS depression

Question 5

Behavioral Addictions
Do they have clear identifiable intoxication or withdrawal symptoms?
Is Tolerance an ISSUE?

Answer 5

Behavioral addictions NO clear intox or withdrawal symptoms

Tolerance NOT an issue

Question 6

Behavioral Addictions

How are they assessed?

Answer 6

Patterns of behavior and consequences

Question 7

Co-occurring disorders. COMORBITIY

Answer 7

Two or more disorders occurring in the same person at the same time with potential interactions and exacerbation of symptoms. Can be SUD or Psychiatric Disorders from DSM-5

Question 8

Codependence

Answer 8

Cluster of behaviors
client id’s self-worth in terms of caring for others to the exclusion of their own needs
nursing attracts people who are codependent (care for people’s fundamental needs)

Question 9

COMMORBIDITY

ETOH affects _____

Answer 9

Liver, 
esophageal varies
gastritis
CA
Whole body
nutrition
ecteric
edema from cirrhosis/ascites

Question 10

COMORBITITY

name two types

Answer 10

Psychiatric 6/10 that have SUD also affected by mental health d/0

Medical (most common ETOH)

Question 11

COMORBITIY

Answer 11

Having more than two disorders at the same time.

Question 12

Drug Schedules

Answer 12

I - high potential for abuse, no acceptable medical use (heroin, LSD)
II - high potential for abuse, dangerous, by RX only, methadone, meperidine (demerol) and methylphenidate (ritalin)
III - low to moderate potential for abuse, by RX only, testosterone, acetaminophen/Codeine/Tylenol with codeine, buprenorphine (Suboxone)
IV - low-risk for abuse, by RX only, alprazolam (Xanax), lorazepam (ativan), propoxyphene/acetaminophen (darvocet)
V - contain limited amount of narcotics for treatment of diarrhea, coughing, and pain. atropine/diphenoxylate (lomotil), guaifenesin and codeine (robitussin AC), and pregabalin (Lyrica), available over the counter.

Question 13

Substance abuse + Substance disorder =

Answer 13

Substance Use Disorder (SUD). DSM-5

Question 14

FLASHBACKS

Answer 14

Transitory recurrences of perceptual disturbance caused by a person’s earlier hallucinogenic drug use when they are in a drug free state.

Examples
visual
time expansions
loss of ego boundaries
intense emotions
mild/pleasant to frightening images or thoughts.

Question 15

Fragmented Care Began To Change in 20__

Answer 15

2001
with federal initiative to address mental health and SUD treatment systems
-cross training of mental health professionals
-integrated screenings
-early intervention

Question 16

Fragmented Care Began To Change in 20__

Answer 16

2001
with federal initiative to address mental health and SUD treatment systems
-cross training of mental health professionals
-integrated screenings
-early intervention

Question 17

INTOXICATION

Answer 17

INTOXICATION
when person using a substance to excess.
-under the influence, intoxicated or high
“STATE OF EXPERIENCING ACUTE EFFECTS OF A SUBSTANCE” -NG

may be different terms -alcohol - drunk. Weed -high, stoned

Question 18

ADDICTIONS IN USA

what is the most common

Answer 18

ALCOHOL

Question 19

TOLERANCE
with RX meds
Considered abuse for addiction?
what drugs?

Answer 19

No
Antidepressants
beta-blockers
Analgesics
anti-anxiety meds

Question 20

Substance Use Disorders (SUD’s) are represented by three actions-

Answer 20

CRAVING

SEEKING

USING (regardless of consequences)

Question 21

Substance Use Disorder

Answer 21

Pathological use of a substance that leads to a disorder of use, intoxication, and often withdrawal if the substance is taken away.

Can be swallowed, injected, rectal, IV, smoke, skin pop, or inhaled.
From caffeine to LSD

Question 22

SUD - continuous can do what to the brain structure?

Answer 22

Actual change to the Brain structure and to
the function of the limbic (reward and pleasure) system

Mood disorder and self medicated - SUD
Drugs and then mood disorders - SUD

Question 23

SUD

How long to have brain chemistry revert back with some drugs?

Answer 23

Up to 5 years.

Question 24

SYNERGISTIC EFFECT of DRUGS

Answer 24

When drugs are taken together, the effect of either or both is intensified or prolonged

IE ETOH with BZO’s

Question 25

TOLERANCE

Answer 25

SUD experience TOLERANCE to effects of the substance. They need a higher dose to achieve the same response as initially. Or the same amount over time is decreased effect

Question 26

Tolerance | What drug increases tolerance RAPIDLY?

Answer 26

Cocaine

Question 27

What % of adults in USA during the year will abuse alcohol? | What % will be alcohol dependent>

Answer 27

5% Abuse | 4% Dependent

Question 28

What question do you ask a SUD

Answer 28

What do they use? How do they use it? This is important. Withdrawal need to know. What amount? When did they last use?

Question 29

TOLERANCE | What drug is a slow tolerance?

Answer 29

prescription pain meds

Question 30

WITHDRAWAL

Answer 30

Physiological and or psychological symptoms when substance is stopped. Blood and tissue concentrations decrease after heavy and prolonged use of substance. Specific to the drug, can be mild or life-threatening. the more intense the symptoms, more likely to use again

Question 31

Withdrawal to behavioral addictions | symptoms

Answer 31

``` cravings sleep disruption anxiety depression ie gambling ```

Question 32

Alcohol

Answer 32

Most common drug of abuse in USA Greatest danger for withdrawal - Seizures Deliriums fatality NEED to find out when they last drank and how much?

Question 33

ANTABUSE (Disulfiram)

Answer 33

Used with motivated patients to remain sober. Take daily. Only w patient consent. RX if have any alcohol Handsanitizer

Question 34

CNS Stimulants | signs

Answer 34

``` Pupils dilated oronasal cavity - dry HR - tachycardia N and V insomnia excessive motor activity Cardiac problems prev - ER ```

Question 35

Cocaine and crack | how long does it last?

Answer 35

4-6 seconds will feel it | lasts 5-7 minutes

Question 36

Crack Cocaine | Withdrawal

Answer 36

``` Depression Paranoia Suicide Lethargy Anxiety Insomnia Nausea and Vomiting Sweat and Chills ```

Question 37

OPIATES | list

Answer 37

``` Morphine Heroin Codeine Fentanyl Methadone Meperidine (Demerol HCL) ```

Question 38

Opiates | What do they affect?

Answer 38

CNS and ANS

Question 39

Opiates | medical use

Answer 39

analgesic - pain killer may be RX Ask when, what, how, know what does under the influence look like and know what withdrawal looks like

Question 40

Opiates | most common?

Answer 40

Heroin

Question 41

Opiates | Withdrawal

Answer 41

``` Yawning Irritability Runny nose rhinorrhea panic Diaphoresis Cramps N and V Muscle aches - bone pain Fever, Chills Lacrimation (teary) Diarrhea Like a very bad FLU not life threatening ```

Question 42

OPIATES | INtoxication

Answer 42

``` Pupils - constricted RR - decreased BP - decreased Drowsy Slurred speech Psychomotor retardation initial euphoria followed by dysphoria and impairment of attention, judgement and memory ```

Question 43

OPTIATES | OD

Answer 43

``` pupils - dilations RR depression or arrest coma shock convulsions death ```

Question 44

Opiates | OD treatment

Answer 44

Narcotic antagonist naloxone narcan reverses depression of CNS

Question 45

OPIATE | withdrawal treatment

Answer 45

Methadone tapering Clonidine Naltrexone Buprenorphine

Question 46

Behavior Addictions

Answer 46

``` Gambling Internet gaming Use of social media shopping Sexual activity ```

Question 47

TRIGGER THOUGHT CRAVING USING | Treatment

Answer 47

stop before the craving

Question 48

Marijuana (Cannabis sativa) Indian hemp plant What is the active ingredient?`

Answer 48

Tetrahydrocannabinol (THC)

Question 49

Marijuana | category

Answer 49

Depressant | hallucenogen

Question 50

Marijuana | how is it used?

Answer 50

Smoked ingested. baked oils

Question 51

Marijuana | desired effects?

Answer 51

euphoria detachment relaxation medical use

Question 52

Marijuana | long term effects

Answer 52

lethargy anhedonia difficulty concentrating loss of memory

Question 53

Marijuana | intoxication symptoms

Answer 53

``` giddy tired red eyes increase appetite cotton mouth giggly ```

Question 54

Marijuana | withdrawal symptoms and overdose symptoms

Answer 54

Rarely OD and withdrawal | symptoms - cravings

Question 55

Marijuana | Indications for Medical use

Answer 55

Chemo - control nausea glaucoma - reduce intraocular pressure AIDS wasting syndrome - stimulates appetite many more

Question 56

Hallucinogens | name 4

Answer 56

LSD lysergic acid diethylamide Mescaline - peyote - cactus Psilocybin - magic mushrooms Phencyclidine piperidine - PCP, angel dust, horse tranquilizer, peace pill religions rites by native americans

Question 57

Hallucinogens | Intoxication symptoms

Answer 57

psychotic hallucinations - auditory, tactile bad trip - paranoia - can be at risk for danger, PCP - very aggressive, super human powers.

Question 58

PCP | onset

Answer 58

Ingested - 1 hour | Intranasal or inhaled (smoked) - 5 minutes

Question 59

PCP | intoxication signs

Answer 59

acute anxiety to acute psychosis

Question 60

PCP | chronic use.

Answer 60

``` Dulled thinking Poor memory Lethargy Poor impulse control Depression ```

Question 61

Inhalants | % of adolescents in USA

Answer 61

19%

Question 62

Inhalants | what are they?

Answer 62

``` spray paint glue cigarette lighter fluid propellant gases used in aerosols dust offfuels early marker for SAD long island - heroin ```

Question 63

Inhalants | harmful effects

Answer 63

``` permanent brain damage hearing loss nose bleeds loss of smell suffocation sudden death irregular HR, Heart attack, death N and V Kidney and Liver damage Muscle weakness and cramping abdominal pain involuntary passing of urine and feces bone marrow depression could be a co-occuring disorder cmp fbs, cbc nutrition ```

Question 64

Inhalants | neuropathy treatment

Answer 64

gapapentin | B12

Question 65

Inhalants Organic solvents symptoms

Answer 65

``` alchohol-like effects eurphoria impaired judgement slurred speech flushing CNS depression Visual hallucinations and disorientation ```

Question 66

Inhalants | VOLATILE NITRATES

Answer 66

Room deodorizers | other products

Question 67

Inhalants Gas esp nitrous oxide intoxication

Answer 67

giggling laughter euphoria

Question 68

Date Rape Drugs | name 2

Answer 68

Flunitrazepam = Rohypnol - roofie | Gamma hydroxybutyric acid - GHB

Question 69

Date Rape Drugs | intoxication symptoms

Answer 69

disinhibition relaxation of voluntary muscle lasting anterograde amnesia - blank slate that period of time when under the influence

Question 70

Self-Assessment

Answer 70

examine your own attitudes attend to personal feelings that arise

Question 71

Chemically Impaired Nurse what % abuse ETOH or drugs ___ What % have a serious problem that interferes with safe care

Answer 71

10% | 6%

Question 72

Chemically Impaired Nurse what % abuse ETOH or drugs ___ What % have a serious problem that interferes with safe care

Answer 72

10% | 6%

Question 73

Chemically Impaired Nurse | warming signs

Answer 73

Offering to go in to medicate patients with opiods If your patients meds not effective after break - hyped up sedated frequent absences, excues

Question 74

Chemically impaired Nurse | responsiblity

Answer 74

must report

Question 75

Chemically Impaired- Substance abuse | Assessments

Answer 75

Assessments- ``` withdrawal overdose suicidal or self-destructive behaviors physical complications explore interest in treatment knowledge of community resources ```

Question 76

Nursing DX | SAD Symptoms: V/ diarr., poor nutrition and fluid intake

Answer 76

Imbalanced nutrition, less than body requirements

Question 77

Nursing DX | SAD Symptoms: Halluc. impaired judgement, memory deficits, cog. impairments

Answer 77

disturbed/impaired thought process

Question 78

Nursing DX | SAD Symptoms: changes in sleep/wake, interference with stage 4 sleep, inability to sleep or long sleep periods

Answer 78

disturbed sleep patterns

Question 79

Treatment Goal for SUD

Answer 79

abstinence 12 step one day at a time relapse - no shame happy you are back for help

Question 80

Treatment SUD | CONSIDERATIONS

Answer 80

Social status, income, ethnic background, gender, age, culture SUD history current condition

Question 81

Treatment | Goals

Answer 81

self-responsibility | need to match patient with treatment

Question 82

Treatment | relapse prevention

Answer 82

``` self-help groups patient and familyl sponsor residential programs outpatient intensive outpatient employee assistance ```

Question 83

Alcoholism | Pharmacological interventions

Answer 83

Naltrexone (ReVia) - reduces or eliminates alcohol craving Acamprosate (Campral) -Helps client abstain from alcohol Topiramate (Topamax) - Works to decrease alcohol cravings Disulfiram (Antabuse) Alcohol-disulfiram reaction causes unpleasant physical effects MUST CONSENT, MUST KNOW SYMPTOMS, CANNOT BREAK DOWN ETOH, WILL keep very sick if ingest any ETOH, BAD Rx. Stays in system for 2 weeks. Repeat offenders remaining sober.

Question 84

OPIOID ADDICTION | Pharm Treatments

Answer 84

*Methadone (Dolophine) Synthetic opiate blocks craving for and effects of heroin LAAM (l-α-acetylmethadol) An alternative to methadone. Not commonly used. *Naltrexone (ReVia) Antagonist that blocks euphoric effects of opioids *Clonidine (Catapres) Effective somatic treatment when combined with naltrexone *Buprenorphine (Subutex) Blocks signs and symptoms of opioid withdrawal

Question 85

OPIOID | evaluation

Answer 85

Increased time in abstinence. cravings? meeting? Decreased denial - starting to own their cravings? Acceptable occupational functioning - are they back to work, training? Improved family relationships? Ability to relate comfortably to other individuals

Question 85

OPIOID | evaluation

Answer 85

Increased time in abstinence. cravings? meeting? Decreased denial - starting to own their cravings? Acceptable occupational functioning - are they back to work, training? Improved family relationships? Ability to relate comfortably to other individuals? assess anxiety, depression

Question 86

12 step program

Answer 86

``` Effective AA, alcohol NA, narcotics CA, cocaine SA, sex anon. GA gambling anon. OA overeaters Al-Anon Al-Ateen- families ```

Question 87

Residential Programs

Answer 87

for individual who have a long history of antisocial behaviors, or other..lack housing effects lifestyle change According to the AA glossary, the phrase “Stinking Thinking” refers to an alcoholic's reversion to old thought patterns and attitudes. Stinking thinking may include, blaming others, alcoholic grandiosity, fault-finding, self-centeredness, and skipping meetings.

Question 88

Outpatient Drug Free Programs | Employee Assistance Programs (EAP)

Answer 88

EAP: provide the delivery of MG services in occupational settings. Many hospitals and corporations offer their employees counseling and support as an alternative to job termination when the employee’s work performance is negatively affected by impairment.