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Flashcards in chemical dependency Deck (96):
1

dependence

state in which normal function only occurs in the presence of a drug; manifested as physical disturbance when drug is removed (withdrawal)

2

biological theory of addiction

specific effects on selected neurotransmitters

DOPAMINE especially!

3

psychological theory of addiction

defense mechanism against anxious impulses; self-medication for depression and other chronic stressors

4

behavioral theory of addiction

positive reinforcement

5

sociocultural theory of addiction

social and cultural norms; socioeconomic stress

6

abuse

pattern of use that results in negative consequences
- inability to fulfill role expectations
- participation in hazardous activities while impaired
- recurring legal, personal problems
- continued use despite problems

7

dopamine significance in addiction

regulates pleasure and pain, plays a major role in all addictions

8

psychological dependence

SUBJECTIVE experience of need for drug to experience "normal" functioning

ALL drugs/events that are mood altering have potential for psychological dependence.

9

physical dependence

an event occurs when TOLERANCE DEVELOPS in response to use of a psychoactive substance and upon cessation results in WITHDRAWAL sequela

10

tolerance

greatly increased amounts of substance needed to achieve intoxication or desired effect

11

withdrawal

SUBSTANCE SPECIFIC SYNDROME that follows cessation or reduction in intake of a psychoactive drug on which an individual is physiologically dependent

12

polysubstance abuse

abuse of more than one substance at a time

13

dual diagnosis

coexistence of major psychiatric disorder and substance related disorder (at least 50% addictions w/ mental illness)

14

chemical dependence phase I: prodromal

- increase of tolerance
- temporary loss of memory
- sneaking chemical(s)
- preoccupation with use of chemical
- avoidance of reference to personal use

more frequent loss of memory --> phase II

15

chemical dependence phase II: crucial (basic)

- loss of control, morning use of chemical(s), change in use pattern, periodic abstinence
- alibis and excuses, protecting supply
- reproof by significant others, loss of friendships, position
- extravagance, escape
- aggression, resentment, persistent remorse

16

chemical dependence phase III: chronic

- more or less continuous use
- ethical deterioration
- inconsistent, inappropriate thinking
- indefinable fears
- tremors, psychomotor inhibitions

- decrease of tolerance if ALCOHOL

17

common personality traits of chemically impaired

- avoidance: emotional, physical
- grandiosity
- impulsiveness: craving/anxiety = act without thinking
- manipulation: rationalizing, intellectualizing, projecting, excuses

18

associated personal factors of chemically impaired people

- decreased tolerance for frustration
- risk taking
- low self-esteem, lack of success and meaningful relationships

can be good at appearing fine outwardly

19

cardinal symptom/most common defense mechanism*

DENIAL!*

20

family roles: codependence

dysfunctional behavioral patterns characterized by excessive focus on emotional, social, physical needs of another

21

codependent person: characteristics

- develops unhealthy pattern of relating to others
- low self-esteem, willingness to suffer
- needs to be needed
- strong urge to change, control others

codependent needs treatment if addict gets treatment or role will be screwed up

22

family roles: hero

exceeds at whatever he/she does to avoid dysfunctional feelings through the praise of others

23

family roles: mascot/clown

makes everything all right through humor and showing off

24

family roles: scapegoat

gets into trouble, takes focus off dysfunction in the family by bringing it onto him/herself

25

family roles: lost child

avoid family turmoil by being so quiet he/she is never noticed

26

alcoholism

primary, chronic disease with genetic psychosocial and environmental factors influencing its development and manifestations
- often progressive, fatal
- affects dopamine in brain enough to force adaptation because not working correctly

27

alcoholism: characteristics*

- impaired control over drinking
- preoccupation with alcohol
- use despite adverse consequences
- distortions in thinking; DENIAL*

28

alcoholism: specific s/s

- gulping drinks
- drinks alone
- use as medicine
- blackout
- non-premeditated use

29

alcohol pharmacokinetics: absorption

20% stomach
80% small intestine

30

alcohol pharmacokinetics: distribution

all tissues and body fluids

31

alcohol pharmacokinetics: metabolism

PRIMARILY LIVER 90%
- consistent rate of metabolism

32

blood alcohol level

can be used to assess level of intoxication and level of tolerance
- as tolerance develops, discrepancy seen between BAL and expected behavior

33

ascites

?

34

alcohol withdrawal

early signs a few hours after decreasing alcohol (depends on how dependent and how much used)

signs peak after 24-48 hours then rapidly disappear

35

alcohol withdrawal: s/s

- hyperalertness
- jerky movements
- irritability
- easily startled
- "shaking inside"

36

delirium tremens

aka DT aka alcohol withdrawal delirium
- medical emergency that can result in death
- delirium peaks at 2-3 days after cessation, lasts 2-3 days

37

delirium tremens: s/s

- tachycardia, diaphoresis, elevated bp
- disorientation, clouding of consciousness
- visual, tactile hallucinations
- hyperexcitability through lethargy (extremes)
- paranoid delusions, agitation
- fever (100 - 103F)
- SEIZURES!

38

red flag of possible alcohol withdrawal

tactile hallucinations (not frequently seen in psychotic disorders!)

39

delirium tremens: pharm intervention

PRIORITY: long acting benzodiazepine
- thiamine: prevent encephalopathy
- folic acid/multivitamins: correct deficiencies
- magnesium sulfate: reduce seizures
- anticonvulsants: control seizures

40

delirium tremens: thiamine

prevent encephalopathy

41

delirium tremens: folic acid/multivitamins

correct deficiencies

42

delirium tremens: mag sulfate

reduce seizures

43

delirium tremens: anticonvolsants

control seizures

44

delirium tremens: benzodiazepine

long acting; PRIORITY!

act on the benzodiazepine-GABA-chloride receptor complex, having a similar GABA-potentiating effect as alcohol

45

cocaine/stimulant abuse: health issues

- extreme weight loss
- malnutrition
- myocardial infarction
- stroke

46

intravenous drug use: health issues

infections, sclerosing of veins

47

intranasal drug use: health issues

sinusitis, perforated nasal septum

48

smoking substance: health issues

respiratory issues

49

cns depressants: intoxication s/s

- euphoria
- sedation, unsteadiness
- decreased: bp, hr, rr
- cognitive decline
- BARBS: cardiac, respiratory depression

50

cns depressants: abrupt withdrawal s/s

seizures, coma, death
taking patient off benzo? WEAN

51

taking patient off benzo?

WEAN!!!!

52

cns depressants: withdrawal s/s

- n, v
- tachycardia
- tremors
- pupil dilation
- severe insomnia

53

pupil dilation cardinal sign of

cns depressant withdrawal

54

cns depressant: therapeutic management of withdrawal

titrate with similar drug

55

cns depressant: therapeutic management of overdose

- induce vomiting, activated charcoal
- gastric lavage
- fluid support
- seizure precautions

56

stimulants: intoxication s/s

- restless, agitated, anxious, increased vital signs
- paranoia
- absence of appetite

57

stimulants: overdose s/s

myocardial infarction, stroke, collapse

58

stimulants: withdrawal s/s

DEPRESSION, suicide, paranoia, n/v

59

stimulant: therapeutic management of withdrawal

- antidepressant
- dopamine agonist

60

stimulant: therapeutic management of overdose

- treat sx
- maintain body systems

61

opioid drugs: common effects

- euphoria
- relaxed
- lethargic
- pupil CONSTRICTION

62

pupil constriction cardinal sign of

opioid drug use!

63

opioid drugs: intoxication effects

depressed vital signs, lethargy, coma leading to death

64

opioid drugs: withdrawal s/s*

U N C O M F O R T A B L E!!!!!!!*
- n, d, muscle cramps
- chills
- runny nose/eyes

65

opioid drugs: therapeutic management of withdrawal

tapering, substitution

66

opioid drugs: therapeutic management of overdose

narcotic antagonist (naloxone/Narcan)

67

hallucinogens: common effects

- altered thoughts, perceptions
- diverse effects
- intense, profound mood swings

68

hallucinogens: toxic effects

- acute panic reactions
- "flashbacks"

69

hallucinogens: therapeutic management of toxic effects

- decrease stimuli
- LSD: no pharm
- PCP: Haldol and/or Valium

70

marijuana: physiological effect

cns depressant, also has hallucinogenic properties

71

opioids: physiological effect

suppresses cns

72

hallucinogens: physiological effect

inactivates some 5HT receptor sites and decreases GABA, which permits increased dopamine activity resulting in altered thoughts, perceptions

73

marijuana: common/toxic effects

- euphoria
- time distortion
- increased appetite
- dry mouth, red eyes
- may cause anxiety reactions

long term: memory loss

74

caffeine: physiological effect/withdrawal

cns stimulant
- withdrawal: severe ha, irritability

75

nicotine: physiological effect/withdrawal

cns stimulant of ne (nicotinic receptors)
- withdrawal: ha, anxiety, irritability

76

inhalants: physiological effect

cns depressant
- prolonged use: toxic to brain

77

steroids: mechanism & psych effect

alter genetic material to produce new proteins
- psych: psychotic symptoms

78

therapeutic management of chemically impaired individual

- acute treatment
- rehabilitation
- group treatment

79

alcoholism: cns early effects

cns depression!: decreased inhibitions, judgment, memory, concentration, self-control

80

alcoholism: cardiac early effects

increased hr, hypotension (common), hypertension, cutaneous dilation

81

alcoholism: respiratory early effects

aspiration risk

82

alcoholism: renal early effects

diuretic (inhibits adh)

83

alcoholism: gi early effects

stimulates acid secretion, production; mucosal irritation

84

alcoholism: pancreas early effects

epigastric pain, vomiting

85

alcoholism: hepatic early effects

accumulation of fat, protein in liver

86

alcoholism: hematological early effects

decreased wbc and platelet production, anemia, increase infection risk

87

alcoholism: sexual early effects

decreased capacity for responsiveness, menstrual cycle changes

88

alcoholism: cns late effects

seizures, atrophy, wernicke-korsakoff syndrome

89

alcoholism: cardiac late effects

hyperlipidemia + chf, cad, cardiomyopathy

90

alcoholism: respiratory late effects

risk: aspiration, ineffective breathing, ineffective airway

91

alcoholism: gi late effects

gastritis, hemorrhagic ulcer and gi bleeds, nutritional and vitamin deficiency (damaged tract, malabsorption problems)

92

alcoholism: pancreas late effects

pancreatitis, increased activity of enzymes = autodigestion of pancreas tissue

93

alcoholism: hepatic late effects

vitamin b depletion, coagulation problems, necrosis, cirrhosis + associated secondary illnesses*, liver failure

*esophageal varices, portal hypertension, ascites, hepatic encephalopathy, hepatic coma

94

alcoholism: hematological late effects

bone marrow depression, prolonged clotting (decrease in bile synthesis prevents absorption of fat soluble vitamins -> lack of vitamin K = insufficient clotting factors0

95

alcoholism: sexual late effects

impotence, impaired fertility, sterility, gynecomastia

96

wernicke-korsakoff syndrome

wernicke encephalopathy (damage to thalamus, hypothalamus) + korsakoff psychosis (permanent damage to areas controlling memory)

brain damage caused by a lack of vitamin B1 (common in alcoholics)