SU & medical complications

Question 1

reasons disease is a common complication of SUD

Answer 1

• IV injection
• drugs have pathogens
• contamination of needles
• chronic alcohol and drug use decreases immunity
• malnutrition: an issue in SUD clients
• bacteria such as Neisseria and Streptococcus on needle surfaces
• SUD clients living in close proximity in unclean settings, increasing risk of communicable diseases such as TB

Question 2

bacterial infections seen in intravenous drug abusers

Answer 2

• endocarditis
• Necrotizing fasciitis
• Skin abscesses/Cellulitis

Question 3

what is endocarditis

Answer 3

• When bacteria infect the valves of the heart
• Bacteria normally found on the skin
• Higher in IVDU
• Treatment with ABX

Question 4

what is Necrotizing fasciitis

Answer 4

• Special danger to cocaine users
• An infection in which subcutaneous tissues are attacked by bacteria normally found on the surface of the skin

Question 5

what bacterial infection is a special danger to cocaine users

Answer 5

Necrotizing fasciitis

Question 6

Skin abscesses/Cellulitis

Answer 6

Use of dirty needles, risk of sepsis if not treated with antibiotics.

Question 7

what is pneumonia

Answer 7

Acute infection of the lung tissue, normally caused by bacteria

Question 8

fungal pneumonia

Answer 8

Common complication of HIV infection and of heroin abuse/addiction

Question 9

aspirate pneumonia

Answer 9

strong relationship to alcohol use.

Question 10

Community-acquired pneumonia (CAP)

Answer 10

• 20% with this condition will require hospitalization
• 45,000 die annually
• Pneumovax vaccination
• Poor living conditions
• Higher is clients with co-morbid medical conditions such as diabetes who have poor immune system

Question 11

What is tuberculosis

Answer 11

• Not just a bacterial infection of the lungs
• Other factors:
• • • • Intensity of exposure
• • • • Poor health
• • • • Malnutrition
• • • • SUD

Question 12

How is tuberculosis transmitted, and how does it kill?

Answer 12

• TB kills by invading the pulmonary system and can also infect virtually every organ in the body
• transmitted through droplets via sneezing/coughing
• bacteria can be dormant or become active if immune system low.
• Clients entering treatments centers for SUD need medical clearance for TB

Question 13

symptoms of TB

Answer 13

• productive coughing (mucous, blood)
• dry cough
• poor appetite
• GI symptoms
• SOB,
• chest pain
• flushed face,
• chronic fever
• night swears
• weight loss
• weakness

Question 14

treatment of TB

Answer 14

• Regimens can take as long as 12-24 months
• Lifestyle of typical alcohol/drug abusers often makes treatment compliance for TB very difficult
• Almost 20% of those with Tb also had SUD
• Remains potentially fatal
• Mantoux test- Skin test to assess if exposed to TB
• X-ray and sputum tests to confirm Dx

Question 15

Acquired Immune Deficiency Syndrome (AIDS)

Answer 15

• a constellation of symptoms, most important of which is the destruction of the individual’s immune system
• HIV destroys CD4 cells of immune system
• Person can remain asymptomatic before opportunistic infections appear.

Question 16

How does AIDS kill?

Answer 16

• HIV infects the very cells sent out by the body to destroy typical pathogens
• Can remain asymptomatic for 10+ years
• In 20% of the cases, the development of an opportunistic disease is the first outward sign of HIV infection
• In many cases the individual’s death is the result of one of the opportunistic infections

Question 17

The chain of HIV infection

Answer 17

• Male-to-male sex is most common form of transmission in the US (57% of cases)
• Unprotected heterosexual intercourse is 2nd most common
• Sharing IV needles (40% of IV drug users are infected with HIV)
• Less common is “vertical transmission” infection of baby during childbirth

Question 18

Life expectancy for people with HIV-1 infection

Answer 18

• HIV infected person is thought to lose 10 years of potential life
• Those with HIV and SUD lose approximately 20 years of potential life

Question 19

The treatment of HIV infection

Answer 19

• Nutritional status (IV drug users often have inadequate nutrition)
• Antiviral therapy
  (Slow, but do not eliminate replication of HIV + High cost)

Question 20

AIDS and suicide

Answer 20

Period of greatest risk appears to be the period immediately after the individual learns they are infected

Question 21

RPN role with pt with AIDS

Answer 21

Suicidal risk – assess & provide education on how HIV is not a death sentence

Question 22

How frequentlyshould you repeat an HIV test for patients with substance use disorders?

Answer 22

every 3-6 months

Question 23

what is usually the first type of infection we see in untreated HIV

Answer 23

PCP pneumonia

Question 24

Viral hepatitis “A”

Answer 24

• inflammation of the liver
• hepatitis “A” virus
• 5% of cases thought to involve sharing needles
• 1% of cases develop acute liver failure

-Chronic alcohol use
- Oral fecal transmission
- Vaccine

Question 25

Viral hepatitis "B"

Answer 25

- 100 times as contagious as HIV - Can live on surfaces for up to a week - Transmitted by toothbrush, razor, IV drug use, sexual contact, even kissing - 45-90% of IV drug users are exposed within a year of starting - 90-95%recover completely acute live failure in less than 1% - 20% will develop cirrhosis - Vaccine

Question 26

hepatitis "C"

Answer 26

- 3 million people in the US - 45% attributed to IV drug use - Slowly destroys liver over 20-30 years - Alcohol and/or marijuana users experience increased progression through stages - no vaccine

Question 27

true or false: If an individual is found to have a positive hepatitis C antibody, they are infected with hep C

Answer 27

false it only indicates a previous exposure to hepatitis C.

Question 28

true or false: 15 - 30% of people initially infected with hepatitis C will spontaneously clear the virus within 6 months without any treatment

Answer 28

true

Question 29

true or false: you need a positive hepatitis C antibody test to confirm diagnosis

Answer 29

false - a positive hepatitis C antibody test MUST be followed up with a hepatitis C RNA PCR to confirm active infection. They will be antibody positive for hepatitis C for life, however, this does not provide protection from re-infection with hepatitis.

Question 30

true or false: there is a cure for hep c

Answer 30

true - A cure is possible with the appropriate treatment regimen and all patients are eligible for treatment.

Question 31

true or false: Daily smoking of tobacco or marijuana increases the risk for the development of hepatocellular carcinoma amongst patients with chronic hepatitis C infection

Answer 31

true

Question 32

Signs and Symptoms of Hepatitis

Answer 32

Fever Headache Malaise GI symptoms Dark urine Jaundice Tender liver Increased LFT Self limiting or chronic Complete resolution to chronic state Antibodies detected in blood Fulminant hepatitis (hepatic failure)

Question 33

recommended Vaccinations for SUD clients

Answer 33

- hep A - hep B - influenza - pneumovax 23 - tetanus & diphtheria

Question 34

Syphilis

Answer 34

- Curable bacterial infection - Treponema Pallidum - Painless chancre sore on penis and vagina - VDRL Labs - Teaching/harm reduction - Antibiotic treatments - Cardiac - Ophthalmic - Auditory damage - CNS infections - Regular assessment and screening

Question 35

Gonorrhea

Answer 35

- bacterial infection - Neisseria Gonorrhea - Urethritis and proctitis - Infertility - Treatment with antibiotics - Regular screening through labs and swabs - Center for disease control/Public Health

Question 36

chlamydia

Answer 36

- bacterial infection - Chlamydia Trachomatis - Urethritis and proctitis - Infertility - Treatment with antibiotics - Regular screening through labs and swabs - Center for disease control/Public Health

Question 37

Genital Herpes/Human Papilloma Virus

Answer 37

- Genital herpes type 2 virus - Usually asymptomatic - Antiviral treatments-acyclovir, valtrex - Cervical cancer risk - Transmitted via sex - HPV vaccine-Gardasil