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Psych Exam 2 > Substance Use Disorder > Flashcards

Substance Use Disorder Flashcards

1
Q

predisposing factors for child addiction

A

–genetic
–brain chemistry
–psych factors (stress, impulsive, eating disorders)
–environmental (trauma, substance use)
–starting addictive substance at young age

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2
Q

social components of addiction

A

–social stigma
–environmental
–peer influence
–dysfunctional family dynamics
–abuse hx
–social maladaptation
–family hx of addiction
–peer pressure
–lack of family involvement

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3
Q

psych aspects of addiction

A

–stress
–depression
–low self-esteem
–increased need for success/power
–inability to cope
–anxiety
–loneliness

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4
Q

biological aspects of addiction

A

–genetics
–increased extracellular dopamine
–immature brain development
–acetate
–having another mental health disorder
–being male

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5
Q

cocaine and dopamine

A

stops molecules that usually mop up excess dopamine

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6
Q

amphetamines and dopamine

A

push dopamine out of sacs where it is stored

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7
Q

heroin and dopamine

A

makes dopamine-containing neurons fire more

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8
Q

alcohol and dopamine

A

helps release more dopamine

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9
Q

back of areas of brain are responsible for what?

A

areas of emotion, memory, impulse, psychomotor activity

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10
Q

front areas of brain are responsible for what?

A

areas of executive function, planning, problem solving, judgment, impulse control, organization

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11
Q

difference on brain area between adults and teen decision making

A

adults=frontal cortex
teens=amygdala

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12
Q

what does alcohol break down into?

A

acetate

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13
Q

how is acetate digestion different between addicts and non-addicts?

A

non-addicts: acetate moves through system quickly and exits
addicts: acetate barely processed out so, by staying in the body, it triggers a craving for more acetate, which causes the addict to drink more and more

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14
Q

how does repeated alcohol use lead to tolerance and withdrawal?

A

–fundamental changes in neurotransmitters
–decreased D2 receptors and decreased dopamine release

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15
Q

what does an addicted brain result in?

A

–compulsive behaviors
–decreased inhibitory control
–increased impulsivity
–impaired regulation of intentional action

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16
Q

define addiction

A

a pattern of problematic alcohol use that causes distress and significant impairment

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17
Q

substance intoxication

A

recent overuse/excessive use of a substance, such as an acute alcohol intoxication, that results in a reversible substance-specific syndrome

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18
Q

physiological changes with alcohol intoxication

A

–slurring of speech
–poor coordination
–impaired memory
–stupor
–coma

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19
Q

substance withdrawal

A

symptoms develop when a substance is discontinued abruptly after frequent, heavy, and prolonged substance use

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20
Q

symptoms of substance withdrawal

A

–anxiety
–irritability
–restlessness
–insomnia
–fatigue

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21
Q

symptoms appearing 6-12 hours after alcohol intake

A

–minor withdrawal symptoms
–insomnia
–tremulousness
–mild anxiety
–GI upset
–headache
–diaphoresis
–palpitations
–anorexia

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22
Q

symptoms appearing 12-24 hours after alcohol intake

A

–alcoholic hallucinosis: visual, auditory, or tactile hallucinations

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23
Q

symptoms appearing 24-48 hours after alcohol intake

A

withdrawal seizures: tonic-clonic

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24
Q

symptoms appearing 48-72 hours after alcohol intake

A

–alcohol withdrawal delirium (delirium tremens)

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25
Q

symptoms of delirium tremens

A

–hallucinations
–disorientation
–tachycardia
–hypertension
–low-grade fever
–agitation
–diaphoresis

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26
Q

CIWA components

A

–N/V
–tremors
–anxiety
–agitation
–paroxysmal sweats
–orientation
–tactile disturbance
–auditory disturbance
–visual disturbance
–headache

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27
Q

CIWA score 0-9

A

minimal withdrawal

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28
Q

CIWA score 10-19

A

mild-moderate

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29
Q

CIWA score > 20

A

severe

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30
Q

meds given for CIWA scoring 8-10+

A

–chlordiazepoxide
–diazepam
–lorazepam
–thiamine
–phenobarb
–inderal
–clonidine
–mag sulfate
–MVI
–antipsychotics

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31
Q

when should thiamine be given to withdrawal patients?

A

daily, prior to IV dextrose to prevent Wernicke’s

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32
Q

difference between CIWA and COWS

A

CIWA = alcohol
COWS = opioids

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33
Q

components of COWS

A

–resting pulse rate
–sweating
–restlessness
–pupil size
–bone or joint aches
–runny nose or tearing
–GI upset
–tremor
–yawning
–anxiety or irritability
–goosebumps

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34
Q

COWS score 5-12

A

mild

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35
Q

COWS score 13-24

A

moderate

36
Q

COWS score 25-36

A

moderately severe

37
Q

COWS score > 36

A

severe

38
Q

when should nonpharm measures be implemented on opioid withdrawal patients?

A

BEFORE PRN meds

39
Q

nonpharm interventions for nausea for COWS pt

A

crackers, ginger ale, tea, flat warm coke

40
Q

nonpharm interventions for muscle aches for COWS pt

A

hot showers, warm compresses

41
Q

nonpharm interventions for anxiety reduction for COWS pt

A

distraction, relaxation therapy, talk therapy

42
Q

pharm interventions for nausea in COWS pt

A

–ondansetron
–promethazine

43
Q

pharm interventions for anxiety, lacrimation, rhinorrhea in COWS pt

A

–hydroxyzine
–avoid benzos

44
Q

pharm intervention for insomnia in COWS pt

A

trazadone

45
Q

pharm interventions for aches and pains in COWS pt

A

–tylenol
–nsaids

46
Q

pharm interventions for diarrhea in COWS pt

A

–kaopectate
–avoid loperamide (sedation)

47
Q

medication interventions for substance use disorder

A

–naltrexone
–antabuse
–clonidine
–campral
–methadone/suboxone/subutex

48
Q

methadone and pregnant women

A

–decreases variability of illicit drug use on fetus
–limits exposure to health risk for mom and fetus
–dosage may need to be increased throughout pregnancy
fetus experiences symptoms of withdrawal that may be 2-3x intense as mother’s symptoms

49
Q

action of methadone

A

–full agonist at opioid receptor sites to decrease craving and withdrawal
–lower likelihood of resp. depression
–blocks effects of other opioids

50
Q

tolerance

A

using increasing amounts of a substance over time to achieve the same effect and a markedly diminished effect occurs with continued use

51
Q

etiology of Wernicke’s encephalopathy

A

thiamine (vitamin B1) deficiency that directly interferes with glucose production

52
Q

effect of chronic alcoholism on thiamine absorption

A

chronic alcoholism can decrease intestinal absorption of thiamine by 70%

53
Q

other possible causes of thiamine deficiency

A

–gastric carcinomas
–starvation
–chronic gastritis
–hemodialysis

54
Q

classic symptoms of Wernicke’s

A

–mental confusion
–ataxia
–mental status changes (short and long-term memory)
–ophthalmoplegia

55
Q

ophthalmoplegia

A

paralysis or weakness of one or more of the muscles that control eye movement

56
Q

treatment of Wernicke’s

A

–reversible with thiamine replacement
–improve nutritional status

57
Q

outcomes of Wernicke’s

A

–symptom improvement
–without treatment –> Korsakoff Psychosis

58
Q

Korsakoff Psychosis

A

–NOT REVERSIBLE
–persistent learning and memory problems
–ataxia
–disorientation
–delirium/psychosis
–confabulation
–neuropathy

59
Q

confabulation

A

filling in memory gaps with fabricated or imagined data

60
Q

symptoms of Wernicke-Korsakoff

A

–BP and temp low
–pulse rate elevated
–symptoms may mirror intoxication

61
Q

NIDA principles of treatment

A

–no single treatment is appropriate for all individuals
–readily available
–attend to multiple needs of patient, not just drug use
–multiple courses of treatment may be necessary
–adequate time for treatment

62
Q

environmental/community strategies for SUD prevention

A

–change norms
–reduce access
–limit exposure
–family involvement
–role modeling
–social-emotional development
–access to behavioral health services

63
Q

CAGE questionnaire

A

asks about alcohol

64
Q

CAGE-AID

A

asks about alcohol and drugs

65
Q

“not detected or none detected” on UDS

A

the drug or drugs are not present or are below the established cutoff

66
Q

UDS result timing

A

–shows drug use over last 2-3 days for amphetamines, cocaine, and opiates
–marijuana and metabolites may be detectable for several weeks

67
Q

KY DUI threshold

A

–>0.02 for under 21
–> 0.08 for over 21

68
Q

what BAC level can equal death?

A

0.5 and greater

69
Q

typical symptoms of .08 BAC

A

–poor muscle coordination
–harder to detect danger
–judgment, self control, reasoning, and memory are impaired

70
Q

predictable effects of alcohol on driving

A

–concentration
–short-term memory loss
–speed control
–reduced information processing capability
–impaired perception

71
Q

blackout

A

–not same as syncope
–clients function normally but don’t remember

72
Q

relapse

A

recurrence of alcohol or drug dependent behavior in an individual who has previously achieved and maintained abstinence for a significant time beyond the period of detox

73
Q

dual diagnosis

A

co-occurring mental illness and substance use or addictive disorder

74
Q

signs of denial

A

–refusing
–minimizing
–rationalizing
–intellectualizing
–blaming/projecting
–bargaining
–passivity
–hostility

75
Q

priority care needs for SUD

A

–provide support for decision to stop
–strengthening individual coping skills
–facilitate learning of new ways to reduce anxiety/stress
–promote involvement of significant others in rehab program
–provide info about condition, prognosis, and treatment

75
Q

nursing interventions for SUD

A

–encourage honesty of feelings
–listen to individual
–express caring
–monitor own reactions
–hold individual responsible for behavior
–communicate treatment plan to patient and others on treatment team

75
Q

planning responsibilities for rehab/recovery

A

–promote participation in outpatient support system
–assist client to identify alternative sources of satisfaction
–provide support for health promotion and maintenance

76
Q

planning responsibilities for relapse prevention

A

–recognize the danger signs leading to relapse
–develop a relapse prevention plan

77
Q

components of recovery

A

–hope
–self-responsibility
–setting life goals
–adherence to treatment plan
–improving coping skills
–therapies
–peer support programs
–harm-reduction strategies
–patient specific interventions
–life long commitment

78
Q

components of client/family education for SUD

A

–nature of the illness
–management of the illness
–problem solving skills
–essentials of good nutrition
–relaxation techniques

79
Q

nature of the illness (SUD)

A

–effects of substance on the body
–ways in which use of substances affects life

80
Q

management of the illness (SUD)

A

–activities to substitute for in times of stress
–increase coping skills

81
Q

relaxation techniques (SUD)

A

–progressive relaxation
–tense and relax
–deep breathing
–mindful meditation
–imagery
–yoga

82
Q

definition of evaluation

A

reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care

83
Q

CARA addiction

A

Comprehensive Addiction and Recovery Act of 2016 (Obama)

84
Q

What is CARA?

A

authorizes 181 million each year in new funding to fight addiction, engaging SUD through evidence-based practices (medication assisted and individualized treatment and recovery)

Psych Exam 2 (6 decks)

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