substance use disorder & withdrawal Flashcards
(11 cards)
SCIENCE OF ADDICTION/SUBSTANCE USE DISORDER
addiction is a ____ known as ____: affected by both ____ & ___ factors
- brain & behavior
rewarding effects of drugs come from large and rapid surges of _____.
- ___ regular pleasure response, but ____ exceeds it
- lots of these dopamine surges ____ normal dopamine pathways, and ___ normal brain pathways
addiction is associated with issues in the _____.
addiction is a DISEASE known as SUBSTANCE USE DISORDER: affected by both BIOLOGICAL & ENVIRONMENTAL factors
rewarding effects of drugs come from large and rapid surges of DOPAMINE.
- MIMICS regular pleasure response, but GREATLY exceeds it
- lots of these dopamine surges DISTURB normal dopamine pathways, and DISTURB normal brain pathways.
addiction is associated with issues in the PREFRONTAL CORTEX
SUD
risk factors:
protective factors:
risk factors:
- aggressive behavior in childhood
- lack of parental supervision
- poor social skills
- drug experimentation
- availability of drugs at school
- community poverty
protective factors:
- good self control
- parental monitoring and support
- positive relationships
- good grades
- school anti-drug policies
- neighborhood resources
TREATMENT OF SUD
therapy is ____
CBT
contingency management
motivation enhancement therapy
fam therapy
12-step facilitation programs
treatment must address the _____
therapy is CRUCIAL
contingency management: positive reinforcement
motivation enhancement therapy: strategies to make most of ppl readiness to change
fam therapy: esp good for young ppl
treatment must address the WHOLE PERSON
TREATMENT OF SUD CONT
medically assisted detoxification is just the _____.
- ____ way to manage the acute withdrawal symptoms associated with SUDs
treatment programs need to test pt for ____ of other diseases associated with SUD:
medically assisted detoxification is just the FIRST STEP
- SAFEST way to manage the acute withdrawal symptoms associated with SUDs
treatment programs need to test pt for PRESENCE of other diseases associated with SUD: HIV/AIDS, Hep B&C, TB, endocarditis
METHADONE
used as _____
- ___ symptoms of withdrawal r/t opioid use.
MOA:
SE:
has been proven to help ppl addicted to opioids ______.
pt can be addicted to this med and it can be abused but potential is ____.
traditionally get a dose once daily:
used as MEDICATION ASSISTED TREATMENT
- REDUCES symptoms of withdrawal r/ opioid use.
MOA: synthetic opioids analgesic, mu agonist
SE: lightheaded, hives, chest pain, tachycardia, hallucinations, confusion
has been proven to help ppl addicted to opioids AVOID USE OF OPIOIDS.
pt can be addicted to this med and it can be abused but potential is LOWER
traditionally get a dose once daily: methadone clinic
BUPRENORPHINE & NALOXONE
buprenorphine MOA:
- can be used as ___ treatment
naloxone MOA:
combination of the two helps pt ____ from addiction.
SE:
potential for ___, but ___ than methadone & buprenorphine
route:
buprenorphine MOA: partial opioid agonist, helps block receptors to prevent craving
- can be used as A STAND ALONE treatment
naloxone MOA: opioid antagonist, blocks opioid receptors
combination of the two helps pt RECOVER MORE QUICKLY from addiction
SE: h/a, opioid withdrawal symptoms, anxiety, insomnia, sweating, depression, constipation, nausea
potential for ABUSE, but LOWER than methadone & buprenorphine
route: SL & buccal
OPIOID WITHDRAWAL TIMELINE
begin ___ hours following last dose.
lasts ___ days
peak ___ hours
s/s:
supportive treatment and MAT
1 wk:
2 wk:
1 month:
begin 12-24 hours following last dose
lasts 5-10 days
peak at 72 hours
s/s: flu-like symptoms, N/V/D, stomach cramps, goosebumps, depression, drug craving, anxiety, sweating, muscle aches, fever
1 wk: physical symptoms start to lessen
2 wk: psychological and emotional symptoms
1 month: cravings and depression
BENZODIAZEPINE AND ALCOHOL WITHDRAWAL
both act on ____, therefore symptoms are treated the same.
both have dangerous symptoms that can lead to ____.
s/s:
dangerous symptoms:
both act on GABA, therefore the withdrawal symptoms are treated the same.
both have dangerous symptoms that can lead to DEATH.
s/s: sleep disturbances, irritability, nausea, increased tension, weight loss, anxiety, palpitations, panic attacks, anxiety, h/a, muscles aches, sweating, difficulty concentrating, perceptual changes
dangerous symptoms: seizures, hallucinations, delirium tremens, wernicke’s encephalopathy
- wernicke’s encephalopathy:
1. encephalopathy: profound disorientation, indifference, inattention
2. oculomotor dysfunction: nystagmus, lateral rectus palsy, conjugate gaze palsy
2. gait ataxia
- delirium tremens: hallucination, disorientation, tachycardia, HTN, fever, agitation, diaphoresis
BENZODIAZEPINE WITHDRAWAL
commonly abused meds:
withdrawal timeline:
- how long can symptoms last?
signs of abuse:
commonly abused meds: alprozolam, clonazepam, diazepam, lorazepam, zolpidem
withdrawal timeline: starts 1-4 days after last dose, symptoms pack around wk 2
- symptoms can last a few days up to several months or even years if not addressed appropriately
signs of abuse: drowsiness, memory issues, irritability, slower thinking, increased anxiety, muscle weakness, sleeping &. eating pattern changes
ALCOHOL WITHDRAWAL
stage 1:
- s/s:
stage 2:
- s/s:
stage 3:
- s/s:
if not treated:
stage 1: 8 hours from last drink
- s/s: anxiety, insomnia, nausea, abdominal pain
stage 2: 1-3 days
- s/s: high BP, increased body temp
stage 3: 1 wk
- s/s: hallucinations, fever, seizures, and agitation
if not treated: up to wks
ALCOHOL & BENZO WITHDRAWAL TREATMENT
both treated the same way with ______.
- help prevent _____ & DT severity
12-step recommendation and therapy is recommended
those with alcohol withdrawal also require ______ supplementation, esp. _____ (______).
- this is due to decreased ______ of vitamins from long-term stomach inflammation from alcohol consumption.
from 0-2 wk symptoms:
from 1-2 wk symptoms:
from 2-4 wk symptoms:
both treated the same way with BENZODIAZEPINE TAPER.
- help prevent SEIZURES and DT severity
12-step recommendation and therapy is recommended
those with alcohol withdrawal also require VITAMIN supplementation, esp. B12 (THIAMINE)
- this is due to decreased ABSORPTION of vitamins from long term stomach inflammation from alcohol consumption.
from 0-2 wk symptoms: seizures, hallucinations
from 1-2 wk symptoms: coarse tremor, agitation, confusion, h/a, N/V, ANS hyperactivity
from 2-4 wk symptoms: delirium tremens (DT)
