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Module 6 (Psych Mental Health) > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

Know mainly alcohol, opioids, and stimulants (193 cards)

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1
Q

Substance Use Disorder is a

A

cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems
use even though it causes the problems knowingly

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2
Q

Addiction –

A

chronic relapsing long lasting changes to the brain

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3
Q

Flashbacks –

A

drug free state, experiencing disturbances (hallucinations)

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4
Q

Tolerance –

A

reaction decrease with continued use (take more to see the same result)

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5
Q

Amotivational syndrome –

A

apathy with no motivation to do ADLs or societal role

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6
Q

Cross-tolerance

A

– one substance is also tolerance to another substance (morphine and other opioids)

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7
Q

Psychological dependence –

A

need for the drug subjectively and emotionally

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8
Q

Physical dependence

A
  • no physical substance with no longer using the substance
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9
Q

Withdrawal –

A

psychological and physical dependence

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10
Q

Dual diagnosis –

A

substance use and other psych disorder as well

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11
Q

Goals for Substance Use Disorder Treatment

A

recognition of acute toxicity
facilitate of withdrawa
dx and tx medical complications of substance use
edu/counseling/therapy to sustain sobriety and long-term abstinence

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12
Q

10 categories of substances for abuse

A

caffeine
alcohol
nicotine
cannabis
dsedatives/hynotics/anxiolytics
opioids
stimulants
hallucinations
inhalants
**nutmeg and K2 and cough syrup

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13
Q

Substances have different types of reactions after taking a substance including

A

intoxication
toxicity
withdrawal

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14
Q

Abuse

A

Habitual use of a substance which falls outside of medical necessity or societal acceptance
Used solely for the purpose of altering mood, emotion or state of consciousness

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15
Q

Addiction

A

Chronic/relapsing disease
Compulsive substance-seeking behaviors motivated by cravings, despite harmful consequences
Long-lasting changes in the brain.
May include development of tolerance and withdrawal symptoms

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16
Q

SUD criteria

A

large amounts for a long period than intended
1+ unsuccessful to cut down or control use
time dedicated to obtain/use/recover
craving
failure to fulfill obligations (ADL or work)
persistent social problems
activities are neg. affected
continued use despite problems
hazardous situations in driving
tolerance

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17
Q

Tolerance of SUD

A

increased amounts to achieve intoxication/desired effect
diminished effects with continued use of the same amount

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18
Q

Withdrawal is manifested by

A

same substance taken to relieve or avoid withdrawal s/s

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19
Q

Mild SUD has how many criteria

A

2-3

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20
Q

Moderate SUD has how many criteria

A

4-5

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21
Q

Severe SUD has how many crieria

A

6+

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22
Q

Psychological risk factors for SUD

A

low frustration levels
poor impulse control
lack of meaningful relationships
childhood trauma
low self esteem
propensity for risk taking behaviors

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23
Q

Social risk factors for SUD

A

peer influences
family acceptance

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24
Q

Which gender has a greater risk for SUD

A

MALES

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25
Patho of SUD
Brain reward system (reinforcement of behaviors and memories) neurotransitters not effective - double the amount of dopamine and floods the brain and neurotransmitters
26
Route Complications for SUD IM/SubQ
scarring lesions abscesses infections
27
Route Complications for SUD IV
infectious venous sclerosis disease tranmission endocarditis - track marks on arms and legs with repeated injections
28
Route Complications for SUD intranasal
Chronic sinusitis Perforated nasal septum
29
Route Complications for SUD smoking
respiratory problems
30
CNS Depressants are
alcohol barbituates bezodiazepines - affect the GABA receptors
31
Barbituates are easier to
overdose
32
Benzodiazepines are extremely
addictive
33
Alcohol Use Disorder - acute patho
binds with GABA/glutamate and dampens them - activate reward circuit - inhibits ADH (diuretic)
34
How much alcohol is too much?
4+ for men in 1 day or 14 in one week 3+ for women in 1 day or 7 in one week
35
Can moms drink alcohol and breastfeed at the same time?
no
36
Standard Drink formula
12 oz of beer = 8 oz of malt = 5 oz of wine = 1.5 oz o spirits
37
Life-threatening signs of alcohol poisoning
inability to wake up vomiting slow breathin <8 irregular breathing seizures hypothermia
38
0.05 mg = 1-2 drinks effects
chnages in mood and behavior, impaired judgment
39
0.08 mg = 5-6 drinks effects
legal limit of intoxication -clumbsiness in voluntary activity
40
0.2 mg = 10-12 drinks effects
depressed fucntions staggering and ataxia emotional lability
41
0.3 mg = 15-19 drinks effects
confusion stupor
42
0.4 mg = 20-24 drinks effects
coma
43
0.5 mg = 25-30 drinks effects
death by respiratory depression
44
CIWA evaluates for
N/V Tactile disturbances auditory and visual distrbances anxiety HA/fullness orientation x4 tremor (stick out tongue and move fingers) paroxymal sweats agitation
45
In a CIWA, the nurse should get a BP and apical heart rate for how long
1 minute
46
If the CIWA score is _______ then notify the doctor
>20
47
Alcohol Withdrawal peaks
within 24-48 hours - rapid disappear unless goes to delirium
48
What is possible in 7-48 hours of an alcohol withdrawal
grand mal seizures
49
Alcohol withdrawal s/s
irritable "shaking inside" illusion (misinterpret) early signs in a few hours
50
Delirium Tremens (rapid)
emergency and possible death **peak 2-3 days** after cessation and reduction **autonomic hyperactivity** disturbances fluctuating LOC delusions agitated 100+ temp
51
Autonomic hyperactivity
HTN sweating hyper/hypo thermia
52
The clock starts from the last
drink consumed
53
Acute withdrawal needs to be closely monitored on
BP and heart rate
54
Post-acute withdrawal syndrome episodic
days to weeks - up to 2 years
55
Post-acute withdrawal syndrome s/s
**Mood swings** Anxiety Irritability Tiredness **Variable energy** Low enthusiasm Variable ability to concentrate **Disturbed sleep**
56
Risks for Post-acute withdrawal syndrome
distressing relapsing - brain remodels to regular chemistry
57
Effects of chronic alcohol use
CV damage (cardiomyopathy), liver damage (hepatitis, cirrhosis), erosive gastritis, GI bleed, esophageal varices, ascites, acute pancreatitis, thiamine deficiency, peripheral neuropathy, inc risk of cancer, thrombocytopenia, damage to the brain, dilation of cutaneous blood vessels, hypertension, testicular atrophy, impotence, sterility, & breast enlargement in men
58
Wernicke’s encephalopathy
Inflammatory, hemorrhagic, degenerative condition of the brain - caused by **thiamine deficiency from poor diet** & alcohol-induced suppression of thiamine absorption
59
Wernicke’s encephalopathy tx
- reversed if treated immediately and completely - tx with tyramine and vitamin B
60
Wernicke’s encephalopathy can lead to
Korsakoff’s psychosis
61
Korsakoff’s psychosis is a
irreversible form of amnesia with - short term memory loss - long term memory gaps - inability to learn
62
Korsakoff’s psychosis notable behavior
confusion amnesia
63
Tx for Alcohol Withdrawal
1st Benzo (Lorazepam) - cross tolerance taper Gabapentin (low anxiety and prevent seizures) Propanolol and Clondine (Beta and Alpha blocker) - autonmic and elevate vitals Thiamine - prevent syndrome and correct high output heart failure Folic acid, B12 (anemia and halt peripheral neuropathy)
64
If benzos aren’t effective in alcohol withdrawal, the nurse will
transfer to ICU and give barbituates - phenobarbital
65
Alcohol Withdrawal Sobriety Naltrexone
opioid antagonist - block opioid recpetors with cravings **reduce relapse
66
Alcohol Withdrawal Sobriety Acamprosate (Campral)
reduce symptoms of long-lasting withdrawal insomnia, anxiety
67
Alcohol Withdrawal Sobriety Disulfiram (Antabuse)
Interferes with breakdown of alcohol leading to **unpleasant reactions such as flushing, NV** Stays in system up to 14 days
68
Alcohol Withdrawal Sobriety Gabapentin (Neurontin)
Works on GABA to calm down the brain and mitigate hyper-aroused state Reduces cravings by lowering anxiety, improving sleep
69
With Disulfiram, you should avoid alcohol for
14 days - vanilla and mouthwash
70
Benzodiazepines toxicity s/s
Severe Confusion Drowsiness Lack of coordination/weakness Lightheadedness Memory loss Fainting
71
Benzodiazepines overdose occurs with
ETOH, opiates, TCAs, or CNS depressants
72
Benzodiazepines withdrawal s/s
Body pain Muscle tension Cramping Insomnia Vomiting Tremors Sweating Seizures **miserable**
73
Benzodiazepines reversal agents
Flumazenil
74
Opiates include what types of drugs
Opium (poppy flower latex) Oxycodone Fentanyl Heroin Meperidine Morphine Codeine Methadone Hydromorphone
75
Heroin lipid solublity is
high -easier to enter cells and overdose quicker
76
When Heroin crosses the blood-brain barrier it converts to
active form of morphine
77
Heroin effectiveness IV Internasal
7-8 sec 10-15 sec
78
Lethality comparison
Heroin 30 mg = Fentanyl 3 mg = Carfentanyl 30 mcg
79
Oxycodone is a
controlled release of morphine - chew, crush, snort, inject If tolerance is too high = risk for OD
80
Meperidine effective when taken
orally - w/o obvious isgns of IV drug use
81
Meperidine has minimal effects on
smooth muscles - less constipation and less retention less pupillary constriction
82
Opiates Intoxication s/s
constricted pupils decreased respirations sedation decreased BP slurred speech psychomotor retardation - slow and tight
83
Opiates Toxicity Triad
Pinpoint pupils (to nothing) Respiratory Depression Coma
84
Opiates Overdose can lead to death r/t
Shock Seizures Cardiac arrest
85
Opiates withdrawal s/s
Yawning (continuous) Insomnia Irritability Rhinorrhea, lacrimation Panic Diaphoresis Cramps N/V/D Muscle aches Bone pain Chills/fever Increased BP & HR - speed up and juicy fluid loss
86
Opiate Toxicity Tx
airway mgmt and O2 Naloxone (Narcan) - short acting Nalmefene(Revex) - long acting
87
Naloxone (Narcan)
reverses s/s of opioid OD **precipatate withdrawal s/s short acting - violent reaction at revival shoter half-life than opioid (multiple doses)
88
Nafelmene (Refex)
long acting and longer half-life - precipitate prolonged withdrawal syndrome
89
Opioid Withdrawal time line
Begins 1-12 hours after last use Peaks 3-5 days Lasts 1-4 weeks based on severity
90
Opiate Post-acute withdrawal time frame
Up to 2 years
91
Opiate Post-acute withdrawal
Mood swings Anxiety Depressive symptoms Insomnia
92
Methadone used for opioid withdrawal is
long acting opioid replace substance of abuse **titrate to ease withdrawal s/s**
93
Clonidone (short term)
helps with autonomic s/s (VS)
94
What could occur as a result of an opioid withdrawal that is not addressed by medications?
- DEHYRATION AND HYPERNATREMIA = HEART FAILURE - supportive
95
Opioid **sobriety maintenance**
Methadone - lower cravings and relapses (daily) Buprenorphine (Subutex) - lower cravings and relapses - milder in neonatal Naltrexone - blocks euphoric effects Suboxone - prevents high
96
CNS Stimulants - short acting
Cocaine Crack
97
CNS Stimulants - long acting
Amphetamines Methamphetamines
98
Cocaine patho
increase dopamine and norepinephrine - anethetic and stimulant
99
Cocaine has two forms , what are they?
- cocaine hydrochloride (powder; snorted or uncommonly IV) - cocaine base (aka crack, crystal & rock; smoked aka freebasing – faster the inhale the faster the effects leave)
100
Cocaine is found in
cocoa plant leaves
101
Cocaine Intoxication S/S
**Euphoria** Dilated pupils Elevated BP & HR N/V **Insomnia** – no sleep or hunger **Grand**iosity - genius Impaired judgment
102
Cocaine OD S/S
Respiratory distress Ataxia Hyperpyrexia Convulsions Hemorrhagic stroke Ventricular dysrhythmias MI Coma Death
103
Cocaine Withdrawal S/S
Fatigue, **lethargy, sleepiness** Anxiety, agitation, insomnia Disorientation Apathy **Craving** Depression **Suicidal ideation**
104
Cocaine ADVERSE EFFECTS long term use
atrophy of the nasal mucosa loss of smell injury to lungs (from free-basing)
105
Cocaine use in pregnancy
**Crosses placenta** barrier Can result in: **Early delivery, Smaller head, Decreased birth length Low birth weight** Long term effects may include deficits in: Attention Memory & language development
106
Methamphetamines patho
Increases release of Norepi and dopamine Reduces uptake of Norepi and dopamine
107
Methamphetamines aka
Speed, chalk, ice, meth, crystal, crank, blue, glass, rocket fuel
108
Methamphetamines dissolves in
water and becomes bitter
109
Methamphetamines easy to
manufacture - decongestat
110
Methamphetamines Intoxication short term
**Dialated pupils Increased energy Increased respirations Hyperthermia Euphoria**
111
Methamphetamines Intoxication long term
Paranoia with delusions Hallucinations Anxiety **Potential for violence** - increase physical strength Resemble schizophrenia - tooth infection and kidney liver damage
112
Methamphetamines OD
Respiratory distress Ataxia Hyperpyrexia Convulsions Hemorrhagic stroke Ventricular dysrhythmias MI Coma Death Psych
113
Methamphetamines Withdrawal
Fatigue, lethargy, sleepiness Anxiety, agitation, insomnia Disorientation Apathy Craving Depression Suicidal ideation Very hungry
114
Meth adverse effects for long use
**Parkinsonian symptoms** **Cracked teeth** Skin infections HTN Stroke Angina Dysrhythmias Respiratory damage **Renal and hepatic damage**
115
Meth use in pregnancy
**Preterm birth** Hypertension Placental **abruption** Intrauterine growth restriction **Neonatal death**
116
CNS Stimulant OD Tx
ABCs O2 Benzodiazepines (sedation and prevent seizures) Cooling measures IV antihypertensives
117
CNS Stimulant Withdrawal Tx
excessive lethargy (Modafinil) Agitation and sleeplessness (Diphenhydramine and Trazodone) Minor pain relief Benxodaizepines (sedative)
118
What are the 3 club drugs
Ecstasy (MDMA) - increase serotonin Gamma-hydroxybutrate (GHB) Rohypnol - date rape drug
119
Ecstasy Intoxication S/S
Euphoria **Disinhibition Increased sensuality, empathy, closeness**
120
Ecstacy OD S/S
Hyperthermia Seizures Hypertensive crises Cardiac dysrhythmias **Serotonin syndrome** Neuro effects Confusion Delirium Paranoia Cognitive impairment
121
Ecstasy Withdrawal S/S
Profound depression Confusion Sleep problems Anxiety Cravings
122
Tx for Ecstasy OD
NO ANTIDOTE - Activated Charcoal Comprehensive Chemistry panel Mgmt of symtoms
123
Symptom Mgmt for Ecstasy OD
ABCs and O2 Cooling measures Calm quiet environment Sedation with benzodiazepines
124
Gamma-hydroxybutyrate (GHB) Intoxication
Euphoria Disinhibiton Impaired judgment Feeling drunk Amnesia Loss of control over movement Dizziness Confusion Sedation N/V Respiratory depression **unconscious quickly**
125
Gamma-hydroxybutyrate (GHB) OD
Cheyne-stokes respirations Seizures Slow Breathing Low Heart rate **Low body temperature** Coma Death
126
Gamma-hydroxybutyrate (GHB) Withdrawal
tremors insomnia anxiety
127
Rohypnol AKA roofies Intoxication S/S
Euphoria Disinhibiton Impaired judgment Feeling drunk Amnesia Loss of control over movement Dizziness Confusion Sedation N/V Respiratory depression
128
Rohypnol AKA roofies OD S/S
Cheyne-stokes respirations Seizures Slow Breathing Low Heart rate Low body temperature Coma Death
129
Rohypnol AKA roofies Withdrawal S/S
Seizures Headache Muscle pain Anxiety Delirium
130
RohypnoL is tasteless and
odorless
131
GHB and rohypnol overdose treatment
GHB - no antidote Rohypnol - Flumazenil Activated Charcoal
132
Stymptom Mgmt for GHB and Roofies is
ABC's cooling calm and quiet sedation with benzo
133
Dissocialtive Drugs
Phenylcyclohexyl piperidine (PCP) Ketamine Salvia
134
PCP Intoxication S/S
**Impervious to pain - FEEL NO PAIN** Elevated VS Ataxia **Assaultive** Impulsive Impaired judgment Severe effects Hallucinations Paranoia **Bizarre behavior Regressive or violent behavior Labile emotions** Risk for suicide
135
PCP OD S/S
Psychosis **Hypertensive crisis** Stroke Respiratory arrest Hyperthermia Seizures
136
PCP Tx
Acidify urine safe, quiet environment low, slow, and clear speech **Benzodiazepines and Haldol** Support for hyperthermia, HTN, and respiratory distress
137
PCP is highly
lipid soluble
138
Ketamine Intoxication
floating and out of body experience
139
Ketamine OD
amnesia confusion HTN **Acute respiratory distress**
140
Ketamine Tx
support airway, vents, and inhalation HTN Respiratory distress
141
Salvia Divinorum intoxication
hallucinations dissociation derealization depersonalization
142
HallucinOGENS
LSD - Lysergic acid diethylaminde Peyote - mescaline Mushrooms - psilocybin
143
Hallucnogens Intoxication S/S
Dilated pupils Tachycardia Diaphoresis Palpitations Tremors Discoordination **Elevated VS** **Hallucinations Synesthesia - smelling colors** Fear Paranoia Anxiety Distorted space/time
144
Hallucinogens OD S/S
Psychosis Can trigger other psychiatric disorders
145
Hallucinogens OD Tx
**Low-stimulation environment Safety** Speech Low Clear Slow Medication **Benzodiazepines Haloperidol - hallucinations**
146
Cathinones includes
Bath salts K2 Spice
147
Cathinones Intoxication
Hallucination Dissociation Disinhibition Increased sex-drive **Extreme agitation Combativeness**
148
Cathinones OD
**Excited delirium** Dehydration Rhabdomyolysis Renal failure Chest pain
149
Cathinones Withdrawal
Depression Anxiety Insomnia Paranoia
150
Rhabdomyolysis
damaged muscle tissue releases its proteins and electrolytes into the blood. These substances can damage the heart and kidneys and cause permanent disability or even death.
151
Inhalants
Volittle solvents (Paint thinner, Glues, Gasoline, Nail polish remover, Dry cleaner fluid) Gases (butane, propane, and nitrous oxide) Nitrates (isoamyl and isobutyl) Aerosols (spray paint, keyboard cleaner, cooking oil)
152
Inhalants Intoxication
Slurred speech Disinhibition **Euphoria** Dizziness
153
Inhalants OD
Respiratory arrest Suffocation **Brain damage Liver damage Kidneys damage Dysrhythmia Heart failure** Myelin sheath damage Muscle spasms Tremors Ataxia Hearing loss Coma Death
154
Inhalants Tx
Medical support B12 and folate
155
Teachign points for inhalants
156
Which paint gets you a better high?
sparkling
157
Nicotine
highly addictive toxic abstinence syndrome whne stopped
158
Nicotine Toxicity
**N/V/D** Salivation **Cold sweats** Visual and Auditory disturbance Confusion Syncope Rapid weak pulse **Death r/t respiratory paralysis**
159
Nicotine Withdrawal
Cravings Impaired concentration Nervousness Increased appetite
160
Pharma. Aids in Nicotine Withdrawal
Patches – 8 hours no for acute Gum Lozenges Nasal sprays Inhalers Varenicline (Chantix) Bupropion (Zyban)
161
Cannabis is used for
anxiety fibromyalgia MS Neuropathy seizure disorders glaucoma antiemetic appetite stimulant muscle spasm bronchodilator
162
Pharmacologic Cannabis is
Sativex Dronabinol (Marinol) Nabilone (Cesamet)
163
THC Cannabis is used in what ways
smoked vape edibles (potent and cute for children)
164
Cannabis Intoxication
Euphoria Detachment Relaxation **Increased appetite Talkativeness Slowed perception of time** Sensitivity to stimuli
165
Cannabis OD
Paranoia Anxiety N/V
166
Cannabis for long term use
**Cannabis hyperemesis syndrome**
167
**Cannabis hyperemesis syndrome**
Severe vomiting Abdominal discomfort Acute dehydration Renal failure
168
Assessments for Hx of Substance Use includes
age of first use substance period of sobriety Hx of Tx, withdrawal complications Hx of OD level of insight DO NOT ASK where or who with
169
Medical Hx for SUD
coexisting conditions meds current and medical status current
170
Psychiatric Hx Assessment for SUD
mental state hx of disorders - Rx meds and outcome **Hx of abuse, violence, suicide, violence toward others** - current Suicidal thought
171
Psychosocial Issues Assessment
work relationships role expectations criminal/legal problems support systems lifestyle
172
What labs need to be done for a SUD?
urine drug screen toxicology BAC
173
Psychological Issues - defense mechanisms
denial underreporting minimization ambivalance
174
Denial
clarifying
175
Underreporting
not saying the amount they really had
176
Minimization
not a problematic drug
177
Ambivalance
not able to be sober or afraid to go off the substance
178
Things that negatively affect the care you provide
CHECK YOUR BIASES! - social stigma and prejudices - personal neg experiences - lack of understanding - lack of empathy
179
Relapse is a
symptom of a complex disease - not a sign of weakness - part of the change process - opportunity to learn
180
SUD nursing dx risk for
Injury Dehydration Delirium/confusion Loneliness Suicide
181
SUD nursing dx impaired
Cognition Sleep Self-care Coping Role performance Family coping
182
SUD nursing dx for all drugs
Denial Craving Shame Spiritual distress Anxiety Distorted thinking process Hallucinations Hopelessness/shame Lack of family support
183
Expected Patient Outcomes for SUD
increased insight and accountability coping attend tx , relapse prevention, AA, group therapy identify stress and social habit triggers
184
Relapse prevention
Common symptom Part of the recovery process Identify triggers - **confront triggers and manage cravings - healthy coping strategies**
185
Dual-diagnosis
Equal priority Individualized treatment Small steps over long period of time
186
Relapse prevention strategies starts with
emotional cues mental reponses physical cues
187
Psychotherapy Tx for SUD
Cognitive-behavioral therapy (CBT) Motivational enhanvement therapy (MET) Screening, brief intervention, referral to treatment (SBIRT) Motivational interviewing
188
Recovery Model
Health - overcome/manage disease Home - safe, stable place to live Purpose - conduct meaningful activities Community - support, friendship, and hope
189
AA and 12 steps helps them
Powerlessness over addiction Responsible for recovery Take ownership of problems and feelings Spirituality
190
SMART Recovery helps them
Motivation to abstain Coping with urges Managing self Lifestyle balance - self-management
191
Residential Programs for SUD
Patients with long history of treatment 24/7 drug-free environment Goal Lifestyle change **Abstinence from all medications** Develop social skills Eliminate problem behaviors
192
Outpatient programs for SUD help
Flexible Diverse Cost-effective
193
Evaluation of a SUD patient depends on
length and extent of sobriety adherence to recovery occupational functioning improved family relationships coping skills support systems

Module 6 (Psych Mental Health) (12 decks)

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