Weeks 14, 15 Flashcards Preview

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Flashcards in Weeks 14, 15 Deck (22):
1

BLOOD ALCOHOL LEVEL

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2

CAGE

    CAGE questions (2 or more positive)

1. Have you ever felt the need to CUT back on your drinking or drug use?

2. Have you ever felt ANNOYED by another’s criticism of your drinking or drug use?

3. Have you ever felt GUILTY about your drinking or drug use?

4. Have you ever had to have an EYE-OPENER in the morning to avoid withdrawal symptoms?

3

ALCOHOL WITHDRAWAL

                Withdrawal

  • “Hangover” is mild form of withdrawal
  • Early signs a few hours after decreasing alcohol
  • Signs peak after 24 to 48 hours then rapidly disappear
  • Signs and symptoms
  • Hyper-alertness
  • Jerky movements
  • Irritability
  • Easily startled
  • "Shaking inside"

4

ALCOHOL WITHDRAWL DELIRIUM

Withdrawal delirium

  • A medical emergency that can result in death
  • Delirium usually peaks at 2 to 3 days (can be 7-9 days) after cessation of alcohol and lasts 2 to 3 days
  • Signs and symptoms:
  • Tachycardia, diaphoresis, elevated blood pressure
  • Disorientation and clouding of consciousness
  • Visual or tactile hallucinations
  • Range from hyper-excitability to lethargy
  • Paranoid delusions, agitation
  • Fever (100° F to 103° F)

5

Medical ComorbidityL

ALCOHOL

  • CNS related
  • Wernicke's encephalopathy
  • Korsakoff's psychosis
  • Gastrointestinal system
  • Esophagitis
  • Gastritis
  • Pancreatitis
  • Alcoholic hepatitis
  • Cirrhosis of the liver

6

Tolerance vs. Withdrawal

    Tolerance

The need for higher and higher doses to achieve the desired effect
            

    Withdrawal

After a long period of continued use, stopping or reducing drug results in specific physical and psychological signs and symptoms

7


Characteristics associated with substance abuse

DENIAL

Depression

Anxiety

Dependency

Hopelessness

Low self-esteem

8

Narcotics (Opiates)

  • Heroin
  • Morphine
  • Opium
  • Codeine
  • Methadone

9

Narcotic Addiction

  • Tolerance develops; increases expense of drug & likelihood of committing crimes
  • Narcotic overdose can rapidly lead to coma, respiratory depression, death
  • Accidental overdoses among narcotic addicts possible with uncertainty of drug’s strength
  • Drugs usually cut with inert (sometimes toxic) substances before sale, resulting in varied strengths available on the streets
  • Narcotic withdrawal rarely life threatening but is very uncomfortable

10

Opiate Withdrawal

  • Anxiety, restlessness, insomnia, irritability, impaired attention, often physical illness
  • Treatment alleviates symptoms by substituting methadone (opiate agonist), then tapering dose slowly
  • Clonidine or librium to manage withdrawal symptoms
  • Clinical Institute Narcotic Assessment or similar tool used for assessment, monitoring
  • Opiate withdrawal usually not life threatening but very uncomfortable

11

Psychopharmacology:
Treatment of Alcoholism

Trexan, Revia (naltrexone)

  • Blocks opiate receptors
  • Interferes with mechanism of reinforcement
  • Reduces or eliminates alcohol craving

Campral (acamprosate)

  • Helps client abstain from alcohol
  • Mechanism not well understood
  • Cleared by kidneys

Antabuse (disulfiram)

  • Works on classical conditioning principle (negative reinforcement)
  • Alcohol+disulfiram  causes unpleasant physical effects (vomiting)
  • Antabuse taken with alcohol can lead
  • to respiratory and cardiac collapse, unconsciousness, convulsions, and death
  • Antabuse should never be given without the patient’s stated willingness to comply 

12

Alcohol Detoxification

  • Long-acting benzodiazepines are drugs of choice
    • Usually chlordiazepoxide (Librium), diazepam (Valium), or lorazepam (Ativan)
  • Monitor for toxicity of benzodiazepines
    • Ataxia: difficulty walking 
    • Nystagmus: involuntary eyeball movement
  • Thiamine and vitamin B12 may help prevent Wernicke encephalopathy, Korsakoff psychosis

13

Psychopharmacology:
Treatment of Opioid Addiction

Dolophine (methadone)

  • Synthetic opiate blocks craving for and effects of heroin
  • Only medication currently approved to treat pregnant opioid addict

Naltrexone (Trexan, Revia)

  • Antagonist that blocks euphoric effects of opioids

Clonidine (Catapres)

  • Non-opioid suppressor of opioid withdrawal symptoms
  • Effective somatic treatment when combined with naltrexone

14

Recovery and Relapse

  • Rare for addicted person to suddenly stop substance use forever
  • Most addicted people try at least once and usually several times to use drug in controlled way
  • Tell patient to return to treatment promptly after relapses
  • Patients can learn from what they did to try to prevent further relapses
  • Recidivism rate can be as high as 90%

15

Dangerous Withdrawal

  • Substances with potentially life-threatening courses of withdrawal include alcohol, benzodiazepines, and barbiturates
  • The possibility of seizures should always be anticipated

16

Withdrawal Issues

  • For patients who are experiencing drug withdrawal, the highest priority is given to patient safety
  • This involves stabilizing the patient’s physiological status until the crisis of withdrawal has subsided.
  • Once safety needs are met, abstinence and support system issues must be addressed
  • PCP users may become violent toward themselves or others

17

Addiction During Pregnancy

  • Taking drugs can cause congenital abnormalities, other health risks to developing baby
  • May be born physically dependent on drugs 
  • Safest pregnancy is totally drug and alcohol free—exception is pregnant women addicted to heroin
  • Methadone maintenance safer for fetus than acute detoxification

18

ANOREXIA NERVOSA

  • usually younger in age
  • fear of gaining weight; distorted body image
  • hunger denied; obsession with food
  • need to control
  • sexually inactive
  • obessional and perfectionistic
  • amenorrhea (an abnormal absence of menstruation)
  • death by starvation, suicide or medical complication

19

BULIMIA 

(BINGE/PURGE)

  • Binges are planned 2000-3000 calories in 30 minutes
  • can be normal or overweight
  • usually begins after a period of dieting for weight loss
  • frequent vomiting and laxative use after eating binges
  • irregular or absent menses; GI problems; cardiac arrythmias
  • avoidant, dependent, obssional or borderline features
  • distoted body image
  • feels out of control, ashamed, low self-esteem
  • death from hypokalemia or suicide 

20

ANORESIA NERVOSA 

INTERVENTION

Psychopharmacology

  • Prozac
  • Zyprexa

Psychotherapy

  • CBT (Cognitive behavioral therapy)
  • psychodynamic
  • psychotherapy

Milieu Therapy

  • Precise meal times and menus
  • Observation during and after meals
  • Regularly scheduled weighing
  • Forced feeding is frightening
  • Set weight goal together

 

 

21

RE-FEEDING SYNDROME

Potentially fatal

  • shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial re-feeding
  • Hormonal and metabolic changes may cause serious clinical complications
  • Can see other disturbances in electrolytes, glucose, fat and protein metabolism

22

BULIMIA NERVOSA 

INTERVENTION

  • Interrupt binge-purge cycle (wait 20-30 min for urge to pass)
  • Prevent disordered eating behaviors 
  • Psychotherapy: CBT (cognitive-behavioral therapy)
  • Psychopharmacology: Fluoxetine (Prozac)