NUR 218: Substance Use Disorder

alcoholism consequences

cirrhosis and brain damage

cocaine consequences

damage to heart and brain

anabolic steroids

heart disease

natural opioids

morphine and codiene

semisynthetic opioids

oxycodone, hydrocodone, hydromorphone, oxymorphone

synthetic opioid

methadone (others are tramadol, fentanyl)

heroin

illicit opioid synthesized from morphine

household psychoactive substances

sleep pills, cough syrup, spray pain, decongestants, alc based products, glues, nail polish remover, aerosols, solvents; short high followed by depression and disorientation

amphetamines

“speed, uppers”

phencylidine (PCP)

“angel dust”

cocaine

“snow, powder”

methamphetamine

“crack, ice, crystal”; easy to make, very addictive, sniffed, injected, smoked, oral

heroine

“blow”

MDMA

“ecstasy, molly”

ketamine

“special K, lady K”

bath salts

synthetic, cheaper substitute for meth and cocaine

anabolic steroids

similar to testosterone, can cause mood distorders, HTN, cardiac injury and liver cancer, impacts sex, fertility, and appearance

withdrawal symptoms

irritability, tremmors, NV, stomach cramps, high BP, psychotic episodes, convulsons

fetal alcohol syndrome

newborns have physical and facial abnormalities, cognitive delays

cigarette exposure

decreased placental blood flow, increase in stillbirths, low birthweight, infant irritability

cocaine in pregnancy

maternal HTN, decreased placental bloodflow→ developmental defects or premature birth

cardiovascular issues w/ substance abuse

irregular heartbeats, increased BP→MI strike, HF

infection d/t substance abuse

hep B, HIV; local lesions at injection sites→gangrene→systemic infection

neuro issues with substance abuse

distorted sensory inputs→fear, panic, depression→ increased suicide risk and impaired memory

cirrhosis

lipid accumulation causing fatty liver to begin, then, fibrous scar tissue

wernicke syndrome

confusion, disorientation, loss of motor conduction

korsakoff syndrome

altered personality and amnesia

reward circuit

misused drugs often increase availability of dopamine and other neurotransmitters
[serotonin and gamma-aminobutyric acid (GABA)] →mood elevation or euphoria → motivation to repeat the experience

alcohol toxicity

large amounts over a short period of time, avg person only metabolized 10g/ alc per hour

alcohol toxicity symptoms

vomiting, choking, dehydration, seizures, hypothermia, brain damage, death

alcohol toxicity treatment

airway management, O2, glucose management, IV hydration; IM thiamine to prevent neuro damage, HD to remove alcohol form blood, if impaired hepatic function

CAGE questionaire

screens for AUD, asks about drinking habits, if “yes” to two+ then issue with alcohol

drugs for AUD treatment

disulfiram, acomprostate, naltrexone

disulfiram (antibuse)

best for newly abstinent, excreted in breastmilk, works well will with behavior modification, psychotherapy, couseling

disulfiram (antibuse) MOA

inhibits aldehyde dehydrogenase, the enzyme involved in metabolizing alcohol; causes NV, headache, chest pain, issues breathing

disulfiram (antibuse) contraindications

those who are drunk or have ingested ANYTHING with alcohol in the last 12 hours

acomprosate

reduces cravings and distress associated with prolonged withdrawal symptoms like anxiety and insomnia; only for those who are abstinent, can be continued through a relapse; monitor creatinine clearance levels (hold if < 30 mL/min)

acamprosate MOA

restores neuronal excitation and inhibition of GABA and glutamate

acomprosate side effects

pain, loss of appetite, NV, dizzy, anxiety, rash, depression, insomnia

naltrexone (ReVia/ Vivitrol)

competitive opioid antagonist for those who are abstinent; pt must be opioid free for 7 days; if concerned about OUD give nalaxone and observe; excreted in breast milk

naltrexone (ReVia/ Vivitrol) MOA

binds to mu receptors in brain, blocks other opioids from activating the receptor and works for both alcohol and opioids

naltrexone (ReVia/ Vivitrol) side effects

insomnia, NV, headache, abnormal pain, myalgia, arthralgia, rash

naltrexone (ReVia/ Vivitrol) adverse effects

suicidality, depression, hepatoxicity, hypersensitivity

cannabis use disorder

causes issues with memory, learning, ability to focus, balance, coordination, halluciniations, panic attacks, psychosis; long term use causes cough, frequent respiratory infections, exposure to cancer causing compounds

cannabis use puts users at risk for

MI and CVA

smoking cannabis oil

increases risk for anxiety, paranoia, memory loss, distraction

cannabis use disorder treatment

CBT, contingency management, motivational enhancement therapy

medical marijuana

effective for MS, chronic pain, IBS, and for palliative care

opioid use disorder

oxycodone, hydrocodone, morphine, methadone, fentanyl; flood brain w/ dopamine

OUD treatment

inpatient or OP, may use naloxone, naltrexone, methadone, buprenorphine

naloxone (narcan)

used for respiratory depression w/ opioid OD

naloxone (narcan) MOA

short acting antagonist, attaches to receptors in the CNS to block activation by opioid drugs

naloxone (narcan) admin

IV, IM, subQ, intrannasal; low dosing (.1-.2 mg/2-3 mins)

naloxone (narcan) side effects

IMMEDIATE WITHDRAWL; NV, abdom cramps. hyperthermia, HTN

naltrexone

same as used fro AUD but can be used for OUD to reduce cravings

methadone

for heroin treatment, do not give with rifampin, phenytoin, st. johns wart, phenobarbital, carbamazepine, MUST be tapered, crosses into breastmilk

methadone MOA

opioid agonist at mu receptor and antagonist at N-menthyl-aspartate receptor; blocks sense of euphoria and prevents withdrawal and craving

methadone side effects

lightheadedness, constipation, dizzy, sedation, NV

buprenorphine

outpatient drug, some euphora but has ceiling effect, given with naloxone, crosses into breastmilk

buprenophine MOA

mixed opioid agonist antagonist, decreased withdrawal and cravings; works as antagonist mu receptors and kappa receptors

buprenophine side effects

NV, constipation, muscle aches, cramps, craving, sedation, headache, depression, anxiety

tobacco use disorder (TUD)

nicotine stimulates release of dopamine, norepinephrine, GABA, glutamate, and endorphins → stimulation, pleasure, & reduction in stress/anxiety → fuels the reward circuit

TUD short term effects

increased BP, RR, HR

TUD longterm effects

damages all organs; cancers, resp disorders, heart disease, stroke, immune dysfunction, type 2 diabetes

TUD when pregnant

miscarriage, premies, stillbirth, low birth weight; often have learning and behavior issues

nic replacements side effects

HTN, tachy, dizzy, insomnia, irritability, anorexia, dyspepsia, NV, hiccups, cough

nic replacements when pregnant

safer than smoking, crosses into breastmilk

nic replacements over the counter

nicoderm CQ, Habitrol, Nicorette

nic replacements prescription

nasal spray (Nicotrol NS)

buproprion (Wellbutrin)

antidepressent, mimics nic, must be tapered, can cause false pos drug screen, crosses into breastmilk

buproprion (Wellbutrin) contraindications

seizure disorders, eating disorders, or taking MAOIs

varenicline (Champix)

partial nicotinic receptor agonist → stimulates dopamine in the brain but not to same extent as nicotine →reduced cravings and withdrawal; dose adjustment needed for creatinine clearance < 30mL/min

varenicline (Champix) BBW

serious neuropsych symptoms

varenicline (Champix) side effects

NVD, insomnia, headache, abnormal dreams, constipation, fatigie, malaise