substance abuse exam 2

physical dependence

body adapts to repeated useage, and the body views the useage of the medication as normal

psychologic dependence

no physical discomfort but strong mental desire to use

tolerance

body adapts to a substance and requires higher doses to produce the same effect

withdrawal syndrome

occur w/ physical dependence and abrupt discontinuation

alcohol is a

CNS depressant

moderate doses

warm flushed skin

enhances gastric & cutaneous blood flow

vasodilation

exerts as diuretic effect by inhibit antidiuretic hormone a

alcohol has what and what r the uses

Limited medical uses

topically: disinfectant

orally: ethylene glycol can be used as a treatment for drinking antifreeze.

long term & excessive use is assoc. w/ ? alcohol

Nutritional and Vitamin Deficiencies (B vitamins)
• Liver disease (•Cirrhosis)
• Cardiomyopathy
• Pancreatitis
• Lungs
• Stomach
• Brain

withdrawal symptoms for alcohol (mild)

SBP>150; DBP>90; HR>110; TEMP above 100; tremors,
agitation , insomnia

withdrawal symptoms (moderate)

SPB: 150-200; HR 110-140; TEMP 100-101; agitated, tremors,

withdrawal symptoms (severe)

SPB > 200; HR >140; Temp above 101

withdrawal treatment for alcohol

Benzodiazepines
Restraints are sometimes required
Thiamine and magnesium replacement

What is the mechanism of action of disulfiram (Antabuse)?

Inhibits aldehyde dehydrogenase, causing acetaldehyde to accumulate

• causes acetaldehyde syndrome.

Which patients are best suited for disulfiram?

Patients with a strong desire to quit drinking (viewed as a last resort option)

How long must a patient abstain from alcohol before starting disulfiram?

12hrs

How long can disulfiram's effects last after the drug is stopped?

2 weeks

Besides alcoholic beverages, what must patients on disulfiram avoid?

Mouthwash and certain foods or products containing alcohol

What are the cardiovascular signs of acetaldehyde syndrome?

Hypotension and chest pain

Which set of symptoms is typical of acetaldehyde syndrome?

Intense headache, nausea, copious vomiting, and difficulty breathing

What safety measure should a patient on disulfiram take?

Wear a medical alert bracelet

Who is acamprosate used for?

Patients who are already abstinent from alcohol

What is the main action of acamprosate?

Reduces cravings and restores neurotransmitter balance

Which side effects are associated with acamprosate?

Diarrhea and suicidal ideation

How does naltrexone help in alcohol use disorder?

Blocks opioid receptors, suppressing alcohol's pleasurable effects

What formulation advantage does naltrexone have?

Oral tablet or long-acting IM injection

Naltrexone should be avoided in which patients?

Patients taking opioids

Which statement correctly matches each drug to its approach?

Disulfiram = aversive;

acamprosate = craving reducer;

naltrexone = reward blocker

opioid use disorder side effects

drowsiness, euphoria, tranquility

effects are known as stupor or narcosis

s/s of opioid use disorder

Peak 1-3 days
Elevated BP and
HR
Sweating
Rhinorrhea
Insomnia
Mydriasis (dilated
pupils)

methadone (Dolophine) treatment for OD from opioids

Prevents opioid withdrawal and
cravings
Black Boxed warning due to
increased risk of cardiac and
respiratory- related deaths
Tapering should only be done under
medical supervision
Can be addictive

naltrexone

Blocks the euphoric effects of
opioids
Hepatoxicity
Can lower an individual’s
tolerance to opioids.... Making
relapse very dangerous if they
resume previous dose

quitting nicotine use disorder

very difficult

Irritability, anger, anxiousness, difficulty
thinking, cravings, and increased hunger

pleasure nicotine use disorder

BBB stimulating the
release of dopamine,
norepinephrine,
GABA, glutamate, and
endorphins

Nicotine replacement drugs

Gums, patches, sprays, inhalers, or lozenges- mimic the effects of
nicotine
Patches help sustain nicotine levels throughout the day
Other forms are used just when the urge to smoke is felt

varenicline (Chantix) side effects

Nausea, Insomnia, Irritability,
Restlessness.
Side effects can be intensified with nicotine
replacement therapy such as patches

varenicline (Chantix)

Stimulates dopamine in the brain to help
reduce cravings and withdrawal
Start 1-2 weeks before quitting
Carries a black box warning for serious
neuropsychiatric symptoms:
Behavior changes, hostility, agitation,
depression, and suicide

bupropion (Zyban)

• Mimics the rewarding effects of
  alcohol
  Start 1-2 weeks before quitting
  - Contraindicated in patients with
  seizure disorders or eating disorders
  Behavioral changes in addition to
  insomnia and dry mouth
  Can result in tachycardia and
  hypertension.. Check vital signs
  before administering