NURS 340 - Substance-Related & Addictive Disorders

substance use disorders

not illnesses of choice, complex diseases of the brain characterized by craving, seeking, and using regardless of consequences

self-control and decision making

substance use disorders result in compromised executive function circuits that mediates _____ and _____

- impaired control

- social impairment

- risky use

- physical effects (i.e., intoxication, tolerance, and withdrawal)

according to the DSM-5, symptoms of substance use disorder fall into what four major groups?

addiction

a chronic disease of the brain with cycles of relapse and remission

addiction

individuals with _____ are unable to consistently abstain from the substance or activity, even though they result in harmful consequences

intoxication

when people are in the process of using a substance to excess, they are experiencing _____

tolerance

occurs when a person no longer responds to the drug in the way that the person initially responded

withdrawal

a set of physiological symptoms that occur when a person stops using a substance

process addictions

*while the physical signs of drug addiction do not accompany these types of addictions, compulsive actions activate the reward or pleasure pathways in the brain similarly to substances

type of addiction: there are NO substances, but rather a behavior or the feeling brought about by the relevant action (e.g., addictive behaviors like gambling, sex, social media, and shopping)

schedule I

drug schedule: drugs carry a high potential for abuse and have no acceptable medical use

schedule I

drug schedule: heroin

schedule I

drug schedule: lysergic acid diethylamide (LSD)

schedule II

drug schedule: drugs have a high potential for abuse, are considered dangerous, and are available only by prescription

schedule II

drug schedule: methadone

schedule II

drug schedule: methylphenidate (Ritalin)

schedule II

drug schedule: ADHD drugs

schedule II

drug schedule: meperidine (Demerol)

schedule III

drug schedule: drugs have a low to moderate potential for misuse and are available only by prescription

schedule III

drug schedule: testosterone

schedule III

drug schedule: acetaminophen/codeine (Tylenol with codeine)

schedule III

drug schedule: buprenorphine (Suboxone)

schedule IV

drug schedule: drugs are low-risk drugs and are available by prescription

schedule IV

drug schedule: alprazolam (Xanax)

schedule IV

drug schedule: lorazepam (Ativan)

schedule V

drug schedule: contain limited quantities of certain narcotics for the treatment of diarrhea, coughing, and pain

opioid receptors, dopamine and GABA

the major neurotransmitters involved in developing substance use disorders

caffeine

the most widely used psychoactive substance in the world

delta-9-tetrahydrocannabinol (THC)

chemical in marijuana that is responsible for the drug's mind-altering and intoxicating effects

the actual drug component of marijuana

cannabidiol (CBD)

chemical in marijuana that does NOT cause intoxication

red eyes, increased appetite, dry mouth, tachycardia

physical symptoms of cannabis intoxication:

irritability, anger, aggression, anxiety, restlessness, depressed mood, insomnia, and decreased appetite

abdominal pain, shakiness, sweating, fever, chills, headache

symptoms of cannabis withdrawal:

abstinence and support

the main principles of treatment for cannabis use disorder

antianxiety

____ medications may be useful for short-term relief of cannabis withdrawal symptoms

4 weeks

drug screens can detect cannabis for up to _____ after use

schedule I

drug schedule of hallucinogens:

hallucinogens

substances that cause a profound disturbance in reality

hallucinogens

substances associated with flashbacks, panic attacks, psychosis, delirium, and mood and anxiety disorders

- classic hallucinogens (e.g., LSD)

- dissociative drugs (e.g., phencyclidine (PCP))

hallucinogens are commonly divided into what two broad categories?

phencyclidine (PCP)

_____ intoxication is a medical emergency that can result in dangerous and violent side effects

phencyclidine (PCP)

people under the influence of this drug can be belligerent, assaultive, impulsive, and unpredictable

paranoia, impaired judgment, illusions, hallucinations, synesthesias (hearing colors and seeing sounds), depersonalization, derealization, pupil dilation, tachycardia, sweating, palpitations, blurred vision, tremors, incoordination, hyperthermia

symptoms of PCP intoxication

phencyclidine (PCP)

patients who have ingested _____ cannot be talked down

may require restraint and a calming medication, such as a benzodiazepine, or a short-term antipsychotic, such as haloperidol

SAFETY

the patient does not have the ability to understand where they are and are out of touch with reality

the number one concern for patients on PCP

the reexperiencing of perceptual symptoms that were experienced while intoxicated

what is the hallmark of hallucinogen withdrawal?

volatile hydrocarbons

toxic gasses inhaled through the nose or mouth to enter the bloodstream

inhalant use disorder

this disorder is primarily one that occurs in youth—ages 12 to 17

- solvents for glues and adhesives

- propellants found in aerosol paint sprays, hair sprays, and shaving cream

- thinners, such as paint products and correction fluids

- fuels, such as gasoline and propane

common household products with chemicals that share similar pharmacological properties as inhalants:

disinhibition and euphoria

small doses of inhalants can cause:

fearfulness, illusions, auditory and visual hallucinations, and a distorted body image

high doses of inhalants can cause:

nausea, anorexia, nystagmus, depressed reflexes, and diplopia

physical symptoms of inhalant intoxication:

delirium, dementia, and psychosis

serious symptoms of inhalant intoxication:

inhalant

_____ intoxication usually does not require any treatment

opioid use disorders

in _____ disorders , cravings result in larger amounts and longer periods of time being devoted to the drug and increasing tolerance to its effects

opioids

the use of this substance results in significant impairment in life roles, interpersonal conflict, and puts a person in physically hazardous situations

psychomotor retardation, drowsiness, slurred speech, altered mood (withdrawn to elated), and impaired memory and attention

miosis (pinpoint pupils) and decreased bowel sounds

symptoms of opioid intoxication:

The Clinical Opiate Withdrawal Scale, or COWS

tool used to assess opiate withdrawal

Resting pulse rate

Sweating

Restlessness

Pupil size

Bone or joint aches

Piloerection (gooseflesh skin)

Rhinorrhea (runny nose or tearing)

GI upset

Tremor

Yawning

Anxiety, irritability

categories of COWS: ***

methadone

drug for opioid withdrawal: only dispensed through an opioid treatment program certified by SAMHSA, which includes once-a-day dosing

methadone

drug for opioid withdrawal: the patient must show up to a clinic everyday to receive their dose

buprenorphine [suboxone]

drug for opioid withdrawal: administered BID as a strip on the tongue

buprenorphine [suboxone]

drug for opioid withdrawal: can be prescribed by a regular MD

naltrexone [vivitrol]

drug for opioid withdrawal: indicated for relapse prevention following opioid detoxification

pinpoint pupils, respiratory depression, coma

symptoms of opioid overdose:

naloxone [narcan]

drug for opioid overdose:

- benzodiazepines

- barbiturates (e.g., secobarbital)

- barbiturate-like hypnotics (e.g., methaqualone)

- prescription sleeping medications

- prescription anti-anxiety drugs

drugs in the sedative, hypnotic & anti-anxiety medication use disorder category include:

craving

a typical feature of sedative, hypnotic & anti-anxiety medication use disorder

slurred speech, incoordination, unsteady gait, nystagmus, impaired thinking, coma

symptoms sedative, hypnotic, and antianxiety medication intoxication:

coma

a dangerous possibility of sedative, hypnotic, and antianxiety medication intoxication, especially with concurrent use of ETOH

- gastric lavage, activated charcoal, and careful vital sign monitoring

- if unconscious, an IV should be started and the patient should be intubated

- flumazenil [romazicon] if benzodiazepine overdose

treatment of sedative, hypnotic, and antianxiety medication overdose:

patients who are awake after overdosing should be kept awake to prevent a loss of consciousness

should patients be kept awake after a sedative, hypnotic, and antianxiety medication overdose?

flumazenil [romazicon]

an IV medication to reverse benzodiazepines in overdose

tremor, insomnia, psychomotor agitation, anxiety, and grand mal seizures

symptoms sedative, hypnotic, and antianxiety medication withdrawal:

seizures

the biggest concern for benzodiazepine withdrawal:

gradual reduction of benzodiazepines

patients should NOT detox from benzodiazepines at home with no guidance !!!!!!

*benzodiazepines block signals in the brain—if this is taken away quickly, the brain will have an influx of signals, causing a seizure

how to prevent seizures and other withdrawal symptoms in benzodiazepine withdrawal:

stimulants

people feel superhuman while using _____—they feel elated, euphoric, sociable, hypervigilant, sensitive, anxious, tense, and angry

chest pain, cardiac arrhythmias, high or low blood pressure, tachycardia or bradycardia, respiratory depression, dilated pupils, perspiration, chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, weakness, confusion, seizures, or coma

physical symptoms of stimulant intoxication include two or more of what symptoms?

cardiac effects, particularly cardiac arrhythmias

the biggest concern for stimulant abuse:

managing cardiac effects and monitoring for arrhythmias

treatment of stimulant intoxication includes:

beta-blockers and cocaine

with stimulant intoxication, use caution with:

tiredness, vivid nightmares, increased appetite, insomnia or hypersomnia, psychomotor retardation or agitation, depression and suicidal thoughts

symptoms of stimulant withdrawal:

depression and suicidal thoughts

the most serious side effects of stimulant withdrawal

amphetamines (e.g., meth)

an inpatient setting is usually necessary for withdrawal of what stimulant drugs?

cocaine

*for cocaine, the 1-2 week cocaine withdrawal period is distinct because there are no physiological disturbances that require inpatient care

outpatient settings are tried as a first approach for withdrawal of what stimulant drugs?

intense craving

*the intense craving associated with cocaine withdrawal may require hospitalization to remove the affected individual from the usual social settings and drug sources

*there are no drugs that reliably reduce the intensity of these symptoms

for what symptom may cocaine withdrawal require inpatient care?

craving, persistent and recurrent use, and tolerance

symptoms of tobacco use disorder:

behavioral therapy

useful for tobacco withdrawal to teach the patient to recognize cravings and respond to them appropriately

bupropion [wellbutrin]

drug for tobacco withdrawal: reduces the cravings for nicotine and withdrawal symptoms

varenicline [chantex]

drug for tobacco withdrawal: a nicotinic receptor partial agonist that mimics the effects of nicotine, thereby reducing cravings and withdrawal

binge drinking

type of problematic drinking: drinking too much too quickly

heavy drinking

type of problematic drinking: drinking too much too often

0.08 to 0.10 g/dL (80 or 100 mg)

the legal definition of intoxication in most states requires a blood concentration of _____ ethanol per deciliter of blood (mg/dL)

0.08 g/dL (80 mg/dL)

4 drinks is equivalent to a blood alcohol level of _____

4

a blood alcohol level of 0.08 g/dL (80 mg/dL) is equivalent to _____ drinks

0.15 g/dL (150 mg/dL)

6 drinks is equivalent to a blood alcohol level of _____

6

a blood alcohol level of 0.15 g/dL (150 mg/dL) is equivalent to _____ drinks

0.30 g/dL (300 mg/dL)

> 10 drinks is equivalent to a blood alcohol level of _____

> 10

a blood alcohol level of 0.30 g/dL (300 mg/dL) is equivalent to _____ drinks

poor muscle coordination, altered speech and hearing, difficulty detecting danger, impaired judgment, poor self-control, and decreased reasoning

symptoms of an individual with a blood alcohol level of 0.08 g/dL (80 mg/dL)

vomiting (unless high tolerance) and major loss of balance

symptoms of an individual with a blood alcohol level of 0.15 g/dL (150 mg/dL)

reduction of body temperature, blood pressure, respiratory rate, sleepiness, and amnesia

symptoms of an individual with a blood alcohol level of 0.30 g/dL (300 mg/dL)