Lecture 2 Mark K

# 1 psychological problem is the same in any/all abusive situations

DENIAL

• Can use the alcoholism rules for any abuse (- ex. # 1 psych problem in child abuse, gambling or (cocaine abuse is denial •why is denial the problem? HOW CAN YOU TREAT SOMEONE WHO DENIES/DOESN’T RECOGNIZE THEY HAVE A PROBLEM

How do you treat this: You confront it!

For loss and grief: you support it

#2 psychological problem in abuse

DEPENDENCY, CO-DEPENDENCY

• dependency = when the abuser gets significant other ( to do things for them or make decisions for them( -> the dependent = abuser.

• co-dependency = when the significant other derives ( positive self-esteem from making decisions for or ( doing things for the abuser( -> the abuser gets a life w/o responsibilities( -> the sig. other gets positive self-esteem (which is ( why they can’t get out of the relationship)

• how do you treat it?( set limits and enforce them

• ( start teaching sig. other to say NO (and they ( have to keep doing it)-

• must also work on the self-esteem of the co-dependent ( (ex. I’m a good person because I’m saying “no”)

• Manipulation = when the abuser gets the sig. other to do things for them that are not in the best interest of the sig. other. The nature of the act is dangerous/harmful

Wernicke’s & Korsakoff’s

• Psychosis induced by Vit. B1 (Thiamine) deficiency

• lose touch w/ reality, go insane because of no B1

• primary symptom -> amnesia w/ confabulation (significant memory loss w/ making up stories (they believe their stories)

How do you deal w/ PT’s that have Wernicke’s & Korsakoff’s?

Bad way = confrontation (because they believe what (they are saying and can’t see reality)

Good way = redirection (take what the PT can’t do (and channel it into something they can do)

Characteristics of Wenicke Korsakoff’s:

Psychosis induced by Vit. B1 (Thiamine) deficiency (lose touch w/ reality, go insane because of no B1)

Primary symptom -> amnesia w/ confabulation (significant memory loss w/ making up stories (they believe their stories)

It’s preventable = take Vit. B1 (co-enzyme needed (for the metabolism of alcohol which keeps alcohol (from accumulating and destroying brain cells) *PT doesn’t have to stop drinking

It’s arrestable = can stop it from getting worse by (taking Vit. B1(

It’s irreversible (70% of cases) -> Hint: On boards, (answer w/ the majority (ex. if something is majority (of the time fatal, you say it’s fatal even if 5% of the (time it’s not)

Drugs for Alcoholism:

DISULFIRAM (Antabuse)

type of aversion therapy:

-> interacts w/ alcohol in the blood to make you very ill

( -> works in theory better than in reality

( -> onset & duration: 2 weeks (so if you want to, drink again, wait 2 weeks)

PT teaching for medication (alcoholism)

Avoid ALL forms of alcohol to avoid (nausea, vomiting & possibly death (-> including mouthwash, aftershaves/colognes/perfumes (topical stuff will make them nauseous), insect (repellants, any OTC that ends with “-elixer”, alcohol-(based hand sanitizers, uncooked (no-bake) icings (which have vanilla extract)

DO NOT PICK THE ANSWER CHOICE: red wine vinaigrette

EVERY ABUSED DRUG IS EITHER A

UPPER OR DOWNER

*Laxatives in the elderly

What’s the first question that you ask with an abused drug?

“Is it an upper or a downer?”

What are the FIVE “upper” drugs (stimulants)

• Caffeine

• Cocaine

• PCP/LSD (psychedelic (hallucinogens)

• Methamphetamines,

• Adderol (ADD drug)

What are the S&S for upper meds (stimulants)

• Make you go up, euphoria

• Tachycardia,

• Restlessness,

• Irritability,

• Diarrhea,

• Borborygmi, (hyper-reflexia, spastic, seize (need suction)

What are “DOWNER” meds? (depressants)

EVERYTHING THAT IS NOT AN UPPER IS A DOWNNNER

What are the signs and symtpoms of a downer?? (depressant)

• Make you go down.

• Lethargy,

• Respiratory (depression (& arrest)

• Constipation

What’s the second question that you ask with an abused drug??

Are they overdosing or withdrawing?

Whats the difference between an overdose and withdraw?

Overdose: too much

Withdraw: Not enough

If the patient has overdosed on an upper choose the answer choice that shows…

Pick the answer choice that has all upper signs and symptoms (tachycardia, tachypnea, hypertension)

If the patient has overdosed on a downer choose the answer choice that shows….

Pick the answer choice that has all the downer signs and symptoms (bradycardia,bradypnea,hypotension)

If the patient is withdrawing from an upper choose the answer choice that shows….

Not enough upper makes everything go down!!! (downer signs and symptoms)

if the patient withdrawing from a downer choose the answer choice that shows….

Not enough downer makes everything go up!!! (upper signs and symptoms)

In what 2 situations would resp. depression & arrest be your highest priority:

- Downer overdose

- Upper withdrawal

In what 2 situations would seizure be the biggest risk:

- Upper overdose

- Downer withdrawal

Drug Abuse in the Newborn:

Always assume intoxication,

NOT withdrawal at birth (after 24 hrs -> withdraw)

Caring for infant of a Quaalude addicted mom 24 (hrs. after birth, select all that apply:

• Exaggerated startle

• Seizing

• High pitched shrill/cry

Alcohol withdraw syndrome

• Every alcoholic goes through withdrawal 24 hrs after they stop drinking

Delirium tremens

Delirium tremens happens when a person who has been drinking heavily for a long time suddenly stops or drastically reduces alcohol intake. The brain becomes overactive because it was used to alcohol’s depressant effect.

Signs and symptoms of delirium tremens

• Severe confusion (delirium)

• Agitation / restlessness

• Hallucinations (visual, tactile—“bugs crawling”)

• Severe tremors

• Fever

• Sweating (diaphoresis)

• Tachycardia (↑ HR)

• Hypertension

• Seizures ⚡ (can occur before or during DTs)

Time frame of when an alcoholic might get DT (delirium tremens)

• ONLY a MINORITY of people get delirium tremens

• Within 72 HOURS, Alcohol withdraw comes FIRST.

Is Delirium Tremens/ DT dangerous??? or can the patient themselves be a danger to themselves and others?

• Delirium Tremens ARE LIFE THREATNING

• Patient going through AWS (Alcohol withdraw syndrome) ARE NOT at risk for dying.

• Patients going through AWS (alcohol withdraw syndrome) ARE NOT DANGEROUS TO SELVES OR OTHERS BUT patients with DT (delirium tremens) ARE DANGEROUS TO SELVES AND OTHERS.

AMINOGLYCOCIDES

• powerful class of antibiotics (when nothing else works pull these outs, the big guns)

• don’t use unless anything else works •boards love to test these drugs because they’re dangerous and are a test of safety

• think: A MEAN OLD MYCIN ( a mean old = they treat serious, life-threatening, resistant, Gram-neg bacteria infections

• A mean ( old antibiotic for a mean old infection)

• mycin = what they end with (all end w/ -mycin) ( ** not all -mycin’s are aminoglycosides BUT most ( are (the 3 that are not are erythromycin, ( azithromycin, clarithromycin = throw it off the list!)(

3 “-mycins” that are not aminoglycosides

• Erythromycin,

• Azithromycin

• Clarithromycin

*hint they have “THRO” in the name = throw it off the list!!!

2 toxic affects when taking aminoglycosides

• When you think of -mycin think of your favorite Disney world character!! = Mice!!! what do mice have?? really big ears!!! = one of the toxic side of aminoglycosides is = otto toxic!!

• Now next, the ears are shaped like a kidney= The second toxic affect aminoglycosides have is = nephrotoxicity!!

What levels do you have to monitor for aminoglycosides?

• Monitor creatinine (NOT BUN, output, daily weight)

• Creatinine = the best indicator of kidney/renal ( function (pick 24 hr. creatinine clearance over ( serum creatinine if both available)

#8 (fits nicely in the kidney) reminds you about 2 things about these drugs (aminoglycosides)

• Toxic to cranial nerve 8 =ear nerve

• Administer Q8

What route do you give aminoglycosides?

• IM or IV

YOU DO NOT GIVE AMINOGLYCOSIDES COMMONLY PO THEY ARE NOT ABSORBED

When do you give aminoglycosides PO?

2 cases (bowel sterilizers)

• 1: Hepatic Encephalopathy (hepatic coma) = to get ( ammonia down, oral ‘-mycin’s’ will sterilize the ( bowel by killing Gram-neg bacteria (E. coli) to help ( bring down ammonia and won’t harm the ( damaged liver because it doesn’t go through the ( liver (also gives diarrhea, more poop out is good)

• Pre-op bowel surgery = it sterilizes the gut by ( killing the E. coli bacteria

• * if oral, no otto or nephro toxicity because not absorbed

What aminoglycosides do can you give oral (if needed)

• Neomycin

• Kanamycin

“Who can sterilize my bowels? NEO KAN”

Trough and Peak levels:

trough = drug at lowest

peak = drug at highest

1. Draw trough levels first

2. Administer your drug

3. Draw peak levels after drug administration

Why do you need to draw levels?

To narrow therapeutic window

• You get to see in what range the drug works and kills

• A MEAN OLD MYCINS = major class that needs TAPs drawn because of narrow window

When do you draw TAPS for Trough

* doesn’t matter which route or med, always 30 mins.

Ex: sublingual = 30 mins. before next dose

IV = 30 mins. before next dose

IM = 30 mins. before next dose

Sub-Q = 30 mins. before next dose

PO = 30 mins. before next dose

When do you draw TAPS for peak levels?

* Different but depends on the route (not the med)

• Sublingual = 5-10 mins after drug is dissolved

• IV = 15-30 mins after drugs is finished infusing

• IM = 30-60 mins. after administration

• * Hint: if you get two values that are correct (i.e. a (15 min. answer and a 30 min. one) pick the highest (without going over so 30 mins)