drug abuse overview 1

controlled substances act: what? when? enforced by?

federal law that helps regulate substances; 1970; DEA

cross-tolerance

tolerance to one drug leads to tolerance of another drug

cross-dependence

dependence of one drug leads to dependence of another

schedule _ is the highest abuse potential while schedule _ is the least

I; V

most commonly used and abused psychoactive (psychological and physical effects) agent in the US

alcohol

ETOH acute effects (2)

CNS depression and activate reward circuit by release of dopamine

ETOH chronic effects (13)

wernicke’s encephalopathy, korsakoff’s psychosis, preserve cognitive function (at low amount), sleep disturbances (more than 1 glass), CV (increased BP and impaired myocardium)/resp effects (depression), sexual effects, hepatitis, cirrhosis, erosive gastritis, diuresis, pancreatitis, FAS, and FASD

wenicke’s encephalopathy effects (4)

confusion, nystagmus, abnl ocular movements, and abnl vitamin B

korsakoff’s psychosis effects (2)

no positive short-term memory and confabulation

alcohol drug interactions (5)

CNS depressants (overly depress), NSAIDs (gastric lining damage/inflam.), acetaminophen (liver damage), disulfiram, and antihypertensive drugs

blood level of what defines intoxication? what level are effects seen? >0.4% risk for what? (3)

0.08%; 0.05%; respiratory depression, peripheral collapse, and death

alcohol OD symptoms (4)

vomiting, coma, respiratory depression, and hypotension

which drug is known as alcohol aversion therapy?

disulfiram

when to avoid acamprosate?

pregnancy

nutritional support for chronic alcohol use (4)

vitamin B (thiamin, folic acid, and cyanocobalamin), vitamin supplements, fluid replacement, and abx

drugs for withdrawal are used _____-term while drugs for abstinence are used ____-term

short; long

disulfiram disrupts the breakdown of ____ and causes ____________ buildup when taken with ETOH

ETOH; acetaldehyde

acetaldehyde syndrome effects (7) (can be life threatening!)

N/V, flushing, HA, sweating, angina, blurred vision, and hypotension

do not take the first dose of disulfiram until…

at least 12 hrs after last drink

at what route and how often and is disulfiram administered? admin?

PO qd; can be crushed or mixed with liquids

2 patient teachings for alcohol use

avoid ETOH in any substance and effects of drug last 2 weeks after last dose

greatest single cause of preventable illness and premature death

cigarette smoking

nicotine MOA

activates nicotinic receptors in sympathetic ganglia, adrenal medulla, carotid body, aortic arch, and CNS

CNS effects of nicotine mimic those of _______

cocaine

nicotine causes _________ effects

stimulant

5 A’s for treating tobacco use

ask, advise to quit, assess willingness, assist, arrange follow-up

nicotine withdrawal symptoms (10)

craving, nervousness, restlessness, irritability, impatience, hostility, insomnia, impaired concentration, increased appetite, and weight gain

acute nicotine poisoning treatment (2)

activated charcoal and ventilatory assistance

5 types of nicotine replacement therapy

gum, lozenge, transdermal patch, nasal spray, and inhaler

nicotine chewing gum for nicotine replacement therapy nursing implications (2)

chew slowly over 30 min and avoid eating/drinking 15 min prior

nicotine transdermal patches are changed how often?

daily

nicotine inhaler: how many puffs? over how long? contraindication?

1-2; 20 min; asthma

most effective drug for smoking cessation

varenicline (combination tx- var. with nicotine patch and PRN nasal spray/gum)

start varenicline when? titrate dose up for _ week(s) then _ time(s) daily for _ week(s), then additional _ week(s) after cessation achieved

before cessation begins; 1; 2; 12; 12

patients with renal disease need a lower dose of what medication?

varenicline

to whom is varenicline banned? (3)

truck drivers, pilots, and air traffic controllers