Substance Use Disorders- Unit 3

Hallucinogen Intoxication

paranoia, palpitations

Hallucinogen Withdrawal

visual disturbances, flashback hallucinations occurring intermittently for years

Hallucinogen Nursing considerations

maintain safe environment to prevent falls, seizure precautions, observe for withdrawal effects (1:1 recommended, restraints=last resort)

Amphetamine intended effect

increased energy, euphoria

Amphetamine Intoxication

impaired judgement, psychomotor, agitation, hypervigilance

Amphetamine Withdrawal

intense cravings, depression, fatigue, and increased sleeping

Amphetamine Nursing Considerations

assess vital signs (increased HR, BP, temp), asses for paranoia, agitation, and hallucinations, and mood and suicide risk during withdrawal

Inhalant Intoxication

dizziness, uncoordinated movements or gait, slurred speech, drowsiness, and respiratory depression (NO WITHDRAWAL MANIFESTATIONS)

Cocaine & Crack Intended effects

increased energy, euphoria, pleasure

Cocaine & Crack Intoxication

tachycardia, extreme fever, HTN, dysrhythmias, diaphoresis, chest pain

Cocaine & Crack Withdrawal

depression, fatigue, cravings/increased appetite

Nicotine Intoxication

long term effects include, cardiovascular disease (hypertension and stroke), respiratory diseases (emphysema, lung cancer)

Nicotine Withdrawal

irritability, craving, nervousness, insomnia, increased appetite, difficulty concentrating

Nicotine Nursing Considerations

nicotine gum, chew slowly and intermittently over 30 minutes, avoid eating/drinking for 15 minutes prior and while chewing gum

Caffeine Intoxication

tachycardia, arrythmias, muscle twitching, restlessness, diuresis

Caffeine Withdrawal

irritability, inability to focus, drowsiness

Opioid Withdrawal & Maintenance

-Methadone (orally)

ADEs: constipation, nausea, vomiting, drowsiness and sedation

-Clonidine (off label use for withdrawal symp)

considerations: BP & HR in range b4 admin

-Buprenorphine

ADEs: N/V, muscle aches/cramps, insomnia, fever, irritable

-Naltrexone

opioid & alc suppression-IM inj once monthly

Opioid Maintenance Nursing Considerations

-ECG for possible cardiac risk factors (due to risk of QT prolongation)

-Respiratory depression and possible sedation

- Constipation: bowel management regimen to prevent

-Assess BP & HR before administering doses

-Educate on moving slowly to prevent orthostatic hypotension

Opioid Withdrawal

insomnia, flu-like manifestations, rhinorrhea and sweating, not life threatening- but suicidal ideation can occur

Opioid Withdrawal Nursing Considerations

-Assess for opioid toxicity, especially respiratory depression/CNS depression

-Administer an antidote, such as Naloxone

Opioid Intoxication

3 Opiates: Heroin, Morphine, Hydromorphone

Rush of euphoria, slurred speech, decreased respirations & LOC=death

Opioid Intoxication Nursing Considerations

-Asses VS, decreased RR

Cannabis/Marijuana Intoxication

• occurrence of paranoia (delusions and hallucinations)

• Increased appetite, dry mouth, tachycardia

• Impair motor skills for 8-12 hours, impacting driving and use of machinery

Cannabis/Marijuana Withdrawal

irritability, anxiety, insomnia, depressed mood

Sedative/ Hypnotics Intoxication

Types of Sedatives: Benzos, Barbituates, Benzo-like drugs: zolpidem

-Resp depression

-lethargy/ extreme sleepiness

Sedative/ Hypnotics Withdrawal

anxiety/agitation, tremors, sweating, tachycardia, seizures

Sedative/ Hypnotics Nursing Considerations

-Do not stop medication suddenly — taper slowly over weeks or months

-Avoid driving, heavy machinery, alcohol, or other CNS depressants

Alcohol Abstinence & Maintenance

-Disulfuram

ADEs: induce nausea, vomiting, weakness, sweating, palpitations, and hypotension= acetaldehyde syndrome

*AVOID ALL ALC-INCLUDING ITEMS W/ ALC: aftershave, vanilla extract, mouthwash, hand sanitizer

-Naltrexone:

suppresses craving & pleasurable effects of alc

-taken with meals to decrease gastrointestinal distress

-identify whether the client is also dependent on opioids

-Acamprosate

take orally 3x day

Alcohol Withdrawal

identify whether the client is also dependent on opioids, manifestations may appear within 4-12 hrs, delirium symptoms begin as early as 2-3 days, can lead to death if not promptly treated, anxiety, diaphoresis, HTN, N/V, hand tremors

Alcohol Withdrawal Nursing Management

safe environment for both yourself and the patient (fall prevention, seizure precautions, reduce patient stimulation

Alcohol Acute Meds

-Benzos

-Carbamazepine (seizure reduction)

-Clonidine (low BP & HR)