Week 7 | patho | Misuse, Abuse, and Illicit Drugs

Misuse, abuse, illicit use definition

• The use of a substance/drug that isn’t intended to be used in the manner in which it is being used

• The use of a substance/drug that is not legally approved for consumption

Random but How to tx pt w/chest pain? | MONAT

M ….. Morphine → dec. pain + myocardial O2 demand… dec. SOB + angina

O ….. Oxygen

N ….. Nitro

A ….. Aspirin

T ….. TPA, thrombolytic

Food and Drug Act (1953)

• Protect consumers from drugs that are contaminated, adulterated, or unsafe for use

• To address drugs that are labeled falsely and those with misleading or deceptive labeling

Controlled Drug and Substances Drug Act (1997)

• Formerly the Narcotic Control Act

  • changed cause not all drugs were narcotics

• Regulates the possession, sale, manufacture, disposal, production, import, export,, and distribution of certain drugs

New Drug Development - Health Canada Drug Approval

• Preclinical investigational drug studies…in vitro and animal testing

• Clinical investigational drug studies (4 phases)

4 Phases of clinical investigational drug studies

Phase 1 → Safety: determine side effects, dosage range, pharmacokinetics

• done on healthy ppl

Phase 2 → Effectiveness: refining dosage range, etc

• done in limited scope on pts w/problems, very few pts

Phase 3*** → Duration/Long term impacts: efficacy, benefits, longterm adverse effects

• Most important phase, studies u see in the news that’re changing things

Phase 4 → Post-marketing studies

• not controlled, ways to get docs to prescribe more stuff

Special Access Program

• Access to drugs not yet approved

• Limited to those w/serious or life threatening illnesses

• Wishy washy balance, ethical issues, cancer drugs…you can only give these unstudied drugs to people who are hopeless and their meds aren’t working, drugs that havent been approved yet

Drugs/substances common to abuse (x8)

1. alcohol

2. tobacco

3. narcotics

4. sedative-hypnotics

5. stimulants

6. marijuana

7. hallucinogens

8. OTCs

Narcotics

Substances that bind to opiate receptors in the CNS and ANS

• Euphoria

• Analgesia

Raw Morphine

Natural substance

• Opium

  • Morphine + Codeine

• Semi-synthetic

  • Heroin

• Synthetic

  • Meperidine + Dilaudid + Percodan, percocet

Morphine causes nausea PERIOD. You almost always have to give anti-nausea drugs

If ppl got dizzy last time they had morphine, thats a normal reaction

Heroin

• semi-synthetic, raw form of morphine

• no practical use, gets rid of pain but at an expense SUPER ADDICTIVE

Meperidine

• synthetic, raw form of morphine

• used to be used in labor and delivery before epidurals, N&V

Dilaudid***

• synthetic, raw form of morphine

• Super clean, doesn’t have reactions w/other meds, always works

Percodon + Percocet

• synthetic, raw form of morphine

• only available orally

Narcotic Intoxication causes:

• Euphoria

• Poor comprehension

• Memory disturbances

• Drowsiness

• Decreased social interactions

• Miosis/contraction of pupils***

• Mild hypotension w/tachycardia + decreased respirations

Narcotics: How does the body respond to narcotic overdose? | steps to OD death

1. Decreased LOC → comatose

2. Decreased resp. → apnea → resp arrest

3. Decrease HR + BP → shock

4. GI atony

Does Opium tolerance develop quickly? True/False

True

• also causes psychological and physiological dependence

What does someone need to take chronically if they are taking narcotics chronically?

anti-constipation meds chronically

Are narcotic withdrawals life threatening?

No

• Withdrawals appear 8-12 hours after last use ***

When is peak narcotic withdrawal?

48-72 hours

Narcotic withdrawal: S&S

• Tearing

• Perspiration

• Restlessness

• Irritability

• Stomach cramps

• Hand/leg tremors (kicking the habit)

• Insomnia

Hallucinogens are both CNS ________ & ________

stimulants & depressants

• most are plant derivatives

• No tolerance developed, no evidence of dependency

Psychedelics

Mind manifesting

Psychotogenic

Psychosis generating

Hallucinogen Intoxication

Consistency is the problem

• Hypersuggestibility

• Euphoria with transcendent experience

• Perceptual alterations

• Inc sensory sensitivity

• Altered thought process

• Distractibility

• Labile mood

• Altered judgment

• Pupil dilation

• Poor coordination

• Tremors*

• Nausea

What does LSD stand for?

Lysergic Acid Diethylamide

• can never come out with a dose, just depends on the person, blotter stickers

Psilocybin Mushrooms (magic mushrooms) cause….

There's auditory and visual hallucination. Visual ones are RARE with mental illness

• Euphoria

• Easily distracted

• Increased Temp, Pulse, BP

• Open to suggestion

• Involves limb movements

• Hallucinations

The body’s response to hallucinogen overdose:

Anxiety, panic, hypervigilence, paranoid delusions

Hallucinogen Mortality

Mortality typically relates to the behavior and loss of inhibition rather than the drug itself

What do stimulants do?

Stimulates the part of your brain that basically makes you productive

Examples of stimulants

• Cocaine

• Amphetamines***

• Caffeine

• Dextroamphetamine

• Methamphetamines

• Methylphenidates: Ritalin***

Stimulants: Intoxication

• Inc. sensation of wellbeing, euphoria

• Inc. energy and alertness

• Power, mastery, confidence

• Compulsions, impaired decision-making

• Paranoid psychotic reactions

• Leads to hostile, violent behavior

Coca Plant (cocaine)

• Cocaine isolated in 1800s

• Used for pain and anesthesia

• Tx for depression and morphine addiction

Cocaine and nose bleeds

If the nose bleeds, it causes vasoconstriction and stops blood flow. 

Ritalin

Methylphenidates

• Used to tx hyperactive kids

• seems paradoxical to give hyper kids stimulants

  • Enhances the reticular activating system (RAS) which helps to focus attention and filter out extraneous stimuli

Nicotine drug effect:

• Inc. HR + BP

• Constrict peripheral blood vessels

• Lower O2 carrying capacity of hemogloin (CO2 in smoke inds with Hgb)

Nicotine (Tobacco) Side Effects

• Coronary Artery Disease

• Bronchospasm + bronchoconstriction

• Paralysis of cilia

• Thickening of mucous

• COPD

• Cancer: aromatic amines

Stimulants withdrawal:

• severely depressed mood

• prolonged sleep

• apathy (lack of interest or concern)

• irritability

• disorientation

Alcohol (depressant) uses:

• To relax

• To reduce inhibitions

• For pleasure

• Rituals and celebrations

Alcohol equivalency | beer, spirits, wine

Beer - 5%, 10oz

Spirits - 40%, 1.5oz

Wine - 8-14%, 4oz

What does alcohol do to the cerebrum:

affects judgement, inhibitions, reasoning

What does alcohol do to the liver:

• Metabolism: alcohol dehydrogenase

• Fatty liver

• Alcohol hepatitis

• Cirrhosis

Blood alcohol level:

intake minus excretion

Wernicke-Korsakoff’s Syndrome***

• Alcohol interferes w/ability to utilize vitamins

• Especially thiamin (vit B1)

• Disorder affects memory - short term

• Degree of memory impairment becomes extreme - unable to function

Alcohol Withdrawal Minor, Major, Extreme***

Minor: Peaks 24-36hrs

• Coarse tremor, achy, anxiety, mild autonomic hyperactivity, anorexia

Alcohol Withdrawal Minor, Major, Extreme***

Major: occurs 24hrs, peaks 50hrs

• pronounced ANS hyperactivity, fever, disorientation, diaphoresis, hallucinations

Alcohol Withdrawal Minor, Major, Extreme***

Extreme:

• Grand mal seizures (tonic/clonic)

• Delirium Tremors (DTs): day 3

  • Profound confusion, incontinence, frightening, visual hallucinations, gross tremors, fever

Marijuana | THC (tetrahydrocannabinol) psychological effects:

• perceptual

• cognitive skills

• appetite

• amotivational syndrome*

• Tolerance + psychological dependence

Weed uses:

• Convulsions

• Chronic cough

• Sleeplessness

• GI disorders

• Gonorrhea

• Pain

Weed current indications | Ethical + Legal considerations

• Glaucoma: reduces intraoccqular pressure

• N/V

• Asthema: bronchodilator

• Appetite stimulant

• Muscle relaxant: related to paralysis

• Some other chronic conditions

Weed withdrawal

• No acute withdrawal

• Chronic users may experience: irritability and sleeplessness

Nursing responsibilities to keep in mind with drug using pts

• Being knowledgable abt drugs that’re abused isn’t a sign of approval

• Nurses morally must build caring relationships w/pts @ their most vulnerable times

• Being truly present w/clients as they navigate through this struggle is nursing work