Substance Use Disorders 1

what is substance use disorder defined as

a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems

define addiction

relasping disease when someone seeks out substance even though it causes physical or psychological harm

define intoxication

when substance temporarily affects your body and brain

define blackout

happens while intoxicated, person remains awake but remembers none of what happened

define tolerance

when body gets used to a substance so you need more of it for the same effect

define flashbacks

after someone takes a hallucinogen; will have perceptual disturbances even though drug not in system

define cross tolerance, provide example

tolerant to one drug so they are tolerant to a related drug; ex: alcohol and benzos

define amotivational syndrome

when someone loses drive or motivation to do everyday things

define overdose

when someone takes too much of a drug, causing serious harm or life-threatening effects to the body

define psychological dependence

when someone feels like they need a drug to cope with stress, emotions, or feel "normal"

define physical dependence

when the body adapts to a drug and going without it causes withdrawal symptoms

define withdrawal

the unpleasant physical and/or psychological symptoms that happen when someone stops or reduces a substance they're dependent on

define dual diagnosis

psychiatric condition + substance use disorder

what are the goals of substance use disorder (SUD) treatment

- recognize if person OD'd

- help them with withdrawal

- dx and treat any complications

- education/counseling/therapy

- maintian sobriety

define abuse (of substance)

habitual use of substance outside of medical necessity or societal acceptance; used for purpose of altering mood/emotions/state of consciousness

define addiction

chronic, relapsing disease characterized by compulsive drug-seeking and use despite negative consequences, and by long-lasting changes in the brain

define tolerance (SUDs)

needing increased amounts to achieve intoxication/desired effect

what are some risk factors for developing SUDs

- low frustration levels, poor impulse control, lack of meaningful relationships, childhood trauma, low self esteem, propensity for risk taking behaviors

- peer pressure

- family acceptance

- male

- family member with SUD

how do SUDs affect the brain

- alter brain reward system by releasing dopamine

- drug affecting neurotransmitters

- increased risk with genetic markers

what are the routes of admin for SUDs from fastest to slowest

- IV

- inhalation (intranasal/smoking)

- PO

routes that take longer to come on typically

last longer with less intense effects

what are some IV route complications

- infections

- venous sclerosis

- disease transmission

- endocarditis

what are some intranasal complications

- chronic sinusitis

- perforated nasal septum

what are some smoking complications

respiratory problems

what are some IM/SQ problems

accidental - meant to be IV

- scarring

- lesions

- abscesses

- infections

what are three classes of CNS depressants

alcohol, barbituates, benzodiazepines

CNS depressants affect what brain chemical

GABA

alcohol, barbituates and benzos are considered

sedative hypnotics

with alcohol use disorder the more alcohol you have the more

effects you will have > will reach more primitive parts of brain

what is considered heavy drinking for men

> 4/day or 14/week

what is considered heavy drinking for women

>3/day or 7/week

what is important to educate breast feeding moms on drinking

- BAC = milk alcohol conentration

once alcohol out of her system her milk will not be affected

what are some S/S of alcohol poisoning

- inability to wake up

- vomiting

- slow breathing (<8/min)

- irregular breathing

- seizures

- hypothermia

for someone who has a BAC of 0.05% what SE might we see

changes in mood and behavior; impaired judgement

for someone who has a BAC of 0.08% what SE might we see

legal level of intoxication, clumisness in voluntary motor activity

for someone who has a BAC of 0.20% what SE might we see

depressed function of entire motor area of the brain, causing staggering and ataxia; emotional lability

for someone who has a BAC of 0.30% what SE might we see

confusion, stupor

for someone who has a BAC of 0.40% what SE might we see

coma

for someone who has a BAC of 0.50% what SE might we see

death caused by respiratory depression

is diaphoresis a S/S of uncomplicated alcohol withdrawal or delirium tremens

uncomplicated alcohol withdrawal

when do we start to see signs of uncomplicated alcohol withdrawal and when does it peak

within first few hours after last drink; 24-48 hours

is increased BP/HR a S/S of uncomplicated alcohol withdrawal or delirium tremens

uncomplicated alcohol withdrawal

what is a priority assessment for someone going through uncomplicated alcohol withdrawal

BP/HR

is irritability/"shaking inside" a S/S of uncomplicated alcohol withdrawal or delirium tremens

uncomplicated alcohol withdrawal

are tremors a S/S of uncomplicated alcohol withdrawal or delirium tremens

uncomplicated alcohol withdrawal

are illusions a S/S of uncomplicated alcohol withdrawal or delirium tremens

uncomplicated alcohol withdrawal

when are grand mal seizures possible in someone who is experiencing uncomplicated alcohol withdrawal

7-48 hours after last drink

is autonomic hyperactivity a S/S of uncomplicated alcohol withdrawal or delirium tremens

delirium tremens

delirium tremens is a ____________________ and can lead to __________________

medical emergency; possible death

when does delirium tremens peak

2-3 days after cessation/reduction

define illusion (uncomplicated alcohol withdrawal)

visual distortions: see something that is their but it is misinterpreted

what is autonomic hyperactivity

life threatening disorder of PNS and CNS

what are some S/S of autonomic hyperactivity

- severe HTN

- tachyarrythmias

- hyperhyrdrosis

- peripheral vasoconstriction

- hyperthermia

are sensorial and perceptual disturbances a S/S of uncomplicated alcohol withdrawal or delirium tremens

delirium tremens

is fluctuating loss of consciouness a S/S of uncomplicated alcohol withdrawal or delirium tremens

delirium tremens

are delusions a S/S of uncomplicated alcohol withdrawal or delirium tremens

delirium tremens

is a body temp of 100+ a S/S of uncomplicated alcohol withdrawal or delirium tremens

delirum tremens

are agitated behaviors a S/S of uncomplicated alcohol withdrawal or delirium tremens

delirium tremens

what is usually the 1st thing noticed when someone starts delirium tremens

mood change > b/c irritable and confused

what med would be used for a cross tolerance taper for ETOH withdrawal, and if that doesn't work what is the second line of defense

benzos then barbituates

why would anticonvulsants (gabapentin) be given to someone with ETOH withdrawal

lower anxiety and prevent seizures

why would betablockers (propanolol) or alpha blockers (clonidine) be given to someone with ETOH withdrawal

for autonomic symptoms and elevated vitals

why is thiamine given to someone in ETOH withdrawal

prevent wernicke-korsakoff syndrome and to correct high output HF

why is folic acid (B12) given to someone in ETOH withdrawal

correct megaloblastic anemia and halt peripheral neuropathy

what is wernicke-korsakoff syndrome

is a brain disorder caused by a severe lack of vitamin B1 (thiamine), usually from chronic alcohol use

wernicke-korsakoff syndrome can look a lot like

dementia

what are some S/S of wernicke-korsakoff syndrome

- nystagmus

- ataxia

- confusion

- short term memory loss

- inability to learn new information

- long term memory gaps

- inability to learn

what are some notable behaviors of wernicke korsakoff syndrome

confusion, amnesia

what is post acute withdrawal syndrome (PAWS)

lingering symptoms that can occur after someone stops using a substance, even after the acute withdrawal phase is over

how long can PAWS last

- days to weeks

- occur up to 2 years

what are some features of PAWS

- mood swings

- tiredness

- variable ability to concentrate

- disturbed sleep

what is a major risk of PAWS

distressing S/S can lead to relapse

PAWS is less physical and more ______________/_______________ because

mental/emotional; brain remodeling itself as it adjusts to no drugs

what are some meds that can be prescribed for ETPH sobriety

- naltrexone

- acamprosate

- disulfiram

- gabapentin

what is naltrexone

opioid antagonist > if taking it and drinking won't get good feeling; reduces relapse

what is acamprosate

may reduce symptoms of withdrawal

what is disulfiram

interferes with alcohol breakdown leading to unpleasant reactions such as flushing, N/V; stays in system up to 14 days

what is gabapentin

works on GABA to calm down the brain and mitigate hyper-aroused state; reduces craving by lowering, anxiety, improving, sleep

severe confusion with a benzo is a S/S of

OD

drowsiness with a benzo is a S/S of

OD

lack of coordination/weakness with a benzo is a S/S of

OD

lightheadedness with a benzo is a S/S of

OD

memory loss with a benzo is a S/S of

OD

fainting with a benzo is a S/S of

OD

coma with a benzo is a S/S of

OD

with benzos you can OD by themselves or paired with

use of ETOH, opiates, TCAs, CNS depressants

body pain with a benzo is a S/S of

withdrawal

muscle tension/cramping with a benzo is a S/S of

withdrawal

insomnia with a benzo is a S/S of

withdrawal

vomiting with a benzo is a S/S of

withdrawal

tremors with a benzo is a S/S of

withdrawal

sweating with a benzo is a S/S of

withdrawal

seizures with a benzo is a S/S of

withdrawal

what is the reversible agent of benzos

flumazenil

with benzo withdrawal there is more

physical body pain and restlessnes

when d/c or lowering benzos there is a lot of rebound

anxiety

heroin is an

opiate

heroin has a _______ lipid solubility

high

what happens when heroin crosses the blood brain barrier

it converts to active morphine

constricted pupils is a sign of

opiate constriction