substance use

substance use disoer

cluster of cogitve and behabiroal ,psy symptom

affect indicidual family friend

factor influence substance use

-gene

-family environment

-social environment

-trauma

-mental illness

-chronic pain

-social determinant of health

-access to healthcare

-stigma and discrimniation

continum of substance use

-non use

-expeirmental

-scoial

-regular

-misuse

-dependence

deoebdence withdrawk

-psy dependence;emotional and mental reliance on substance d/t reinforceing effect

-physical dependence:physcially need to function

chartacteristic of substance use

-loss control of consumption

-continued substance use depiste problem and conseuqnce

-craving

-use misuse physcial/psy dependence

-tendency to relapse

dopamine r/t substance use

-rewaard craving

-brain seek out behavior that relase dopamine

=psycoactive increase reward pathway activity ,produce mood elevation and euphoria,incrrease endorphine,seroti,dopamine, GABA

tolerance

repeated long germ use change neural circuitry dopamine

decrease responsiveness ,need larger dose

cross tolerance

tolerance to one drug lead tolerance to other drug

substance use classification

-opoid;morphine, codeine,dilaudi, supeudol

-cannabis

-spice inhalant;cleaning,paint,amylnitrite

-cns stimulant;nictoine,methamephetamine,cocaine

-hallucinogen:LSD,psolocybin-magic mushrrom,ketamine,phencyclidine-angel dust,peyot

alcohol hormone

act on GABA, increase NE,gluctamate,dopamine

BAC

-higher ,more intoxicated,imparied

-measure 20min ingestion

-limit 0.08%

-one drink incrase 0.01-0.03 in 1 hr

means 1bottle of beer, 142 wine, 43ml vodka

-women 10 per week, no more than 2 per day

mean 15,no more than 3 per day

factlr affect bac

-rate of consumption-more quick

-amount consumed, tolerance,could high BAC minimal sign of impariement, low BAC but high intoxication

-age increase when older,d/t decrease muscle ,water, decrease liver blood flow

-female

-more weigh, more water, lower BAC

-empty stomach higher

-Rx:antianxiety, antidepressant,antihistamine

alcohol dependence

disturbance in memory and blackout

after acute intoxication, hangover;malasie, nausea, headache, thirst, fatigue

-imparie judgment/ impulse lead to injury

-hypoglycemia

-vilence, trauma, driving accident

wernick encelopathy

acute reversible

3drink /hr women 4 drink/hr men

• Mental status changes Vision problems

  nystagmus, double vision, Gait abnormalities

  Lack of energy, hypothermia, low blood pressure, tremors

korsakoff syndrom

chronic hard to recover

profound disorientation,indifference, inattentive,oculomotor abnormality,ataxia

severe anterograde, retrograde amnesia

cofabulation-false memory

korsakoff r/t ?

thiamine deficency

-malasorption nutrient

whole body impact

-hallu, delu

-anemia

-cardiomyopathy

-cirrhosis

-gastritis

-pancreatitis

-slow rr hr

cannabis key active ingredient

THC tetrahydroc annbinol

available otc control nasuea d/t chemo, stimulate appetite in AIDS pt, decrease chronic pain

cannabis effect

-euphoria

-talkative

-laughter

-relxation

-slow perception

-dry mouth

-red eye

-increase appetie

-increase sensitivity to stimuli

-paranoia

cannabis long term use

-lethargy

-anhedonia

-difficult concentrating

-no motivation

-meomry impraiment

-bronchitis

synthetic cannabinoid

harmless?but not safe actually

inparied driving,poison,increase crminal chagreZ

opoid

act on endorphine, and dopamine, brain reward system

physio:analgesia, euphira, drow, bradypnea, constricted pupil constipation, imparie judgment

stimulant

increase dopamine leadt o rapud dependence

seortonin, NE, enhance mood

stimulant effect

euphoria, grandiosity, increase nergy, hyperalert, insomnia, suppress appetie, HTN, tachycardia,disphoresis, dilated pupil,dysrhtmia

agitation, aggression,psychosis

stimulant exmaple

-cocaine:iv,po,nose

lead to MI, sz, stroke, psychosis

overodse:agitation,increae VS, hallucination, sz

-metha-ice/speed

harm r/t subatnce use

route oise special harm

placign safety at risk

assessment substance use

substance use-alcohol, cannabis, opoid, stimulant

last dose. use,pattern of use, amount freuqnecy, duration

problem in life fx

head to toe assessment

suicidal

medical, psy hx

trauma

fall,fight, burn

period of abstience and ss

readiness to change

alochol withdrawl ss

ss: H/A, anxiety, irritability, tachycardia, swaeting,nausea,insomnia, hand tremor, fever, dysthymia, liver impariment

alchol withdrawl time

begin 6-12

peak 24-48

then disappeera unless progress

sz r/t alcohol

24-48hr undertreated withdrawl

alcohol withdrawl delirirum

medical emergency lead to death

altred loc with sz

tachycardia, htn,sweating,disorientation,hallucination,delu,fever,agiation

48-72hr

give benzo /antipsy

cannabis withdral ss

insomnia anxiety in rare case

heavy:irritability, anxiety, depress, nausea, insomnia,fever, chill, tremor

cannabis overdose ss

fatigue, paranoia, painc,psychosis

opoid withdrawl

abd cramp,diarrhea, n/v, sweating, insomnia, yawning, chill,pain,anxeity, restless

onset 4-6hr, peak 2-3,resolve day 5-7

tx:bupro,methodone

opoid overdose

constricetd pupil,calmmy skin,slow rr, loc chanhge

drow,sluruy sppech,myooiss, resp depression MI, coma

stimulant withdrawl

craving, anxeity, irritability, depress, exhustion,apthy,disoreintation

onset iv 2hr, inasal 2-4hr

stimulant overdose

agitation,hallu, HTN, tachycardia, resp distress, hyperthermia, MI, sz

CAGE

for alcohol

-cut down?

-people criticize?

-guilt?

-eye opened?

CIWA

alchol, monitor wiuthdralw

lab

CBC< Lft, BUN,cr,coa profile,BAC, urine tox screen

ETOH 2-12 hr, benzo 3-5d, cannabis 3wk, cocain 2-4d

nursing interventiomn

-moniotr phy VS, hydration

-increase agitation

-ensure safety

-quiet calm encirment

-adm rx

tx for alcohol withdralw

-prevent sz

-enhance GABA effect give antixilytic, anti sz, muscle relacant, valium,ativan ,serax,benzo

multi vi,folic acid, dilntin, Mg ,haldol,zofran

tx for wernick encelppathy, korsafkoff

thiamine

large IV thiamine tid for 2-3wk

for sndrome 3-12 m

tx for drug

cannabis:benzo,

opoid;methadonem naloxone,

stimulantLldiazepam, ativan

overdose intervention

check ABC,

airway;incubvation

iv

ecg

monitor vs, neuro,cardiac rhythm, IO

tox screen

overdose tx

haldol-psyhcos

diazepam,lorazepam,sz

propanol,labetalol-HTN

naloxone-opoid

flumazenil-benzo

gastric lavafe, if po 4-6hr