3060 Substance use disorders

What are the 4 aspects of substance use disorder

impaired control, social impairment, risky use, physical effects

difficulty stopping a medication

addiction

using a substance to a point of impairment

intoxication

the need to use more and more of a substance for it to have the same effect

tolerance

What do the following fall under?

alcohol

caffeine

cannabis

hallucinogens

inhalants

opioids

sedatives/hypnotics/anxiolytics

stimulants

tobacco

gambling disorder

Substance related and addictive disorders

What does the following describe?:

1 week after cessation:

anger, irritability, aggression, anxiety, depression, insomnia, weight loss, HA

Withdrawal from cannabis

What is the treatment for withdrawal from cannabis?

abstinence, psychotherapy, antidepressants

What Intoxication does the following describe?:

restlessness, nervousness, agitation, flushing, diuresis, gi disturbance, tachycardia, arrhythmia, seizures, death

Intoxication of caffeine

What drugs are related to hallucinogen use disorder

LSD, PCP, ketamine

What intoxication does the following describe?:
belligerence

impulsiveness

psychomotor

agitation

PCP intoxication

What SUD does the following describe?:

Usually short term, but may continue for longer periods

huffing, sniffing, whippets

glues, paints, solvents, propellants, fuel

long term: diminished social/occupational functioning, aggressive behavior, poor judgment

Inhalant use disorder

What Intoxication does the following describe?:

·      Euphoria, disinhibition, hallucinations, anxiety; nausea/anorexia, nystagmus, double vision

·      Stupor, unconsciousness, amnesia, delirium, dementia, psychosis

·      Can result in death (arrhythmias) “sudden sniffing death”- butane & propane

Intoxication of inhalants 

What SUD treatment does the following describe?:

Haloperidol for psychosis

Treatment with inhalant use disorder

What intoxication does the following describe?: 

o   Nystagmus (eyes back and forth), HTN, tachycardia, decreased pain, seizures

o   Coma, hyperthermia

Intoxication of hallucinogens 

What SUD treatment does the following describe?:

·      “Talking down” ; haloperidol, diazepam; cooling blankets for hyperthermia

Treatment for Hallucinogen use disorder

What are the only two SUDs that have no official withdrawal?

Hallucinogens, inhalants

What SUD does the following describe?:

o   long-term, chronic disorder- high relapse

- Significant social/occupational impairment

-  Prescription medications, heroin

Opioid use disorder 

What does the following intoxication describe?:

·      Psychomotor impairment, drowsiness, slurred speech

·      Pupil constriction, bradypnea, bradycardia, hypothermia, coma

Opioid use disorder intoxication

What substance does the following withdrawal symptoms describe?:

·      Very physically uncomfortable symptoms: tearing, runny nose, yawning, anxiety, piloerection, tachycardia, HTN, bone/muscle pain

·      Begins 6-12 hrs. after last dose. Lasts 1 wk.

Opioid use disorder withdrawal

What substance do the following Overdose symptoms describe?:

§  respiratory depression/ arrest, coma, pinpoint pupils

Opioid use disorder overdose

What SUD is related to the following treatment options?:

·      Overdose: ventilatory support

·       Naloxone: IM, SQ, IV, intranasal (repeat)

·      Therapy (inpatient), methadone, clonidine, buprenorphine/buprenorphine & naloxone, naltrexone

Opioid use disorder 

How many doses of narcan do people normally require?

multiple doses

When you have a new admit who used to smoke, what should you ensure they get ordered?

a nicotine replacement

What SUD does the following describe?:

• Benzodiazepines, barbiturates, prescription sleep meds

• Depressants: may affect relationship & role performance; tolerance

Sedatives/ hypnotics/ anxiolytics 

What SUD intoxication does the following describe?:

·      Slurred speech, impaired coordination

Sedatives, hypnotics, anxiolytics

What SUD withdrawal symptoms does the following describe?:

·      Tremors, insomnia, psychomotor agitation, anxiety, seizures (may occur even if taken as intended!)

Sedatives, hypnotics, anxiolytics

What SUD does the following treatment describe?:

·      Overdose: gastric lavage, activated charcoal, support ventilation

·      Flumazenil for benzodiazepine overdose

·      Wean off meds

sedatives, hypnotics, anxiolytics 

What SUD does the following describe?:

-amphetamines, cocaine

• Use disorder may result even after short-term use

Stimulants

What SUD does the following intoxication describe?:

·      Elation, euphoria, sociability, hypervigilance, anxious, aggressive, decreased appetite, chest pain, arrhythmias, dilated pupils, sweating, nausea/vomiting, “crawling” skin

Stimulants

What SUD does the following withdrawal describe?:

·      Fatigue, nightmares, depression, suicidal thoughts, cravings

stimulants

What SUD does the following treatment relate to?:

·      Therapy (inpatient), antipsychotics, antidepressants (bupropion)

·      Symptomatic treatment: no FDA-approved meds; only help w symptoms

Stimulants

What SUD does the following describe?:
o   most substance-related deaths

§  Dependence results quickly

tobacco

What SUD withdrawal does the following describe?:

]·      Irritability, anxiety, depression, poor concentration, restlessness, insomnia

tobacco

What SUD does the following treatment relate to?:

·      Behavioral therapy, hypnosis,

·      nicotine replacements (gum, lozenges, patches): ensure new patients who used to smoke get replacement

·      bupropion, varenicline

Tobacco

What SUD does the following describe?:
- 5.8% of adults

Alcohol use disorder

What does the following describe?:

4 (women) or 5 (men) drinks/ 2 hours (26.5% of adults

binge drinking

What does the following describe?:
8 (women) or 14 (men) drinks/ week (6.6% of adults)

heavy drinking 

What SUD does the following intoxication relate to?:

·      Initially: euphoria, decreased inhibition

·      Impaired judgement, decreased motor function, slurred speech, vomiting, blackouts, hypothermia, hypotension, bradypnea

Alcohol

·What does the following describe?:

does not exhibit signs even if the concentration is high

tolerance

What SUD does the following withdrawal describe?:

·      Shakiness/jitters, nausea, vomiting, agitation, insomnia: common with heavy drinking

·      Hallucinations/impaired perception, seizures, delirium (DT’s): less common, but life-threatening

alcohol use disorder

What SUD does the following treatment relate to?:

·      Benzodiazepines: chlordiazepoxide (Librium): mild agitation

·      Diazepam (valium): seizures/delirium prevention

·      Lorazepam (Ativan): acute delirium

·      Disulfiram; Naltrexone; Acamproste

·      Therapy: inpatient/out

·      Withdrawal: inpatient

Alcohol use disorder

What SUD does the following describe?:

o   Possible future DSM process additions: social media, shopping, sex

o   Similar to other use disorders: related to anxiety

o   Significant family, social, and financial repercussions

o   Increased w stress/depression

Gambling disorder

What SUD does the following treatment relate to?:

• Support groups, inpatient treatment

• SSRIs, mood stabilizers (lithium), anticonvulsants

Gambling use disorder (process addiction)

what are the 4 main risks for SUD in nursing?

stress, burnout, injuries, access

what does the CAGE assessment ask?

Cut down, Annoyed, Guilty, Eye-opener

What deficiency is Wenicke-Korsakoff syndrome associated with?

thiamine deficiency

Korsakoff symptoms are reversable

FALSE

What are the outcomes of SUD?

blackouts, FAS, Neuropathy, cardiomyopathy, Esophagitis, pancreatitis, Cirrhosis, leukopenia, cancer

A nurse on a med-surg unit begins volunteering to give other nurses’ narcotics, often avoids witnessed wasting, and has inconsistent work performance. What is the nurse manager’s PRIORITY action?

A. Offer the nurse emotional support
B. Reassign the nurse to a lighter patient load
C. Report observations according to facility policy
D. Encourage the nurse to take scheduled vacation time

C

Which findings place nurses at higher risk for developing substance use disorders? (Select all that apply.)

A. Frequent exposure to narcotics
B. Working in high-stress environments
C. Limited access to controlled substances
D. Physical injuries
E. Low patient acuity

A B D

The nurse is assessing alcohol withdrawal using the CIWA-Ar scale. Which assessment findings are included? (Select all that apply.)

A. Tremors
B. Nystagmus
C. Nausea/vomiting
D. Hallucinations
E. Blood pressure only

A C D

A patient reports needing a drink first thing in the morning to “steady their nerves.” Which screening tool does this question belong to?

A. CIWA-Ar
B. COWS
C. CAGE
D. AUDIT

C

A patient with long-term alcohol use is confused, has abnormal eye movements, and unsteady gait. What is the PRIORITY intervention?

A. Give IV glucose
B. Administer IV thiamine
C. Provide benzodiazepines
D. Start restraints

B

Which outcome is associated with Korsakoff syndrome?

A. Rapid reversibility with medication
B. Irreversible memory impairment
C. Excess dopamine production
D. Vision loss only

B

Which findings are expected in cannabis intoxication? (Select all that apply.)

A. Red eyes
B. Increased appetite
C. Dry mouth
D. Miosis
E. Tachycardia

A B C E

A teen arrives to the ED after using marijuana and is violently vomiting. Which condition does the nurse suspect?

A. Cannabis overdose
B. Cannabinoid hyperemesis syndrome
C. Stimulant withdrawal
D. Gastritis

B

Which medication is used to reverse benzodiazepine overdose?

A. Naloxone
B. Flumazenil
C. Naltrexone
D. Disulfiram

B

A patient intoxicated with PCP presents with nystagmus, severe agitation, and hyperthermia. What is the PRIORITY intervention?

A. Provide “talking down” therapy
B. Administer haloperidol
C. Induce vomiting
D. Start nicotine replacement

B

Which signs are associated with stimulant intoxication? (Select all that apply.)

A. Dilated pupils
B. Euphoria
C. Increased appetite
D. Chest pain
E. Crawling skin sensations

A B D E

A patient withdrawing from opioids reports bone pain, tearing, runny nose, and piloerection. What should the nurse anticipate?

A. Administer flumazenil
B. Administer clonidine
C. Prepare for seizures
D. Apply cooling blankets

B

Which finding is MOST concerning in alcohol withdrawal?

A. Anxiety
B. Tremors
C. Vomiting
D. Hallucinations

D

A patient in alcohol withdrawal is experiencing seizures. Which medication is expected?

A. Disulfiram
B. Chlordiazepoxide
C. Diazepam
D. Naltrexone

C

Which are outcomes of long-term alcohol use? (Select all that apply.)

A. Cardiac myopathy
B. Pancreatitis
C. Leukopenia
D. Hyperthyroidism
E. Cirrhosis

A B C E

Which is a sign of benzodiazepine withdrawal?

A. Bradypnea
B. Slurred speech
C. Tremors and seizures
D. Pupil dilation

c

A patient is diagnosed with gambling disorder. Which treatments are appropriate? (Select all that apply.)

A. SSRIs
B. Mood stabilizers
C. Anticonvulsants
D. Disulfiram
E. Support groups

A B C E

A nurse caring for a patient with tobacco dependence should anticipate which interventions? (Select all that apply.)

A. Nicotine patches
B. Bupropion
C. Varenicline
D. Benzodiazepines
E. Hypnosis

A B C E

Which finding indicates opioid overdose?

A. Dilated pupils and tachycardia
B. Restlessness and diarrhea
C. Pinpoint pupils and respiratory depression
D. Tremors and agitation

C

A patient presents with caffeine intoxication. Which symptoms should the nurse expect? (Select all that apply.)

A. Restlessness
B. Arrhythmias
C. Seizures
D. Slurred speech
E. Flushing

A B C E