Substance Abuse

addiction

a compulsive, abnormal dependence on a substance or on a behavior

CNS depressants

alcohol, sedatives, hypnotics, anxiolytics

signs of intoxication from alcohol

relaxation and loss of inhibitions, slurred speech, unsteady gait, lack of coordination, impaired attention concentration memory judgment, aggression, inappropriate sexual behavior, blackout sig

signs of overdose on alcohol

unconsciousness, vomiting, respiratory depression, aspiration pneumonia or pulmonary obstruction, alcohol induced hypotension

what can alcohol induced hypotension lead to

cardiovascular shock and death

alcohol chronic effects on the body

cardiomyopathy, wernicke encephalopathy, korsakoff psychosis, pancreatitis, esophagitis, hepatitis, cirrhosis, leukopenia, thrombocytopenia, ascites

what are the labs for pancreatitis

elevated amylase and lipase

what are the labs for cirrohsis

elevated AST and ALT

leukopenia

low white blood cell count

thrombocytopenia

abnormally low levels of platelets

cirrhosis

scaring of the liver tissue

ascites

accumulation of fluid in the abdomen

most dangerous adverse effects of alcohol

wernicke encephalopathy, korsadoff’s psychosis

wernicke encephalopathy

most serious form of thiamine B1 deficiency

what happens if a thiamine replacement is not given quickly when having wernicke encephalopathy

death

korsadoff’s psychosis

syndrome of confusion, loss of recent memory, and confabulation in alcoholics

when does alcohol whithdrawal symptoms begins, peaks, and end

begins: 4-12 hours after last drink
peaks: second day

end: day 5

how long would withdrawal symptoms of alcohol persist for if you are a longer alcoholic

1-2 weeks

s/s of alcohol withdrawal

hand tremors, sweating, elevated HR and BP, insommnia, anxiety, nausea and vomiting

severe symptoms of alcohol withdrawal

hallucinations, delirium, seizures

what do you do if one of the severe symptoms of alcohol withdrawals are seizures

seizure precautions, padded side/head rails and provide suction

withdrawal treatment of alcohol

benzodiazepines and disulfiram (antabuse)

which benzodiazepines are used for alcohol withdrawal

lorazepam, chloridiazepoxide, diazepam

disulfiram

deters patients from drinking alcohol

what would happen if a patient ingest anything with alcohol while on disulfiram

flushing, throbbing, headache, sweating, nausea, vomiting

what items has alcohol in them

cough syrup, lotion, mouth wash, perfume, aftershave, vinegar, any extracts

sings of intoxication of sedatives, hypnotics and anxiolytics

slurred speech, labile mood, lack of coordination, stupor, unsteady gait, coma, impaired attention and memory

what should you do if intoxication from sedative, hypnotics and anxiolytics is suspected

assess vitals and respiratory status immediately

what other drugs are abused during the time of intoxication of sedatives, hypnotics and anxiolytics

benzodiazepine and barbiturates

barbiturates overdose symptoms

coma, death, respiratory distress, cardiac failure

what is important to ask when a pt is having withdrawals from sedatives, hypnotics and anxiolytics

what did they take and when was teh last time they taken it

s/s of withdrawals from sedatives, hypnotics, anxiolytics

increased HR BP RR and temp, hand tremors, insomnia, anxiety, nausea, psychomotor

what are severe withdrawal symptoms from sedatives hypnotics and anxiolytics

seizures and hallucinations

what should you do when withdrawaling from sedatives, hypnotics, anxiolytics

slowly taper off the drug, do not stop use abruptly

stimulants

limited use in the clinical setting with the exception of ADHD meds

types of stimulants

cocaine and methamphetamine

what does cocaine do

creates intese feeling of euphoria

what does methamphetamine do

causes psychotic behavior and brain damage

typical effects of intoxication from stimulants

high/euphoric feeling, hyperactivity, hypervigilance, talkativeness, grandiosity, hallucinations, anger, figghting, impaired judgment, stereotypic or repetitive behavior

physiologic effects when intoxicated from stimulants

tachycardia, chills, elevated BP, nausea, dilated pupils, chest pain, perspirations, cunfusion, cardiac dysrhythmias

stimulant overdose signs

seizures, coma, death

withdrawal signs from stimulants

dysphoria, fatigue, vivid/unpleasant dreams, insomnia or hypersomnia, increase appetite, psychomotor retardation or agitation, may be suicidal

withdrawal treatment for stimulants

treat symptomatically

when does the cannabis effects begin, peaks, and how long they last

begins: 1 minute after inhalation

peaks: 20-30 minutes

last: 2-3 hours

s/s of cannabis intoxication

impaired motor coordination, inappropriate laughter, impaired judgment and short term memory, distortion of time and perception, anxiety, dysphoria, social withdrawal

physiological effects from intoxication of cannabis

increased appetite, conjuctival injection, dry mouth, hypotension, tachycardia

what does excessive use of cannabis produce

delirium, cannabis induced psychotic disorder

what drugs can you not overdose on

cannabis and ecstasy

withdrawal symptoms of cannabis

muscle aches, sweating, anxiety, tremors

what does opioids do

desensitize the user to both physiological and psychological pain

example of opioids

morphine, demerol, methadone, oxycodone, synthetically produced fentanyl, heroin

s/s of intoxication from opioids

euphoria, apathy, lethargy, listlessness, impaired judgment, psychomotor retaidation/agitation, constricted pupils, drowsiness, slurred speech, impaired attention/memory

severe s/s of intoxication from opioids

coma, respiratory depression, pupillay consticution, unconsciousness, death

when does withdrawal symptoms from opioids begins

drug intake stops or when an opioid antagonist is given

when does short acting opioids like heroin withdrawal begins, peaks, and subsides

begins: within 6-24 hours

peaks: 2-3 days

subsides over 5-7 days

when does long acting opioids like methadone begin and ends

begins: 2-4 days

ends: 2 weeks later

when do cravings for opioids last

2-3 months

s/s of opioid withdrawal

anxiety, ache in back and legs, nausea, vomiting, lacrimation, sweating, yawning, fever, insomnia, restlessness, cravings for more, dysphoria, rhinorrhea, diarrhea

when opioid intoxication or withdrawal symptoms are present what should you do

obtain a drug history including the time and amount of last use and drug screening

intoxication treatment for opioids

naloxone and methadone

naloxone (narcan)

opioid antagonist, reverse all signs of opioid toxicity

when should you administer naloxone

every few hours until opioid levels drop to non toxic

process may take a few days

methadone

used as a replacement for opioids, use to taper off, helps abstain from opioids like heroin

what symptoms does methadone have when withdrawaling from heroin

substitution during detox can reduce symptoms to no worse than a mild case of the flu

hallucinogens

substances that distort the user’s perception of reality

examples of hallucinogens

ecstasy and PCP

behavior and psychological changes when intoxicated and overdosed on hallucinogens

anxiety, depression, paranoid ideations, ideas of reference, fear of lsoigng one’s mind, potentially dangerous behavior

ideas of referrence

inaccurate interpretation that general events are personally targeted to them

what potentially dangerous behavior does a person do while on hallucinogens

jump out of window or off a bridge believing they could fly

physiological symptoms of hallucinogen intoxication and overdose

sweating, tachycardia, palpitations, blurred vision, tremors, lack of coordination

along with the hallucinogens intoxication symptoms what are the intoxication symptoms for PCP

belligerence, aggression, impulsivity, unpredictable behavior

intoxication treatment for hallucinogen

toxic reactions except PCP are psychological, drugs are not direct cause of death, isolation from external stimuli, restraints

what is the direct cause of hallucinogens

people don’t die from the drug, they die from their actions while on the drug

PCP toxicity symptoms

seizures, HTN, hyperthermia, respiratory depression

how do you treat PCP toxicity

symptomatically

withdrawal interventions for hallucinogens

talk down the pt/reassure they are safe, do not treat pharmacologically, treatment is supportive

withdrawal symptoms from hallucinogens

cravings and flashbacks

what can inhalants cause

peripheral nervous system damage and liver disease

intoxication symptoms from inhalants

dizziness, lack of coordination, unsteady gait, muscle weakness, stupor, nystagmus, slurred speech, tremors, blurred vision, coma and death

behavioral symptoms from inhalants

belligerence, aggression, apathy, impaired judgment, inability to function

acute toxicity from inhalants

anoxia, respiratory depression, vagal stimulation, dysrhythmias, death related bronchospasm, cardiac arrest, suffocation or aspiration from compound or vomit

are there antidotes and medication for inhalant use

no

example of inhalants

spray paint, gasoline, any fumes

withdrawal symptoms of inhalants

psychological cravings, may experience inhalant induced disorders

withdrawal from inhalants interventions

support the respiratory system and cardiac function until it is out of the system, no detoxification procedures

what diseases can inhalants induce

psychosis, dementia, anxiety, mood disorders

withdrawal treatment for inhalants

treat symptomatically

substance abuse treatment and prognosis

12 step programs, treatment settings, pharmacological treatment

12 step programs

based on the philosophy that total abstinence is the best and essential for alcoholics to have support from otehrs

requirements for membership of 12 step programs

having a desire to stop drinking or using

dual diagnosis

substance abuse + psychiatric illness

why is dual diagnosis pt have limited treatment success

one thing they have to be taken off of in order to combat the substance use is what they have to have in order to treat their metnal illness

key elements to address with dual diagnosis pt

healthy nurturing supportive living environments, assistance with fundamental life changes, connections with other recovering people, treatment of comorbid conditions

assessment for caring for pt with substance use problems

history, appearance and motor behavior, mood and affect, thought process and content, sensorium and intellectual process, judment and insight, self consept, roles and relationships, physiological considerations

what does a pt with substance abuse self concept

low self esteem or grandiose behavior

what do you look for when caring for a pt with substance use problems

assessment, data analysis and priorities, outcome identification, actions, evaluation

what is the priority for a pt with substance use problems

detox, based on physical needs, safety, nutrition, fluids, elimination, sleep

what are the actions of caring for a pt with substance use problems

provide healthy teaching for pt and family, address family issues, promote coping skills, teach families the importance of understanding relapse

how to teach families the importance of understanding relapse

let the family know how to see signs of relapse and the next steps of what to do

what is the main goal for an addict

pt is able to abstain from the substance