Substance and Addictive Disorders - exam 1

How to treat a pt who has tolerance to a drug?

pt may require increase dose to achieve effective pain control

Physical dependence v Psychological dependence

Physical Dependence

-have physical rxn if we dont have it

-we NEED it

Psychological Dependence

-NO physical rxn if we dont have it

-an overwehleming DESIRE

substance intoxication (def + s/s)

development of reversible symptoms from excessive substance use

s/s: labile mood, impaired judgement, impaired social/job f(x)ing, slurred speech, incoordination, unsteady gait, flushed face

substance withdrawl

symptoms that develop from abrupt reduction or discontinuation of substance that has been used

s/s: hand/tongue/eyelid tremors, n/v, malaise, weakness. tachycardia, incr BP, sweaty, anxious, depressed mood/irritable, hallucinations/illusions, insomnia, headaches

Factors of Substance Related Disorders

1. biological = genetics or biochemical

2. psychological = developmental or personality, or cognitive/way of thinking

3. sociocultural = social learning or conditioning, or cultural/ethnic influence

classes of psychoactive substances

Alcohol

Caffeine

Cannabis

Hallucinogens

Inhalants

Opioids

Stimulants

Sedatives/hypnotics

Tobacco

(Albert Cant Comprehend How Isabella Optimizes Smoking Stellar Tobacco)

Average sized glass of beer

12 oz

average size glass of win

3-5oz

avg glass of hard liquor

1 oz

Where is alcohol metabolized?

liver

Effect of alcohol

depressant

low dose = relaxed, sleepy

high dose = stupor, resp arrest, death

What nutr becomes deficient w/ chronic alcohol use?

deficiency of B vitamins (especially thiamine)

→ Peripheral neuropathy + alcoholic myopathy + Wernicke’s Encephalopathy + Korsakoff’s Psychosis (aka brain, nerves, muscles)

peripheral neuropathy from chronic alcohol use

peripheral nerve damage, pain, burning → reversible with thiamine supplement

alcoholic myopathy

m pain, red urine, incr in m enzymes in bld → gradual wasting and weakness in skeletal muscles

Wernicke’s Encephalopathy from chronic alcohol use

paralysis of ocular m, diplopia, ataxia, somnolence, and stupor → immediate thiamine replacement therapy

korsakoff’s psychosis from chronic alcohol use

syndrome of confusion, loss of recent memory and confabulation

confabulation

filling in memory gaps w/ made up/distorted/misinterpretted memories

Organs effected by chronic alcohol use

brain + nerves + muscle = from thiamine deficiency

GI + heart + blood + sex organs

GI disorders from alcohol use

1. esophagitis

2. gastritis → n/v, distensions

3. pancreatitis → occurs 1 to 2 days after binge of excessive alcohol

4. alcoholic hepatitis → from long term heavy drinking

5. cirrhosis → end stage of alcoholic liver disease

s/s of cirrhosis

portal hypertension

ascites

esophageal varices

hepatic encephalopathy

Blood disorders from chronic alcohol use

1. impaired WBC production, f(x), and movement → leukopenia

2. impaired PLT production and survival → thrombocytopenia

chronic alcohol use effect on sex organs

sexual dysfunction → incr/decr sex drive, errection failure, gynecomastia, sterility

Alcohol + pregnant

= fetal alcohol spectrum disorders (ex: fetal alcohol syndrome, birth defects, neurodevelopment disorder)

fetal alcohol syndrome

problems with learning, memory, attention span, communication, vision, and hearing

bld alcohol levels for alcohol intoxication

100-200mg/dL

texas’s bld alcohol levels for alcohol intoxication

>80mg or 0.08g/dL

bld alcohol levels where death occurs

400-700mg or >0.4g/dL

When does alcohol withdrawal occur?

w/i 4-12 hours of cessation/reduction in heavy/prolonged drinking

When does delirium present during alcohol withdrawal?

2nd or 3rd day

Types of Sedative/Hypnotics Substances

1. barbiturates (Seconal, penobarbital)

2. non barbiturates (Benadryl, Ambien)

3. anti-anxiety meds (xanax, ativan/lorazepam)

4. club drugs (rohypnol, GHB)

Antidote for sedatives/hypnotics toxicity (benzodiazepine + barbiturate)

benzodiazepine toxicity = flumazenil antidote

barbiturate toxicity = NO antidote

pt has hx of substance use disorder and is requesting a sedative to help them sleep, what should a nurse recommend first?

non pharmacological interventions bc of risk of potentially addictive sedative

onset of withdrawal symptoms (short half-life v longer half-life)

shorter half life:

onset: 12-24hr after last dose

peak: 24-72hr

subside: 5-10days

longer half life:

onset: 2-7days

peak: 5th to 8th day

subside: 10-16days

Types of Stimulants

1. amphetamines (Adderall)

2. synthetic stimulant (bath salt)

3. non-amphetamine stimulant (Ritalin, Focalin)

4. cocaine

5. caffeine

6. nicotine

Effects of stimulants

-restless, insomnia

-incr BP & HR, palpitations, sudden cardiac death

-incr in BMR, anorexia, incr temp

-incr sex drive

caffeine intoxication

>250mg → restlessness + insomnia

amphetamine and cocaine intoxication

euphoria, impaired judgement, confusion, change in VS

stimulant withdrawl

incr appetite, restlessnes, dysphoria, headache

opioid withdrawl

dysphoria, m aches, n/v, lacrimation, runny nose, pupillary dilation, goosebumps (but not cold), sweaty, abd cramps, diarrhea, yawning, insomnia, fever

inhalants (ex)

paint, glue, fuel, canned air → cheap/easy to get for younger kids

How does death occur from inhalants?

suffocation & asphyxiation → body does not receive enough oxygen

s/s of inhalant use

rash/discoloration around mouth/nose

Hallucinogens (ex)

natural → mushrooms, seeds

synthetics → LSD, MDA, bath salts, ectasy, PCP

s/s of PCP overdose

(hallucinogen)

panic attacks + hallucinations + dehydration + kidney failure

Flashbacks

repetition of intense experience

caused by hallucinogens

cannabis (ex:)

natural → marijuana

synthetic → K2, spice

therapeutic f(x) of cannabis

relieves n/v from chemotherapy/chronic pain

Assessment tools for pts w/ substance abuse

1. CIWA-Ar (asses if med support are needed for withdrawl)

2. MAST (asses for excess alcohol use)

3. CAGE (identify problems w/ alcohol)

CAGE questionaire

Cut (feeling to cut down on drinking?)

Annoyed (have ppl annoyed you by criticizing your drinking?)

Guilty (felt bad/guilt about drinking?)

Eye opener (drink first thing in the morning to steady nerves?)

Nursing actions for pt trying to stop substance abuse

1. safety

2. help manage detox symptoms

pt/family edu over management of the substance abuse illness

1. activities to substitute for substance in times of stress

2. relaxation techniques

   1. good nutrition (like vitamin intake)

Collaborative treatment modalities for substance related disorders

1. AA

2. counseling

3. group therapy

   1. in-pt recovery programs

AA (characteristics)

1. peer support

2. acceptance

3. understanding from others who have experienced the same problem

4. higher power

Meds to use during Alcohol intoxication/withdrawl

1. benzodiazepines → Librium (chlordiazepoxide), Ativan (lorazepam), Valium (diazepam)

2. anticonvulsant

3. multivitamins

4. thiamine

Meds to maintain alcohol abstinence

1. disulfiram (Antabuse) → for alcohol

2. Naltrexone → for opioids + alcohol

3. Acamprosate

What MUST be avoided when taking Disulfiram and Naltrezone

Alcohol! even avoid hidden sources of alcohol (sanitizer, cough syrup, etc)

How long must a pt be free from opioid use to take naltrexone?

no opiod use w/i 10 days of starting naltrexone

How long must a pt be free from alcohol use to take disulfram?

pt must abstain from alcohol for 12 hr to start meds

acamprosate (f(x))

reduces the unpleasant effects of abstinence

Meds to maintain opioid abstinence

1. methadone → reduce pain of opioid withdrawal)

2. suboxone → naloxone + buprenorphine (less addictive than methadone)

3. clonidine → reduces n/v/d from opioid withdrawal

Codependency

“overly responsible”

person protecting someone from their consequences allowing them to continue their behaviors