substance use disorders

alcohol withdrawal starts and ends when?

4-12 hr; 5-7 days

when can alcohol delirium come? what is it considered?

2-3 days; medical emergency

alcohol delirium symptoms (5)

disorientation, psychotic manifestations, hypotension, dysrhythmias, and death

alcohol withdrawal meds (3)

benzos, beta blockers, and anticonvulsants/epileptics

alcohol abstinence maintenance drugs (3)

disulfiram, naltrexone, and acomprosate

disulfiram nursing education

avoid products with alcohol, medical alert bracelet, 12-step self-help program, med effects persist 2 weeks after discontinuation of disulfiram

naltrexone nursing actions (2)

hx to determine opioid dependence→ withdrawals if so and clients must abstain prior to taking

acamprosate nursing education (4)

diarrhea, good fluid intake/rest, take tid with meals, and avoid in pregnancy

when are withdrawals from opioids

1 hr-several days

3 drugs for opioid abstinence/withdrawal

methadone, buprenorphine, and clonidine

opioid abstinence withdrawal med antidote

naloxone

methadone risk and nursing education

respiratory depression; 12-step self-help program

clonidine does not…

reduce opioid cravings

clonidine adverse effect?

dry mouth

buprenorphine use and benefits

decrease opioid cravings; safer than methadone with less respiratory depression risk

nicotine withdrawal/abstinence drugs (2)

bupropion and varenicline

bupropion use and nursing education

decrease nicotine cravings; avoid caffeine and CNS stimulants

varenicline use and nursing implications

decrease nicotine cravings and withdrawal; monitor BS in DM, titrate, take after a meal, notify provider with N/V insomnia depression and suicidal thoughts, banned for pilots and truck drivers

nicotine lozenge nursing implications

avoid po intake 15 min prior, 5 in 6 hrs or 20/day max

nicotine gum nursing implications

<6 mo, chew over 30 min, avoid eating/drinking 15 min prior

nicotine patch nursing implications

remove before MRI and avoid nicotine while patch is on

nicotine inhaler nursing implications

gradually taper over 2-3 months then discontinue