NURS3804 Chapter 8: Substance Use Disorders

What is polydrug use?

the concurrent use of multiple drugs

What are protective factors against substance use disorders?

- caregiver involvement

- healthy self-esteem

- physical and psychological safety

- positive norms

- positive peer relationships

What are risk factors for substance use disorders?

- trauma

- mental health conditions

- child abuse and neglect

- poverty

- academic problems

- peer substance use

- drug availability

What are short-term effects of alcohol use?

- nausea

- vomiting

- headaches

- slurred speech

- impaired judgment

- memory loss

- hangovers

- blackouts

What are long-term effects of alcohol use?

- stomach ailments

- heart problems

- cancer

- brain damage

- serious memory loss

- immune system compromise

- liver cirrhosis

What is abstinence?

refraining from drug use

What is craving?

strong desire for a drug or for the intoxicating effects of that drug

What is intoxication?

a condition that results in disturbances in the level of consciousness, cognition, perception, judgment, affect, or behavior, or other psychophysiological functions and responses

What is stabilization?

acute treatment for substance use disorder

What is withdrawal syndrome?

a group of symptoms of varying severity that occur upon cessation or reduction of use of a drug

What is remission?

period of time where none of the 11 criteria for substance use disorder is true for at least 3 months

What is a controlled environment?

environment where access to any drug is restricted

What is impaired control?

diminished ability of an individual to control his or her use of a drug

What is social impairment?

recurrent drug use despite social problems

What is risky use?

recurrent drug use despite the difficulty it is causing

What is recovery?

a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential

What is relapse?

a return to drug use after a period of abstinence

What are 4 general types of treatment for alcohol use disorder?

- inpatient

- outpatient

- drug-assisted treatment

- nonpharmacologic therapy

What are 3 commonly used drugs for alcohol use disorder?

- disulfiram

- acamprosate

- naltrexone

Why does disulfiram keep patients from drinking alcohol?

unpleasant side effects occur if alcohol is consumed while taking it

What are effects of disulfiram when alcohol is consumed?

- nausea

- headache

- vomiting

- chest pains

- difficulty breathing

What are side effects of disulfiram?

- rash

- drowsiness

- impotence

- acne

- metallic aftertaste

What are side effects of acamprosate?

- pain

- loss of appetite

- nausea

- diarrhea

- dizziness

- anxiety

- pruritus

- depression

- insomnia

- xerostomia

- paresthesia

What are side effects of naltrexone?

- insomnia

- nausea

- vomiting

- anxiety

- headache

- abdominal pain

- myalgia

- arthralgia

- rash

- dizziness

- fatigue

- constipation

- increased creatine phosphokinase (CPK)

What are effects of cannabis?

- impairs short-term memory, learning, ability to focus, and balance/coordination

- difficulty responding to stimuli

- increases heart rate

- hallucinations

- anxiety

- harmful to the lungs

- frequent respiratory infections

- increased blood pressure

What are effects of opioids?

- euphoria, tranquility, reduced pain

- drowsiness and confusion

- nausea

- constipation

- respiratory depression

What are symptoms of opioid withdrawal?

- nausea and vomiting

- abdominal cramps

- hyperthermia

- hypertension

- restlessness

What drugs are used for opioid use disorder?

- naloxone

- naltrexone

- methadone

- buprenorphine

What are side effects of methadone?

- lightheadedness

- constipation

- dizziness

- sedation

- nausea and vomiting

What are side effects of buprenorphine?

- nausea and vomiting

- constipation

- muscle aches and cramps

- cravings

- sedation

- headache

- depression

- anxiety

- withdrawal symptoms

What are some treatments for tobacco use disorder?

- cognitive behavior therapy (CBT)

- self-help materials

- drug-assisted treatment

- electronic cigarettes

What drugs are used to help patients stop smoking?

- bupropion

- varenicline

- nicotine replacement

What are side effects of varenicline?

- nausea and vomiting

- insomnia

- headache

- abnormal dreams

- constipation or diarrhea

- fatigue and malaise

- upper respiratory tract infection

- dyspnea

- chest pain

- abdominal pain

- xerostomia

- appetite changes

- rash

- emotional disturbances

Why does varenicline have a black-box warning?

it can cause serious neuropsychiatric symptoms such as :

- behavior changes

- hostility

- agitation

- depression

- suicidality

What are the effects of tobacco use?

- hypertension

- increased breathing rate

- tachycardia

- cancer

- heart disease

- respiratory disorders

- stroke

- immune dysfunction

- type 2 diabetes

What are effects of high doses of dextromethorphan?

- euphoria

- dissociation

- hallucinations

What are side effects of dextromethorphan?

- nausea and vomiting

- stomach pain

- confusion

- dizziness

- double or blurred vision

- slurred speech

- impaired coordination

- tachycardia

- drowsiness

- numbness

- disorientation

What are effects of high doses of promethazine-codeine?

- euphoria

- relaxation

What are short term effects of anabolic-androgenic steroids?

- headache

- acne

- edema

- oily skin

- jaundice

- aggression

- extreme mood swings

- anger

- paranoid jealousy

- extreme irritability

- delusions

- impaired judgment

- infection at injection site

What are long term effects of anabolic-androgenic steroids?

- kidney damage and failure

- liver damage

- hypertension

- cardiomegaly

- hypercholesteremia

- men: shrunken testicles, infertility, baldness, breast development, increased risk for prostate cancer

- women: excess facial and body hair, male-pattern baldness, menstrual cycle changes, enlargement of the clitoris, deepened voice

- adolescents: stunted bone growth and height

What are symptoms of withdrawal from anabolic-androgenic steroids?

- depression and suicide attempts

- mood swings

- fatigue

- restlessness

- loss of appetite

- decreased sex drive

How should the nurse assess a postsurgical patient regarding substance use?

- signs and symptoms of drug interactions with main medications/anesthesia

- monitor for signs and symptoms of withdrawal

What is substance abuse disorder?

when the recurrent use of drugs causes clinically and functionally significant impairment

What is tolerance?

the need for a larger dose of a drug to obtain an effect

What are contributing factors to substance abuse in nurses?

- job stress

- emotional demands of nursing

- long hours

- easy access to drugs

When caring for a patient recovering from an episode of opioid toxicity, the nurse determines that the patient has opioid use disorder based on which finding?

a. Withdrawal symptoms

b. A history of daily use

c. Craving that results in drug-seeking behaviors

d. Intravenous, rather than oral, use of the drug

c. Craving that results in drug-seeking behaviors

A patient hospitalized with a fractured femur after an automobile accident develops nausea and vomiting, abdominal cramps, and restlessness. The nurse suspects that the patient is experiencing which reaction?

a. Opioid withdrawal

b. Alcohol toxicity

c. Flashbacks from LSD use

d. Nicotine withdrawal

a. Opioid withdrawal

Which treatments will the nurse anticipate administering to a patient who has been admitted with alcohol toxicity? (Select all that apply.)

a. Naloxone

b. Thiamine

c. Intravenous fluids

d. Naltrexone

e. Intravenous glucose solution

f. Flumazenil

b. Thiamine

c. Intravenous fluids

e. Intravenous glucose solution

The nurse observes another nurse taking oral opioids from the medication room at the hospital. Which is the best action for the nurse who observes drug diversion to take?

a. Report the finding to the nursing supervisor to enable the nurse's participation in a nondisciplinary program.

b. Ignore the situation to protect the nurse from dismissal and possible loss of licensure.

c. Confront the nurse and demand that the drugs be returned before someone notices their absence.

d. Ask the nurse to request pain medications from a physician rather than stealing them from the hospital.

a. Report the finding to the nursing supervisor to enable the nurse's participation in a nondisciplinary program.

A patient is to start disulfiram to help with alcohol use disorder. The nurse providing medication education about the drug will include which topics in the education plan? (Select all that apply.)

a. Importance of taking the medication every day

b. That better results are experienced when a support group helps with treatment adherence

c. Common food and hygiene products that contain alcohol

d. That disulfiram treatment should be stopped 1 day before alcohol consumption

e. That disulfiram works by disrupting the metabolism of alcohol

f. That use of alcohol with disulfiram may cause nausea and vomiting and may even be fatal

a. Importance of taking the medication every day

b. That better results are experienced when a support group helps with treatment adherence

c. Common food and hygiene products that contain alcohol

e. That disulfiram works by disrupting the metabolism of alcohol

f. That use of alcohol with disulfiram may cause nausea and vomiting and may even be fatal

Which schedule of drugs has a high potential for abuse, the potential to create severe dependence, and no currently accepted medical use?

Schedule I

Which schedule of drugs have a high potential for abuse, the potential to create severe dependence, and have some medically acceptable uses?

Schedule II

Which schedule of drugs has a moderate to low potential for dependence?

Schedule III

Which schedule of drugs has a low potential for abuse and dependence?

Schedule IV

Which schedule of drugs has the least potential for abuse?

Schedule V

What are the 3 most commonly abused drug classes?

- amphetamines

- opioids

- benzodiazepines