Hehi Test #3 - Chemically Imapired

Front 1

Biological Theory of Addiction

Back 1

Various substances have specific effects on selected neurotransmitters. the number of receptors and their ability to be activated is genetically determined

Front 2

Psychological Theory of addiction

Back 2

Defense against anxious impulses

Self-medication for depression results in the desired effects

Front 3

Behavioral Theory of Addiction

Back 3

Positive reinforcement by peers

Front 4

Sociocultural Theory of Addiction

Back 4

Social and cultural norms

Socioeconomic stress

Front 5

Abuse

Back 5

Pattern of use that results in negative consequences

- Inability to fulfill role expectations
- Participation in hazardous activities while impaired
- Recurring legal or personal problems
- Continued use despite problems

Front 6

Psychological Dependence

Back 6

Subjective experience of a need for a drug to experience "normal" functioning
*ALL drugs (or events) that are mood altering have potential for psychological dependence.

Front 7

Physical Dependence

Back 7

An event which occurs when tolerence develops in response to use of a psychoactive substance and upon abrupt cessation results in withdrawal

Front 8

Tolerance

Back 8

The need for greatly increased amounts of the substance to achieve intoxication or the "desired" effect

Front 9

Withdrawal

Back 9

A substance specific syndrome that follows cessation or reduction in intake of a psychoactive drug on which an individual is physiologically dependent

Front 10

Polysubstance Abuse

Back 10

The abuse of more than one substance at a time

Front 11

Dual Diagnosis

Back 11

The coexistence of a major psychiatric disorder and asubstance related disorder (50% in people with mental illness)

Front 12

Prodromal Phase

Back 12

Phase 1 or chemical dependency

* Increase of tolerance
*Temporary loss of memory (blackouts)
* Sneaking chemicals
* Preoccupation with use of chemical
* Avoidance of reference to personal use

If a person stops their progression there, it is alcohol abuse, NOT dependence

Front 13

Crucial (or basic) phase

Back 13

Phase II of chemical dependency (Active phase)

* Loss of control
* Alibis and excuses
* Reproof by significant others
* Extravagance - money and opinions
* Aggression
* Persistent remorse
* Periodic abstinence/ change in use pattern - "I could stop if I wanted to" - don't know when/ how much they will use
* Loss of friendships
* Loss of position
* First treatment
* Escape - "No matter where you go, there you are."
* Protecting supply
* Morning use of chemical(s)

Front 14

Chronic Phase

Back 14

Phase III of chemical dependency

* More or less continuous use of chemicals (at least q18h)
* Ethical desperation
* Inconsistent, inappropriate thinking
* Decrease of tolerance if drug is alcohol
* Indefinable fears
* Tremors
* Psychomotor inhibitions

Front 15

Personality Traits of the Chemically Impaired

Back 15

1. Avoidance
2. Grandiosity
3. Impulsiveness
4. Manipulation - any means to achieve ends
5. Projection
6. Denial

Front 16

Associated Factors of the chemically Impaired

Back 16

1. Decreased tolerance for frustration and pain
2. Risk taking
3. Decreased esteem
4. Lack of success
5. Lack of meaningful relationships

Front 17

Co-dependence

Back 17

Dysfunctional behavior patterns characterized by excessive focus on the emotional, social, and physical needs of another

1. Develops an unhealthy pattern of relating to others
2. Has low self esteem
3. Needs to be needed
4. Has strong urge to thange and control others
5. Has a willingness to suffer

Front 18

Characteristics of alcoholism

Back 18

1. Impaired control over drinking
2. Preoccupation with the drug alcohol
3. Use of alcohol despite adverse consequences
4. Distortions in thinking (denial)

Front 19

S/S of alcoholism

Back 19

1. Preoccupation
2. Increased tolerance
3. Gulping drinks
4. Drinks alone
5. Use as a medicine
6. Blackouts
7. Protects supply
8. Non-premeditated use

Front 20

Pharmacokinetics of alcohol

Back 20

- Absorption - 20% in stomach, 80% in small intestine (rebukes belief that drinking on a full stomach will keep you from getting drunk)
- Distibution - all tissues and bod fluids
- Metabolism - 90% liver,consistent rate of metabolism

Front 21

Liver alcohol metabolism in one hour

Back 21

1 oz. hard liquer
5 oz. wine
12 oz. beer

Front 22

Blood Alcohol Levels (BAL) effects on non tolerant drinker

Back 22

0.05% - change in mood, behavior, and impaired judgement
0.20% - Staggering, ataxia, emotional lability
0.40% - Coma
0.50% - Death from respiratory depression

Front 23

Trexan, Revia (Naltrexone)

Back 23

1. Blocks opiate receptors
2. Interferes with mechanism or reinforvement
3. Reduces or eliminates alcohol craving

Front 24

Campral (acamprosate)

Back 24

1. Helps client abstain from alcohol
2. Mechanism not well understood

Front 25

Antabuse (disulfiram) KNOW FOR NCLEX!!

Back 25

Rarely used
1. Works on classical conditioning principle
2. Alcohol-disulfiram reaction causes unpleasant physical effects - inhibits enzyme that degrades alcohol

Front 26

Alcohol Withdrawal

Back 26

Early signs a few hours after decreasing alcohol
- Signs peak 24-48 hours then rapidly disappear

Front 27

S/S of alcohol withdrawal

Back 27

- Hyperalertness
- Jerky movements
- Irritability
- Easily startled
- "Shaking inside"

Front 28

Nursing interventions for alcohol withdrawal

Back 28

1. Orient to time/ place (reduce anxiety)
2. Clarify illusions to reduce client's terror

Front 29

Alcohol Withdrawal delirium

Back 29

A medical emergency that can result in death - peaks 2-3 days after cessation, and lasts for 2-3 days

* 50% of people with untreated DTs will die.

Front 30

S/S of DTs

Back 30

1. Tachycardia
2. Disorientation and clouding of consciousness
3. Visual or tactile hallucinations
4. Hyperexcitability
5. Paranoid delusions, agitation
6. fever (100-103)
7. SEIZURES
* Treated with bezos

Front 31

Pharmacological Intervention for DTs

Back 31

1. Priority = long acting benzodiazepines (Atavor or Librium)
2. Thiamine - prevent encephalopathy
3. Folic acid/ multivitamin - correct deficiencies - alcohol cocktail
4. Anticonvulsants: control seizures

Front 32

General Medical Comorbidity of cocaine/ stimulant abusers

Back 32

1. Extreme weight loss
2. Malnutrition
3. Myocardial infarction
4. Stroke

Front 33

Intraveneous drug users

Back 33

1. Infections
2. Sclerosing of the veins

Front 34

Intranasal Users

Back 34

1. Sinusitis
2. Perforated nasal septum

Front 35

Smoking a substance

Back 35

1. Respiratory Problems

Front 36

CNS depressants

Back 36

Suppresion of CNS

Intoxication:
1. Euphoria
2. Sedated, unsteady
3. Decreased BP/ HR/ RR
4.Cognitive decline
5. BARBS: cardiac and respiratory depression

Abrupt Withdrawal - siezures, coma, death

Front 37

CNS depressant withdrawal

Back 37

1. Nausea/ Vomiting
2. Tachycardia
3. Tremors
4. Pupil dilation (overdose = pupil constriction)
5. Sever insomnia

Front 38

Therapeutic Management of CNS depressant withdrawal and overdose

Back 38

Withdrawal - titrate with similar drug

Overdose:
1. Induce vomiting
2. Activated charcoal
3. Gastric lavage
4. Fluid support
5. Seizure precautions

Front 39

Stimulants

Back 39

Increase activity or heart and brain

Intoxication:
1. Restless, agitated
2. Paranoia
3. Absence or appetite

Overdose: MI, CVA, collapse

Withdrawal: DEPRESSION, suicide, paranoia, N/V

Front 40

Therapeutic Management of Stimulant withdrawal/ overdose

Back 40

Withdrawal - antidepressants, dopamine agonists (bind access dopamine)

Overdose: Treat symptoms, maintain body systems

Front 41

Opiods

Back 41

Suppression of CNS

Common toxic effects:
1. Euphoria
2. Relaxed
3. Lethargic
4. Pupil constriction

Intoxication:
1. Depressed VS
2. lethargy
3. coma - death

Front 42

S/S of opiod withdrawal

Back 42

DISCOMFORT
1. Nausea
2. Muscle cramps
3. Diarrhea
4. Chills
5. Runny nose/ eyes

Front 43

Therapeutic management of opiod withdrawal/ overdose

Back 43

Withdrawal:
1. Tapering or substitution (ex. for heroin, substitute a clean drug)

Overdose:
1. Narcotic antagonist - Narcan

Front 44

Dopophine (methadone)

Back 44

Synthetic opiate blocks craving for and effects of heroin; only medication currently approved to treat pregnant opiod addicts

Front 45

LAAM (L-alpha - acetylmethadol)

Back 45

An alternative to methadone - not approved for pregnant women

Front 46

Naltrexone (Trexan, Revia)

Back 46

Antagonist that blocks euphoric effects of opiods

Front 47

Clonidine (Catapres)

Back 47

Nonopiod suppressor of opiod withdrawal symptoms

Effctive somatic treatment when combined with naltrexone

Front 48

Hallucinogens

Back 48

1. Inactivates some 5HT receptor sites - and decreases GABA
2. Which permits: increased dopamine activity: resulting in altered thoughts and perceptions

Diverse effts, perceptiual alterations, intense, profound, mood swings

toxic effects: acute panic reactions, flashbacks

Front 49

Therapeutic Management of toxic effects of hallucinogens

Back 49

1. Decrease stimuli
2. LSD: no pharm nursing interventions - calm
3. PCP: Haldol and/or Valium

Front 50

Marijuana

Back 50

CNS depressant (also has hallucinogenic properties)

- Euphoria
- Time distortion
- Increased appetite
- Dry mouth, red eyes
- Long term effect: memory loss
- Glucose intolerance

*May cause anxiety reactions

Front 51

Common Rave and Techno Drugs

Back 51

1. Ecstasy (3,4-methylededioxymethamphetamine) aka MDMA, Adam, yaba., XTC
2. MDA (methylededioxyamphetamine) aka love
3. MDE (2,4 - methylenedioxyethylamphetamine) aka Eve

Front 52

Side Effects of Rave drugs

Back 52

1. Euphoria
2. Increased self confidence
3. Increased sociability
4. Feeling of closeness to others

Front 53

Adverse Effects of Rave drugs

Back 53

1. Hyperthermia
2. Heart failure
3. Kidney failure
4. Acute dehydration

Front 54

Caffeine

Back 54

CNS stimulant

Withdrawal - severe headache, irritability

Front 55

Nicotine

Back 55

Stimulant of NE and nicotine receptors

Withdrawal - headache, anxiety, irritability

Front 56

Inhalants

Back 56

CNS depression

Withdrawal - prolonged use: organ toxic (brain)

Front 57

Steroids

Back 57

Alter genetic material to produce new proteins

Can produce psychotic symptoms

Front 58

Priority Assessment of currently chemically Imaired clients

Back 58

1. Safety - suicidal or homicidal thoughts or plans
2. Overdose needing immediate medical attention
3. Withdrawal symptoms
4. Time of last use and what?
5. Physical complications

Front 59

Questions for the chemically impaired individual

Back 59

1. In the last year have you ever drank or used drugs more than you meant to?

2. Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?

3. What drug is used and the route, quantity, time of last use, and usual pattern or use

Front 60

CAGE

Back 60

Cut down
Annoyed
Guilty
Eye opener

Front 61

Therapeutic Management - General related health history

Back 61

1. Suicide assessment
2. Medical history
3. Psychiatric history
4. Past substance use/ abuse
5. Psychosocial changes

Front 62

Therapeutic Management - focused health history and physical exam

Back 62

1. Ceneral questions r/t use
2. Motivation
3. Severity

- BAL
- Toxicology screens
- Liver profiles
- Glucose
- Hgb and Hct
- HIV screen

Front 63

Therapeutic Management - Chemically Impaired individual

Back 63

1. Acute treatment
2. Rehabilitation
3. Group therapy - most effective treatment of alcohol addiction/ abuse