Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
85 Cards in this Set
- Front
- Back
|
What are the only two substances from which withdrawal can be deadly
|
Alcohol and barbiturates
|
|
|
Define abuse
|
Abuse is using a substance despite the fact that you know it's causing a problem for you and you continue to do it anyway
|
|
|
Define dependence
|
Dependence is the physiological requirement of a substance in order to function
|
|
|
Define intoxication
|
The use of a substance to the point that it impairs you it doesn't necessarily mean you have an abuse or dependence problem
|
|
|
Define withdrawal
|
The physiological and mental readjustment that accompanies the discontinuation of an addictive substance
|
|
|
Explain the DSM-IV criteria for substance abuse
|
A maladaptive pattern of substance use leading to impairment or distress over a 12 month period with one or more of the following
1 - We current substance use results in an inability to perform normal duties at home school or work 2 - Recurrent substance use resulting hazardous situations while impaired such as driving under the influence 3 - recurrent substance related legal problems 4 - Continued substance use despite the problems it causes |
|
|
How do you identify macrocytic anemia
|
Through a CBC. It will show decreased red blood cell count, decreased hematocrit, decreased hemoglobin, and mean corpuscular volume goes up because the blood cells get large.
|
|
|
Explain the DSM-IV criteria for substance dependence
|
A clinically significant impairment over a 12 month period including three or more of the following:
1 - Evidence of tolerance 2 - Withdrawal effects 3 - The substance taken in larger amounts or for a longer period of time and was intended 4 - a persistent but unsuccessful desire to cut down or control use 5 - a great deal of time is spent obtaining using and recovering from the use 6 - Reduction in normal social or occupational activities 7 - Continued use despite the problems it causes |
|
|
Explain the DSM-IV criteria for substance withdrawal
|
The development of symptoms caused by the reduction or cessation of heavy or prolonged use
The distress or impairment in social relationships occupational or other areas of functioning The symptoms are not caused by a general medical condition or another mental disorder |
|
|
Explain physical dependence
|
The need for increasing amounts to produce the desired effect and the experience of withdrawal symptoms if the product is stopped.
|
|
|
Explain psychological dependence
|
The overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort. It is extremely powerful producing intense cravings for a substance as well as compulsive use of it.
|
|
|
Define intoxication
|
A physical and mental state of exhilaration and emotional frenzy or lethargy and stupor.
|
|
|
Explain the DSM-IV criteria for substance intoxication
|
1 - Reversible physiological effects of the substance on the CNS developed shortly during or after use.
2 - Clinically significant serious changes due to the effect of the substance such as belligerence, mood lability, cognitive impairment, impaired judgment, impaired social or occupational functioning. 3 - Symptoms are not due to a general medical condition or by another mental disorder |
|
|
What are the four phases of alcohol abuse and dependence
|
1 - The pre-alcoholic phase
2 - The early alcoholic phase 3 - The crucial phase 4 - The chronic phase |
|
|
Explain the pre-alcoholic phase
|
Characterized by use of alcohol to relieve everyday stress and tensions of life
|
|
|
Explain the early alcoholic phase
|
Begins with blackouts this usually occurs after long-term use of a substance
|
|
|
Explain the crucial phase
|
This is when the person has lost control and physiological and psychological dependence are evident
|
|
|
Explain the chronic phase
|
Characterized by emotional and physical deterioration the person is intoxicated more than 50% of the time
|
|
|
What deficiency might you see with peripheral neuropathy
|
A vitamin b deficiency particularly Thiamine
|
|
|
What are the signs and symptoms of peripheral Neuropathy
|
Pain, burning, tingling, and prickly sensations of the extremities
|
|
|
What deficiency will you see with alcoholic myopathy
|
A vitamin b deficiency particularly Thiamin
|
|
|
What other hallmarks of alcoholic myopathy
|
1 - If you see a patient is on thiamin, multivitamin and folate OR thiamin and a prenatal vitamin (combines the multivitamin with frolic acid)
2 - In the ER you might see patients receiving a banana bag. a banana bag is a yellow bag of IV fluid. it is yellow because it has thiamin in it. |
|
|
What are the signs and symptoms of acute alcoholic myopathy
|
Sudden onset of muscle pain, Swelling and weakness, Reddish tinged in the urine, a rapid rise in muscle enzymes in the blood.
|
|
|
What are the signs and symptoms of chronic alcoholic myopathy
|
A gradual wasting and weakness in skeletal muscles
|
|
|
What does folate do?
|
It stimulates the production of red blood cells.
|
|
|
What primary vitamins does alcoholism deplete?
|
thiamin and niacin
|
|
|
What is the most serious form of thiamin and deficiency
|
Wernicke's encephalopathy
|
|
|
What happens physiologically with Wernicke's encephalopathy
|
Ammonia in the body increases and causes cognitive status to be impaired if ammonia level continues to rise it can be deadly
|
|
|
What are the signs and symptoms of Wernicke's's encephalopathy
|
Mental confusion, vision impairment, paralysis of the ocular muscles, diplopia, ataxia, somnolence, stupor, hypothermia, hypotension.
|
|
|
What is Korsakoff's psychosis
|
It is a syndrome of confusion, loss of recent memory, and confabulation. It is a psychosis frequently encountered in clients recovering from Wernecke's encephalopathy.
|
|
|
How do you treat Wernecke's encephalopathy and Korsakoff psychosis
|
With parenteral or oral thiamin replacement
|
|
|
What effect does alcohol have on the heart
|
It causes alcoholic cardiomyopathy. It causes an accumulation of lipids in the myocardial cells resulting in enlargement and weakened condition. The left ventricle gets so thickened that it is ineffective at pumping blood.
|
|
|
How does alcoholism cause esophagitis?
|
1 - Alcohol has toxic effects on the esophageal mucosa
2 - Frequent vomiting deteriorates the esophagus. |
|
|
What effects does alcohol have on the stomach?
|
Alcohol breaks down the lining of the stomach allowing damage caused by hydrochloric acid. This causes inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention.
|
|
|
can gastritis be quickly resolved after terminating drinking?
|
No. It's effects are long-term.
|
|
|
What are the long-term effects that alcohol has on the pancreas?
|
Alcohol irreversibly damages the pancreas leading to diabetes mellitus.
|
|
|
What lab values would you look at if you were concerned about pancreatitis?
|
You would look at the levels of amylase and lipase which would be elevated with pancreatitis.
|
|
|
What are the signs and symptoms of acute pancreatitis?
|
These symptoms usually occur one to two days after a binge. The symptoms are severe epigastric pain, Nausea, Vomiting, And abdominal distention.
|
|
|
How does gastritis and pancreatitis affect digestion?
|
Between the two they have no digestive juices therefore they may require pancreatic enzymes and or may require TPN.
|
|
|
What are the symptoms of chronic pancreatitis?
|
Steatorrhea, malnutrition, , and diabetes mellitus.
|
|
|
How would you diagnose malnutrition?
|
With lab values on total protein and albumin which would be slightly increased.
|
|
|
What is alcoholic hepatitis
|
An inflammation of the liver caused by long-term alcohol use.
|
|
|
What are the signs and symptoms of alcoholic hepatitis?
|
An enlarged tender liver, Nausea, Vomiting, lethargy, Anorexia, elevated white blood cell count, fever, jaundice, ascites, and weight loss in severe cases.
|
|
|
Why would the white blood cell count the elevated with alcoholic hepatitis?
|
The liver detoxifies stuff and if that fails infections can occur more easily.
|
|
|
What is cirrhosis of the liver?
|
It is the end stage of alcoholic liver disease believed to be caused by long-term chronic alcohol abuse. It is a widespread destruction of liver cells which are replaced by fibrous scar tissue.
|
|
|
What are the four complications related to cirrhosis of the liver?
|
1 - Portal hypertension
2 - Ascites 3 - Esophageal varices 4 - Hepatic encephalopathy |
|
|
Explain portal hypertension
|
It is an elevated blood pressure through the portal circulation that results from defective bloodflow through a cirrhotic liver. Don't correlate this to regular blood pressure.
|
|
|
Explain Ascites.
|
It is a condition of excessive serous fluid that accumulates in the abdominal cavity. This condition occurs in response to portal hypertension.
|
|
|
Explain a esophageal varices.
|
The veins in the esophagus become distended because of excessive pressure from defective blood throw through the cirrhosis liver. This is an emergency as patients can bleed to death.
|
|
|
Explain hepatic encephalopathy.
|
This occurs in response to the inability of the liver to convert ammonia to urea for excretion. The continued rise in serum ammonia causes impaired mental functioning. If left untreated it can lead to coma and eventual death.
|
|
|
What impact does alcoholism have on white blood cells?
|
It affects the production, function, and movement of white blood cells. This condition places the individual at high risk for contracting infectious diseases as well as for complicated recovery.
|
|
|
What impact does alcohol have on platelet production?
|
Platelet production and survival are impaired as a result of the toxic effects of alcohol. Platelets don't clot so they can't help you from bleeding out. patients are at risk for hemorrhage.
|
|
|
What sexual dysfunction for women does alcohol cause?
|
It changes the menstrual cycle. It also causes a decrease or loss of ability to become pregnant.
|
|
|
What sexual dysfunction for men does alcohol cause?
|
Diminished libido, decreased sexual performance, and impaired fertility.
|
|
|
How is alcohol intoxication identified?
|
With a blood alcohol level from 100 to 200 mg/dL.
|
|
|
When are signs and symptoms of alcohol withdrawal first noticed?
|
Within 4 to 12 hours of reduction of alcohol.
|
|
|
If the patient on the MedSurg floor within three days of admittance suddenly experiences sudden behavior changes what might you suspect?
|
Alcohol or substance abuse withdrawal. Without treatment they could end up with delirium tremens and die.
|
|
|
Explain delirium tremens.
|
It is an overexcitement of the CNS. This overstimulation cannot be maintained for a long period of time.
|
|
|
What is the most common type of hallucination experienced during alcohol withdrawal.
|
Visual hallucinations.
|
|
|
What is the most dangerous stage of alcohol withdrawal?
|
Delirium tremens.
|
|
|
When will a person experience DTs after stopping drinking?
|
At approximately 48 to 72 hours.
|
|
|
What is the hallmark of DTs
|
Profound delirium or confusion. People are awake but they are thoroughly confused.
|
|
|
What are the signs and symptoms of DTs?
|
Confusion, agitation, delusions, sweating, hallucinations, rapid heart rate, high blood pressure. This is a medical EMERGENCY. The condition has a high death rate up to 35%.
|
|
|
What benzodiazepines are used for alcohol detox? Why are they given?
|
Valium, Librium, and Ativan. They are given in elevations of heart rate, blood pressure, temperature, and in the presence of tremors.
|
|
|
What substances are included with the sedatives, hypnotics and anxiolytics (aka CNS depressants)?
|
Barbiturates, nonbarbiturate hypnotics and anti-anxiety agents.
|
|
|
What effects do sedative hypnotic's and Anxiolytics have on sleep and dreaming?
|
It messes with the REM state of sleep
|
|
|
What effects do barbiturates have on renal function
|
Barbiturates suppress urine function when doses are high enough to produce anesthesia.
|
|
|
Which anxiolytics has the shortest half-life
|
Ativan
|
|
|
What effects do barbiturates (sedative hypnotics anxiolytics) on the liver?
|
They can cause jaundice with doses large enough to produce acute intoxication.
|
|
|
What effects do barbiturates (sedative hypnotics anxiolytics) have on body temperature?
|
Barbiturates decrease body temperature.
|
|
|
What effects do barbiturates (sedative hypnotics anxiolytics) have on sexual functioning?
|
Initially it increases the libido r/t disinhibitory effects. It is then followed by a decrease in the ability to maintain an erection.
|
|
|
What effects do Sedatives,hypnotic's and anxiolytics have on cardiac function?
|
Hypotension, decreased cardiac output, decreased cerebral blood flow, and direct impairment of myocardial contractility.
|
|
|
What are the signs of intoxication related to sedatives hypnotic and anxiolytics?
|
Disinhibition of sexual or aggressive impulses, mood lability, impaired judgment, slurred speech, incoordination, Unsteady gait, impairment in attention or memory, disorientation, and confusion.
|
|
|
What are the withdrawal signs related to sedative hypnotic's and anxiolytics?
|
Nausea and vomiting, malaise, weakness, tachycardia, sweating, anxiety, irritability, orthostatic hypotension, tremors, insomnia, and seizures.
|
|
|
Give the drug profile for CNS stimulants.
|
Amphetamines, non-amphetamine stimulants, cocaine, caffeine, and nicotine.
|
|
|
What are the two most commonly used CNS stimulants?
|
Caffeine and nicotine.
|
|
|
What Identifies the CNS stimulants?
|
They are identified by the behavioral stimulation and psychomotor agitation that they induce.
|
|
|
What are the CNS effects on the body associated with the CNS stimulants?
|
Tremor, restlessness,anorexia, insomnia, agitation, and increased motor activity.
|
|
|
What effects do CNS stimulants have on children?
|
They produce a paradoxical effect. instead of hyping them up it calms them down.
|
|
|
What are the cardiovascular effects that CNS stimulants cause?
|
Increased systolic and diastolic blood pressure, Increased heart rate and cardiac arrhythmias.
|
|
|
What are the signs of intoxication found with amphetamines and cocaine?
|
Euphoria, fighting, grandiosity, hypervigilance, psychomotor agitation, impaired judgment, tachycardia, elevated blood pressure, pupillary dilation, perspiration, chills, nausea, and vomiting. in addition cocaine can cause hallucinations and delirium.
|
|
|
What are the symptoms of caffeine intoxication?
|
Restlessness, nervousness, excitement, insomnia, flushed face, diuresis, G.I. disturbance, muscle twitching, rambling flow of thoughts and speech, tachycardia, cardiac arrhythmia, period of inexhaustability and psychomotor agitation.
|
|
|
What are the signs and symptoms of CNS stimulant withdrawal associated to amphetamines and cocaine?
|
Dysphoria, fatigue, sleep disturbances, increased appetite, and psychomotor retardation or agitation.
|
|
|
What are the signs and symptoms of caffeine withdrawal in the CNS stimulant group?
|
Headache, fatigue, anxiety,irritability, depression, impaired psychomotor performance, nausea, vomiting, craving for caffeine, and muscle pain and stiffness.
|
|
|
What are the signs and symptoms of nicotine withdrawal?
|
Dysphoria, anxiety, difficulty concentrating, restlessness, insomnia, irritability, frustration, decreased heart rate and increased appetite.
|
