Nursing 3Rd Semester: Mental Health: Substance Abuse & Anxiety

Front 1

The DSM-IV-TR identifies ____ _____ as a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use of the substance. It has also been referred to as any use of substances that poses significant hazards to health.

Back 1

substance abuse

Front 2

Substance abuse is described as a mal_____ p____ of substance use leading to clinically significant impairment or distress, as manifested by ___ or more of the following within a __ month period:

-recurrent substance use resulting in a failure to fulfill major role obigations at work, school, or home (e.g. repeated absences or poor work performance r/t substance use, expulsions from school, neglect of children or household)
-recurrent substance use in situations in which it is physically hazardous (e.g. driving under the influence)
-recurrent substance-related legal problems
-continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

Back 2

Substance abuse is described as a MALADAPTIVE PATTERN of substance use leading to clinically significant impairment or distress, as manifested by ONE or more of the following within a 12 month period:

-recurrent substance use resulting in a failure to fulfill major role obigations at work, school, or home (e.g. repeated absences or poor work performance r/t substance use, expulsions from school, neglect of children or household)
-recurrent substance use in situations in which it is physically hazardous (e.g. driving under the influence)
-recurrent substance-related legal problems
-continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

Front 3

Physical ______ on a substance is evidenced by a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. As this condition develops, repeated administration of the substance necessitates its continued use to prevent the appearance of unpleasant effects known as withdrawal syndrome associated with the particular drug. The development of physical _____ is promoted by the phenomenon of _____, the need for increasingly larger or more frequent doses to obtain desired effects originally produced by a lower dose.

Back 3

Physical DEPENDENCE on a substance is evidenced by a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. As this condition develops, repeated administration of the substance necessitates its continued use to prevent the appearance of unpleasant effects known as withdrawal syndrome associated with the particular drug. The development of physical DEPENDENCE is promoted by the phenomenon of TOLERANCE the need for increasingly larger or more frequent doses to obtain desired effects originally produced by a lower dose.

Front 4

The DSM-IV-TR diagnostic criteria for Substance Dependence involve presence of at least ___ of the following:
1. Evidence of _______, as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve intoxication or desired effects
b. Markedly diminished effect with continued use of the same amount of the substance
2. Evidence of _______symptoms, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance
b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
3. The substance is often taken in larger amounts or over a longer period than was intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain, use, or recover from the substance.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite ______ of having a persistent or recurrent psychological problem that is likely to have been caused or exacerbated by the substance.

Back 4

The DSM-IV-TR diagnostic criteria for Substance Dependence involve presence of at least three of the following:
1. Evidence of tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve intoxication or desired effects
b. Markedly diminished effect with continued use of the same amount of the substance
2. Evidence of withdrawal symptoms, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance
b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
3. The substance is often taken in larger amounts or over a longer period than was intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain, use, or recover from the substance.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent or recurrent psychological problem that is likely to have been caused or exacerbated by the substance.

Front 5

True or False: No single theory can be implicated in the predisposition to abuse of substances

Back 5

true

Front 6

As a form of self-medication, ______ may be used to control panic, ______ to diminish anger, and ______ to alleviate depression.

Back 6

As a form of self-medication, alcohol may be used to control panic, opioids to diminish anger, and amphetamines to alleviate depression.

Front 7

What are some personality traits that are common in people who abuse substances?

Back 7

low self-esteem
depression
passivity
inability to relax
inability to delay/defer gratification
inability to communicate effectively

Front 8

The psychodynamic approach to the etiology of substance abuse focuses on a punitive ______ and fixation at the ___ stage of psychosexual development.

Back 8

The psychodynamic approach to the etiology of substance abuse focuses on a punitive superego and fixation at the oral stage of psychosexual development. Individuals with punitive superegos turn to alcohol to diminish unconscious anxiety and increase feelings of power and self-worth.

Front 9

Describe the 4 phases through which a drinker's pattern of drinking progresses to alcoholism.

Back 9

Phase I: The Pre-alcoholic Phase
During childhood, the person may have observed adult family members drinking alcohol and enjoying the effects. The child learns that alcohol use is an acceptable method of dealing with stress. As an adult, the individual begins to use alcohol to relieve the everyday stress and tensions of life. With continued drinking, tolerance inevitably develops, and the amount required to achieve the desired effect steadily increases.
Phase II: The Early Alcoholic Phase
Alcohol is no longer a source of pleasure or relief, but rather a drug that is required for the individual. Common behaviors include sneaking drinks or drinking in private, preoccupation with drinking and maintaining the supply of alcohol, and rapid gulping of drinks. Blackouts, brief periods of amnesia that occur during or immediately following consumption of alcohol, are also a common occurrence within this phase.

Phase III: The Crucial Phase
Individual has lost control in that they no longer have the ability to choose whether or not to drink. Physiological dependence is clearly evident. Binge drinking is common, which last from a few hours to several weeks. These binge drinking episodes are characterized by loss of consciousness, degradation, and appearing very ill and unkept. Common manifestations include anger and aggression. Drinking becomes the individual’s total focus. The person is willing to risk losing everything that was at one time important in order to maintain their possession and use of alcohol. In this phase of the illness, the individual may experience the loss of his or her job, marriage, family, friends, and especially his or her own self-respect.

Phase IV: The Chronic Phase
During this phase, the individual is intoxicated more often than sober. Marked emotional disintegration are apparent such as feelings of intense helplessness and self-pity. Impairment in reality testing may result in psychosis. Life-threatening physical manifestations may be evident in virtually every system of the body. Abstaining from alcohol results in a terrifying syndrome characterized by hallucinations, tremors, convulsions, panic, and severe agitation. Depression and suicidal ideation are very common.

Front 10

Alcohol can produce a general/specific, selective/nonselective, irreversible/reversible depression of the CNS.

Back 10

Alcohol can produce a general, nonselective, reversible depression of the CNS.

Front 11

At low doses, alcohol produces relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, and sleep. Chronic abuse results in multisystem physiological impairments such as peripheral ______, alcoholic myo_____, Wernicke's _______, _________ Psychosis, Alcoholic Cardio______, Es______, Gas_____, Panc_____, Alcoholic H_____, _____ of the Liver, Leukopenia, Thrombocytopenia, and ____ Dysfunction.

Back 11

At low doses, alcohol produces relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, and sleep. Chronic abuse results in multisystem physiological impairments such as peripheral neuropathy alcoholic myopathy, Wernicke's encephalopathy, Korsakoff's Psychosis, Alcoholic Cardiomyopathy, Esophagitis, Gastritis, Pancreatitis, Alcoholic Hepatitis, Cirrhosis of the Liver, Leukopenia, Thrombocytopenia, and Sexual Dysfunction.

Front 12

What is the most serious form of thiamine deficiency in alcoholics?

Back 12

Wernicke's encephalopathy

Front 13

What are some symptoms of Wernicke's encephalopathy? If ______ replacement therapy is not undertaken quickly, death will ensue.

Back 13

diplopia
paralysis of ocular muscles
ataxia
somnolence
stupor

If thiamine replacement therapy is not undertaken quickly, death will ensue.

Front 14

Korsakoff's psychosis is identified by a syndrome of c______, loss of recent _____, and c_______ in alcoholics. It is frequently encountered in clients recovering from...

Back 14

Korsakoff's psychosis is identified by a syndrome of confusion, loss of recent memory and confabulation in alcoholics. It is frequently encountered in clients recovering from Wernicke's encephalopathy

Front 15

_____ _____ is characterized by peripheral nerve damage, which results in pain, tingling, or prickly sensations in the extremities. It is thought o be directly resulting from deficiencies in ___ vitamins, particularly _____. Nutritional deficiencies are common in chronic alcoholics because of insufficient intake of nutrients as well as the toxic effects of alcohol that results in malabsorption of nutrients. The process is reversible with abstinence from alcohol and restoration of nutritional deficiencies. Otherwise, permanent muscle ____ and p____ can occur.

Back 15

Peripheral neuropathy is characterized by peripheral nerve damage, which results in pain, tingling, or prickly sensations in the extremities. It is thought o be directly resulting from deficiencies in B vitamins, particularly thiamine. Nutritional deficiencies are common in chronic alcoholics because of insufficient intake of nutrients as well as the toxic effects of alcohol that results in malabsorption of nutrients. The process is reversible with abstinence from alcohol and restoration of nutritional deficiencies. Otherwise, permanent muscle wasting and paralysis can occur.

Front 16

What complication of alcohol is described: a sudden onset of muscle pain, swelling and weakness, a reddish tinge in the urine caused by myoglobin (a breakdown product of muscle excreted into urine), and rapid rise in muscle enzymes in the blood. Muscle symptoms are usually generalized, but pain and swelling may selectively involve the calves or other muscle groups. Lab studies show increases in CPK, LDH, and AST.

Back 16

alcoholic myopathy

Front 17

Alcoholic _________: the effect of alcohol on the heart is an accumulation of ____ in the myocardial cells, resulting in enlargement and a weakened condition. The clinical findings generally relate to __ or dysrhythmias. Symptoms include decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, and nonproductive cough.

Back 17

Alcoholic cardiomyopathy: the effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition. The clinical findings generally relate to CHF or dysrhythmias. Symptoms include decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, and nonproductive cough.

Front 18

What is the tx for Alcoholic cardiomyopathy?

Back 18

total abstinence from alcohol
Tx of CHF may include rest, oxygen, digitalization, sodium restriction, and diuretics.
(Prognosis is good if treated in early stages, but death rate is high if advanced).

Front 19

inflammation and pain in the esophagus due to toxic effects of alcohol on esophageal mucosa; also due to frequent vomiting associated with alcohol abuse

Back 19

esophagitis

Front 20

Gastritis, another complication of chronic alcohol abuse, involve inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention. Alcohol breaks down the stomach's protective mucosal barrier, allowing hydrochloric acid to erode the stomach wall. Damage to blood vessels may result in ______.

Back 20

hemorrhage

Front 21

Signs of _________ intoxication include: fighting, grandiosity, hypervigilance, psychomotor agitation, impaired judgment, tachycardia, pupillary dilation, elevated BP, perspiration or chills, nausea and vomiting

Back 21

amphetamine

Front 22

Signs of _________ intoxication include: euphoria, anxiety, suspiciousness, sensation of slowed time, impaired judgment, social withdrawal, tachycardia, conjunctival redness, increased appetite, hallucinations

Back 22

marijuana (cannabis)

Front 23

Signs of _________ intoxication include: aggressiveness, impaired judgement, impaired attention, irritability, euphoria, depression, emotional lability, slurred speech, incoordination, unsteady gait, nystagmus, flushed face

Back 23

alcohol

Front 24

Signs of _________ intoxication include: euphoria, fighting, grandiosity, psychomotor agitation, hypervigilance, impaired judgement, tachycardia, increased BP, pupillary dilation, perspiration or chills, nausea/vomiting, hallucinations, delirium

Back 24

cocaine

Front 25

Signs of _________ intoxication include: belligerence, asaultiveness, apathy, impaired judgment, dizziness, nystagmus, slurred speech, unsteady gait, lethargy, depressed reflexes, tremor, blurred vision, stupor or coma, euphoria, irritation around eyes, throat, and nose.

Back 25

inhalants

Front 26

Signs of _________ intoxication include: restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI complaints, muscle twitching, rambling flow of thought and speech, cardiac arrythmias, periods of inexhaustibility, psychomotor agitation

Back 26

caffeine

Front 27

Signs of _________ intoxication include:euphoria, lethargy, somnolence, apathy, dysphoria, impaired judgment, pupillary constriction, drowsiness, slurred speech, constipation, nausea, decreased resp. rate & bp

Back 27

opioids

Front 28

Signs of _________ intoxication include:belligerence, assaultiveness, impulsiveness, psychomotor agitation, impaired judgment, nystagmus, increased HR & BP, diminished pain response, ataxia, dysarthria, muscle rigidity, seizures, hyperacusis, delirium

Back 28

phencyclidine & related substances

Front 29

Signs of _________ intoxication include: disinihibition of sexual or aggressive impulses, mood lability, impaired judgment, slurred speech, incoordination, unsteady gait, impairment in attention or memory, disorientation, confusion

Back 29

sedatives, hypnotics, and anxiolytics

Front 30

Signs of _________ withdrawal include:
nausea/vomiting, malaise, weakness, tachycardia, sweating, anxiety, irritability, orthostatic hypotension, tremor, insomnia, seizures

Back 30

sedatives, hypnotics, anxiolytics

Front 31

Signs of _________ withdrawal include: craving for the drug, nausea/ vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection or sweating, diarrhea, yawning, fever, insomnia

Back 31

opioids

Front 32

Signs of _________ withdrawal include: craving for he drug, irritability, anger, frustration, anxiety, difficulty concentrating, restlessness, decreased heart rate, increased appetite, weight gain, tremor, headaches, insomnia

Back 32

nicotine

Front 33

Signs of _________ withdrawal include: headache

Back 33

caffeine

Front 34

Signs of _________ withdrawal intoxication include: restlessness, irritability, insomnia, loss of appetite

Back 34

cannabis (marijuana)

Front 35

Signs of _________ withdrawal include: craving for the substance, anxiety, depressed mood, irritability, fatigue, insomnia or hypersomnia, psychomotor agitation, paranoid and suicidal ideation

Back 35

amphetamines & related substances

Front 36

Signs of _________ withdrawal include: depression, anxiety, irritability, fatigue, insomnia or hypersomnia, psychomotor agitation, paranoid or suicidal ideation, apathy, social withdrawal

Back 36

cocaine

Front 37

Signs of _________ withdrawal include: tremors, nausea/vomiting, weakness, tachycardia, sweating increased BP, anxiety, depressed mood, irritability, hallucinations, headache, insomnia, seizures

Back 37

alcohol

Front 38

When do the signs of alcohol withdrawal begin? When can delirium tremens occur? What is the common medication used for substitution therapy?

Back 38

Alcohol withdrawal begins within 4-6 h after last drink. May progress to delirium tremens on 2nd or 3rd day. Librium or Serax is common for substitution therapy.

Front 39

Withdrawal symptoms of amphetamines usually peak within ___ to ___ days, although depression and irritability may persist for... What can be helpful?

Back 39

Withdrawal symptoms of amphetamines usually peak within 3 to 4 days, although depression and irritability may persist for months. What can be helpful? Antidepressants

Front 40

Intoxication from cannabis (marijuana) occurs immediately and lasts about ___ hours. ___ ingestion is absorbed more slowly and has longer/shorter lasting effects.

Back 40

Intoxication from cannabis (marijuana) occurs immediately and lasts about 3 hours. Oral ingestion is absorbed more slowly and has longer lasting effects.

Front 41

Large doses of ____ can result in convulsions or death from cardiac arrythmias or respiratory paralysis.

Back 41

cocaine

Front 42

Intoxication of ___ occurs within 5 minutes of inhalation and symptoms last 60-90 minutes. Large doses can result in death from CNS depression or cardiac arrythmias.

Back 42

inhalants

Front 43

Opioid withdrawal symptoms appear within ___ to ___ hours after last dose, reach a peak on the ___ or ___ day and disappear in ___ to ___ days. Times are shorter with m_____ and longer with m_____.

Back 43

Opioid withdrawal symptoms appear within 6 to 8 hours after last dose, reach a peak on the 2nd or 3rd day and disappear in 7 to 10 days. Times are shorter with meperidine and longer with methadone.

Front 44

Delirium from _____ intoxication can occur within 24 h after use, or may occur up to a week following recovery from an overdose of the drug.

Back 44

phencyclidine & related substances

Front 45

Withdrawal from sedatives, hypnotics, and anxiolytics may progress to ______, usually within __ week of last use. Long-acting __________ or ____________ may be used in withdrawal substitution therapy.

Back 45

Withdrawal from sedatives, hypnotics, and anxiolytics may progress to delirium usually within 1week of last use. Long-acting barbiturates or benzodiazapines may be used in withdrawal substitution therapy.

Front 46

Describe the CAGE questionnaire.

Back 46

1. Have you ever felt you should Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)>
Scoring: 2 or 3 "yes" answers strongly suggest a problem with alcohol

Front 47

Withdrawal from _____ include restlessness, irritability, insomnia, and loss of appetite

Back 47

cannabis

Front 48

Clinical manifestations of ____ ___ (due to long-term heavy alcohol use) include enlarged and tender liver, nausea & vomiting, lethargy, anorexia, elevated WBC count, fever, and jaundice. Ascites and weight loss may be evident in severe cases. Severe cases can lead to ____ or ___ _____. What is the treatment? Prognosis?

Back 48

Clinical manifestations of alcoholic hepatitis (due to long-term heavy alcohol use) include enlarged and tender liver, nausea & vomiting, lethargy, anorexia, elevated WBC count, fever, and jaundice. Ascites and weight loss may be evident in severe cases. Severe cases can lead to cirrhosis or hepatic encephalopathy. TX: strict abstinence from alcohol, proper nutrition, and rest. The individual can experience a full recovery.

Front 49

_____ of the liver may be caused by anything that results in chronic injury to the liver. It is the ___-stage of alcoholic liver disease and results from long-term alcohol abuse. There is widespread destruction of liver cells, which are replaced by ____ tissue. Clinical manifestations include nausea, vomiting, anorexia, weight loss, abdominal pain, jaundice, edema, anemia, and blood coagulation abnormalities. What is the treatment?

Back 49

Cirrhosis of the liver may be caused by anything that results in chronic injury to the liver. It is the end-stage of alcoholic liver disease and results from long-term alcohol abuse. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue. Tx: abstinence from alcohol, correction of malnutrition, and supportive care to prevent complications of the disease.

Front 50

What are some complications of cirrhosis of the liver caused by chronic alcoholism?

Back 50

Portal hypertension- elevation of BP through the portal circulation that results from defective blood flow through the cirrhotic liver

Ascites- a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal hypertension. Increased pressure results in the seepage of fluid from the surface of the liver into the abdominal cavity

Esophageal varices- veins in the esophagus that become distended because of excessive pressure from defective blood flow through the cirrhotic liver. As this pressure increases, these varicosities can rupture, resulting in hemorrhage and sometimes death.

Hepatic encephalopathy- serious complication that occurs in response to the inability of the diseased liver to convert ammonia to urea for excretion. The rise in serum ammonia results in progressively impaired mental functioning, apathy, euphoria or depression, sleep disturbance, increasing confusion, and progression to coma and eventual death.

Front 51

Hepatic encephalopathy involves an increase in serum _____. What is the treatment?

Back 51

ammonia.
Treatment requires complete abstinence from alcohol temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose.

Front 52

What are some blood dyscrasias that can result from chronic alcohol abuse?

Back 52

leukopenia- the production, function, and movement of the WBC's are impaired in chronic alcoholics. Results in high risk of infection and complicated recovery

Thrombocytopenia- Platelet production and survival are impaired as a result of the toxic effects of alcohol. This places the alcoholic at risk for hemorrhage. Abstinence from alcohol rapidly reverses this deficiency.

Front 53

What are some sexual dysfunctions that can occur in men and women due to alcohol abuse?

Back 53

Alcohol interferes with the normal production and maintenance of female and male hormones.

Women- this can mean changes in the menstrual cycles and a decreased or loss of ability to become pregnant.

Men- decreased hormone levels result in a diminished libido., decreased sexual performance, and impaired fertility.

Front 54

Symptoms of _____ or _____ use: relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, sleep

Back 54

alcohol & Other (barbiturates and nonbarbiturates

Front 55

Symptoms of _____ use: euphoria, lethargy, drowsiness, lack of motivation, constricted pupils

Back 55

opioids

Front 56

Symptoms of _____ use: visual hallucinations, disorientation, confusion, paranoid delusions, euphoria, anxiety, panic, increased pulse

Back 56

hallucinogens

Front 57

Symptoms of _____ use: euphoria, hyperactivity, restlessness, talkativeness, increased pulse, dilated pupils, rhinitis

Back 57

cocaine

Front 58

Symptoms of _____ use: hyperactivity, agitation, euphoria, insomnia, loss of appetite, dilated pupils

Back 58

amphetamines & other CNS stimulants

Front 59

Symptoms of _____ use: relaxation, talkativeness, lowered inhibitions, euphoria, mood swings

Back 59

cannabinols (marijuana)

Front 60

What level is considered alcohol intoxication?

Back 60

100-200 mg /dL
0.1 -0.2
(legally drunk in CA is 0.08)

Front 61

Someone can be under the influence of alcohol up to ___ h after last drink.

Back 61

12

Front 62

True or False: If there are increasing signs of alcohol withdrawal, such as fine tremors, sweating, nausea/vomiting, and increased HR, the patient may have a more severe, chronic condition and the treatment or drug may need to be adjusted.

Back 62

true

Could lead to delirium, tremors, electrolyte imbalance, hallucinations, seizures, death... could lead to cardiovascular collapse

Front 63

Anti-anxiety meds and sedatives are ____ forming and should only be used ___-term.

Back 63

Anti-anxiety meds and sedatives are habit forming and should only be used short-term.

Front 64

what are some withdrawal effects of heroin? When do they begin, peak, and how long do they last?

Back 64

flu-like
nausea, vomiting
cramping
sweating
insomnia

begin 6-12 h after last dose
peak at 1-3 days
last 5-7 days

Front 65

Methadone is shorter/longer acting than heroine. The withdrawal starts when? Lasts how long?

Back 65

shorter acting
starts 1-4 days after last dose
lasts 10-14 days

Front 66

What kinds of signs would someone on ecstasy (MDMA) come into the hospital ER with?

Rhabdomyolysis can lead to ...

Back 66

Increased HR
hyperthermia
dehydration

rhabdomyolysis can lead to kidney failure

Front 67

If there is no liver impairment, give _____ for alcohol withdrawn, if there is liver impairment, _____ is drug of choice.

Back 67

librium, ativan

Front 68

If there is no liver impairment, give _____ for alcohol withdrawn, if there is liver impairment, _____ is drug of choice.

Back 68

librium, ativan

Front 69

________ is a drug that can be administered as a deterrent to drinking to individuals who abuse alcohol. Ingestion of alcohol while on this drug results in a syndrome of symptoms that can cause great discomfort. What are some of these symptoms? It can even prouce death if the blood alcohol level is high enough. The reaction varies according to the _____ of the individual and how much alcohol is ingested. It works by inhibiting the enzyme aldehyde dehydrogenase, thereby blocking the oxidation of alcohol at the stage when acetaldehyde is converted to acetate. This results in an accumulation of acetaldegyde in the ____, which is thought to produce the symptoms. These symptoms persist as long as alcohol is being metabolized. Is the rate of alcohol elimination effected? Symptoms can occur within ___ to ___ minutes of alcohol ingestion. Mild reaction can occur at alcohol levels as low as 5 to 10 mg/dl. With a blood alcohol level of approximately 1__ to 1___ mg/dl, severe reactions can occur such as respiratory _____, cardiovascular c_____, ar_______s, MI, acute CHF, unconsciousness, convulsions, and death. This medication should not be administered until it has been established that the client has abstained from alcohol for at least __ hours. When this medication is discontinued, let the client know that sensitivity to alcohol can last for as long as __ weeks. Other than alcohol containing items should the client be taught to avoid? The client should inform all HCP’s that they are taking this medication. In addition, it is important that the client carry a card explaining participation in this therapy, possible consequences of therapy, and symptoms that may indicate an emergency situation. A thorough medical screening is performed before starting therapy and a written _____ ____ is usually required. It is contraindicated for clients at high risk for alcohol ingestion. It is also contraindicated for psychotic clients and clients with severe cardiac, renal, or hepatic disease.

Back 69

Disulfiram (Antabuse) is a drug that can be administered as a deterrent to drinking to individuals who abuse alcohol. Ingestion of alcohol while on this drug results in a syndrome of symptoms that can cause great discomfort.
Symptoms:
flushed skin
throbbing in head/neck
respiratory difficulty
dizziness
nausea & vomiting
sweating
tachycardia
hypotension
weakness
blurred vision
confusion
It can even produce death if the blood alcohol level is high enough. The reaction varies according to the SENSITIVITY of the individual and how much alcohol is ingested. It works by inhibiting the enzyme aldehyde dehydrogenase, thereby blocking the oxidation of alcohol at the stage when acetaldehyde is converted to acetate. This results in an accumulation of acetaldegyde in the BLOOD, which is thought to produce the symptoms. These symptoms persist as long as alcohol is being metabolized. Is the rate of alcohol elimination effected? No, not thought to be. Symptoms can occur within 5 to 10 minutes of alcohol ingestion. Mild reaction can occur at alcohol levels as low as 5 to 10 mg/dl. With a blood alcohol level of approximately 125 to 150 mg/dl, severe reactions can occur such as respiratory depression, cardiovascular collapse, arrythmiass, MI, acute CHF, unconsciousness, convulsions, and death. This medication should not be administered until it has been established that the client has abstained from alcohol for at least 12 hours. When this medication is discontinued, let the client know that sensitivity to alcohol can last for as long as 2 weeks. Other than alcohol containing items should the client be taught to avoid? Liquid cough/cold meds, vanilla extract, aftershave, colognes, mouthwash, nail polish remover, isopropyl alcohol (even topically). The client should inform all HCP’s that they are taking this medication. In addition, it is important that the client carry a card explaining participation in this therapy, possible consequences of therapy, and symptoms that may indicate an emergency situation. A thorough medical screening is performed before starting therapy and a written verbal consent is usually required. It is contraindicated for clients at high risk for alcohol ingestion. It is also contraindicated for psychotic clients and clients with severe cardiac, renal, or hepatic disease.

Front 70

Naltrexone (ReVia) is a narcotic _______. It works for _____ intoxication and _____ dependence by decreasing _____. It works on the same receptors in the brain that produces the feelings of pleasure when heroin or other opiates bind to them, but it does not produce the narcotic ____ and is not ___ forming. A study showed that subjects on naltrexone therapy showed significantly lower overall relapse rates and (fewer drinks per drinking day among those clients who did resume drinking).

Back 70

Naltrexone (ReVia) is a narcotic antagonist. It works for opioid intoxication/overdose and alcohol dependence by decreasing cravings. It works on the same receptors in the brain that produces the feelings of pleasure when heroin or other opiates bind to them, but it does not produce the narcotic high and is not habit forming. A study showed that subjects on naltrexone therapy showed significantly lower overall relapse rates and (fewer drinks per drinking day among those clients who did resume drinking).

Front 71

Campral (acamprosate) is indicated for the detox/maintenance therapy after a patient has achieved ______ and helps by …... It is not indicated for patients….. Psychosocial therapy is recommended in conjunction.

Back 71

Campral (acamprosate) is indicated for the maintenance therapy after a patient has achieved abstinence and helps by decreasing cravings. It is not indicated for patients who have not undergone detox and not achieved alcohol abstinence. Psychosocial therapy is recommended in conjunction.

Front 72

Counseling of the client who abuses substances passes through various phases, each of which is of indeterminate length. In the first phase ____ is conducted. Factual data are collected to determine whether the client does indeed have a problem with substances (that they are impairing functioning in a significant area of life). Then, during the ____ phase of the relationship, the counselor assists the individual to work on acceptance of the fact that the use of substances causes problems in significant life areas and that he or she is not able to prevent it from occurring. The client states a ____ to make changes. The strength of the ___ system is determined by the duration and extent of substance-related adverse effects in the person’s life. The individual also works to gain self-control and abstain from substances. Once the problem has been identified and sobriety is achieved, the client must have a concrete and workable plan for getting through the early weeks of abstinence. A____ guidance through __-play helps the individual practice how he or she will responds to temptations or impulses and take control. Counseling often includes the family in which the therapist tries to help each member see how he or she has affected and been affected by the substance abuse behavior. Family strengths are assembled and family members are encouraged to move in a positive direction. Referrals are made to places like Al-Anon.

Back 72

Counseling of the client who abuses substances passes through various phases, each of which is of indeterminate length. In the first phase ASSESSMENT is conducted. Factual data are collected to determine whether the client does indeed have a problem with substances (that they are impairing functioning in a significant area of life). Then, during the WORKING phase of the relationship, the counselor assists the individual to work on acceptance of the fact that the use of substances causes problems in significant life areas and that he or she is not able to prevent it from occurring. The client states a DESIRE to make changes. The strength of the DENIAL system is determined by the duration and extent of substance-related adverse effects in the person’s life. The individual also works to gain self-control and abstain from substances. Once the problem has been identified and sobriety is achieved, the client must have a concrete and workable plan for getting through the early weeks of abstinence. ANTICIPATORY guidance through ROLE-play helps the individual practice how he or she will responds to temptations or impulses and take control. Counseling often includes the family in which the therapist tries to help each member see how he or she has affected and been affected by the substance abuse behavior. Family strengths are assembled and family members are encouraged to move in a positive direction. Referrals are made to places like Al-Anon.

Front 73

______ therapy may be required to reduce the life-threatening effects of intoxication or withdrawal from some substances. The severity of the withdrawal syndrome depends on what?

Back 73

Substitution therapy may be required to reduce the life-threatening effects of intoxication or withdrawal from some substances. The severity of the withdrawal syndrome depends on the particular drug used, how long it has been used, the dose used, and the rate at which the drug is eliminated from the body.

Front 74

________ are the most commonly used group of drugs used in substitution therapy for alcohol withdrawal. The approach to treatment is to start with relatively high/low doses and increase/decrease the dosage by ___ to ___ % each day until withdrawal is complete. Some examples include Chlordiazepoxide (Librium), oxazepam (Serax), diazepam (Valium) are the most commonly used. What is used if there is liver impairment?

Back 74

Benzodiazepines are the most commonly used group of drugs used in substitution therapy for alcohol withdrawal. The approach to treatment is to start with relatively high doses and decrease the dosage by 20 to 25 % each day until withdrawal is complete. Some examples include Chlordiazepoxide (Librium), oxazepam (Serax), diazepam (Valium) are the most commonly used. What is used if there is liver impairment? Ativan

Front 75

To manage withdrawal seizures, anticonvulsants may be ordered such as ____, _____, and ______. These are especially useful for people who undergo…

Back 75

To manage withdrawal seizures, anticonvulsants may be ordered such as carbamazepine, valproic acid, or gabapentin. These are especially useful for people who undergo repeated episodes of alcohol withdrawal, which appear to “kindle” even more serious withdrawal episodes, including the production of seizures that can result in brain damage. These anticonvulsants have been used successfully in both acute withdrawal and longer-term craving situations.

Front 76

________ is the number one choice for opioid intoxication or overdose. What are some nursing implications?

Back 76

Narcan (naloxone)- It is given in small, frequent doses and titrated based on the effect. It needs to be used cautiously in order to get respiratory & CNS depression under control. The half life is only about 60-90 min so respiratory depression might come back. Doses should be titrated carefully in postop patients or patients in real pain to avoid interference with control over the pain (just get rid of the CNS/resp. depression).

Front 77

Methadone is given on the ___ day in a dose sufficient to suppress opioid withdrawal symptoms. The dose is gradually tapered over a specified time. As the dose diminishes, renewed symptoms may be improved by the addition of ____.

Back 77

Methadone is given on the first day in a dose sufficient to suppress opioid withdrawal symptoms. The dose is gradually tapered over a specified time. As the dose diminishes, renewed symptoms may be improved by the addition of clonidine.

Front 78

Buprenorphine (Buprenex/Subutex) is an opioid analgesic and is also used as a _____ agonist. It is more/less powerful than methadone but is considered to be safer and causes fewer side effects. SE include confusion, dysphoria, hallucinations, confusion, nausea, constipation, and sweating. It is especially helpful for people who are mildly, moderately, or severely addicted? Physicians (who require special addiction qualifications) can prescribe this in office settings which is an alternative to methadone clinics. The initial dose should be given at least __ h after last dose and preferably when early signs of opioid withdrawal appear. Once stable- continued, unsupervised administration is preferred.

Back 78

Buprenorphine (Buprenex/Subutex) is an opioid analgesic and is also used as a partial agonist. It is less powerful than methadone but is considered to be safer and causes fewer side effects. SE include confusion, dysphoria, hallucinations, confusion, nausea, constipation, and sweating. It is especially helpful for people who are mildly or moderately addicted. Physicians (who require special addiction qualifications) can prescribe this in office settings which is an alternative to methadone clinics. The initial dose should be given at least 4 h after last dose and preferably when early signs of opioid withdrawal appear. Once stable- continued, unsupervised administration is preferred.

Front 79

Clonidine (catapres) is an anti_____ also used for opioid withdrawal. (Action: It stimulates the alpha-adrenergic receptors in the CNS which results in decreased sympathetic outflow inhibiting cardioacceleration and vasoconstriction centers. It prevents pain signal transmission to the CNS by stimulating alpha-adrenergic receptors in the spinal cord.) It helps suppress opiate withdrawal symptoms. It is not as effective as substitution with methadone, but it is non____ing and serves effectively as a bridge to enable the client to stay opiate free long enough to facilitate termination of ____ maintenance. When is the best time to take the medication? What are 3 nursing implications? (2 teaching, one lab consideration)

Back 79

Clonidine (catapres) is an antihypertensive also used for opioid withdrawal. (Action: It stimulates the alpha-adrenergic receptors in the CNS which results in decreased sympathetic outflow inhibiting cardioacceleration and vasoconstriction centers. It prevents pain signal transmission to the CNS by stimulating alpha-adrenergic receptors in the spinal cord.) It helps suppress opiate withdrawal symptoms. It is not as effective as substitution with methadone, but it is nonaddicting and serves effectively as a bridge to enable the client to stay opiate free long enough to facilitate termination of methadone maintenance. When is the best time to take the medication? HS because it can cause drowsiness. What are 3 nursing implications? (2 teaching, one lab consideration) Patient teaching about orthostatic hypotension, teaching about good oral hygiene & frequent mouth rinses because it may cause dry mouth, It also may increase blood glucose.

Front 80

Substitution therapy for CNS depressant withdrawal, particularly barbiturates, is most common with the short/long acting barbiturate _____. The dosage required to suppress withdrawal symptoms is administered. What are some lab test considerations? When stabilization has been achieved, the dose is gradually decreased by ___ mg per day until withdrawal is complete. What is an important nursing implication? Long acting ______are commonly used for substitution therapy when the abused substance is a nonbarbiturate CNS depressant.

Back 80

Substitution therapy for CNS depressant withdrawal, particularly barbiturates, is most common with the long acting barbiturate Phenobarbital (Luminal). The dosage required to suppress withdrawal symptoms is administered. Periodic Hepatic, renal function tests and CBC’s should be done.When stabilization has been achieved, the dose is gradually decreased by 30 mg per day until withdrawal is complete. This med should be weaned off gradually. Long acting benzos are commonly used for substitution therapy when the abused substance is a nonbarbiturate CNS depressant.

Front 81

Treatment of stimulant intoxication usually begins with minor/major ________ such as _____ and progresses to minor/major ______ such as _____. Anti___ should be administered with caution because of the potential for lowering the ____ ____. Repeated seizures are treated with IV ____.

Back 81

Treatment of stimulant intoxication usually begins with minor tranquilizers such as chlordiazepoxide and progresses to major tranquilizers such as Haldol. Antipsychotics should be administered with caution because of the potential for lowering the seizure threshold. Repeated seizures are treated with IV diazepam.

Front 82

Treatment for CNS stimulant withdrawal is aimed at reducing drug craving and managing severe _____. The client is placed in a quiet atmosphere and allowed to sleep and eat as much as needed. ____ precautions may need to be instituted. Antidepressants may be helpful.

Back 82

Treatment for CNS stimulant withdrawal is aimed at reducing drug craving and managing severe depression. The client is placed in a quiet atmosphere and allowed to sleep and eat as much as needed. Seizure precautions may need to be instituted. Antidepressants may be helpful.

Front 83

flumazenil (Romazicon) is used to treat what? What are some nursing implications?

Back 83

flumazenil (Romazicon) is used to treat CNS depressant (benzos) overdose include versed or other general anesthetics during diagnostic or therapeutic procedures. It works by reversing the effects of benzodiazepines but has no effect on other depressants like opioids, alcohol, barbiturates, or other general anesthetics. What are some nursing implications? Side effects include dizziness, nausea, and vomiting.
Institute seizure precautions.
Assess LOC and resp. status before and during therapy.
Observe patient for at least 2 h after administration; resedation or hypoventilation can occur.

Front 84

What is more of an emergency, withdrawal from CNS stimulants or depressants?

Back 84

Withdrawal from depressants is more life threatening (although suicide could occur with either)

Front 85

What is the treatment for hallucinogen and cannabinol intoxication/withdrawal?

Back 85

Substitution therapy not required. When adverse reactions such as anxiety or panic occur, benzos may be prescribed. Psychotic reactions can be treated with antipsychotics.

Front 86

Review handout on Librium dosages etc.

Back 86

… ok time for anxiety disorders…

Front 87

True or False: Anxiety is usually considered a normal reaction to a realistic danger or threat to biological integrity or self-concept.

Back 87

true

Front 88

True or False: Normal anxiety dissipates when the danger or threat is no longer present.

Back 88

true

Front 89

Anxiety is considered abnormal or p_______ if it is out of _____ to the situation that is creating it or it i_____s with social, occupational, or other important areas of functioning.

Back 89

Anxiety is considered abnormal or pathological if it is out of proportion to the situation that is creating it or it interferes with social, occupational, or other important areas of functioning.

Front 90

Generalized anxiety disorder is characterized by chronic, unrealistic, and excessive anxiety and worry. The symptoms have existed at least ___ months, and it can’t be attributed to specific organic factors such as caffeine intoxication or hyperthyroidism.

Back 90

6

Front 91

In _____ _____, the client is gradually exposed to the phobic stimulus, either in a real or imagined situation. Emphasis is placed on reciprocal inhibition or counterconditioning

Back 91

In systemic desensitization, the client is gradually exposed to the phobic stimulus, either in a real or imagined situation. Emphasis is placed on reciprocal inhibition or counterconditioning.

Front 92

_______ _______ is described as the restriction of anxiety prior to the effort of reducing avoidance behaviors. The rationale behind this concept is that because relaxation is antagonistic to anxiety, individuals cannot be anxious and relaxed at the same time. Systemic desensitization with reciprocal inhibition involves what 2 main elements?

Back 92

Reciprocal inhibition is described as the restriction of anxiety prior to the effort of reducing avoidance behaviors. The rationale behind this concept is that because relaxation is antagonistic to anxiety, individuals cannot be anxious and relaxed at the same time. Systemic desensitization with reciprocal inhibition involves what 2 main elements? Training in relaxation exercises & Progressive exposure to a hierarchy of fear stimuli while in a relaxed state.

Front 93

_____ therapy, or flooding, is a therapeutic process in which the client must imagine situations or participate in real-life (in vivo) situations that he finds extremely frightening for a prolonged period of time.

Back 93

Implosion therapy, or flooding, is a therapeutic process in which the client must imagine situations or participate in real-life (in vivo) situations that he finds extremely frightening for a prolonged period of time. ( Read more about this page 464)

Front 94

Antianxiety agents are also called _____ and minor _____

Back 94

anxiolytics & minor tranquilizers.

Front 95

True or False: Benzodiazapines are preferred over SSRI’s and Buspar (busiporone) in treating generalized anxiety disorder (GAD).

Back 95

False- the latter are preferred due to the addiction & dependency potential of benzos

Front 96

True or False: Basically all of the CNS depressants, antianxiety meds, opioids etc may cause drowsiness and should not be combined with alcohol or other CNS depressants because the effects can be potentiated

Back 96

true

Front 97

___________ does not cause physical dependence or tolerance and is the drug of choice for GAD. It binds to serotonin and dopamine receptors in the brain and also increases norepinephrine metabolism in the brain. What are some nursing implications?

Back 97

Buspar (busiporone) does not cause physical dependence or tolerance and is the drug of choice for GAD. It binds to serotonin and dopamine receptors in the brain and also increases norepinephrine metabolism in the brain. What are some nursing implications? Teach patient not to consume large amounts of grapefruit juice, take with food to decreases GI upset, and it takes 10-14 days to work

Front 98

1st line drug for all anxiety disorders is...

Back 98

ssri's

Front 99

The med class: ____ ______ are especially helpful for phobias and performance anxiety.

Back 99

beta blockers

Front 100

Beta blockers like Inderal (propanolol) can be used for many other disorders such as PTSD, alcohol withdrawal, and anxiety disorders. The main side effects include ____, weakness, and e_____ d_____. Monitor HR and blood pressure, may cause orthostatic hypotension. Other implications: (extra caution with other BP meds) and diabetics need to closely monitor blood sugar because this med can mask symptoms of hypoglycemia. Tenormin (atenolol) is another beta blocker sometimes used for anxiety disorders and has similar implications.

Back 100

Beta blockers like Inderal (propanolol) can be used for many other disorders such as PTSD, alcohol withdrawal, and anxiety disorders. The main side effects include fatigue, weakness, and ED. Monitor HR and blood pressure, may cause orthostatic hypotension. Other implications: (extra caution with other BP meds) and diabetics need to closely monitor blood sugar because this med can mask symptoms of hypoglycemia. Tenormin (atenolol) is another beta blocker sometimes used for anxiety disorders and has similar implications.

Front 101

True or False: many anti-anxiety meds can cause orthostatic hypotension

Back 101

true

Front 102

Benadryl is an antihistamine that can have a short/long term negative/positive effect on anxiety because it has a sedative effect.
Advise patients not to ever abruptly stop any anti-anxiety med without talking to a doctor, especially ____.

Back 102

Benadryl is an antihistamine that can have a short term positive effect on anxiety because it has a sedative effect.
Advise patients not to ever abruptly stop any anti-anxiety med without talking to a doctor, especially Xanex (alprazolam)