Pharm-Substance Abuse

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Physical Dependence

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a physiologic dependence on a substance, will see withdrawl symptoms as intake is stopped

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Psychological Dependence

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a stong desire to obtain and take a substance

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Habituation

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build up a tolerance to a substance after prolonged use but does not have physical or psychological dependence

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Addiction

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a strong physiologic and psychologic dependence on a drug or substance

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Wernickes encephalopathy

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a neurologic disorder characterized by apathy, drowsiness, ataxia, nystagmus, and opthalmoplegia, caused by a thiamine (b1) deficiency secondary to alcohol abuse

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Korsakoffs psychosis

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a syndrome of anterograde and reterograde amnesia with confabulation (making up stories) associted with chronic alcohol abuse, often occurs with wernickes encephalopathy

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Commonly Abused Stimulants

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mehtamphetamine, methyendioxymethamphetamine (ecstasy, MDMA), and cocaine

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Commonly Abused Depressents

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Benzodiazepines, barbituates, marijuana

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Other commonly abused substances

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opiods, alcohol, nicotine

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Opiod use

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include the drugs heroin and opium. Are an analgesic that Works by blocking receptors in the CNS, and can produce feelings of euphoria, They are intended to be used to relieve pain, reduce cough, relive diarrhea, and induce anesthesia.

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Contraindications of Opioid use

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Include known drug allergy, pregnancy, respiratory depressions or sever asthma, and paralytic ileus.

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Adverse Effects of Opioid use

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Major CNS issues inlcude diuresis, miosis, convulsions, nausea, vomiting, and respiratory depression. Non CNS include a release of histamine which causes vasodilation leading to hypotension; spasms of the colon leading to consitpation, increased spasms of the ureter resulting in urine retention, dilation of cutaneous blood vessels leading to flushing of skin of face, neck and upper thorax. May also cause sweating, urticaria, and pruritus.

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Methadone substitution (used for opioid withdrawl treatment)

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a program used to try to reduce a patients dosage gradually to help the client eventually become drug free, the drug has a long half-life which allows it be administered once a day in most circumstances. a test dose of 10 mg is given as a liquid or crushed tablet, additional 10-20 mg doses are given to help control signs and symptoms of withdrawl every 4-6 hours for the first 24 hours after the initial dose,and then daily a dose of 15-30 mg. the dosae is reduced by 5-10 mg per day until medication is completely withdrawn

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Signs and Symptoms of Opiod Withdrawl

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peaks in 1-3 days, 5-7 days duration, will see drug seeking, mydriasis, piloerection, diaphoresis, rhinorrhea, lacrimation, vomiting, diarrhea, insomnia, elevated blood pressure and pulse rate. pt will feel itense desire for drugs, muscle cramps, arthralgia, anxiety, nausea, malaise

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Clonidine (Catapres) Substitution (used to treat opioid withdrawl)

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0.1 or 0.2 mg orally given 4-6 hours as needed for signs/symptoms for 5-7 days. Days 2-4 difficult for the client in detoxification, blood pressure must be checked before each dose and cannot be given is patient is hypotensive

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Naltroxene

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an opioid antagonist used to help those abusing or dependent on opioids, (50 mg/day), it blocks the opioid receptors so that use of the drugs does not produce euphoria, but patient must be free from opioids for at least 1 week because medication can produce withdrawl syptoms if given too soon. is also given for alcoholism to reduce the craving for alcohol/drugs.

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Opoid Analgesics aka Narcotics

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Include codeine, hydomorphone, hydrocodone, meperidine, morphine, oxycodone, propoxyphene. Opium and Heroin are schedule 1, and most others are schedule 2 bacuase of high potential for abuse.

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Stimulants/designer drugs

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include amphetamines, cocaine, methylphenidate (ritalin), methamphetamine, methylendioxymethamphetamines (MDMA ecstasy)

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Factors leading to stimulant abuse

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elevation of mood, reduction of fatigue, and a sense of alertness, which can lead to physical and psychologic dependence

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Methamphetamine

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stronger than other amphetamines, come in many forms, pills, powders, and crystallized

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Signs and Symptoms of Stimulant Withdrawl

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peak 1-3 days, duration 5-7 days, social withdrawl, psychomotor retardation, hypersomnia, hyperphagia, depression, suicidal thoughts and behavior, there are no pharmacologic treatments to help with withdrawl.

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Stimulant Overdose

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death can result from convulsions, coma, cerebral hemorrahge, and can occur in periods of intoxication and withdrawl.

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Depressant Withdrawl

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can peak from 2-7 days, and last from 4-12 days. Will see increased psychomotor activity, agitation, muscular weakness, diaphoresis, delirium, convulsions, elevated BP, pulse, and temperature; tremore (eyelids, hands, tongue), patient will feel anxiety, depression, euphoria, incoherent thoughts, hostility, disorientation, hallucinations, suicidal thoughts

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Depressent Overdose

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the mixture of benzodiazepines with ethanol or barbituates can be lethal, an death results from respiratory arrest, Flumazenil(romazicon) may be used to reverse the acute sedative effects of benzodiazepines

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Flumazenil (Romazicon)

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a benzodiazepine reveral agent, it antagonizes the action of benzodiazepines on teh CNS by directly competing with them for binding and the benzodiapine recptors in the CNS which causes a reversal of sedations.

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Adverse Effects of Depressants

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CNS-drowsiness, sedation, loss of coordination, dizziness, blurred vision, headaches, and paradoxical reactions (hallucinations, insomnia, increased excitability) GI-nausea, vomiting, constipation, and abdominal cramping

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Effects of Chronic Ethanol Ingestion

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Nutritional and vitamin deficiencies-especially B vitamine (thiamine defficient), wernickes encephalopathy, korsakoff's psychosis (painful extremities due to nerve damage), polyneuritis,(inflammation of the nerves), nicotinic acid deficiency encephalopathy, seizures alcoholic hepatiis, progressing to cirrhosis, and Fetal alcohol syndrome (FAS)-craniofactial abnormalities, CNS dysfunction, and prenatal and postnatal growth retardation. may depress respirations, and can have largely irreversible effects on the heart (cardiomyopathy)

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Ethanol Withdrawl Treatment

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Benzodiazepines are the treatment of choice includeing Diazepam (Valium), lorazepam (Ativan, or chlordiazepoxide (libirum), disulfiram (Antabuse), Acamprosate, and counseling. For severe withdrawl symptoms monitoring in an ICU is recommended.

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Disulfiram (Antabuse)

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a drug that works by altering the metabolism of acohol which helps patient that are sincere in wanting to stop drinking. It works by causing acetaldehyde syndrome when the drug and alcohol are taken together or even within 3-4 days of antabuse use. The reaction/syndrome causes severe illness for the patient and can be dangerous for those patient suffering any other major illness. when alcohol is ingested the blood acetaldehyde concentration rises 5-10 times the normal and causes the patients face to feel hot and will beome flushed and scarlet, throbing in the head and neck, nasea, copious vomiting, diaphoresis, dyspnea, hyperventilation, vertigo, blurred vision, and confusion. These affects will occur with even a tiny amt of alcohol, and effects will last from 3 min to several hours. Usual dosage is 250 mg/day or 125/mg day for those with adverse effect of sedation, sexual dysfunction, and elevated liver enzymes.

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smoking cessation drugs

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Transdermal patches-habitrol, nicoderm, nicotrol, prostep.
Gum-Nicotine Gum (resin), Antidepressant-Buprion (Zyban), Partical Nicotine Agonist -Varenicline (Chantix)

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Transdermal Nicotine Systems/Gum

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used to provide nicotine without the carcinogens in tobacco, and uses a stepwise reduction in subcutaneous delivery to gradually decrease the nicotine dose, acute relief of craving is achieved by chewing the gum. Patches include Habitrol, nicoderm, nicotrol, and prostep, and the gum is nicotine gum (resin)

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buproprion (Zyban)

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an antidepressent used to aid in smoking cessation treatment. a sustained release, nicotine free, prescription medicine that treats nicotine dependence. days 1-3 15mg, then 150 mg bid for 7-12 weeks. Adverse effects- CNS- Headache, agitation, confusion, seizures, delusions, insomnia, sedation, tremors, dizziness, akinesia, bradykinesia, suicidal ideation. CV-dysrhuythmias, hypertension, palpitates, tachycardia, complete AV block, QRS prolongation, blurred vision, auditory disturbance, nausea, dry mouth, vomiting, constipation, rash. Pregnancy Class B.

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Varenicline (Chantix)

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activates and antagonizes the alpha-4 beta-2 nicotinic receptors in the brain, provides some stimulation of receptors while reducing the pleasurable effect of nicotine from smoking. 12 week treatment with 0.5 mg orally 2xdaily, titrating up to 1 mg 2xdaily by day 8. ADVERSE reactions-nausea, vomiting, headache, flatulence, insomnia, and taste disturbance, drowsiness possible. Pregnancy class C. Contraindicated for those with hypersensitivity, and eating disorders. BB-bipolar disorder, depression, schizophrenia, suicidal ideation.

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Diazepam (Valium)

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Pregnancy Class D, Controlled substance Schedule IV. A benzodiazepine,that Potentiates the actions of GABA. Results in decresed anxiety, restlessness, and insomnia. Used for anxiety, acute alcohol withdrawl, adjunct seizure disorders, preoperative skeletal muscle relaxation. ADVERSE effects- dizziness, drowsiness, orthostatic heypotension, ECG changes, tachycardia, blurred vision Contraindications-hypersensitivity to benzodiazpines, closed-angle glaucoma, coma, respiratory depresion, untreated open-glaucoma, renal/hepatic disease, sleap apnea.