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53 Cards in this Set
- Front
- Back
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What is abuse?
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Abuse is when a person uses alcohol or drugs for the purpose of intoxication or, in the case of prescription drugs, for purposes beyond their intended use
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What is dependence?
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Dependence refers to physiological dependence as evidenced by tolerance and withdrawal or impairment in social and occupational functioning resulting form teh pathological and repeated use of substances
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What are examples of uppers?
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Amphetamines and cocaine
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What are examples of downers?
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Ativan, Quaalude, Phenobarbital, Ambien
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What are examples of dual effects drugs?
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Alcohol and nicotine
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What pathway in the brain is responsible for ensuring we keep eating, drinking, and having sex?
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The dopaminergic reward pathway
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What are the stages of alcohol withdrawal syndrome?
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Stage I: mild anxiety, hand tremors, "shakes"
Stage II: HR 100-120 bpm, N/V, anxiety, motor restlessness, transient AH, VH, intermittent confusion Stage III: HR 120-140 bpm, HTN, disoriented, confused, insomnia, seizures |
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What are delirium tremens?
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Rare, but life threatening, occurrence of severe alcohol withdrawal. Characterized by cardiac dysrhythmias, tachypnea, profuse sweating, tremor, vivid hallucinations, delusions.
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What distinguishes opioid and alcohol withdrawal?
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Opioid withdrawal is not life-threatening, but alcohol withdrawal may be fatal
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What are some pharmacologic treatments for alcohol withdrawal?
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- Benzodiazepines to produce sedation and reduce anxiety symptoms
- Nutrition and vitamins (thiamine, folic acid, magnesium sulfate) - Disulfiram (Antabuse) to produce nauseau - Naltrexone to reduce cravings |
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Name 3 classes of sedatives, hypnotics, and anxiolytics
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1. Benzodiazepines
2. Barbiturates (Xanax, Ativan) 3. Z-drugs (Ambien, Sonata) |
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What are the symptoms of intoxication caused by alcohol?
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- disinhibition
- inappropriate behavior - impaired judgment - psychomotor impairments - confusion - stupor - coma |
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What are the symptoms of alcohol withdrawal?
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- GI upset
- malaise - irritability - seizures |
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How does cocaine work?
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Short-term: it increases release and blocks the reuptake of norepinephrine, serotonin, and dopamine
Long-term: depletion of dopamine and increased prolactin level leads to sense of euthymia that is reversible |
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What are the symptoms of intoxication caused by cocaine?
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CNS stimulation followed by depression. Increasing doses cause restlessness, tremors and agitation, seizures, respiratory depression, cardiac arrest, death
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What are the symptoms of cocaine withdrawal?
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Norepinephrine depletion causes increased sleep. Dopamine depletion causes "post-coke blues". Can be treated with antidepressants and dopamine agonists.
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What are CNS stimulants?
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- Cocaine
- caffeine - nicotine - amphetamines |
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How do amphetamines work?
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Block reuptake of norepinephrine and dopamine, and also stimulate release of newly synthesized norepinephrine. They effect the peripheral nervous system as powerful sympathomimetics: tachycardia, increased BP, peripheral hyperthermia
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What are the symptoms of amphetamines intoxication?
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- Agitation
- Aggression - Psychosis - Impaired judgment - elevated HR & BP - Dilated pupils - Diaphoresis |
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What are the symptoms of amphetamine withdrawal?
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Anxiety, depression, irritability, cravings, insomnia/hypersomnia, psychosis, suicidal ideation. Can be treated with antidepressants and dopamine agonists
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What is Wernicke's syndrome?
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Complication of having a history of many years of drinking. Often presents in patients over the age of 40.
Caused by thiamine deficiency, and is reversible if caught early enough. Symptoms include: ataxia, confusion, ocular motility abnormalities |
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What is Korsakoff's psychosis?
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AKA alcochol amnestic disorder.
Complication of having a history of many years of drinking. Often presents in patients over the age of 40. Korsakoff's follows Wernicke's. It effects retrograde and anterograde amnesia. Key symptom is confabulation: pt tells plausible but imagined scnarios that fill in memory gaps. |
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What are the effects of Nicotine?
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Increased release of dopamine, acetylcholine, norepinephrine.
Causes improved cognition and appetite suppression. |
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What are some adverse effects of nicotine?
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Emphysema, stherosclerosis, peripheral cardiovascular disease, stroke, cancer, tolerance, dependence (nicotine addiction is as strong as heroine and cocaine addictions).
Smoking during pregnancy can lead to birth defects related to hypoxic conditions created for the fetus |
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What are symptoms of withdrawal from nicotine?
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Cravings, irritability, anxiety, difficulty concentrating, increased appetite/weight gain, headaches, insomnia, decreased heart rate.
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What are the effects of caffeine?
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Increases release of dopamine in prefrontal cortex, which causes improved mental acuity.
This occurs when doses of caffeine are less than 200mg -- note that a grande Starbucks coffee has 320 mg) |
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What are some adverse effects of caffeine?
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Anxiety, GI problems, agitation, cardiac arrhythmia, rambling speech, restlessness.
>300 can lead to tremors, poor motor performance, and insomnia >500mg can lead to increased HR and force of cardiac contraction, dilated pulmonary and corony blood vessels and constricted cerebral vasculature |
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What are symptoms of withdrawal from caffeine?
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headache, drowsiness, fatigue, difficulty concentrating, craving, nausea
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What are the effects of opiates?
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Narcotics bind to opiate receptors to increase dopamine. This causes CNS depression, sedation, euphoria, pleasure; relief of pain, cough, diarrhea.
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What are negative effects of opiates?
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Constipation
Physical dependence |
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What 3 opioids have a natural origin?
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Opium, morphine, codeine
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What 5 opioids are synthetic?
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Meperidine, methadone, propoxyphene, fentanyl, pentazocine
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What are symptoms of withdrawal from opiate treatment?
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Yawning, insomnia, irritability, rhinorrhea, panic, diaphoresis, cramps, nausea, vomiting, muscle aches, bone pain, chills, fever, diarrhea.
Remember: patients cannot die from opioid withdrawal |
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What psychopharmacologic treatments are available for opioid withdrawal?
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- Buprenorphine and methadone are used as opioid substitutes
- Naloxone and naltrexone are used as opioid antagonists (to reverse OD) |
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What are the effects of cannabis?
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Enhances dopamine activity and caused euphoria, relaxation, drowsiness, food cravings
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What are the adverse effects of cannabis?
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Amotivational syndrome, memory impairments, coordination problems, slows reaction time, increased appetite, paranoia, social withdrawal, visual hallucinations, suicide attempts
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What are symptoms of withdrawal from cannabis?
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Restlessness, irritability, insomnia, loss of appetite, depressed mood
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What are 3 hallucinogens?
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LSD
Mescaline Psilocybin |
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How do hallucinogens work?
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They activate serotonin receptors, which leads to unusual perceptual experiences including altered body image, distortions in the flow of time, distorted or sharpened visual/auditor perception.
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What are adverse reactions to hallucinogens?
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Paranoia
Fear of losing one's sanity (LSD particularly has a long half-life) Impaired judgment and memory |
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How does phencyclidine (PCP) work?
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Disrupts NMDA receptor function. Causes detachment, decreased awareness, hallucinations, destructive behavior
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How do club drugs (ecstasy or MDMA) work?
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They increase serotonin release, which causes euphoria, increased energy, increased self-confidence, and increased sociability
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What are adverse effects of club drugs?
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-Serotonin syndrome
-Malignant hyperthermia (muscle breakdown, cardiovascular and renal failure) |
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What are symptoms of withdrawal from club drugs (ecstasy and MDMA)?
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Fatigue, loss of appetite, depressed feelings, difficulty concentrating
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How does methamphetamine work?
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It increases dopamine, which increases activity level, decreases appetite, and causes euphoria
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What are adverse effects of methamphetamines?
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Increased wakefulness, dry mouth, tooth decay, increased respiration, psychosis, obsessive scratching, violent behavior, CVA, arrhythmia, cardiac arrest
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What is GHB and how does it work?
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Date-rape drug, gamma-hydroxybutyric acid. It increases euphoria, social disinhibition, and libido. 1 dose is equal to 6 alcoholic drinks
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What is rohypnol and how does it work?
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Date-rape drug. Decreases anxiety and muscular tension, drowsiness.
Adverse effects include amnesia, decreased BP, dizziness, confusion, lack of muscle control, loss of consciousness |
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What is the CAGE questionnaire?
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1. Have you ever felt you should Cut down on your drinking?
2. Have others Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty about your drinking? 4. Have you ever needed an Eye-opener to start your day? |
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What are significant nursing diagnoses for someone with substance abuse?
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-Risk for suicide
-Risk for other-directed violence -Disturbed self-esteem -Disturbed sleep pattern -Risk for deficient fluid volume -Ineffective coping -Ineffective health maintenance |
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What are significant nursing interventions for someone with substance abuse during detoxification?
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Monitor vital signs
Administer medications Monitor intake and output Fluids, nutrition Seizure precautions |
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What are important points of patient teaching for patients and family members regarding substance abuse?
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Symptoms
Dependence Relapse Dangers |
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What are significant nursing interventions for someone with substance abuse looking towards recovery?
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-Encourage verbalization of feelings
-Motivational interviewing for patients who might not know they have a problem -Review necessary lifestyle changes (development stops once substance abuse starts) -Stress management and coping skills |
