Chapter 14: Substance-Related And Addictive Disorders

Front 1

Physical Dependence

Back 1

Need for increasing amounts to produce the desired effects

Syndrome of withdrawal upon cessation

Front 2

Psychological Dependence

Back 2

Overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort

Front 3

Substance Addiction

Back 3

-Use interferes with ability to fulfill role obligations

-Attempts to cut down or control use fail

-Intense craving for the substance

-Excessive amount of time spent trying to procure substance or recover from use

-Use causes difficulty with relationships/become isolated

-Engages in hazardous activities while impaired

-Tolerance develops

-Substance-specific symptoms occur upon discontinuation of use

Front 4

Substance Intoxication

Back 4

-Development of a reversible syndrome of symptoms following excessive use of a substance

-Direct effect on the central nervous system

-Disruption in physical and psychological functioning

-Judgment is disturbed and social and occupational functioning is impaired

Front 5

Substance withdrawal

Back 5

-Development of symptoms that occurs upon abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period of time

-Symptoms are specific to the substance that has been used

-Disruption in physical and psychological functioning, with disturbances in thinking, feeling, and behavior

Front 6

1. Which of the following has been implicated in the predisposition to substance abuse?

a) Hereditary factor

b) Fixation in the adolescent stage of psychosexual development

c) Punitive ego

d) Narcissistic and dependent personality traits

Back 6

Correct answer: A

Research has indicated that an apparent hereditary factor is involved in the development of substance-use disorders. This is especially evident with alcoholism.

Front 7

Phase I: Prealcoholic phase

Back 7

characterized by use of alcohol to relieve everyday stress and tensions of life.

Front 8

Phase II: Early alcoholic phase

Back 8

Early alcoholic phase: begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person.

Front 9

Phase III: The crucial phase

Back 9

Person has lost control; physiological dependence is clearly evident. may go into withdrawal if they don't have the substance.

Front 10

Phase IV: The chronic phase

Back 10

Characterized by emotional and physical disintegration. The person is usually intoxicated more often than sober. relationships start to dissolve, fired from work, fail school, etc…

Front 11

Wernicke’s encephalopathy

Back 11

most serious form of thiamine deficiency in alcoholic patients

Front 12

Korsakoff’s psychosis

Back 12

syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients

Front 13

Alcoholic cardiomyopathy

Back 13

effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition

Front 14

Esophagitis

Back 14

inflammation and pain in the esophagus occurs because of the toxic effects of alcohol on the esophageal mucosa and also because of frequent vomiting associated with alcohol use

Front 15

Gastritis

Back 15

effects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention

Front 16

Pancreatitis

Back 16

Acute: usually occurs 1 or 2 days after a binge of excessive alcohol consumption. Symptoms include constant, severe epigastric pain; nausea and vomiting; and abdominal distention

Chronic: leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus

Front 17

Alcoholic hepatitis

Back 17

-Caused by long-term heavy alcohol use

-Symptoms: enlarged, tender liver; nausea and vomiting; lethargy; anorexia; elevated white cell count; fever; and jaundice. Also ascites and weight loss in severe cases.

Front 18

Cirrhosis of the liver

Back 18

Cirrhosis is the end-stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue.

Front 19

Portal hypertension

Back 19

elevation of blood pressure through the portal circulation results from defective blood flow through cirrhotic liver

Front 20

Ascites

Back 20

a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity; occurs in response to portal hypertension

Front 21

Esophageal varices

Back 21

veins in the esophagus become distended because of excessive pressure from defective blood flow through the cirrhotic liver

Front 22

Hepatic encephalopathy

Back 22

occurs in response to the inability of the diseased liver to convert ammonia to urea for excretion. The continued rise in serum ammonia, if allowed to progress, leads to coma and eventual death.

Front 23

Leukopenia

Back 23

impaired production, function, and movement of white blood cells

Front 24

Thrombocytopenia

Back 24

platelet production and survival are impaired as a result of the toxic effects of alcohol

Front 25

Sexual dysfunction

Back 25

-In the short term, enhanced libido and failure of erection are common

-Long-term effects include gynecomastia, sterility, impotence, and decreased libido

Front 26

2. A client is brought to the ED. The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dl. Among the physician’s orders is thiamine. Which is the rationale for this intervention?

a) To prevent nutritional deficits

b) To prevent pancreatitis

c) To prevent alcoholic hepatitis

d) To prevent Wernicke's encephalopathy

Back 26

Correct answer: D

Wernicke’s encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.

Front 27

Alcohol Intoxication

Back 27

Occurs at blood alcohol levels between 100 and 200 mg/dl

Front 28

Alcohol withdrawal

Back 28

Occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use

Front 29

Sedative/Hypnotic Use Disorder

Back 29

- A profile of the substance:

Barbiturates

Non-barbiturate hypnotics

Antianxiety agents

Club drugs

Front 30

Effects on the body: Sedatives/hypnotics

Back 30

Effects on sleep and dreaming

Respiratory depression

Cardiovascular effects

Renal function

Hepatic effects

Body temperature

Sexual functioning

Front 31

Intoxication from sedative/hypnotics

Back 31

With these CNS depressants, effects can range from disinhibition and aggressiveness to coma and death (with increasing dosages of the drug).

Front 32

Withdrawal from Sedative/hypnotics

Back 32

Onset of symptoms depends on the half-life of the drug from which the person is withdrawing.

Severe withdrawal from CNS depressants can be life threatening.

Front 33

Stimulant Use Disorder

Back 33

Amphetamines

Synthetic stimulants

Non-amphetamine stimulants

Cocaine

Caffeine

Nicotine

Front 34

Effects on the body: Stimulant use

Back 34

CNS effects

Cardiovascular effects

Pulmonary effects

Gastrointestinal and renal effects

Sexual functioning

Front 35

Intoxication: Stimulants

Back 35

Amphetamine and cocaine intoxication produce euphoria, impaired judgment, confusion, changes in vital signs (even coma or death, depending on amount consumed).

Caffeine intoxication usually occurs following consumption in excess of 250 mg. Restlessness and insomnia are the most common symptoms.

Front 36

Withdrawal: Stimulants

Back 36

Amphetamine and cocaine withdrawal may result in dysphoria, fatigue, sleep disturbances, and increased appetite.

Withdrawal from caffeine may include headache, fatigue, drowsiness, irritability, muscle pain and stiffness, and nausea and vomiting.

Withdrawal from nicotine may include dysphoria, anxiety, difficulty concentrating, irritability, restlessness, and increased appetite.

Front 37

Inhalant Use Disorder

Back 37

Aliphatic and aromatic hydrocarbons found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners

Front 38

Effects on the body: Inhalants

Back 38

CNS effects

Respiratory effects

Gastrointestinal effects

Renal system effects

Front 39

Intoxication: Inhalants

Back 39

Develops during or shortly after use of or exposure to volatile inhalants

Symptoms include:

-Dizziness, ataxia, muscle weakness

-Euphoria, excitation, disinhibition, slurred speech

-Nystagmus, blurred or double vision

-Psychomotor retardation, hypoactive reflexes

-Stupor or coma

Front 40

Opioid Use Disorder

Back 40

Opioids of natural origin

Opioid derivatives

Synthetic opiate-like drugs

Front 41

Effects on the body: Opioids

Back 41

CNS effects

Gastrointestinal effects

Cardiovascular effects

Sexual functioning

Front 42

Intoxication: Opioids

Back 42

Symptoms are consistent with the half-life of most opioid drugs and usually last for several hours.

Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment.

Severe opioid intoxication can lead to respiratory depression, coma, and death.

Front 43

Withdrawal: Opioids

Back 43

From short-acting drugs (e.g., heroin):

Symptoms occur within 6 to 8 hours, peak within 1 to 3 days, and gradually subside in 5 to 10 days

From long-acting drugs (e.g., methadone):

Symptoms occur within 1 to 3 days, peak between days 4 and 6, and subside in 14 to 21 days

From ultra-short-acting meperidine:

Symptoms begin quickly, peak in 8 to12 hours, and subside in 4 to 5 days

Front 44

Symptoms of Opioid Withdrawal

Back 44

Dysphoria, muscle aches, nausea/vomiting, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, abdominal cramping, diarrhea, yawning, fever, and insomnia

Front 45

Hallucinogen Use Disorder

Back 45

A profile of the substance

Naturally occurring hallucinogens

Synthetic compounds

Patterns of use

Use is usually episodic

Front 46

Intoxication: Hallucinogens

Back 46

Occurs during or shortly after using the drug

Symptoms include perceptual alteration, depersonalization, derealization, tachycardia, palpitations

Front 47

Physiological Effects on the Body: Hallucinogens

Back 47

Nausea/vomiting

Chills

Pupil dilation

Increased BP, pulse

Loss of appetite

Insomnia

Elevated blood sugar

Decreased respirations

Front 48

Psychological Effects on the Body: Hallucinogens

Back 48

Heightened response to color, sounds

Distorted vision

Sense of slowed time

Magnified feelings

Paranoia, panic

Euphoria, peace

Depersonalization

Derealization

Increased libido

Front 49

Cannabis Use Disorder

Back 49

Marijuana

Hashish

Front 50

Effects on the body: Cannabis

Back 50

Cardiovascular

Respiratory

Reproductive

Central nervous system

Sexual functioning

Front 51

CAGE Questionnaire

Back 51

Have you ever felt you should Cut down on your drinking?

Have people Annoyed you by criticizing your drinking?

Have you ever felt bad or Guilty about your drinking?

Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)

Front 52

Plan for Detox

Back 52

Provide safe and supportive environment

Administer substitution therapy

Front 53

Clues for recognizing substance impairment in nurses

Back 53

High absenteeism may be present if the person’s source is outside the work area

Or, the person may rarely miss work if the substance source is at work

Increase in “wasting” of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs than for other nurses may be present

Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall

Problems with relationships

Irritability, tendency to isolate, elaborate excuses for behavior

Unkempt appearance, impaired motor coordination, slurred speech, flushed face

Patient complaints of inadequate pain control, discrepancies in documentation

Front 54

Codependency

Back 54

Defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person, or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions

Front 55

Pharmacology for alcoholism

Back 55

Disulfiram (Antabuse)

Naltrexone (ReVia)

Nalmefene (Revex)

SSRIs

Acamprosate (Campral)

Benzos (withdrawal)

Anticonvulsants (withdrawal)

Multivitamin Therapy (withdrawal)

Thiamine (withdrawal)

Front 56

Pharmacology for Opioid Use

Back 56

Narcotic antagonists

Naloxone (Narcan)

Naltrexone (ReVia)

Nalmefene (Revex)

Methadone

Buprenorphine (subutex)

Clonidine

Front 57

3. A client diagnosed with chronic alcoholism says to the nurse, “I’m tired of using and I want to stop. Is there a medication that can help me maintain sobriety?” About which medication would the nurse provide information?

a) Carbamazepine (Tegretol)

b) Clonidine (Catapres)

c) Disulfiram (Antabuse)

d) Folic acid (Folvite)

Back 57

Correct answer: C

Disulfiram is used as a deterrent to drinking. Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol, are strictly prohibited when taking this drug.