Pharmacology Ati Substance Use Disorders (Chapter 12; Unit 2)

Front 1

abstinence syndrome occurs when ______

Back 1

clients abruptly withdraw from a substance to which they are physically dependent

Front 2

withdrawing from a substance that has the potential to cause addiction can cause __________________

Back 2

abstinence syndrome

Front 3

manifestations of abstinence syndrome can be distressing and may lead to _____________

Back 3

coma and death

Front 4

what are the major substances associated with substance use disorder?

Back 4

1. alcohol

2. cannabis

3. hallucinogens

4. inhalants

5. opioids

6. sedatives/hypnotics

7. stimulants

8. tobacco

Front 5

what are some of the manifestations substance withdrawal can produce?

Back 5

GI distress, neurological/behavioral changes/cardiovascular changes and seizures

Front 6

substance withdrawal varies depending on the ____________

Back 6

substance

Front 7

when do effects of alcohol withdrawal start, peak, and subside?

Back 7

start within 4 to 12 hours of last intake of alcohol, peak after 24 to 48 hours and subside within 5 to 7 days

Front 8

why might the effects of alcohol withdrawal not subside within 5 to 7 days?

Back 8

withdrawal delirium occurs

Front 9

what are the manifestations of alcohol withdrawal?

Back 9

nausea, vomiting, tremors, restlessness, and inability to sleep; depressed mood or irritability; increased HR, BP, respiratory rate, and temp; tonic-clonic seizures; illusions are common

Front 10

alcohol withdrawal delirium

Back 10

may occur 2 to 3 days after cessation of alcohol, last 2 to 3 days and is considered a medical emergency

Front 11

what are the clinical findings of alcohol withdrawal delirium

Back 11

severe disorientation, psychotic manifestations (hallucinations), severe hypertension, and cardiac dysrhythmias that may progress to death

Front 12

detoxification from alcohol (examples, intended effects, nursing interventions): using benzodiazepines

Back 12

ex. chlordiazepoxide (Librium); diazepam (Valium); lorazepam (Ativan)

IEs: maintenance of clients vital signs within normal limits; decrease in risk of seizures; decrease in intensity of withdrawal manifestation

NIs: admoinister around the clock or PRN; use chlordiazepoxide only if client is able to toleralte oral intake otherwise use IV diazepam or lorazepam, client may continue to take diazepam/lorazepam orally; obtain baseline vitals; monitor clients vitals and neuro status ongoingly; provide seizure precautions (padded side rails and suction equipment at bedside)

Front 13

detoxification from alcohol (examples, intended effects, nursing interventions): using adjunct medications

Back 13

ex: carbamazepine (Tegretol), clonidine (Catapres), propranolol (Inderal)

IEs: decrease in seizures (carbamazepine); depressions of autonomic response (decrease in BP and HR) -- clonidine and propranolol; decrease in craving (propranolol)

nursing interventions: seizure precautions (padded siderails, suction at bedside); obtain baseline vitals and ongoingly monitor

Front 14

what drugs are used for abstinence maintenance (following detoxification) from alcohol

Back 14

1. disulfiram (Antabuse)

2. naltrexone (Vivitrol)

3. acamprosate (Campral)

Front 15

what are the intended effects when using disulfiram for abstinence maintenance after alcohol detoxification

Back 15

1. it is a daily oral that is a type of aversion (behavioral) therapy

2. used concurrently with alcohol will cause acetaldehyde syndrome to occur

3. effects include nausea, comiting, weakness, sweating, palpitations, and hypotension

4. acetyldehyde syndrome can progress to respiratory depression, cardiovascular suppression, seizures, and death

Front 16

what are the nurisng interventions for using disulfiram (antabuse) for abstinence maintenance after alcohol detoxification?

Back 16

1. inform of potential dangers of alcohol

2. avoid products containing alcohol (cough syrups, mouthwash, aftershave lotion)

3. monitor frequent liver function tests to detect hepatotoxicity

4. encourage clients to wear a medical alert bracelet

5. encourage clients to participate in a 12-step self-help program

6. advise that med effects (potential for acetaldehyde syndrome with alcohol ingestion) persist for 2 weeks following dicontinuation

Front 17

what are the intended effects/nursing interventions of naltrexone (Vivitrol) in abstinence maintenance after alcohol abuse (following detoxification)

Back 17

IEs: naltrexone is a pure opioid antagonist that suppresses craving and pleasurable effects of alcohol (also used with opioid withdrawal)

NIs: take accurate hx to determine if dependent on opioids, concurrent use of naltrexone and opiates increase risk for an opiate overdose; advise to take med with meals b/c of GI distress; suggest monthly IM injections for client having difficulty adhering

Front 18

what are the intended effects/nursing interventions of acamprosate (Campral) in abstinence maintenance after alcohol abuse (following detoxification)

Back 18

IEs: acamprosate decreases unpleasant effects resulting from abstinence (anxiety, restlessness)

NIs: inform clients that diarrhea may result, advise clients to maintain adequate fluid intake and to receive adequate rest; advise clients to avoid use in pregnancy

Front 19

when does characteristic withdrawal syndrome for abistinence from opioids occur?

Back 19

within 1 hr to several days after cessation of substance

Front 20

what are the clinical findings of opioid abstinence/withdrawal

Back 20

agitation, insomnia, flulike manifestations, rhinorrhea, yawning, sweating and diarrhea

Front 21

are manifestations of opioid withdrawal life-threatening

Back 21

no BUT suicidal ideation may occur

Front 22

what are the intended effects for using methadone (Dolophine) substitution when treating opioid withdrawal

Back 22

1. is an oral opioid agonist that replaces the opioid to which client is addicted

2. will prevent abstinence syndrome from occuring and remove need for client to obtain illegal substances

3. used for withdrawal and long-term maintenance

4. dependence will be transferred from the illegal opioid to methadone

Front 23

what are the nurisng interventions for methadone (Dolophine) in opioid withdrawal syndrome?

Back 23

1. inform clients that methadone dose must be slowly tapered to produce detoxification

2. encourage clients to participate in a 12-step self-help program

3. inform clients that med must be administered from an approved treatment center

Front 24

what are the drugs used to treat opioid withdrawal?

Back 24

1. methadone (Dolophine) substitution

2. clonidine (Catapres)

3. buprenorphine (Subutex)

Front 25

what are the intended effects/nursing interventions of clonidine (Catapres) when treating opioid withdrawal?

Back 25

1. IEs: assists with withdrawal effects related to autonomic hyperactivity (diarrhea, nausea, vomitting); does not reduce craving for opioids

2. NI: obtain baseline vital signs, advise clients to avoid activities that require mental altertness until drowsiness subside; encourage clients to chew sugarless gum or suck on hard candy or sip water or suck on ice chips to treat dry mouth

Front 26

what are the intended effects/nursing interventions for buprenorphine (Subutex)

Back 26

IEs: is an agonist-antagonist opioid used for detox and maintenance; decreasing cravings and may be effective in maintaining adherence

NIs: must be administered from approved treatment center; administer sublingual IM or IV

Front 27

abstinence syndrome from nicotine is EVB ______

Back 27

irriitability, nervousness, restlessness, insomnia, and difficulty concentrating

Front 28

what meds are used in treating nicotine abstinence/withdrawal

Back 28

1. bupropion (Zyban)

2. nicotine replacement therapy

3. varenicline (Chantix)

Front 29

what meds fall under nicotine replacement therapy?

Back 29

1. nicotine gum (nicorette)

2. nicotine patch (Nicotrol)

3. nicotine nasal spray (Nicotrol NS)

Front 30

the intended effect of bupropion in nicotine withdrawal is to _______

Back 30

decrease nicotine craving and manifestations of withdrawal

Front 31

what are nursing interventions of buproprion when used for nicotine withdrawal?

Back 31

1. treat dry mouth (sugarless gum, hardy candy, sip water small amounts, suck on ice chips)

2. advise clients to avoid caffein and other CNS stimulants to control insomnia

Front 32

what are inteded effects of nicotine replacement therapy?

Back 32

1. are pharmaceutical product substitutes for nicotine in cigarettes or chewing tobacco

2. nico repl. therapy doubles rate of smoking cessation

Front 33

which clients should avoid using nicotine products?

Back 33

while pregnant or breastfeeding

Front 34

nursing interventions for nicotine gum (Nicorette)

Back 34

1. use of chewing gum is not recommended for longer than 6 months

2. advise clients to chew gum slowly and intermittently over 30 min

3. advise clients to aboid eating or drinking 15 min prior to and while chewing the gum

Front 35

nursing interventions for nicotine patch (Nicotrol)

Back 35

1. apply patch to an area of clean, dry skin each day

2. advise to avoid using nicotine products while patch is on

3. follow product directions for dosage times

4. advise clients to stop patches and notify if local skin reactions occur

5. remove patch prior to MRI scan and replace when scan is completed

Front 36

nursing interventions for nicotine nasal spray (Nicotrol NS)

Back 36

1. provides pleasurable effects of smoking due to rapid rise of nicotine in client's blood level

2. one spray in each nostril delivers amount of nicotine in cigarette

3. advise client to follow product instructions and dose frequency

4. no recommended for those who have disorder affecting upper resp. system such as chronic sinus problems allergies or asthma

Front 37

what are the intended effects of varenicline (Chantix) when treating nicotine withdrawal

Back 37

1. it's a nicotinic receptor agonist that promotes release of dopamine to stimulate pleasurable effects of nicotine

2. reduce cravings and severity of withdrawal manifestations

3. reduces incidence of relapse by blocking desired effects of nicotine

Front 38

nursing interventions of varenicline (Chantix)

Back 38

1. instruct client to take meds after a meal

2. monitor BP during treatment

3. monitor clients who have DM for loss of glycemic control

4. follow instructions for titration to minimized adverse effects

5. notify if nausea, vomiting, insomnia, new-onset depression, or suicidal ideation

Front 39

nursing evaluation of medication effectiveness for substance use disorders

Back 39

1. absence of injury

2. abstinence from substance

3. regular attendance at self-help group