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Terms in this set (72)
Relevance to Nursing
Abuse of legal and illegal drugs is a very common problem in the population at large
Drug abuse causes significant health problems and affects nursing care for other diseases
Knowledge of drug abuse enables nurses to recognize abuse and toxicity, participate in treatment and withdrawal, and educate patients who are struggling with addiction and recovery.
Drug abuse is highly situation dependent
Acceptable use vs. abuse is what?
Acceptable use vs. abuse is socially and culturally defined. In some religions alcohol is completely unacceptable. The acceptability of smoking has changed.
Drug abuse exists on a spectrum?
Drug abuse exists on a spectrum from occasional use to compulsive
Drug Abuse Definition
Drug abuse is defined as use of a drug in a fashion that is inconsistent with medical and social norms
"A disease process characterized by the continued use of a psychoactive substance despite the physical, psychological and social harm"
Addiction is exhibited by what?
Addiction is exhibited by behavior. We see addiction based on someone's behavior
Addiction is related to but not equal to what?
Addiction is related to, but not equal to physical dependence on a substance
Addiction is just the continued use
over time the patient has a reduced response to the same dose, so much increase the drug's dose to get the same response
If you are tolerant to one drug in a class you will be tolerant to other drugs in the same class
A subjective feeling when a person craves a drug
dependent on other drugs of the same class
The American Psychiatric Association has done what?
The American Psychiatric Association has set criteria to diagnose substance abuse and dependence
Abuse: negative effects of social life, responsibilities, legal problems, physical harm from drug use
its the first step, no tolerance or dependence have developed
Dependence: worsening social effects of drug use, increased physical harm, may include tolerance and withdrawal syndrome
What leads to drug abuse?
1) the reinforcing qualities of a drug (they make you feel good, euphoria)
2) Physical Dependence
3) Psychological Dependence
4) Social Factors- who you hang out with
6) Individual vulnerability- certain personality characteristics- impulsive, easily frustrated, rebellious, mental health disorders, and genetics
The Neurobiology of Addiction
The reward circuit/pathway are dopamine projections. These areas are stimulated by dopamine. We dont have to do drugs to get the DA release, but drugs cause 5-10x higher release than the normal biologic caues
These pathways can adapt and become needy and want dopamine (causes a terrible withdrawal)
Addiction Treatment: What is the ultimate goal?
The ultimate goal is abstinence
Addiction is a brain disease, a chronic relapsing illness
Detox is the first step of treatment (getting them through that first few days-week of withdrawal) followed by long-term rehabilitation
With addiction treatment what is expected?
RELAPSES are expected!!!!
How long is an average rehab program?
An average rehab program is 3 months and it can be mandatory if it is court mandated
Controlled Substances Act
Federal legislation categorized potentially addictive substances into 5 categories : Schedule I-V
Schedule I Drugs
Highest abuse potential, no approved medical use
LSD, Heroin, Weed
Schedule 2 Drugs
Cocaine, amphetamines, and demerol
decreasing abuse potential
To prescribe a controlled substance you need what?
To prescribe a controlled substance you need a DEA licenses
There are other regulations on dispensing controlled substances
There are other regulations on dispensing- how you can prescribe, some need to be called in , some need to be on paper, and limits on number of refills
Alcohol (ETOH) Two main effects
1) general depression (activation of GABA receptors, and inhibition of glutamate)
2) activation of the reward center (eventual dopamine release)
The depressant effect of alcohol is what?
The depressant effect of alcohol is dose dependent. As the concentration increases, "deeper" levels of the brain are effected.
At a few drinks we lose some fine motor control and judgment but it can progress to basic respiratory depression
Chronic effects of alcohol
Cerebral atrophy/ventricle enlargement
Chronic effects of alcohol: Wernicke's encephalopathy
reversible - shows up as bad confusion and nystagmus, related to vitamin B1 def (thiamin), if thiamin is restored problem is reversed
Chronic effects of alcohol: Korsakoff's psychosis
permanent- neuropathies, trouble making long term memories, confabulating (if they cant remember something they make it up!) also related to the vitamin b1 (thiamin) deficiency
Chronic effects of alcohol: Cerebral atrophy and ventricle enlargement
The brain gets smaller and the ventricles enlarge to fill the space
Chronic effects of alcohol: Liver damage
Liver cirrhosis, liver cancer, liver failure
Effected by gastric emptying time and presence of food
crosses BBB and placenta
primarily hepatic (some in the stomach)
constant steady rate of metabolism
can metabolism 15 milliliters per hour, so thats about one drink per hour
Alcohol Adverse Effects
Cardiovascular: cutaneous vasodilatation, elevation of BP (with heavy use)
Erosive Gastritis- damage to the stomach lining
Diuresis- inhibits ADH release
Several Cancers (liver and others)
Metabolism of Alcohol
Two Step process
Ethanol-- Alcohol Dehydrogenase-- Acetaldehyde-- Aldehyde Dehydrogenase-- Acetic Acid
Woman have a little less of the Alcohol Dehydrogenase enzyme
Don't really worry about this unless we get stuck in the middle step-- negative physiologic effects
-Other CNS depressants- potentiation
-NSAIDs- both damage the gastric lining, increased risk of gastric damage
-Acetaminophen- increased risk of liver damage, can't metabolize acetaminophen as well
-Disulfiram- slows down aldehyde dehydrogenase, so we get stuck at the middle step
Alcohol Abuse/ Dependence
MAJOR public health problem
Chronic use builds up significant tolerance, but not to the respiratory depression
Withdrawal syndrome can be drastic- sx appear 12-72 hours after last alcohol intake
Alcohol Withdrawal Symptoms
Appears 12-72 hours after last alcohol intake
sx- GI distress, SNS over activation (increased HR &BP), hallucinations, tonic-clonic seizures, disorientation, and delirium tremens (rare!)
Drugs to treat alcohol abuse: When Facilitating Withdrawal
When facilitating withdrawal:
- benzodiazepines (Xanax, valium) ease CNS excitement
- beta blockers- help with HR and BP
- antiepileptics- prevent seizure activity
Drugs to treat alcohol abuse- When maintaining abstinence
To maintain abstinence:
Aversion therapy- only use if ETOH treatment
irreversibly inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde with ingestion of alcohol
ETOH + Disulfiram = WHAT?
ETOH + Disulfiram = Acetaldehyde Syndrome
Acetaldehyde Syndrome Symptoms
vomiting, flushing, SNS activation, blurred vision, hypotension (vasodilatation)
if severe, can be life threatening (could go into shock)
may last several hours
-consuming any alcohol can cause a reaction
-only takes 7mL to cause a reaction
-this also includes transdermal absorption
-Effects last two weeks after the last dose because it irreversibly inhibits the enzyme
a pure opioid antagonists, decreases cravings, and decreases pleasure of alcohol
can be PO (daily) or IM depot (Monthly)
helps maintain abstinence after detox, decreases negative symptoms of abstinence
MOA: restores the GABA/glutamate balance ?
Includes cocaine and amphetamines
Schedule II because there are therapeutic uses (more with the amphetamines)
Cause stimulation of CNS and cardiovascular system
HIGHLY addictive drugs
Prevents dopamine uptake in the CNS neurons thereby increased its levels in the brain
Cocaine has two forms
Cocaine HCl: white powder, often diluted, cut with other things, and take intranasally
Cocaine base: Crack, smoked, very fast absorption the lungs
Cocaine onset and duration
Onset and duration of effects depend on the route of administration
Adverse effects of cocaine
-Adaptation of neural structures (can have severe fatigue and depression)
-Angine pectoris/MI from coronary vasospasm
-Nasal mucosa atrophy/bleeding, and septum perforation with snorted form
increases levels of NE and DA in the CNS
Meth causes what?
Meth causes arousal, improved mood, euphoria, decreased pain perception, decreased appetite, and need for sleep
Can be snorted, injected or smoked
Meth Adverse Effects
CNS: can cause psychosis, paranoia usually with long term use
Cardiovascular: HTN, angina, vasoconstriction, CVAs
Psychologic dependence is very strong-- the cravings!
cig smoking is the number one cause of preventable death in america
costs of related diseases is astronomical
secondhand smoke concerns
gradual changes in regulation of cigarette sales, advertising, and smoking ordinances are public health measures to decrease smoking
At low doses, activates the nicotine receptors in the reward center which stimulates a DA release
Nicotine Delivery System
The delivery system of inhalation through smoking is particularly addictive- 90-98% get into the bloodstream
Nicotine Adverse Effects
cardiovascular stimulation, nausea, and fetal harm
long term increased risk of CVD, several cancers, and COPD
Treatment of Nicotine Addiction: Nicotine Replacement therapy
gums, patches, lozenges, nasal spray, and inhaler
goal is for therapy to be tapered to zero
DO NOT overlap cig smoking and replacement therapy--- could OD!
relapses likely unlikely to quit on first try
Gum, patches, lozenges, and inhaler
gum, patches, lozenges and inhaler give slow absorption, don't mimic the quick hit of a cigarette. It maintains blood levels, can adjust the dosage depending on how heavy of a smoker the patient was
nasal spray gives quick absorption more like the rapid absorption of a cigarette, patients often have trouble ever putting the spray down, not as preferred
An atypical antidepressant
blocks uptake of NE and DA? reduces cravings for nicotine and eases withdrawal symptoms
Bupropion Adverse Effects
dry mouth, insomnia, decreased appetite (may be a positive thing for some patients)
Bupropion when is drug started?
Drug is started 1-2 weeks before the quit date, and then taken for 7-12 weeks
Partial agonist of nicotine receptors, has a higher affinity for nicotine receptors than nicotine itself, preventing activation by nicotine
eases nicotine withdrawal and reduces cravings
Varenicline Adverse effects
Nausea (most common, dose dependent), sleep disturbances, headaches
Psychiatric disturbances: mood problems, behavior changes and suicidal ideation
Pt should be screened for depression/suicide thoughts before being put on drug
Varenicline does not ....
Varenicline does not suppress appetite so could cause weight gain
start 1-5 weeks before the quit date
take after a meal with a full glass of water
titrate the dose up during the first week to a stable dose of 1mg twice a day
take for another 12 weeks after client quits
Reduced dosage for clients with severe renal impairment
What substances are not absorbed by activated charcoal?
What is the onset of oxygen?
What are the symptoms of hallucinogen intoxication?
how do you treat chocolate toxicity?
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