psych exam 3 substance abuse – Flashcards
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what is the most abused drug?
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alcohol (then smoking, then cocaine)
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there is a high comorbidity between substance abuse and what?
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mental health illnesses
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why do those who have mental illnesses abuse drugs/substance?
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self-medication (relieves symptoms temporarily by reducing mania, improving mood)
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what are three common factors that play a role in substance abuse?
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genetics, brain chemistry, brain regions and pathways
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Genetics Environmental Substance used Self-esteem - lower Pain and frustration tolerance - lower Few meaningful relationships Life stressors (loss of spouse, loss of job) Few life successes Risk-taking tendencies Socio-cultural theories these are all risk factors for what?
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addiction
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what is the single most important neurotransmitter/chemical that plays a role in addiction?
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dopamine
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what is our normal system of pleasure, euphoria, sense of well-being which involves dopamine called?
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reward system
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can drugs mimic or trigger the symptoms of a mental illness?
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yes
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long term use of amphetamine can look like what mental illness?
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schizophrenia
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withdrawal can look like what two mental illness?
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psychosis, anxiety
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when a person is using drugs, there is a flood of what neurotransmitter?
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dopamine
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Keeping body in balance Memory Learning Emotions Sexual behavior Motivation Feeding behaviors these are the functions of what in the brain?
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limbic system-mid brain
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drugs of abuse target what area in the brain?
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nucleous accumbens (reward system)
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for drug abusers, is the natural high effective anymore?
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no (seek that unnatural high b/c this is a bigger euphoria, more dopamine put out)
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which neurotransmitter is excitatory?
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Glutamate
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which neurotransmitter is inhibitory, tranquilizing?
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GABA
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what is an example of a drug that increases glutamate?
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caffeine (or PCP)
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what is an example of a drug that decreases glutamate?
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alcohol
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Maladaptive pattern of use with problems in at least one of the following areas: -Use resulting in failure in obligations. (marriage, work, etc) -Use in hazardous situations. (driving, work, caring for kids/infant) -Substance related legal problems. (DUI, possession, abuse) -Continued use despite social or interpersonal problems. (marital conflicts, family issues, loss of job) this is the criteria for what?
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substance abuse
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Maladaptive substance use leading to impairment or distress by three or more of the following criteria: -Withdrawal - Experiences sx: needing same or related substance taken to relieve or avoid withdrawal. -Tolerance - increase in substance to achieve effect. -Use of larger amounts over longer periods of time. -Persistent desire. -Increasing amounts of time spent to obtain substance. -Decrease engagement in other activities. -Continued use despite physical or psychological problems which are exacerbated by using. this is the criteria for what?
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substance dependence
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Alcohol Benzodiazepines Barbiturates (Phenobarbital) these are examples of what kinds of drugs?
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CNS depressants
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Caffeine Cocaine Amphetamines & Methamphetamine these are examples of what kinds of drugs?
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stimulants
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Heroin Morphine these are examples of what kinds of drugs?
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opiates
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Marijuana Hashish these are examples of what kinds of drugs?
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cannabis
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LSD, PCP, Inhalants these are examples of what kinds of drugs?
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hallucinogens
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What does CAGE stand for? list all 4 questions
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ever tried to cut down on use, ever annoyed by criticism of use, ever feel guilty about use, ever had a morning eye opener
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what stage of motivation to change is least concerned/least motivation?
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precontemplation
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what stage of motivation to change is examine actions but no action towards change. (help them to move towards preparation)?
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contemplation
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what stage of motivation to change is desire help with change?
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preparation
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what stage of motivation to change is committed to change engaged in changing behaviors?
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action
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what stage of motivation to change is continue with change process?
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maintenance
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what does the FRAMES acronym stand for?
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feedback, responsibility, advice, menu, empathy, self-efficacy
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what does OARS acronym stand for?
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open-ended questions, affirmations, reflective listening, summarizing
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what is the blood alcohol level that is legally intoxicated?
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0.08% (80g/dL)
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what phase of alcohol use is use alcohol to relieves stress, tension?
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pre-alcoholic
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what phase of alcohol use is brief periods of insomnia or blackouts immediately following use of alcohol?
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early alcoholic
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what phase of alcohol use is lose control of drinking, physiologically dependent, go through withdrawals?
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crucial
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what phase of alcohol use ishave emotional and physical disintegration. More intoxicated than are sober?
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chronic
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Dopamine Reward System Glutamate inhibit GABA increases Sedating/ calming these are the effects of what drug?
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alcohol
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Hypertension, tachycardia, tremors, irritability, anxiety, poor judgement, autonomic responses, nausea, and vomiting these are the s/sx of what with alcohol intoxication?
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early withdrawal
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what is the time period of early alcohol withdrawal?
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16-24 hours after last drink
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how long does early alcohol withdrawal last?
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5-7 days with/without tx
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with alcohol withdrawal, what Appears 1-3 days abstinence ( peak12-48 hours) General motor seizures 2% can develop status epilepticus (these continue on and on) medical attention needed?
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seizures
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with alcohol intoxication/stoppage of use, what is appears 1-3 days abstinence (peak 4-5th day) Mortality rate +/- 1% treated and up to 15% untreated Hallucinations, hyperactivity, anxiety, agitation, confusion, disorientation, insomnia, increased temp, restless, combative immediate medical attention is needed?
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delirium tremens (DT)
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with alcohol withdrawal, what peaks 48-72 hours and lasts 10 days, consists of Severe disorientation-Confusion, Changes in cognition, Psychotic symptoms-hallucinations, Hypertension, Dysrhythmias-Tachycardia, Delirium - fluctuates,May progress to death
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delrium tremens (DT)
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CNS (results from malnutrition and difficult with thaimin, vit B. will give vit b shots, never recover completely from these)-Wenicke's encephalopathy, Korsakoff's psychosis Liver damage-Fatty liver, Cirrhosis CV-Cardiomyopathy, Sexual dysfunction GI-Gastritis, GI bleed, Pancreatitis, Esophagitis these are toxic effects of what?
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alcohol use
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Benzodiazepine - use titrating dose - Librium Frequent monitoring of MSE and VS Keep patient in quiet room Supportive measures Hydration Vitamin supplements - thiamine (vit B1) multi vit Electrolyte imbalance correction Magnesium sulfate - especially for seizure hx Dilantin Beta-blockers - hypertension Long term use Disulfram (Antabuse) these are treatments/nursing interventions for what?
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alcohol withdrawal
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Monitor vital signs. (q 15 mins till stable, then q 4-8 hrs) Assess for withdrawal. Safe, calm, environment. safety, seizure precautions Nutritional/metabolic needs. Relationship - motivational interview. Teach healthy life-style. 12 step program - begin for relapse prevention Detox. these are treatments/nursing interventions for what?
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alcohol withdrawal
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facial flushing, sweating, headache (throbbing), neck pain, tachycardia, resp. distress, decrease in BP and N/V these are the s/sx of what syndrome?
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acetylaldehyde syndrome
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with what medication used for alcohol abstinence can you not use any other alcohol products, if do will cause acetylaldehyde syndrome, Class conditioning, Daily - action from last dose 5 days to 2 weeks, advise to wear a medical alert bracelet?
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antabuse
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which medication can be used for both alcohol and opioid withdrawal, Opioid antagonist suppress craving & pleasurable effects, Eliminates craving, Long acting injectable forms, Take with food to decrease GI upset?
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naltrexone (revia)
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which medication used for alcohol abstinence is decreases unpleasant effects from abstinence, Possible diarrhea, Good fluid intake?
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acamprosate (campral)
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An alcohol-dependent patient admitted yesterday believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe which three medications out of the following below a. Chlordiazepoxide (Librium) (withdrawal syndrome) b. Buprenorphine (Subutex) c. Olanzapine (Zyprexa) (hallucinations) d. Phenelzine (Nardil). e. Valporic Acid (Depakote) (antiseizure)
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a, c, e
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A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse) therapy. Patient teaching should include the need to: (Select all that apply.) a. avoid aged cheeses. b. avoid alcohol-based skin products. (acetylcholine reaction thing) c. read labels of all liquid medications. d. wear sunscreen and avoid bright sunlight. e. maintain and adequate dietary intake of sodium. f. avoid breathing fumes of paints, stains, and stripping compounds. (same as above)
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b, c, f
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what area of the brain do stimulants impact?
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prefrontal cortex
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Mild toxicity Anxiety, dizziness, irritability, tremor, blurred vision, increased HR Severe Hallucinations, seizures, extreme fever CV: Tachycardia, hypertension, chest pain, possible CV collapse and death these are the s/sx of toxicity in what drug?
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cocaine
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when does withdrawal occur with cocaine?
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one hour-several days
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Depression, fatigue, craving, excessive sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation or agitation Not life threatening, but possible suicidal ideation these are s/sx of what with cocaine abuse/stoppage?
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withdrawal
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Mild toxicity Anxiety, impaired judgment, psychomotor agitation, hypervigilance, extreme irritability, paranoia, increased HR Severe CV: Tachycardia, hypertension, CV collapse and death, hallucinations these are the s/sx of toxicity with what drug?
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amphetamines
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Depression, fatigue, Craving,, fatigue, sleeping Not life threatening - SI possible these are s/sx of what with amphetamine abuse?
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withdrawal
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Burn out Depletion of dopamine levels Damage to axon of neurons Depression that is hard to treat Paranoia & Ideas of Reference Thinking impairment Memory problems Long time- years to reverse if at all Motivational interviewing, referring to appropriate places these are long term effects of what drug abuse?
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stimulant
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Sexual terms Facial flushing & deep voice what phase of heroin use is this?
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1, euphoria or rush
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Sense of Well being Last several hours what phase of heroin use is this?
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2, high
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Escape from reality Lethargy to unconsciousness what phase of heroin use is this?
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3, the nod
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Seek drug to avoid withdrawal what phase of heroin use is this?
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4, withdrawal
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Restlessness/ Panic/ Irritable Diaphoresis Rhinorrhea Tremors Muscle & Bone Pain Insomnia Abdominal Cramps Diarrhea Vomiting Piloerection: goose bumps Chills Lacrimation these are s/sx of what with opioid drug use?
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withdrawal
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when does withdrawal for opioid users typically occur?
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7-10 days
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Dilated pupils Respiratory dep/arrest Coma/Shock Convulsions Possible death medical emergency these are s/sx of what with opioid drug use?
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overdose
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Methadone taper Clonidine Naloxone (Narcan) this is the treatment for what drug overdose?
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opioid
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which medication used for opioid withdrawal is Use for withdrawal Slowly withdrawn Long term maintenance Clinic
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methadone
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which medication used for opioid withdrawal is New analog of methadone Action up to 3 days More freedom for client
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levomethadyl (Orlaam)
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what medication used for opioid withdrawal is Controls autonomic hyperactivity (N &V) Baseline vitals Dry mouth
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clonidine (catapres)
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which medication used for opioid withdrawal is Blocks euphoric effects 72 hours - 3 times a week Also used for Alcoholism
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naltrexone (trexan, revia)
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which medication used for opioid withdrawal is Agonist- antagonist Detox and maintenance Special licensed prescriber
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Buprenorphine (Suboxone or Subutex)
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what is Second most widely used drug THC, Hashish, Joint, Bong, Blunt Medical uses Chemotherapy nausea Appetite stimulation Pain reduction Reduce intraocular pressure - Glaucoma
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cannabis/marijuana
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Relaxation Reduced coordination Reduced blood pressure Sleepiness Disruption in attention span short Altered sense of time and space Perception- pain Increased appetite (munchies) Conjunctiva (red eyes) these are the effects of what drug?
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MJ
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Light use - 2 joints or less a day 4 times a week Mod use - 2-3 joints a day almost daily Heavy use - 4 joints daily Symptoms Occur 24- 48 hours after last use Loss of appetite Trouble sleeping - strange dreams Physical malaise: abd. discomfort, chills, shaky Anxiety, irritability & depressed mood General Expectations resolves in 2- 4 weeks Anxiety and irritability can persist for over 4 weeks these are the s/sx of what with MJ use?
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withdrawal
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what syndrome with MJ long term use is Heavy daily users Anhedonia Lethargy Decreased drive and ambition
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amotivational syndrome
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Shortened attention span Poor judgment Easy distractibility Impaired communication skills Think about themselves Personal habits deteriorate these are s/sx of social and occupational issues with what drug use?
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MJ
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Effects: heightened sense of self and altered perception (colors more vivid) Generalized anesthesia Lessens sensations of touch & pain Toxic: panic attacks, paranoia, depersonalization, hallucinations, synesthesia, impaired judgment Suicide/Self-harm risk No withdrawal Flashbacks these are the s/sx or effects of what drug?
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hallucinogens
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stimulants and hallucinogens work on what three neurotransmitters?
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serotonin, dopamine, NE
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Reduced inhibitions Love everyone Hyperactive with energy (dance all night) Dilated pupils Elevated pulse, BP, temp Dystonia Bruxism Lots of water consumption these are the s/sx of what drug use?
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club drugs
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Intoxication Catatonia Hallucinations Delusions Paranoia Disorientation Lack of judgment Amnesia Staggering gait Slurred speech Vertical nystagmus these are the s/sx of what drug use?
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ketamine
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Coma Extremely high temp Seizures Muscle breakdown these are s/sx of what with ketamine drug use?
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overdose
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what drug is Used tx of narcolepsy/cataplexy Date Rape Drug Flunitrazepam (Rohypnol) GABA receptors Sedation Amnesia
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GHB
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CV dx (hypertension, stroke), respiratory disease these are the long term effects of what drug use?
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nicotine
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irritability, craving, nervousness, restlessness, anxiety, insomnia, increased appetite, and difficulty concentration these are s/sx of what syndrome with nicotine use?
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abstinence
