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N126-U5-SUB ABUSE

#5-Dobrisky-Substance Abuse

Question	Answer
Physical dependence	a characteristic that is present when withdrawal of the drug results in physiological disruptions
Withdrawal symptoms	biological need that develops when body adapts to having the drug in the system; a substance specific syndrome
Tolerance	with continued use, more of the substance is needed to produce the same effect
Substance abuse	A maladaptive pattern of substance use leading to clinically significant impairment or distress
Substance dependence	Similar definition but involves tolerance and withdrawal
Polysubstance abuse	simultaneous or sequential use of more than one substance
Cross-tolerance	increasing need for drugs of similar composition
Dual diagnosis	When a person has two identified primary psychiatric diagnosis—most commonly used when one dx is drug or alcohol related
Gateway drugs	Substances implicated as forerunners topolysubstance use or drug dependence
Individual risk factors	age, ethnicity, genetic predisposition; co-morbidities; stress
situational risk factors	peer influence; social norms; family influences; support system
environmental risk factors	access to and cost of substance; severity of punishment
neurobiologic basis of addiction is	rapid release of neurotransmitters, followed by a reduced-from-baseline level
dopamine levels change how when drugs are used?	increase
glutamate is associated with	addiction
which cultures and ethnic groups is substance abuse more prevelant?	found in all cultures and ethnic groups
substance abuse is viewed differently depending on...	the substance being used, the person using it and the setting in which it is used
when people are displaced from their original cultures what happens to their risk for abuse?	it rises
barbiturates, benzodiazepines and alchohol are all	depressants
hypnotics are	cns depressants
all prescription sleeping medications, antianxiety medications, and barbiturates are considered to be	cns depressants: hypnotics
what is the major cause of overdose death?	barbiturates
barbiturates produce excessive drowsiness with an initial response of	euphoria
dependence & tolerance develop how with barbiturate use?	rapidly
epilepsy is often treated with what type of drug?	barbiturates
name six barbiturates	barbital, amobarbital, phenobarbital, pentobarbital, secobarbital, and butabarbital
the names of barbiturates all end in	barbital
what was the preferred treatment for anxiety in the 1960's?	benzodiazepines
which is safer: benzo's or barbiturates?	benzos
are benzos addictive	they can be
withdrawal of benzodiazepines is similar to withdrawal of	alcohol
rapid discontinuation of alcohol and benzos may result in	seizures
the symptoms of benzos are different from those of barbiturates how?	benzos are longer acting and less intense
which is longer acting: benzos or barbiturates?	benzos
which is less harmful in case of overdose? benzos or barbiturates?	benzos
GHB is an	illegal CNS depressant
GHB is used with	alcohol
GHB is considered to be a	designer drug
GHB affects are	intoxicating, sedating, euporic
GHB has the same effect as what and builds muscle	growth hormone
GHB affects heart rate and respirations by	decreasing them
What drug is considered to be the forget-me pill?	Rohypnol
this drug is a benzo, it's illegal in the US and is used as a date rape drug	Rohypnol
the Rohypnol pill is accelerated by	alcohol
Rohypnol can be ingested	without knowing
why is rohypnol easily given without the victim knowing?	tasteless, odorless, dissolves quickly
which is the most widely used and most abused substance?	alcohol
any amount of alcohol is considered to be harmful to	fetuses, children, adolescents, recovering alcoholics and those with poor health
the ability to metabolize alcohol is predetermined by	genetics
alcohol is known chemically as	ehtanol (ETOH)
alcohol produces mind and mood	altering effects
alcohol content is expressed as	proof
in the US proof is how much the ethanol concentration?	twice
blood alcohol level measures the degree of	ethanol intoxication
the concentration of alcohol depends on what?	the rate of absorption, transportation into CNS, redistribution to other parts of the body, metabolism and elimination
alcohol is absorbed through	the mouth, stomach and small intestine
what varies depending upon the presence of food, the drinker's emotional state and the drinker's body size?	the rate of absorption
does alchohol cross the placenta?	yes
alcohol is oxidated in the	liver
oxidation in the liver eliminates what percent of the alcohol absorbed by the body?	90
does the excretion of alcohol vary or does it take place at a fixed rate?	fixed rate
the healthy liver can metabolize how much alcohol in an hour	one ounce
alcohol that is not metabolized in the liver	circulates in the blood
what type of dependence is developed with alcohol use?	physical and psychological
BAC stands for	blood alcohol concentration
BAL stands for	blood alcohol level
a BAC of 20 is equivilant to a BAL of	0.02
effects of a BAL of 0.02	light and moderate drinkers begin to feel some effect
at a BAL of 0.04 most people begin to feel	relaxed
at what BAL is judgment mildly impaired and the ability to make rationale decisions is declined?	0.06
at what BAL is driving impaired, speech slurred, and ataxia and decreased sensory function evident?	0.08
at a BAL of 0.10 there is a clear deterioration in	reaction time
at what BAL is the person considered to be legally intoxicated in most states?	0.10
at 0.15 the BAL there is increased impairment and the alcohol level is equivalent to	a half pint of whiskey in the bloodstream
at 0.30 what can happen?	potential cardiovascular and respiratory collapse and loss of consiousness
at what BAL is cardiovascular and respiratory collapse a potential complication?	0.30
at what BAL is there a potential to lose consciousness?	0.30
neurological sydromes resulting from etoh abuse include	wernicke-korsakoff syndrome, marchiafava bignami disease, alcoholic blackouts, mood changes, confusion, hallucinations and peripheral neuropathy
wernicke-korsakoff syndrome is inflammatory	degeneration of brain
wernicke-korsakoff syndrome effects the brain how	inflammatory degeneration
inflammatory degeneration of the brain, as in wernicke-korsakoff syndrome, causes	memory loss and cognitive changes
wernicke-korsakoff syndrome is caused by a deficit of what?	thiamine
marchiafava bignami disease is	brain atrophy with dysarthria and impaired consiousness
alcoholic blackouts cause	anterograde amnesia
what drugs are considered to be the foremost gateway drugs?	alcohol, cigarretes and marijuana
what ethnicities experience more adverse effects from alcohol use?	chinese, japanese and korean
addiction causes a rapid release of neurotransmitters followed by a reduced-from-baseline level that	never fully returns to pre-drug level
barbituates, sleeping aids and anti-anxiety medications are all	cns depressants
barbituates are the major cause of	overdose deaths
what form of alcohol is actually considered to be good for you in moderate amounts?	red wine
what health benefits are gained by moderate consumption of red wine?	increased HDL, decreased LDL, decreased diabetic complications and decreased blood sugar levels
the standard drink size for spirits is?	one ounce
the standard drink size for wine is	five ounces
the standard drink size for beer is	twelve ounces
breathing can potentially stop at what blood alcohol level?	0.45
80% proof is equal to what % alcohol?	40
the absorption rate of alcohol	varies
the metabolism rate of alcohol is	1 ounce per hour
the excretion rate of alcohol is	fixed
alcohol is metabolized by the	liver
the kansas legal limit for alcohol is	0.08 BAL or 80 BAC
alcohol affects thiamine absorption how?	inhibits absorption
a decreased level of thiamine may lead to what syndrome?	wernicke-korsakoff
wernicke-korsakoff-->brain...	inflammation
wernicke-korsakoff-->brain inflammation resulting in	memory loss and cognitive changes
if a person that abuses alcohol is suffering from memory loss and cognitive changes, what syndrome may they have?	wernicke-korsakoff
wernicke-korsakoff	that's a long name to REMEMBER...memory loss...
brain atrophy is associated with	marchiafava bignami
brain atrophy...	big nami
marchiafava bignami is indicated when the brain is affected how?	brain atrophy
what clinical manifestations may result from brain atrophy related to marchiafava bignami	impaired speech and LOC
a common clinical manifestation of "march-i-a-fava big-nami" is	impaired speech
BP, LDL and Triglycerides are all affected how by etoh abuse?	all increased
the risk for what complications r/t bleeding increase with etoh abuse	hemorrhagic stroke
alcohol abuse affects Ca & Mag in what way?	decrease
the cardiovascular systemic effects of alcohol abuse are	elevates bp, triglycerides, ldl and increases the risk for hemorrhagic stroke, cardiomyopathy
what effect does alcohol abuse have on the immune system?	decreased WBC production, increased size of RBC, impaired production of clotting factors and platelets
what happens to WBC when alcohol is abused	production is decreased
what happens to platelets when alcohol is abused	decreased production
what happens to the RBCs when alcohol is abused?	increase in size
when RBCs are increased in size what else is changed?	MCV
the systemic effects on the liver from etoh abuse include	fatty liver, cirrhosis, varices & ascites
accumulation of fats in liver cells leads to	fatty liver
chronic hepatic inflammations lead to	cirrhosis
what develops as a result of impaired liver circulation	varices & ascites; hepatic encephalopathy
alcohol abuse damages the GI tract because of	increased gastric secretions that promote bacterial growth
ulcers, gastritis, pancreatitis, esophageal varices are all GI tract disorders potentially caused by	alcohol abuse
alcohol abuse impairs the function of the pancrease to	respond to insulin
the sleep cycle disturbance caused by etoh abuse is also referred to as	sleep fragmentation
how does alcohol decrease calcium & magnesium in the blood?	by reducing parathyroid hormone release
the leading cause of birth defects is	etoh consumption during pregnancy
hormonal changes due to etoh abuse include changes in prolactin, growth hormone, cortisol and	ACTH
what elevated liver enzyme indicates alcohol has been consumed recently?	GGT
what is the normal range for GGT	2-30
GGT...gin gin tequila	liver enzyme that shows recent etoh use
is a ggt level accurate in the 15-30yo age range?	no
Large RBCs indicate	anemia
what are some lab tests used to determine etoh abuse?	GGT, RBC size, MCV, uric acid, triglycerides, AST, Urea and carbohydrate deficient transferring
how long will etoh be present in the urine?	12-24 hours from last drink
what is AWS?	alcohol withdrawal syndrome
how common is AWS	40% of hospitalized pt have potential to experience it
early symptoms of AWS can start within	6-12 hrs after BAC drops
symptoms of AWS will peak in	24-48 hours
when will AWS symptoms decrease	4-5 days
what time frame is a seizure more likely to occur with AWS	7-48 hours after last drink
what changes in the HR are seen in AWS?	above 100, tachy
seizures can occur within	7-48hrs after last drink
AWS peaks	24-48hrs after last drink
AWS symptoms decrease	4-5days after last drink
is AWS the same as the DTs?	no
early etoh w/drawal symptoms include	n/v, anxiety, tremor
what type of psychosis do AWS patients experience	visual, auditory or tactile hallucinations
what is different about the hallucinations in AWS patients?	the patient knows they aren't real when they are having them
alcohol withdrawal delirium is also referred to as	DTs (delirium Tremens)
which is the most serious form of alcohol withdrawal?	DTs
how common is DT?	occurs in less than 10% of those with AWS
what clinical manifestation may characterize impending DT?	disorientation
the DTs are often accompanied by	liver failure, pneumonia, and head trauma
disorientation is often the first sign of what type of etoh withdrawal?	DTs
what assessment tools are used to determine if a patient may have an substance abuse problem?	the CAGE questionnaire, DAST and AUDIT
CAGE stands for	Cut down, Annoyed, Guilty and Eye-opener
what score on the CAGE questionnaire indicates potential etoh abuse?	2 answers of yes out of the 4 questions
the CAGE assessment refers to what type of abuse?	alcohol
The DAST is	a brief drug abuse screening tool
what DAST score suggests a significant drug abuse problem?	score greater than 6/28
what is an AUDIT	alcohol use disorders identification test
an AUDIT identifies what type of substance abuse?	drug and etoh
if screening tests shows that problems might exist what type of questions with the nurse follow up with?	withdrawal symptoms, tolerance, work history, legal/social complications
when eliciting history of substance abuse how should questioning start?	from etoh, nicotine, mj, and then on to cocaine etc
along with assessing for a substance abuse problem what else should be assessed?	readiness to change
key assessment items include	age of first use, heaviest lifetime use, patterns of use, binges &/or blackouts, last use and family hx, abuse hx and risk for suicide
arcus senilis is	an opage grayish ring around the eyes
what causes arcus senilis?	alcohol abuse
how might the hands be affected by alcohol abuse?	red palms, shaky, cigarette burns, decreased sensation
in addition to red palms what else may be red?	face
facial redness is known as	acne rosacea
an enlarged liver may cause what clinical manifestation?	upper abdominal pain
a positive stool _______ may indicate gi bleed	guaiac
the hr and bp of an alocholic will be	increased
is arcus senilis or cardiac arrhythmia a clinical manifestation of drug abuse?	cardiac arrhythmia
a patient presents with conjuctivitis, you suspect what type of substance abuse?	drug abuse
how are the eyes affected by drug abuse?	the pupil size changes
cardiac arrhythmias, needle tracks, cellulites, conjunctivitis, poor dentition, rapid weight loss and changes in pupil size are indicative of	drug abuse
jaundice, arcus senilis, acne rosacea, palmar erthema, upper abdominal pain, cigarett burns on fingers/clothing, decreased sensation in feet hands, positive stool guaiac, HTN & tachycardia and tremor are all indicative of	alcohol abuse
what is the most effective pharmaceutical for treating withdrawal and detoxification?	benzos
benzo dosing should be	tapered down
patients in withdrawal that have liver failure or impaired cognition should be given what type of benzos?	short-acting: Ativan
the pt with severe withdrawal will more than likely be taking which type of benzo?	librium, long-acting
Ativan is a	short acting benzo
ativan is used when	the w/drawal pt has liver or cognition issues
librium is	a long acting benzo
when is librium prescribed for withdrawal?	when it is severe
which is preferred, symptoms-triggered dosing or fixed schedule?	symptoms-triggered dosing
what is the concern with fixed schedule dosing?	may over medicate patient
what tool is used to assist in symptom triggered dosing?	CIWA scale
what is the antidote for benzos?	romazicon (benZo-->romaZicon)
what is the antidote for opiates?	narcan
if symptoms of withdrawal do not progress in a predictable manner what tool is then used?	CIWA-R
the accuracy of the CIWA-R is decreased when the pt has	co-morbidities and psychiatric illnesses
how often should CIWA-R be repeated if the patient is actively detoxing	every 1-2 hours
if the CIWA-R score is <5	discontinue the CIWA
if the CIWA-R scoring is 9 or less what does that indicate?	the absent or mild withdrawal
what dosing changes are made if there is a CIWA-R score of 9 or less?	discontinue medications for withdrawal
a CIWA score of 10-19 indicates	moderate withdrawal
a CIWA score of greater than 20 indicates	severe withdrawal
it is important to maintain fluid & electrolyte balance during	withdrawal with delirium
history or presence of seizures is vital to asses so that the patient can be	treated with anti-seizure medication
what Vitamins are often needed during withdrawal?	B
what are the B vitamins needed during withdrawal?	Thiamine, Folic Acid and Vitamin B12
besides thiamine, folic acid and vitamin b12 what is also needed	slow mag
what treatment is used as an alcohol teterrent by interupting the metabolism of ETOH	antabuse
what common ADL items should be avoided when taking antabuse?	aftershave lotion and mouthwashes
what common food or bakery ingredients should be avoided in the patient taking antabuse	vanilla extract & vinegar
what over the counter medications should be avoided in the pt taking antabuse?	cough-medicines
what reaction will a patient have if they drink etoh while taking antabuse	they will become violently ill
campral is used to treat what in early sobriety	cravings
to prevent relapse for alcoholics that have a "slip"	Revia
high-dose withdrawal of cns depressants substitutes medication	from the same drug class for gradual tapering
low dose withdrawal depends on	symptoms
insomnia, anxiety, elevated temp, pulse and respiratory rate, fine tremors, GI upset, muscle aches, diaphoresis and a labile BP indicate withdrawal from	cns depressants
what are the nursing priorities in acute situations of withdrawal?	maintain patent airway, monitor VS, intervene with hemorrhage, seizure and respiratory/cardiac arrest and maintain safety for client and others
support during withdrawal process includes	observation, meds, emotional & nutritional
the drug abuser still needs pain relief, it is best to	avoid drug of abuse when treating pain
in order to avoid relapse we should assist the patient to avoid	being hungry, angry, lonely or tired
motivational interviewing focuses on listening rather than	telling
gently persuade the patient, understand that	changes is up to the patient
fatigue, workaholism, cover-ups, exaggerations, rationalizations, self-pity, victim role, frustration vs appropriate anger, impatience and negativism are all signs of	relapse
primary prevention is aimed at	preventing abuse
secondary prevention is aimed at	client with mild to moderate problems
tertiary prevention is aimed at	decreasing complications of addiction
the most important sign of a healthy recovery is when the patient	lets go of toxic people and substances

Created by: Lori Dobrisky

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