#5-Dobrisky-Substance Abuse
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Lori Dobrisky
Popular Nursing sets