psych - quiz 2 - ch. 14

symptoms of stimulant intoxication and withdrawal.

*stimulant intoxication* produces maladaptive behavioral and psychological changes that develop during or shortly after use of these drugs. ~ amphetamine and cocaine intoxication typically produces euphoria or affective blunting; changes in sociability; hyper-vigilance; interpersonal sensitivity; anxiety; tension, or anger; stereotyped behaviors; or impaired judgement. ~ in severe amphetamine intoxication, symptoms may include memory loss, psychosis, and violent aggression. physical affects include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, cardiac arrhythmia, confusion, seizures, dyskinesias, dystonias, or coma. ~ symptoms of caffeine intoxication include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation. *stimulant withdrawal* if the present of a characteristic withdrawal syndrome that develops within a few hours to several days after cessation of or reduction in heavy and prolonged use. often referred to as "crashing." ~ symptoms include fatigue, cramps, depression, headaches, and nightmares. dysphoria may be intense enough to result in an increase suicide risk. peak withdrawal symptoms usually occur within *2 to 4 days* of abstinence. ~ symptoms of caffeine withdrawal may include headache, fatigue, drowsiness, dysphoric mood, irritability, difficulty concentrating, flu-like symptoms, nausea, vomiting, and/or muscle pain and stiffness. ~ nicotine withdrawal results in dysphoric or depressed mood; insomnia; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain.

what is medication-assisted treatment?

AKA "substitution therapy." medications that are used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol or other drugs and to decrease cravings by administering a controlled dose of another medication.

substitution therapy

AKA medication-assisted treatment; the administration of a controlled opiate agonist in substitution for the substance that was being abused. specifically discussed in relation to opioid use disorder. there is evidence that this therapy is beneficial in reducing withdrawal symptoms and recent studies support that addition of this treatment educes overall mortality risks. medications used in this therapy to reduce opiate withdrawal symptoms include methadone (in methadone clinics), buprenorphine/naloxone combinations, injectable naltrexone, and clonidine (catapres).

what are the traits for fetal alcohol syndrome (FAS)?

FAS includes physical, mental, behavioral, and/or learning disabilities with lifelong implications. there may be problems with learning, memory, attention span, communication, vision, hearing, or a combination of these. ~ *no amount of alcohol during pregnancy is considered safe, and alcohol can damage a fetus at any stage of pregnancy.* children with FAS may have the following characteristics: abnormal facial features, small head size, shorter-than-average height, low body weight, poor coordination, hyperactive behavior, difficulty paying attention, poor memory, difficulty in school, learning disabilities, speech and language delays, intellectual disability or low IQ, poor reasoning and judgment skills, sleep and sucking problems as a baby, vision or hearing problems, problems with the heart, kidneys, or bones. neuroimaging shows abnormalities in the size and shape of the brains of children with FAS.

symptoms of someone who overdoses from K2 or Spice?

K2 and Spice are synthetic cannabinoids. the strengths are variable, so the risks of using these substances are unpredictable. symptoms include agitation, high blood pressure, shaking and seizures, nausea and vomiting, hallucinations and paranoia, and violent behavior.

dual diagnosis

a client with a coexisting substance disorder and mental illness.

what are the predisposing factors to substance-related disorders?

a number of factors have been implicated in the predisposition to abuse of substances. the interaction between various elements forms a complex collection of determinants that influence a person's susceptibility to abuse substances. *biological factors* ~ *genetics:* hereditary factors are involved, especially in alcoholism. children of alcoholics are 4x more likely than other children to become alcoholics. scientists estimate that genetics accounts for 40-60% of a person's vulnerability of developing a substance use disorder. some of this may be related to heritable personality traits such as high novelty seeking and low harm avoidance. other variables include lifestyle influences such as diet, exercise, and social activities. ~ *biochemical:* changes in brain structure and neurochemistry occur in the process of addiction. alcohol effects almost all neurotransmitters. this deals with the brain-reward circuitry. *psychological factors* ~ *developmental influences:* focuses on a punitive superego and fixation at the oral stage of psychosexual development. individuals with punitive superegos turn to drugs to diminish unconscious anxiety and increase feelings of power and self-worth. ~ *personality factors:* some clinicians believe that low self-esteem, frequent depression, passivity, antisocial personality traits, high risk-taking traits, the inability to relax or to defer gratification, and the inability to communicate effectively are common in individuals who abuse substances. these are not predictive of addictive behavior, but have been found to accompany addiction in many instances. ~ *cognitive factors:* irrational thinking patterns is a problem that is central in addictions; it is unknown if these patterns contribute to the development or simply perpetrate an existing addiction. *sociocultural factors* ~ *social learning:* the family is an important influence in individuals with substance use disorders. studies have shown that children and adolescents are more likely to use substances if they have parents who provide a model for substance use. peers exert a great deal of influence in the life of the child/adolescent who is being encouraged to use substances for the first time. ~ *conditioning:* a learned response that occurs after repeated exposure to a stimulus. substance abuse can be a learned response from the substance itself as well as from the environment where use occurs. it is the intrinsically reinforcing properties of addictive drugs that "condition" the individual to repeatedly seek out their use. if the environment where the drug use occurs is pleasurable, substance use is usually increased. ~ *cultural and ethnic influences:* factors within a culture may contribute to establishing patterns of substance use by molding attitudes, influencing patterns of consumption based on cultural acceptance, and determining the availability of a substance. some races and ethnic groups (notably asian or native american individuals) have a higher risk for genetic variations that affect the activity of isoenzymes involved in alcohol metabolism. these changes cause alcohol to be converted quickly to acetaldehyde as well as a decrease in the rate at which acetaldehyde is oxidized. acetaldehyde rapidly accumulates in the body, producing unpleasant symptoms such as flushing, headaches, nausea, and palpitations when alcohol is consumed. whether these genetic variations influence higher or lower prevalence of substance use disorders is unclear.

alcohol withdrawal

alcohol withdrawal occurs within *4 to 12 hours* of cessation or reduction in heavy use of alcohol. withdrawal symptoms include coarse tremor of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood or irritability; transient hallucinations or illusions; headache; and insomnia. in ~1% of alcoholic pts, complicated withdrawal syndrome may progress to alcohol withdrawal delirium. the onset or delirium is usually on the 2nd or 3rd day following cessation or or reduction in prolonged, heavy alcohol use. this delirium is characterized by a disturbance in attention and awareness and a change in cognition that develop rapidly over a short period.

evidence supports that long-term use of marijuana causes ...?

amotivational syndrome. impaired cognitive function; impaired memory. p. 307

when is someone considered addicted to a substance?

an individual is considered to be addicted to a substance when he or she is unable to control its use, even knowing that it interferes with normal functioning; when more and more of the substance is required to produce the desired effects; and when characteristic withdrawal symptoms develop upon cessation or drastic decrease in use of the substance.

prenatal exposure to alcohol can cause disorders of the fetus called ____________ _____________ ____________.

fetal alcohol syndrome.

alcohol interference with male and female hormones.

for women, hormone interference can mean changes in the menstrual cycle and a decreased or loss of ability to become pregnant. for men, the altered hormone levels result in a diminished libido, decreased sexual performance, and impaired fertility, and gynecomastia (enlargement or swelling of breast tissue in males) may develop secondary to testicular atrophy.

codependence

individuals who are reared in families with chemically addicted persons learn patterns of dysfunctional behavior that carry over into adult life.

symptoms of opioid intoxication and withdrawal.

opioid intoxication constitutes clinically significant problematic behavioral or psychological changes that develop during or shortly after opioid use. symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment. physical symptoms include pupillary constriction (or dilation due to anoxia from severe overdose), drowsiness, slurred speech, and impairment in attention or memory. symptoms are consistent with the half-life of most opioid drugs and usually last for several hours. severe opioid intoxication can lead to respiratory depression, coma, and death. opioid withdrawal produces a syndrome of symptoms that develops after cessation of or reduction in heavy or prolonged use of an opiate or related substance. symptoms include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, and insomnia.

what are the physical consequences of thiamine deficiency in chronic alcohol use?

physical consequences of thiamine deficiency include peripheral neuropathy (nerve damage), wernicke's encephalopathy (paralysis of ocular muscles, myopia, eye problems), alcoholic myopathy (muscle pain/weakness), and korsakoff's psychosis (confusion, loss of recent memory, confabulation). other consequences include shortness of breath and edema.

what is the purpose of AA?

self-help group based on the concept of peer support- acceptance and understanding from others who have experienced the same problems in their lives. the sole purpose *is to help members stay sober.* AA encourages participants to accept things that they cannot change.

severe withdrawal of sedative, hypnotic, or anxiolytic drugs.

severe withdrawal is most likely to occur when a substance has been used at high doses for prolonged periods. withdrawal symptoms include autonomic hyperactivity, increased hand tremor, insomnia, nausea or vomiting, hallucinations, illusions, depersonalization, psychomotor agitation, anxiety, grand mal seizures, and delirium.

symptoms of hallucinogen intoxication.

symptoms develop during or shortly after hallucinogen use. maladaptive behavioral or psychological changes include marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid ideation, and impaired judgment. perceptual changes occur while the individual is fully awake and alert and include intensification of perceptions, depersonalization, derealization, illusions, hallucinations, and synesthesias. hallucinogens can cause tachycardia, hypertension, sweating, blurred vision, papillary (pupil) dilation, and tremors. symptoms of PCP intoxication are unpredictable and are dose related. they may be manifested by impulsiveness, impaired judgment, assaultiveness, and belligerence, or the individual may appear calm, stuporous, or comatose. physical symptoms include vertical or horizontal nystagmus, hypertension, tachycardia, ataxia, diminished pain sensation, muscle rigidity, and seizures. symptoms of ketamine intoxication are similar to those of PCP. effects of MDMA include increased heart rate, blood pressure, and body temperature; dehydration; confusion; insomnia; and paranoia. overdose can result in panic attacks, hallucinations, severe hyperthermia, dehydration, and seizures. death can occur from kidney or cardiovascular failure.

symptoms of cannabis intoxication and withdrawal.

symptoms of cannabis intoxication include impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment and memory, and social withdrawal. physical symptoms include conjunctival injection (red eyes), increased appetite, dry mouth, and tachycardia. symptoms of cannabis withdrawal include irritability, anger, or aggression; nervousness, restlessness, or anxiety; sleep difficulty; decreased appetite or weight loss; depressed mood; and physical symptoms, such as abdominal pain, tremors, sweating, fever, chills, or headache.

define tolerance as it relates to physical addiction to a substance.

tolerance is a need for an increasing dose of a substance. as tolerance develops, physical addiction also occurs.

what three things are important as far as a medication regimen as ordered by a physician? what are the signs of withdrawal?

treatment with antiseizure meds, vitamin replacement, and medication-assisted treatment. p. 325-328

regarding sedative, hypnotic, and anxiolytic drugs...

~ *cardio effects:* *hypotension may be a problem with large doses.* high doses of barbiturates compromise cardiac contractility and vascular tone, which may result in cardiovascular collapse. individuals with congestive heart failure are more susceptible to these effects. ~ *respiratory depression:* barbiturates may inhibit the reticular activating system, resulting in respiratory depression, which can be lethal in overdose. in addition, additive effects can occur with the concurrent use of other CNS depressants, also effecting a life-threatening situation. ~ "club drugs" include GHB and flunitrazepam (rohypnol). these can produce a state of disinhibition, excitement, drunkness, and amnesia. they have been implicated as "date rape" drugs due to their easily disguised presence in drinks. they produce anterograde amnesia, so the events experienced while under the influence are not remembered. ~ barbiturate use *decreases the amount of sleep time spent in dreaming.* ~ *only a slight decrease in blood pressure is noted with a normal oral dosage of barbiturates.* hypotension may be a problem in large doses. ~ *barbiturates may produce jaundice with doses large enough to produce acute intoxication.* they stimulate the production of liver enzymes, resulting in a decrease of plasma levels of barbiturates and other drugs metabolized in the liver.

complications of liver cirrhosis

~ *portal hypertension:* elevation of BP through the portal circulation results from defective blood flow through the cirrhotic liver. ~ *ascites:* a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity. it occurs in response to portal hypertension; increased BP results in the seepage of fluid from the surface of the liver into the abdominal cavity. ~ *esophageal varices:* veins in the esophagus that become distended because of excessive pressure from defective blood flow through the cirrhotic liver. as this pressure increases, these varicosities can rupture, resulting in hemorrhage and sometimes death. ~ *hepatic encephalopathy:* a serious complication that occurs in response to the inability of the diseased liver to convert ammonia to urea for excretion. the continued rise of serum ammonia results in progressively impaired mental functioning, apathy, euphoria or depression, sleep disturbance, increasing confusion, and progression to coma and eventual death.

define substance intoxication and substance withdrawal.

~ *substance intoxication:* the development of a reversible syndrome of maladaptive cognitive, behavioral, or psychological changes that are due to the direct physiological effects of a substance on the CNS and develop during or shortly after ingestion of (or exposure to) a substance. ~ *substance withdrawal:* the development of a substance-specific maladaptive behavioral change, with physiological and cognitive concomitants, that is due to the cessation of, or reduction in, heavy and prolonged substance use.

wernicke's encephalopathy vs. korsakoff's psychosis

~ *wernicke's encephalopathy:* represents *the most serious form of thiamine deficiency in alcoholics.* symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. if thiamine replacement therapy is not undertaken quickly, death will ensue. ~ *korsakoff's psychosis:* identified by a syndrome of confusion, loss of recent memory, and confabulation in alcoholics. frequently encountered in clients recovering from wernicke's encephalopathy; the US usually considers the two disorder together, called wernicke-korsakoff syndrome. treatment is with parenteral or oral thiamine replacement.

describe current trends and national responses to the opiate use disorder epidemic in the US.

~ a National Practice Guideline for use of medications to treat Opioid use disorder has been established. ~ in 2016, the surgeon general declared illicit drug use and misuse of prescription drugs a national healthcare priority and committed to the need for additional research and treatment options. ~ state programs are providing naloxone education and distribution free of charge. ~ the NIH's HEAL initiative.

regarding alcohol use disorder...

~ alcohol exerts a *depressant* effect on the CNS. ~ the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA) is an excellent tool that is used by many hospitals to assess risk and severity of withdrawal from alcohol. the CAGE questionnaire was developed for the diagnosis of alcoholism. ~ most states develop that an individual is legally intoxicated with a BAC of *0.08%*. intoxication usually occurs at blood alcohol levels between *100 and 200 mg/dL*. death has been reported at levels ranging from 400 to *700* mg/dL. ~ symptoms of alcohol intoxication include disinhibition of sexual or aggressive impulses, mood lability, impaired judgment, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face. ~ approx. *20%* of a single dose of alcohol is absorbed directly and immediately into the bloodstream through the stomach wall. it does not have to be digested.

regarding cannabis use disorder...

~ cannabis withdrawal symptoms include irritability, anger, or aggression; nervousness, restlessness, or anxiety; sleep difficulty; decreased appetite or weight loss; depressed mood; and physical symptoms, such as abdominal pain, tremors, sweating, fever, chills, or headache. ~ heavy, long-term cannabis use is also associated with a condition called *amotivational syndrome.* these persons have a lack of motivation to persist in or complete a task that requires ongoing attention. symptoms include being apathetic, anergic, weight gain, and a "slothful" appearance. ~ cannabis usually causes weight gain. an appetite stimulant. ~ marijuana & reproduction. it *decreases* sperm count. in women, it may result in a *suppression* of ovulation, a *disruption* in menstrual cycles, and an *alternation* of *hormone* levels.

discuss the codependent nurse and list treatment consideration for codependency.

~ codependent nurses have a need to be in control. they often strive for an unrealistic level of achievement. their self-worth comes from the feeling of being needed by others and of maintaining control over their environment. they nurture the dependence of others and accept the responsibility for the happiness and contentment of others. they rarely express their true feelings, and they do what is necessary to preserve harmony and maintain control. they are at high risk for physical and emotional burnout. ~ nurses are sometimes known as "fixers"

defense mechanisms in chemically dependent clients.

~ denial, on the part of the impaired nurse as well as nurse colleagues, is the strongest reason for not dealing with substance abuse problems. ~ the first step in decreasing use of denial is for the patient to see the relationship between substance use and personal problems. ~ drug history assessment... box 14-1. ~ the purpose of peer assistance program is to serve to assist impaired nurses to recognize their impairment, to obtain necessary treatment, and to regain accountability within their profession.

the chemically impaired nurse...

~ peer assistance programs strive to intervene early, reduce hazards to patients, and increase prospects for the nurse's recovery. these programs serve to assist impaired nurses to recognize their impairment, to obtain necessary treatment, and to regain accountability within their profession. ~ it is very easy to overlook what "might" be a problem. denial, on the part of the impaired nurse and the colleagues, is the strongest reason for not dealing with substance abuse problems. signs of substance impaired nurses include either high absenteeism or rarely missed work depending on the source, an increase in "wasting" of drugs, increased incidences of incorrect narcotic counts, and a higher record of signing out drugs for other nurses. late in the disease process symptoms include poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall. other possible signs include irritability, mood swings, tendency to isolate, elaborate excuses for behavior, unkempt appearance, impaired motor coordination, slurred speech, flushed face, inconsistent job performance, and frequent use of the restroom. ~ state boards decide each case on an individual basis. the state board may deny, suspend, or revoke a license based on a report of chemical abuse by a nurse. several state boards have passed laws that allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. when a nurse is deemed safe to return to practice, he or she may be closely monitored for several years and required to undergo random drug screenings. the nurse may also be required under specifically circumscribed conditions for a designated period. ~ it's your duty to report!! any person suspecting impairment of a nurse's ability to provide safe nursing care may report this nurse to the Florida Dept. of Health and/or IPN. in Florida, all licensed nurses must report any suspected impairment in practice to DOH and/or IPN.

case study, Patti ReVia. a 24 year old female, Patti, comes into the Emergency Room with suspected Alcohol Use Disorder. her last drink was 5 hours ago. she is exhibiting and c/o the following symptoms: intermittent nausea with dry heaves, moderate tremor with arms extended, moderate itching, beads of sweat on her forehead, moderate anxiety, fidgety, moderately sensitive to light, moderate headache, is easily frightened by noise, and cannot do serial additions. what you would consider as her CIWA score?? her blood pressure is 200/100, pulse 110. what would be your nursing priority? is an elevated blood pressure expected for someone with withdrawal? (not discussed in class but important that you know). would the patient be discharged from the ER or sent to ICU or a monitored unit? in the process of Patti's recovery, it is important to use substitution therapy. what is substitution therapy and why is it necessary? Patti is not a candidate for Chlordiazepoxide (Librium) due to her existing diagnosis of Hepatitis C. in the case of patients with liver disease, what other medication is more appropriate? replacement therapy with ____________ is also required to prevent neuropathy, confusion and encephalopathy. Patti's psychiatric nurse practitioner considered initiating Antabuse therapy. what patient teaching would be required if Patti is initiated on Antabuse therapy?

~ regarding treatment for alcohol abuse, symptoms of Disulfiram (Antabuse) reaction can occur within __ to __ minutes of ingestion of alcohol. mild reactions can occur at blood alcohol levels as low as ___to ___mg/dL. with a blood alcohol level of approximately ____ to ____ mg/dL, severe reactions can occur. what are the reactions? Antabuse should not be administered until it has been ascertained that the client has abstained from alcohol for at least ______ hours. if it is discontinued, there may be a sensitivity to alcohol for as long as ___ weeks. ~ regarding diet, is a high protein diet import with someone who has a diseased liver?

what are the effects of alcohol on the body?

~ researchers believe neuropathies and myopathies are caused by deficiencies of B vitamins (thiamine). ~ a reddish tinge in the urine is caused by myoglobinuria, a breakdown of muscle excreted in the urine. ~ lab studies indicate elevations in *creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aldolase, and aspartate aminotransferase (AST)* ... regarding alcoholic myopathy. ~ the effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition. the clinical findings of alcoholic cardiomyopathy generally relate to congestive heart failure or arrhythmia. lab studies show elevation of the enzymes CPK, AST, alanine aminotransferase (ALT), and LDH. treatment involves total, permanent abstinence from alcohol. specific treatment of the congestive heart failure may include rest, oxygen, digitalization, social restriction, and diuretics. the prognosis is encouraging if treated in the early stages but the death rate is high for individuals with advanced symptomatology. ~ *steatorrhea:* the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine. ~ *leukopenia:* low white blood cell count. ~ *ascites:* the accumulation of fluid in the peritoneal cavity, causing abdominal swelling ~ regarding alcoholic hepatitis, severe cases can lead to cirrhosis or *hepatic encephalopathy.* ~ complications of liver cirrhosis include portal hypertension, ascites, esophageal varices, and hepatic encephalopathy.

regarding CNS stimulants...

~ the amt of CNS stimulation caused by a certain drug depends on both the area in the brain or spinal cord that is affected by the drug and the cellular mechanism fundamental to the increased excitability. ~ psychomotor stimulants induce stimulation by augmentation or potentiation of the neurotransmitters norepinephrine, epinephrine, or dopamine. ~ the general cellular stimulants (caffeine and nicotine) exert their action directly on cellular activity. ~ the two most prevalent and widely used stimulants are caffeine and nicotine. ~ alpha-PVP (flakka) has a chemical structure similar to bath salts. there have been reports of violent aggression, homicide, and suicide related to the use of this drug. ~ nasal rhinitis is a result of chronic cocaine snorting. ~ cocaine is the most potent stimulant. ~ "crack" is processed powered cocaine with ammonia or sodium bicarbonate and water that is heated to remove the hydrochloride. ~ "uppers" are stimulants, "downers" are depressants. ~ inhaled cocaine can cause pulmonary hemorrhage, chronic bronchiolitis, and pneumonia.

regarding opioid use disorder...

~ the development of opioid addiction may follow one of two typical behavior patterns. the first is an individual who has obtained the drug by prescription for the relief of a medical problem; abuse and addiction occur when the individual increases the amount and frequency of use, justifying the behavior as symptom treatment. he or she becomes obsessed with obtaining more and more of the substance and may see several physicians in order to replenish and maintain supplies. the second pattern occurs among individuals who use the drugs for recreational purposes and obtain them from illegal sources. tolerance develops and addiction occurs, leading the individual to procure the substance by whatever means is required to support the habit. ~ *CNS effects.* all opioids affect the CNS. common manifestations include euphoria, mood changes, and mental clouding. other effects include drowsiness and pain reduction. pupillary restriction occurs in response to stimulation of the oculomotor nerve. respiratory centers in the medulla are depression, resulting in respiratory depression. the antitussive response is due to suppression of the cough center within the medulla. nausea and vomiting associated is related to stimulation of centers in the medulla. ~ *cardiovascular effects.* opioids have a minimal effects on the action of the heart in therapeutic doses. at high doses, opioids induce hypotension. methadone and buprenorphine can prolong the QTc. abuse of loperamide has been linked to cardiac dysrhythmias and death because it is highly cardiotoxic at high doses. ~ *GI effects.* stomach and intestinal tone are increased. peristaltic activity of the intestines is diminished. these lead to a marked decrease in the movement of food through the GI tract. opioids have been most effective in the treatment of severe diarrhea. constipation and fecal impaction may be a serious problem for the chronic opioid used. ~ opiate intoxication is treated with *narcotic antagonists such as naloxone (narcan) or naltrexone (review, vivitrol).* ~ *clonidine (catapres) has been used to suppress opiate withdrawal symptoms.*

regarding hallucinogens...

~ tolerance to hallucinogens develops quickly and to a high degree. ~ *mescaline* is the only hallucinogenic compound used legally for religious purposes today by members of the Native American Church of the US. ~ MDMA ... AKA ecstasy or molly. a synthetic drug with both stimulant and hallucinogenic qualities. ~ the two types of toxic reactions to hallucinogens *are the panic reaction ("bad trip") and the flashback.* symptoms of the panic reaction include an intense anxiety, fear, and stimulation. the individual hallucinates and fears going insane. paranoia and acute psychosis may be evident. the flashback refers to the transient, spontaneous repetition of a previous LSD-induced experience that occurs without taking the substance.