WEEK 10
What are some signs and symptoms of alcoholic hepatitis?
- Enlarged, tender liver - N/V - Lethargy - Anorexia - Elevated WBC - fever - Jaundice - Ascites and weight loss in severe cases
This is a CNS depressant that is absorbed rapidly into the bloodstream; initial effects are relaxation and loss of inhibition
Alcohol
Severe or untreated alcohol withdrawal may progress to...
Alcohol withdrawal syndrome (delirium)
This occurs because the effect of alcohol on the heart is an accumulation of lipids in the myocardial cells
Alcoholic cardiomyopathy
True or False: Dependence develops rapidly with stimulants and periods of highs are followed by depression
True
True or False: It is hard to find pure heroin at all so much of it is cut with fentanyl and its killing more Americans than any other drug in history
True
True or False: Opioids have a sedative and analgesic effect
True
True or False: Severe withdrawal from CNS depressants is most likely to occur when a substance has been used at high dosages for prolonged periods
True
True or False: The intensity of the effect of CNS depressants depends on the particular drug and alcohol intensifies depressive effects
True
True or False: There are no withdrawal symptoms with inhalants
True
True or False: There is no clinically significant treatment or withdrawal syndrome for cannabis
True
True or False: Tolerance to hallucinogens is developed quickly
True
True or False: Withdrawal syndrome is considered lifethreatening which requires detoxification to be accomplished under medical supervision
True
What are some s/s of alcohol withdrawal syndrome (delirium/DTs)
- Confusion - Disorientation - Hallucinations - Tachycardia - Hypertension/hypotension - Extreme tremors - Agitation - Diaphoresis - Fever - Death may result from CV collapse or hyperthermia
What are some s/s of inhalation intoxication?
- Dizziness - Nystagmus - Lack of coordination - Slurred speech - Unsteady gait - Tremor - Muscle weakness - Blurred vision
What are some risks of substance abuse in pregnant women?
- Drug abuse leads to fetus exposure to substance - Baby may develop birth defects, an addiction, and go into withdrawal - The baby may be born with a disease associated with drug abuse such as HIV/AIDS
What are some examples of hallucinogens?
- Ecstasy - LSD - PCP
What equates to .6 ounces of alcohol?
- 1 12oz beer - 1 full glass of wine 5oz - 1 shot of liquor 1.5oz
How long does it take for cannabis to start acting, peak, and last
- 1 minute - 20-30 - 2-3 hours
What are some special populations regarding substance abuse?
- Adolescents - Pregnant women - Older adults
What are some other complications of alcoholism?
- Alcoholic cardiomyopathy - Esophagitis - gastritis - Pancreatitis
What are some acute toxicity symptoms of inhalants?
- Anoxia - Respiratory depression - Vagal stimulation - Dysrhythmias
What are some s/s of hallucinogen intoxication?
- Anxiety - Depression - Paranoid ideation - Fear of losing one's mind Potentially dangerous behavior
What are some withdrawal symptoms of opioids?
- Anxiety - Restlessness - Aching back and legs - Craving more opioids - N/V - Sweating - Diarrhea - Rhinorrhea - Abd cramping - Sweating - Yawning - Fever - Insomnia
What are some psychological symptoms of opioid intoxication?
- Apathy - Lethargy - Listlessness - Impaired judgment - Psychomotor retardation or agitation - Constricted pupils - Drowsiness - Slurred speech - Impaired attention and memory
What are some withdrawal symptoms of CNS depressants?
- Autonomic hyperactivity - Increased hand tremor - Insomnia - N/V - Hallucinations - Illusions - Psychomotor agitation - Anxiety - Grand mal seizures
What is the teaching for antabuse?
- Avoid mouthwash containing alcohol - Do not drink for 14 days after discontinued - Do not take if you have consumed alcohol within past 12 hours
What are some specific examples of CNS depressants?
- Barbiturates - Nonbarbiturate hypnotics - Antianxiety agents (benzodiazepines)
What are some behavioral symptoms of inhalation intoxication?
- Belligerence - Aggression - Apathy - Impaired judgment - Inability to function
Death from inhalants results from...
- Bronchospasms - Cardiac arrest - Suffocation - Aspiration of compound or vomitus
What are some reasons older adults might abuse substances?
- Chronic pain due to specific illness or age - Decreased memory function can attribute to accidental overdose of medications
What are some signs and symptoms of alcohol withdrawal?
- Coarse hand tremors - Sweating - Elevated blood pressure - Insomnia - Anxiety - N/V
What are some things severe intoxication of opioids can lead to?
- Coma - Respiratory depression - Death
What are some signs and symptoms of intoxication with stimulants?
- Euphoric feelings - Hyperactivity - Hypervigilance - Talkativeness - Anxiety - Grandiosity - Hallucinations - Stereotypic or repetitive behavior - Anger - Fighting and impaired judgment - Confusion
Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a great deal of discomfort for the individual including...
- Flushing - Throbbing headache - Sweating - N/V
What are some examples of inhalants?
- Gas - Glue - Paint thinner - Other compounds with esters
What is the treatment for alcohol intoxication?
- Gastric lavage - IV fluid bolus
What are some signs and symptoms of alcohol intoxication?
- Impaired attention and concentration - Impaired memory and judgment - Slurred speech - Unsteady/lack of coordination - Intoxication may lead to blackout
What are some s/s of intoxication of cannabis?
- Impaired motor coordination - Inappropriate laughter - Impaired judgment and short-term memory
What are some physiologic effects of cannabis?
- Increased appetite - Conjunctival redness - Dry mouth - Hypotension - Tachycardia - Excessive use may produce delirium
How are inhalants inhaled usually?
- Inhaled from rag soaked w compound - From paper or plastic bag or directly from the container
What are some signs and symptoms after one week of cannabis cessation?
- Irritability, anger, or aggression - Nervousness, restlessness, or anxiety - Sleep difficulty (insomnia or disturbing dreams) - Decreased appetite or weight loss - Depressed mood - Physical symptoms, abd pain, tremors, sweating, fever, chills, or headache
What are some signs of intoxication with sedative, hypnotics, and anxiolytics (CNS depressants)?
- Labile mood - Impaired attention or memory and social impairment - Slurred speech - Lack of coordination - Unsteady gait - Stupor or coma
What is the cost of opioids to US due to?
- Lost productivity - Health care costs - Premature mortality
Cannabis users report a high feeling similar to that of alcohol...
- Lowered inhibition - Relaxation - Euphoria - Increased appetite
What is the treatment for alcohol withdrawal?
- Monitor for s/s withdrawal - CIWA (clinical institute withdrawal assessment for alcohol) protocol - Provide stimulus free environment - Benzodiazepines (ativan, valium, librium)
What is the nursing assessment tools for substance abuse?
- Motivational interviewing - Drug history and assessment - Clinical institute withdrawal assessment of alcohol scale for alcohol withdrawal - Clinical opioid withdrawal scale
What is the first, second, and third wave of the opioid epidemic?
- Pain pills - Heroin - Fentanyl
What are some signs and symptoms of Wernicke's encephalopathy?
- Paralysis of ocular muscles - Diplopia - Ataxia - Stupor
What are some things to implement/plan for substance abuse?
- Provide safe environment/supportive care/decreased stimuli - Set limits to manipulative behavior - Teach coping skills/tools for sobriety
What is the treatment for CNS depressant withdrawal?
- Provide stimulus free environment - Monitor for withdrawal s/s (seizures may occur) - Benzodiazepine taper (valium or ativan)
What are some signs and symptoms of stimulant abuse?
- Pupil dilation - Dryness of oronasal cavity - Excessive motor activity - Tachycardia - Elevated BP - Twitching - Insomnia - Anorexia - Grandiosity - Impaired judgment - Paranoid thinking - Hallucinations - Hyperpyrexia - Convulsions - Death
Why are inhalants used by younger teenagers?
- Readily available - Legal - Inexepensive
What are some nursing diagnoses related to substance abuse?
- Risk for injury - Denial - Ineffective coping - Dysfunctional family process
What is the teaching for revia(naltrexone)
- Shown to be effective only when used as part of a treatment program that includes counseling and support - Dizziness may occur; don't drive - If they previously used opioids, may be more sensitive to lower doses of opioids and at risk of accidental overdose if they use opioids again
How do you treat toxic reactions with hallucinogens?
- Supportive - Isolation from external stimuli - Physical restraint may be needed for safety
What are some s/s of bad trips with hallucinogens?
- Tachycardia - HTN - Temp - Dilated pupils - Hyperreflexia - Sweating - Palpitations - Blurred vision - Tremors lack of coordination
What are some reasons adolescents abuse substances?
- To get high with friends - Escape pressures of life
What are some teaching points for methadone?
- Using narcotics for a long time can cause severe constipation - Do not use more of this medicine or take more often than directed - Dizziness, lightheadedness, or fainting may occur when you get up - Numerous possible drug interactions - Alert physician of med usage before testing
What are some things that may have due to excessive intake of alcohol?
- Vomiting - Unconsciousness - Respiratory depression
Each drink creates a blood alcohol content of about....
.025-.03
Acute pancreatitis usually occurs.... days after a binge
1-2
Alcohol intoxication occurs when blood alcohol levels are around...
100-2000mg/dl
Withdrawal symptoms for CNS depressants start... after last dose, reach a peak at... and subside in...
12-14 hours 24-72 hours 5-10 days
Studies show that ____% of American adults have had either an alcohol-dependent or alcohol abuse problem at one point in their lives
13.8
When does alcohol withdrawal syndrome begin?
2-3 days after drink or as late as 14 days
Another ____ million people over the age 12 need treatment for drug use disorders, and and additional ___ million people need treatment for alcohol use disorders
2.4, 13
How many drinks in one hour raises the blood alcohol to legal definition of drunk at .08
3
You should monitor this with withdrawal syndrome every... hours for the first 24 hours per CIWA protocol
4
When does alcohol withdrawal begin?
4-12 hours after stop drinking
In 2007, 18,515 Americans died from an opioid overdose, and that number skyrocketed to... in 2017
47,600
When do adverse signs and symptoms begin after drinking alcohol with antabuse?
5-10 minutes after alcohol ingestion
How many deaths are attributed to excessive alcohol annually?
75,000
How long may impaired motor coordination last with cannabis?
8-12 hours
Between 2015-2019, estimated cost the U.S. economy from illicit use of opioids is projected to top over...
800 billion
This drug makes you vomit if you drink alcohol
Antabus
What are common street names for barbiturates (phenobarbital and amytal)?
Blue birds, blue angels, yellow jackets
What are some street names for heroin, dilaudid, oxycontin, vicodin?
Brown sugar, tnt, little D, perks, oxy
This is a long-acting partial opiate agonist that acts on the receptor targets of heroin and morphine, but does not produce the same intense high or dangerous side effects; good potential treatment for addiction to opiates
Buprenophrine
This medications unique formulation with naloxone, an opioid antagonist, limits diversion by causing severe withdrawal symptoms in those who inject it to get high
Buprenophrine
Sedatives, hypnotics, and anxiolytics are all this type of drug
CNs depressants
This is the most widely used illicit substance in the US
Cannbis
This is the end stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use; there is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue
Cirrhosis
This is the term that described marked withdrawal from stimulants that leads to suicidal ideation for several days; usually follows a drug binge; have intense and unpleasant feelings of weakness and depression; require several days in which to recuperate
Crashing
The body's physical need, or addiction, to a specific agent; results in physical harm, behavior problems, social isolation, and association with people who also abuse substances
Dependence
This drug is a deterrent to drinking to individuals who abuse alcohol; a measure of control to avoid impulse drinking
Disulfram (antabuse)
What are the street names for demerol, fentanyl, metahodone?
Dollie, jackpot, china town, goodlfella
What are street names for anxiolytics (librium, klonopin, valium, ativan, serax)
Dolls, roaches, xbar
This is a mood disorder in which te patient is withdrawn from the environment, restless, and unhappy, accompanied by fatigue, vivid and unpleasant dreams, insomnia, or hypersomnia, increased appetite, psychomotor retardation or agitation
Dysphoria
What is the primary symptom of withdrawal of stimulants?
Dysphoria
When does withdrawal occur with stimulants?
Few hours to several days after stopping drug and is not lifethreatening
Withdrawal symptoms for opioids are described as...
Flu like
These drugs produce symptoms similar to a psychotic break including visual hallucinations; patient may become belligerant/aggressive
Hallucinogens
What are street names for cannabis?
Joint, weed, pot, maryjane, texas tea, locoweed
Alcoholic hepatitis is caused by...
Long term heavy alcohol use
What is the definition of heavy drinking for men and women?
M: 2 or more per day W: 1 or more per day
What is the definition of binge drinking for men and women?
M: 4 at once W: 3 at once
What 2 cannabinoids have been approved for treating nausea and vomiting from cancer chemotherapy?
Marinoal and Cesamet
This blocks craving and effects of opioids and heroin; highly addictive; opioid medication that reduces withdrawal symptoms in people addiction to heroin and other narcotic drugs without causing the high associated with drug addiction
Methadone
This can be used to replace opioids; treatment reduces symptoms to no worse than a mild case of the flu; muscle relaxers moderate drugs help with S and S
Methadone
This is used as a pain reliever and as part of drug addiction detoxification and maintenance programs
Methadone
This is used for clients with any disorder; explores openness, motivation, and readiness to change
Motivational interviewing
This is an opioid antagonist and is the treatment of choice; can be given every few hours until the opioid level drops; prescription medicine that blocks the effects of opioids and reverses and overdose
Narcan
Chronic pancreatitis due to alcoholism can lead to...
Pancreatic insufficiency
What are street names for nonbarbituate hypnotics (halcion, restoril, lunesta, sonata, ambien)?
Peter and mickey
What are some street names for opium and codeine?
Poppy, tar, syrup, miss emma
This reduces the craving of alcohol, opioid antagonist (does not produce a high); no therapeutic benefit
Revia (Naltrexone)
Overdoses of stimulants can result in...
Seizures and coma
These are drugs that stimulate or excite the CNS system; high abusive potential; include caffeine, nicotine, and amphetamines
Stimulants
The intense desire to use increasing amounts of a particular substance or substances
Substance abuse
What is the treatment for inhalant intoxication?
Supporting respiratory and cardiac functioning
Why are opioids so popular?
They desensitize an individual to both psychological and physiological pain and induce euphoria
What are some other meds for treatment of withdrawal syndrome
Thiamine for Wernicke's encephalopathy
When this develops, the amount of a substance required to achieve desired effect increases
Tolerance
This results due to a thiamine deficiency
Wernicke's encephalopathy
