Addiction/ Nicotine

Non-medicinal therapies

-Counseling and smoking cessation programs: peer support, group therapy -can also consider therapy, yoga, massage ENCOURAGE PARTICIPATING IN MULTIPLE PROGRAMS -exercise on a regular basis, pick snacks that keep mouth and hands occupied, cigarrete products removed from home, avoid situations that cause relapse (driving in the car, smoke breaks at work, badcompany), healthy food choices, resonable t/x, set little goals and a reward system

Hallucinogens

-LSD, PCP are ingested orally, injected or smoked intended: heightened sense of self (think about how philosophers use this) and altered perceptions (colors more vivid) Effects of intoxification: agitated, anxiety, depression, paranoia, impaired judmgnet, impaired functioning, pupil dilation (fear, tachycardia, diaphoresis, palpitation, blurred vision, tremors, incoordination and panic attacks (think about how pcp is a really dangerous drug and how hallucinogens need to be taken in a safe environment) withdrawal: hallucinogen persisting perception disorder (flashback hallucinations can occur intermittently) -think about how it is a really intense out of body experience

family therapy

-STUDIES HAVE SHOWN THIS METHOD TO BE HIGHLY EFFECTIVE -OFTEN USED FOR ADOLESCENCE WHICH HELPS THE FAMILY identify difficulties in school, difficulties with coping mechanisms, helps them understand family comunication and conflict, learning disorders an peer networds BRIEF STRATEGIC FAMIY THERAPY: IDENTIFIES PROBLEMS WITHIN THE FAMILY 12-16 session cous and finds ways to establish the relationship with the family member Functional family therapy: identifying how family and family dynamics can properly support sobreity, ways to improve communication, problem solving anf conflict resoution principal t/x: engaging in t/x process and enhancing movitation for change multidemensional: MORE EFFECTIVE WITH SEVERE SUBSTANCE USE DISORDERS -will work with family as a whole and with each member separately (think about how during effective communication, sometimes it requires time alone to think about what is being communicated--more controlled and less pressure_ WANT TO USE FOR SEVERE ADDICTION ESPECIALLY IN ADOLESCENT

Cocaine

-blocks reuptake of dopamine, norepinephrine and results in euphoria, increased energy and pleasure toxicity: dizziness, irritability, tremors and blurred vision (think about over excited) severe: hallucinations, seizures, extreme fever, tachycardia, htn, chest pain, possible cardiovascular death (think about how THIS IS A STIMULANT NOT A CNS DEPRESSANT WHICH MEANS OVER STIMULATION) Withdrawal: depression, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation SUICIDAL IDEATION (THINK ABOUT HOW THIS PROVIDES ENERGY, without they can no longer supply energy)

ALCHOOL WITHDRAWAL DELIRIUM

-can occur 2-3 days after cessation of alchol (medical emergency) -severe delirium, severe disorientation, hallucinations, severe hypertension, cardiac dysrhtmisa and delirium

BENZODIAZEPINES

-decreased anxiety and sedation (remember how jasmine used them) EFFECTS OF INTOXICATION: respiratory compromise, decreased judgment, decreased heart rate, decreased level of consciousness, loss of memory, drowsiness, agitation, slurred speech, uncoordinated motor activity, disorientation, n/v ANTIDOTE: FLUMAZENIL (FOR BENZO TOXICITY) NO ANTIDOTE TO REVERE BARBITURATE TOXICITY (THINK THE BARBARIAN THAT KNOCKS YOU OUT) WITHDRAWAL: ANXIETY, insomnia, diaphoresis, htn, possible psychotic reactions, hand tremors, nausea, vomiting, hallucinations or illusions, psychomotor agitation and seizure (think return from depressed nervous system will cause a cns overload=high bp, high resporations, tremors)

S/x of substance abuse/ addictive disorders Risk factors:

-loss of control due to substance use or behavior, participation continues despite problems and tendency to relapse -denial as a defense mechanism (explain they can quit whenever they want to and refusing to get help) Risk factors: -getetics: predisposition to developing a substance use disorder due to family h/x (think about how their neural synapses change) -chronic stress (socioeconomic factors, think unable to manage these stress levels) -h/x of trauma: abuse, combat experience -lowered self esteem -lowered tolerance for pain and frustration -few meaningful personal relationships (think about anna and how she was socially isolated and would easily have anxiety over miniscule things) -few life successes -risk-taking tendancies Sociocultural -aslaska natives and native american groups (higher percentage of alcohol abuse) -asian have low rate of alcohol use disorder -metabolism of alcohol and cultural views of alcohol use (think about how upringing impacts predisposition to addiction) -peer pressure and other sociological facotrs -older adult clients can have h/x or can develop a pattern of substance use later in life due to stressors (losing a partner or frined, retirement and social isolation) THINK ABOUT HOW HAVING RELATIONSHIPS ACTS AS A MOTIVATOR, LOSING A PARTNER WOULD RESULT IN GIVING UP OR LOSING MOVITATION

Management of nicotine addiction

-management with

Treatment for alcohol withdrawal:

-medications (disulfiram) -behavioral therapy -support groups -12-step program alcoholic anonymous -detoxification (especially if high levels which are causing dysrythmias, severe delusions, respiratory collapse, peripheral collapse, etc) -mileiu therapy and family therapy

ASSESSMENT OF ADDICTION/ SUBSTANCE ABUSE

-nursing h/x: -type of substance or addictive behavior -pattern and frequency of substance use -amount of substance used -age at onset of substane use -changes in occupational or school performance (think about not only physiological factors but what are the reprocussions) -changes in use patterns -periods of abstinence in h/x -previous withdrawal manifestations -date of last substance use or addictive behavior Review of systems: -loss of consciousness or blackout: think about how the brain relies on drugs to keep functioning -changes in bowel movements -weight loss or weight gain (think about the changes in bowel movements which impacts metabolism) -experience of stressful situation (think about how anna relapses usually when working again) -sleep probelms -chronic pain -concern over substance use -cutting down on consumption or behavior

Family member teaching and codependancy

-often can experience denial about the drug -often experience fear in being alone, constantly helping when no one has offered Risk of reducing boundaries that establish roles within the family and defending the addict with enabling behavior (justifying actions and abandoning own life to cater to the family member) -additionally they can become isolated due to the diagnosis and can bring about codependency: 0use manipulation, shame or guilt to control others (think about how anna does this to get what she wants), feels like a victim (often anna uses therapy as a way to say how her family wronged her) CHILDREN OF ALCHOLICS HAVE INCREASED RISK FOR DEPRESSION, ANXIETY DISORDERS, PROBLEMS WITH COGNITIVE AND VERBAL SKILLS AND PARENTAL ABUSE OR NEGLECT 9FOUR TIMES MORE LIKELY TO DEVELOP ALCOHOL PROBLEMS) IMPLICATIONS: 1. assess their understanding of substance abuse and addiction -communicate clearly, honestly, openly w/o judgment -anticipate involving the entire family in the t/x process (think about how they can be enablers) ask quetions like: how they perceive the current problem, how they have reacted, how has the problem affected familial roles, who is the problem impacting, how do they manage problems, coping within the family,

Addiction definition Substance use disorder

-psychological and physical need to obtain a substance despite the negative consequences Prescription: sedatives, narcotics and stimulants Illegal drugs: cocaine, heroin, hallucinogens and inhalants Substance use disorder: when they use one ore more of these substances -this involves repeated use of chemical substances leading to impairment during a 12-month period (remember how in the ems program they showed the impacts of meth within a year) THIS CAN INCLUDE CONDITIONS SUCH AS INTOXICATION AND SUBSTANCE-ABUSE RELATED DISORDERS: BIPOLAR DISORDER, SEVERE ANXIETY, DEPRESSION, PSYCHOSIS, SLEEP DISORDERS, SEXUAL DYSFUNCTION AND OTHERS (remember how in the book it talked about Reprocussions of substance abuse: -sleep problems, sexual dysfunction, change in bowel regulation (think about how opiates can cause constipation), loss of consciousness, changes in tolerance to stress, weight loss or weight gain

Substance Use and addictive disorders:

-r/t alchol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/ anxiolytics, stimulants, tobacco and others SUBSTANCE USE DISORDER: repeated use of chemical substances leading to clinically significant impairment during 12-month period (think about how a years worth is considered chronic)

FAMILY EDU OF SMOKING

-second hand smoke has more exposure to toxic chemical than inhaled -increases risk for SIDS, otitis media, ashtma and other espiratory conditions (remember how otitis media often occurs from resp infection, bacteria gets trapped in the ear) -increased risk of lower birth weight (think about the vasoconstriction and n/v that may suppress appetite)

Delirium tremens

-severe complication of alcohol -medical emergency occuring 3-5 days following alcohol withdrawal and lasting 2-3 days -paranoia, disorientation, delusions, visual hallucinations, elevated vs (high bp, high resp, high heart rate and fever), vomiting, diarrhea, diaphoresis (ALSO KNOWN AS ALCOHOL WITHDRAWAL DELERIUM)

teaching about nicotine for adolescents

-someone who smokes a pack of cigarrhetes e/ day lives 7 yrs less than someone who never smoked -are three times more likely to use alcohol -8xs more likely to use marijuana -22xs more likely to use cocaine (think about cocaine being cool around 22) -risk: peer influences, stress, socioeconomic factors, not going to school, not religious, poor parental influences, depression serve as risk factors -conequences: reduces rate of lung growth, expereince s.o.b three times more which can impact sports -show early signs of heart disease and stroke and increased risk for cancer****

Patient teaching regarding nicotine replacement therapy

-transermal patches and gum are for heavy smokers and may contain too large of a dose -may experience unpleasant effects: gi upset (too much gastric motility), htn, fast haeart rate, nausea, or vomiting, panic attacks, difficulty breathing, ringing in ears, anxiety, headache (r/t cardiovascular changes) and muscle twitching NICOTINE POISONING: children who chew on patches or gum (may be a medical emergency)

Nicotine:

-very toxic -long-term: can cause cardiovascular disease, can cause respiratory disorders, can cause stroke and htn (related to artherosclerosis), emphysema and lung cancer chewing tobacco can cause damage to oral mucosa (causing cancer) withdrawal: abstinence, irritability, craving, nervousness, restlessness, anxiety, insomnia, increased appetite, difficuty concentrating, anger and depressed mood (think about how this relaxes people)

ineffective denial

1. determine extent of patients denial and perception of substance and abuse 2. assess patients perspective of substance abuse on their life (determine if they grasp how its impacting relationships, career, finances and others) 3. convey attitude of acceptance while separating individual from behavior 4. provide accurate info about condiiton (unbiased) 5. answer questions honestly 6. positive feedback promote communication: 1. express concerns or pass info without judmgnet -use I statements to describe concerns w/o singling out substance abusing individual -remain calm -listen for contingency words like probably or maybe. mean individual is not going to follow through -hold patients accountable (make a plan with them if they agree) -practice active listening (notice when using defense mechanism) DEFLECTING (TURNING TOPIC BACK ON SPEARKER, USING HUMOR TO LIGHTEN MOOD OR CHANGING SUBJECT) RATIONALIZING: EXPLAINING WHY AN UNACCEPTABLE BEHAVIOR IS ACCEPTABLE MINIMIZING: DOWNPLAYING EXTENDT OF ADDICTION BODY LANGUAGE: EYE CONTACT INDICATES INTEREST, STARING AT FLOOR MAY INDICATE SHAME, EXASPERATION OR REFUSAL TO ENGAGE -muscle tension, hand wringing, turning away

Explain common physical assessement procedures used to assess clients with addiction behaviors and their etiologies 5 As

5 As is used to assess their willingness to quit: 1. Ask: identify and document substance use status for every patient at every visit (think about how this is the very beginning branch) 2. Advise: clear, strong and personalized manner urge user to quit 3. Assess: is the substance user willing to make a quit attempt at this time? ARE THEY LOOKING AT THE GROUND, ATTEMPTING TO WALK AWAY, VERBALLY DEFENSIVE OR IN DENIAL OR USING WORDS LIKE "MAYBE" 4. Assist: for those willing, use counseling and pharmacotherapy to help him or her quit FOR THOSE IN NEED OF HIGHER LEVEL: PROVIDE DETOX 5. Arrange: schedule follow-up contact in person or by telephone within first week after quit due date (think about how 2-3 days of withdrawal can cause an onset of dangerous symptoms) SAMHSA RECOMMENDS THAT NURSES ASSESS, IDENTIFY AND PROVIDE SOME ENCOURAGEMENT AND REFER TO T/X -think about how this correlates with: -ask, advise, assess, assist and arrange for advise: this is brief information on the harms of addiction and why it is important to stpo ASSESSMENT OF AN ADDICT: 1. assessment for any psychological disorders (how this could lead to addiction or how addiction lead to the diagnosis) 2. extent of phsyiological need (are they addicted or dependent?) 3. are they displaying signs of withdrawal (for alcholism, after 2-3 days are they hallucinating, having high vital signs) 4. What is their socioeconomic status (what is the availability of drugs, who has influenced the use of drugs) 5. financial situation, education status, job status (other life motivators) 6. family (how are they coping? what has been their role in the addiciton process?) 7. physical assessment: yellow teeth, yellow fingers, labs (hepatic funciton, renal function), x-ray, evaluation of the heart (alcoholism can cause arrythmias and and an irregularly shaped heart) 8. current willingness to learn 9. conditions and complications 10. loss of interest in personal hygiene and grooming 11. slurred speech, impaired judgment, presence of hallucinations, low respiratory rate/ heart rate, nausea/vomiting, tremors or unusual smells on breath 12. rhinorrhea, weight loss or gain (think about how marijuana increases appetite during use and decreases after and how nicotine is the opposite) 13. inability to concentrate, hyperactivity, agitation or gidiness (think about those in nicotine wihtdrawal are agitated, with cns suppressants during use they are lethargic and slurred and after are emotionally unstable or irritable) -stimulants cause decreased attention span when in withdrawal and increased hyperawareness/ hyperactivity when overused (pcp) 14. INIBILITY TO CONCENTRATE, AGITIATION OR GIDINESS

Addiction vs dependence

Addiction: -caused by changes to the pleasure and reward system of the brain (remember how in the book about addiction how dendrites lengthen for optimization of dopamine and how the dopamine threshold increases) DEFINITION: COMPULSIVE SUBSTANCE ABUSE DESPITE NEGATIVE CONSEQUENCES (GENETIC AND ENVIRONMENTAL FACTORS AFFECTS ADDICTION RISK) -THE CHANGES THAT OCCUR HERE INCLUDE CHANGES IN REWARD AND MOTIVATION (MAKE THEM VALUE THE ADDICTIVE SUBSTANCE AND RECEIVE UNRIVALED PLEASURE OR HAPPINESS) **think addiction is more emotionally driven and dependence is more physically driven Dependence: affects different parts of the brain called the thalamus and brain stem -can be dependent on a drug but not addicted to it ex: person drinks alcohol repeatedly for several days or weeks, brain adapts to presence of substance and becomes dependent on alcohol to feel normal (when they quit withdrawal symptoms occur) -dependence is a state when organisms function normally only in the presence of a drug (changes chemical function and eventually becomes tolerant--think about homeostasis) HOW TO DETERMINE IF YOU ARE DEPENDENT OR ADDICTED: -dependent: will display withdrawal symptoms -they arent addicted if they aren't compulsively seeking the medication despite obvious harms (think about how dopamine is an emotional drug that drives motivation--this is the major sign of addiction) -if they arent experiencing consequences such as family problems or job loss, probably not addicted -if the drug is hurting relationships, creating problems at school or work, may be addicted

Assessment for addiction

Alcohol addiction: Overuse s/x: -assess for respiratory depression, assess for cardiac arrythmias (especially with increased amounts), assess for lethargy/ altered level of consciousness, impaired judgment, slurred speech, stupor, coma, resp arrest, tremors, tachycardia, vomiting, abdominal cramps, hepatic disease, gastritis, wernickle encephalopathy (think i bet ya a nickle that man who drinks a lot of alcohol has brain lesions), gastritis (think about how it irritates the gastric lining, pancreatitis, think about how the metabolites or substances released cause death of pancreatic cells), blackouts, gi heorrhage WITHDRAWAL SYMPTOMS: -assess for agitation/ irritation, hallucinations/ delusions, elevated vs (tachycardia, htn), loss of orientation, tremors, insomnia, anxiety SEDATIVES: monitor for overdose which includes respiratory depression, poor judemgent, agitation, seizures, loss of coordination, slurred speech, anxiety and n/v withdrawal: assess for agitation, elevated vs, diaphoreses, hallucinations, tremors, seizures cannabis: -overdose: extreme euphoria, impaired coordination, increased sensory functioning, tachycardia, htn, reddned eyes, dry mouth CAN CAUSE INCREASED SYMPATHETIC NERVOUS ACTIVITY (ELEVATION OF HR, RESP RATE) withdrawal: anxiety, irritability, tremors, fever, emotional depression, loss of appetite, aggression and loss of appetite

Seizure precautions

Assess: -identify stage of alcohol withdrawal (hyperactivity, tremors, sleplssness, n/v, diaphoresis, tachycardia and htn) stage two: hyperactivity, hallucinations an dseizures stage three: dts and extreme autonomic hyperactivity, profound confusion, anxiety, insomnia and fever (why past 100.4 need to go to the hospital) -Monitor and document seizure activity (keep airway patent, provide environmental safety which includes padded side rils, bed in low position) -grand mal are most common (cause by elevated blood alcohol) USUALLY STOP SPONTANEOUSLY IF ABSENCE OF H/X ANTIEPILEPTIC DRUGS ARE NOT INDICATED -check deep tendon reflexes (assess gait) -ataxia (gait disturbance) is associated with wernicke's syndrome (thiamine deficiency) and cerebellar degeneration REMEMBER: WERNICKE (I BET A NICKLE HES DEFICIENT IN THIAMINE BECAUSE OF HIS ALCOHOL USE) -assist with ambulation BENZOS ARE COMMONLY GIVEN: used to control neuronal hyperactivity because of minimal resp and cardiac depression (think this makes sense for alcoholism because their systems are depressed) -helps relax the muscles r/t ataxic movements(taken cautiously with patients with hepatic impairment) WANT TO TAPER OFF, USE SHORT TERM, CAUTION AGAINST ADDICTION, AVOID WITH ALCOHOL OR COULD INDUCE SEIZURES THIAMINE: used for thiamine deficiency (may lead to neuritis, wernecke's syndrome and korsakoff psychosis (dementia caused by lacerations in the brain--extracting vitamin b1) Magnesium sulfate: reduces tremors and seizure activity

Signs and symptoms of impaired nurses

At risk situations: -easy access to prescription drugs warning signs: -inaccurate narcotic counts or drugs frequently missing (why they have a narcotic book to keep track of the numbers and why wasting requires two nurses) -patient complains of ineffective pain control or denial of recieving meds -excessive wasting of drugs -likelihood of colunteering to give meds to pts -frequent trips to the bathroom Role strain: -frequent tardiness or absenteeism especially before and after scheduled days off -shoddy charting -judgment errors (why often they do drug tests in these scenarios) -unorganized erratic, unkempt appearance Depression: irritability or unable to focus (think about how this coincides with drug withdrawal) -abrupt mood swings -isolating self or taking too long of breaks -apathetic, depressed or lethargic (often when drugs are taken) -unexplained absences SIGNS OF ALCOHOL OR DRUG USE: track marks, yellow on tips of fingers or in teeth, smell of alcohol on breath, excessive sweating, excessive use of perfumes, mouthwash or mints -slurred speech, flushed face, unsteady gait and red eyes -long sleeves to cover up arms withdrawal signs: wrestlessness, mood swings, sweating, agitation, watery eyes, runny nose and stomaches (think about how for depressants it causes slow bowel peristalsis which would change after use) Interventions: should report to a physician, nurse practitioner or physician assistant (notifying supervisor may also be required) 1. code of ethics recommend a. not ignoring poor performance (think about how its like this for a patient. must ask and intervene) b. do not lighten or change the nurses patient assignment c. do not accept excuses (think about how you cant accept excuses for other nurses) d. do not alloy yourself to be manipulated or fear confrontation if patient safety is in jeapordy (think about how family dynamics can fall victim to this)

Alcohol addiction: Diagnostic SIgns/ symptoms t/x

CNS depressant that is absorbed rapidly into the bloodstream, effects are releaxation and loss of inhibition; with intoxication, there is slurred speech, unsteady gait, lack of coordination and impaired attention, concentration, memory and judgment (remember how it is not beneficial to use this substance with other cns depressants like sedatives -also remember how jasmine lost memory when using it DIAGNOSTIC: blood alcohol concentration of 0.08% (80g/dL)--think eighnt that perty to have that much alchol -death can occur at 0.4% (400g/dL) -think 4 shore will die Intended: decreased social anxiety and stress reduction (think about how it is denying a lot of the impacts of the limbic system and prefrontal cortex which creates this relaxation) Effects of excess: -impaired judment, loss of consciousness, decreased respiration/ resp arrest, peripheral collapse, death, decreased motor skills Chronic use: cardiovascular damage (alchol cardiomyopathy which is a heart disease that causes enlargened and distorted heart Arrythmias: heart beats too fast and stroke (think the irregular heart beat and weakened heart muscle can result in blood stasis or a clot when theres improper cardiac output), erosive gastritis (remember how it can irritate the gastric lining) and gi bleeding, acute pancreatitis and sexual dysfunction CAN IRRITATE THE GI TRACT RESULTING IN ULCER FORMATION AND BLEEDING CAN CAUSE BY-PRODUCTS OF ALCOHOL METABOLISM THAT DAMAGES THE CELL MEMBRANES OF THE PANCREAS (THINK ABOUT HOW TERTOGENIC SUBSTANCES RELEASE BYPRODUCTS THAT ARE HARMFUL) WITHDRAWAL SYMPTOMS: -abdominal cramping, vomiting, difficulty sleeping, sexual dysfunction, increased heart rate (think about how the body's systems are suppressed when using alchol), hallucinations or illusions (think dysrupting sleep function which pushes forward conscious rem sleep< increased resp rate and bp, and temp -tonic-clonic seizures (think so much brain overload)

DRUG THERAPY FOR ALCHOL BENZODIAZEPINES ABSITENCE MEDICATIONS ANTISEIZURE DRUGS ANTIDEPRESSANTS VITAMINS

Benzodiazepines: think about how they help with anxiety and with seizure activity (something that can occur especially in alcoholics experiencing withdrawal) medications: chordiazepoxide, diazepam, oxazepam, lorazepam (think those pamcakes are a mega stress reliever-careful of the sugar rush or could cause a seizure) -CAREFUL USING MEDICATION: DONT WANT TO ABRUPTLY STOP OR COULD CAUSE A SEIZURE, DONT USE WITH ALCHOL BECAUSE COULD CAUSE RESPIRATORY DEPRESSION, taper slowly, and only short-term due to dependence (think about how it could be used as a crutch) ABSTINENCE MEDICATIONS: diminishes cravings for alchol -disulfiram, naltrexone, acamprosate and methadone think DISULFIRAM (I am firm on not dying from alcohol addiction/ addiction) CAN CAUSE FLUSHINF OF FACE, HEADACHE, VOMITING AND UMPLEASANT SENSATIONS IF ALCHOL IS CONSUMED (think im firm on not dying, if you do drink will cause near death experience) think naltrexone (think treck alone without the need of sustances) -WILL CAUSE OPOID WITHDRAWAL IF NOT IN DETOX -THINK DETOX IS A TRECK ITSELF AND IF THERES NO DIRECTION, CAN CAUSE CRAVING acamprosate (think Im camping a safe distance from addiction) methadone (think im done with meth) -CAN BE ABUSED, MONITOR FOR CARDIAC ARRYTHMIAS AND OVERDOSE CAN CAUSE RESP DEPRESSION ESPECIALLY IF TAKEN WITH ALCOHOL -think the body is done after saying you are done with meth (arrythmias trying to cause death, resp depression) ANTISEIZURE DRUGS: -phenytoin, carbamazepine, vaproic acid, phenobarbital and magnesium sulfate -reduces and controls seizure activity nursing considerations: -seizure precuaitons to maintain patient safety -place a pillow under the head and time the seizure (noting behavior after the event) Phenobarbital: allergic reaction so monitor for hypersensitivity and should NOT BE TAKEN DURING PREGNANCY (think its funny, the pregnant women is extremely allergic to the plastic on barbie dolls) Magnesium: can cause dizziness, flushing, irregular heart beat, muscle parlayis or weakness (fall precuations, assist with standing)--makes sense since magnesium is a major contributer to heart rythm and conduction of contraction) VITAMINS: THIAMINE (VITAMIN B1) FOLIC ACID MULTIVITAMINS _PREVENTS ALCOHOL RELATED WERNICKE encephalopathy -may not be absorbed properly in clients with impaired liver function -high doses of folic acid may increase risk for heart attack -water soluble overdoses can cause nausea and diarrhe

Chewing tobacco manifestations

Chewing tobacco: -gum disease and gum recession -staining and wearing down teeth (think about how they will also appear yellow r/t to radiation and harmful chemicals) -tooth decay and loss -increased risk for cardiovascular disorders (remember how cavities can increase risk for clots and other issues) -oral cancers (gums, lips, tongue, floor and roof of mouth) T/X: -tobacco cessation, nicotine replacement -daily dental hygine and dental care -supportive care -cancer t/x (related to cancers of the oral passageways) -pain t/x

Care for clients experiencing substance related withdrawal

Client safety: Seizure precautions: Reorienting to reality, time, person and place Fall prevention Monitoring and assessments PRoviding quiet and calm environment (think about how in withdrawal they are especially irritable and can have hallucinations and other distressing symptoms -medications -patient and family edu -info about self-help groups like AA and narcotics anonymous or nicotine anonymous -symptom management -info about codependeencies for family members -prevention of relapse

Risk factors for nicotine use:

Due to changes in vasoconstriciton, increase in gi acid secretion, -this can result in early changes of: high blood pressure -later complications: cancers in the oral membrane, cardiovascular problems, copd, increased saliva production, continual cough, cancer of the gi tract, larynx cancer, MAIN CAUSE OF LUNG CANCER AN DCOPD CAN CAUSE CAD AND STROKE Causes graves disease (think you're putting yourself in that grave if you continue to smoke) -causes overpoduction of thyroid hormone and malfunction of immune system (accompanied with weight loss, heat intolerance since they like the cold, s.o.b, irregular menstrual periods) Pregnancy: can cause incresased risk of infertility, prematurity or abortion of the baby, early menopause, dysmenorrhea, impotence, osteoporois an ddegenerative disc disease -can cause discolored teeth, fingers, loss of teeth, increased mucus secretion, reduced sense of smell and taste, wrinkling of skin, gum disease SMOKING DURING PREGNANCY: preterm birth, failure to thrive, sudden infant death syndrome, spontanous abortion, learning disorders

Prevention:

Education programs (especially educating how second hand smoke can be harmful) -high-impact interventions: mass media compaings, price increases

Cannabis:

Effects: euphoria, sedation, hallucinations, decrease of n/v effects of intoxication: -chronic use: risk for lung cancer and other resp effects (think about how smoking damages lower airways) -high doses: paronoia -increased appetite, dry mouth, tachycardia -can impair motor skills for 8-12 hours (THINK ABOUT HOW EDIBLES LAST ALL DAY LONG AND ACTS SIMILAR TO ANESTHESIA) -k2 and spice (associated with toxic doses) withdrawal: severe anxiety, dirritability, insomnia, lack of appetite, restlessness, depressed, abdominal pain, tremors, diaphroesis, fever and headache (think about how anxiety induced)

Explain management of addiction behaviors and their etiologies

FOR THOSE WITHDRAWING FROM ALCOHOL, OPIODS OR OTHER SUBSTANCES, T/X IS OFTEN HOSPITALIZATION FORR 24HRS OR DETOX (ENCOURAGES SAFETY) SYMPTOMS FOR IMMEDIATE HOSPITLIZATION: increasing anxiety, hallucinations, panic, elevations in vs (temp greater than 100.4, increase or decrease in vs), abdominal pain, gi bleeding (think about how alcholism can cause gi bleeding and nicotine can cause bleeding r/t increase in gastric acid), heightened deep tendon reflexes and cns irritability (why alcholics should be careful taking antidepressive meds with alcohol=increased risk for seizure)

Demonstrate the nursing process in providing culturally competent and caring interventions across the lifespan what are gender disparities

GENDER DISPARITIES: -women: being responsible for care of dependent children is a deterren to t/x -those who do not have access to t/x or child care and cannot arrange alternative are forced to choose -often fear expressing they are addicted because they may lose custody of their children CLINICIANS NEED TO BE SENSITIVE TO THE BARIER, EXPLORE RESOURCES IN THE COMMUNITY AND HELP FERNALE PATIENTS MEN: employment related issues and those with disorders are at greater risk of losing employment. -correlations between drinking and positins with male dominated (think about how doctors drink a lot and it is mostly male dominated0 -it als is craft jobs or jobs working with machinery or hazardous materials--think about the drinking problem in electricians -NEED TO FIND SOLUTIONS TO HELP THEM SAFEGUARD THEIR EMPLOYMENT

Risk factors for addiction:

Genetic/ biological: -children of alcoholic parents are at higher risk for developing alcoholism and drug dependence than children of nonalchoholic -Psychological: children of alcoholics are four times as likely to develop alcoholism compared (think you are predisposed to addiction 4 shore) -may be r/t: poor role modeling, lack of nurturing pave, maladaptive coping (think witnessing coping skills within their parents) NO ADDICTIVE PERSONALITY TYPE HAS BEEN IDENTIFIED -MANY EXPERIENCED SOME KIND OF ABUSE WHEN THEY WERE IN CHILDHOOD (LEADING TO POOR SELF-ESTEEM WHICH IS A LARGE RISK FACTOR, EXTREME ANXIETY, AND DIFFICULTY EXPRESSING EMOTIONS) --think they will seek an outlet due to these experiences -social and environmental factors: -think about how its the community you grow up in (their influences), finances (lake of financial or home stability predisposes), lack of success can predispose, violence, physical and emotional abuse -availability of drugs (think about similarly to other disorders and compliance, it all depends on what is avialable. Obesity often is because of easier availability for processed foods) -academic failure and poor social skills SMOKED OR INEJCTED ENTER BRAIN WITHIN SECOINDS AND PRODUCE POWERFUL EFFECTS (THINK ABOUT HOW THEIR ARE MAJOR BLOOD VESSELS AND HOW ENTERING THE LUNGS WILL ENTER THE BLOOD STREAM VERY QUICKLY -bisexual or lesbian women increased risk for alcohol and drug use -gay men increased risk for illicit drug use -THINK ABOUT ACCEPTANCE BY SOCIETY, ABOUT POTENTIAL FOR HEALTH COMPLICATIONS R/T HIV IN GAY MEN, and other forms of adversity that motivate this kind of behavior

Identify commonly occuring addiction behaviors and their r/t treatments

Interventions: -helping them identify triggers and reducing the environment -treat withdrawal signs: -if it is a mother: a childhood specialist will come and visit to check on the mother and the baby (this reduces stress levels for the mother)

Teaching for teen tobacco users

It is very important to abstain from drugs -the prefrontal cortex isn't as developed as an adults brain which can impair judgment and lead to increased risk for drug use -additionally, the use of drugs at this time (since the brain is still developing until the age of 25 which means if they use drugs can have negative impacts on IQ and cognition) ex: marijuana can impair IQ

Management of alcohol addiction

KEY DIAGNOSES: anxiety/ fear, sensory/ perceptual alterations, risk for injury -risk for decreased co -risk for ineffective breathing pattern t/x: -thiamine medications (b1 to reduce risk of encephalopathy/ korskoff -behavioral therapy: -support groups: -12-step program (aa) -detoxification: especially if showing symptoms of (elevated fever of 100.4, increase or decrease in vs, hallucinations, extreme panic, ) - mileu therapy -family therapy: assist family members who may be supporting the behavior -nutrition therapy: think about how increased triglyceride levels in alcholism, admin vitamins and monitor labs (total albumin, cbc, uranlisyis, electrolytes and liver enzymes) -provide increased calories (espeically if experiencing weight loss) -document intake, output and calorie count and wiegh daily DO NOT ACCPET THE USE OF DEFENSE MECHANISMS, RATIONALIZATION OR PROJECTION (ENCOURAGE TO EXAMINE UNHEALTHY COPING MECHANISMS AND MALADAPTIVE BEHAVIORS AND HOW ITS IMPACTING THEIR LIEVES--THINK ABOUT USE OF HOW SECONDARY SMOKE IS MORE HARMFUL AND CAN CAUSE VARIOUS LUNG CONDITIONS) -ALSO THINK HOW CHILDREN ARE 4XS MORE LIKELY TO GET INTO DRUGS THEMSELVES WITH PARENTS WHO ARE ADDICTED -encourage to view how its impacting their life BEHAVIORAL THERAPY: learn techniques to change addictive behavior (changing behavior essentially) -based on concept that behavirs have consequences (change conditioning where theres reinforcement and punishment) USE METHODS LIKE POSITIVE AND NEGATIVE REINFORCMENT: POSITIVE: when the provider provides a reward for positive behavior Negative reinforcement: removing a negative stimulus to promote positive behavior ex: removing poor influences such as friends to help them reach sobriety punishment: consequences of poor behavior extinction: removal of undesirable behaviors contingency contracts: rewards if they achieve positive behavior token economics: token rewards if on good behavior (think about the child rewarded tokens if he didnt hurt other children) MILEU THERAPY: supports behavior changes, teaches new coping measures and helps them maintain sobriety (supportive environment where clinicians work with patients to prvide safety and structure while assessing patinets relationships and behavior) -have consistent routine which fosters trust (provide membership, belonging) -have structured activities, reinforce participation in events, exposes them to various stresses or responsibilities and guides them as they cope -think about the environment of a rehab Group therapy: helpful for adolescents and other members (gives them a sense of community and sense of self-reflection through examples of others) SIDE EFFECTS: TALKING ABOUT THE USE OF DRUGS AND HOW THEY MISS CERTAIN ELEMENTS OF THE FORM OF ECSTASY Support groups: SMART: FOCUSES ON GAINING INDEPENDENCE AND STRENGTH IN ONESELF RATHER THAN A SENSE OF HELPLESSNESS AND HELPS BUILD AND MAITNAIN MOVITAIOTION, COPING WITH URGES, MANAGING THROUGHS AND BALANCED LIFE 12 step: spiritual plan for recovery -aa, narcotics anonymous -sequential plan: admitting powerlesness and continue through steps to take responsibility of behaviors and seek spiritual awakening (lifelong process) -helping others, building relatinships MAY YIELD MORE MOEDEST OUTCOMES (HAVE REDUCED RELAPSE, IMPROVED RELATIONSHIPS AND PROVIDED SOCIAL SUPPORTS) -think about maslows hierachy of needs (this covers them all by helping them recognize physiological barriers, gaining self esteem with relationships, and self actualization spiritually

INHALANTS

NITROUS OXIDE AND SOLVENTS HUFFED OR BAGGED effects: euphoria -can cause behavioral or psychological changes, dizziness, nystagmus, uncoordinated movements or gait, slurred speech, drowsiness, hyporeflexia, muscle weakness, diplopiia, stuopr, resp depression and death NO WITHDRAWAL MANIFESTATION

Various substances and impacts on the brain: Opioids:

Opoids: mimic or block the brains most important neurotransmitters at respective sites ex: heroin mimics opiate-like neurotransmitters such as endorphine -this means it can cause euporhia and relief of pain (think about how it mimics endorphines which is a sense of excitement Cocaine and other stimulants: block the reuptake of dopamine, serotonin and norepinephrine which causes neurons to release abnormally large amounts of neurotransmittors (produces greatly amplified signals in the brain) -rush of euphoria (extreme-well being) and pleasure, increased energy (think about how it is blocking the reuptake of norephinephrine, serotonin and dopamine and increases the amount of neurotransmittors (this means more focus, more brain action which would provide energy) -can cause releases 2-10xs the amount of dopamine during rewarding activities like eating or sexual intercourse (think about how their are more neurotransmittors which will facilitate more action THIS RESULTS IN PERMANENT CHANGES IN THE BRAIN (THINK NOW THINGS WILL BE LESS STIMULATING WITHOUT THE SUBSTANCE)

T/x: medications

Nicotine replacement therapy: supplies with nicotine to support smoking cessation (available as patch, gum, lozenge, nasal spray and inhaler) ANTIDEPRESSANTS R/T withdrawal symptoms (since they arent releasing as much dopamine) -reduce craving for nicotine (think about how nicotine facilitiates increase in production of dopamine) -CONSIDERATIONS: monitor for suicidal ideation, assess ford drug side effects (drowsiness, blurred vision and insomnia), teach about self-administering, teach not to mix with alcohol because of increased risk for seizures--think about how alcohol is a cns suppressnat which overloads -teach patient antidepressants can take 3-4 weeks to become effective and not to discontinue abrubtly (should be tapered off) --BECAUSE IT WILL WORSEN DEPRESSION=DIFFICULTY SLEEPING, DIZZINESS, AGITATION, PINS AND NEEDLES, TACHYCARDIA, HTN drug ex: bupropion hydrocholoride (think im your bu and promote happiness) fluoxetine (think finally my mood fluxuates, i feel something again) sertraline (think searching for happiness with this antidepressive med) NICOTINE ACETYLCHOLINE RECEPTOR AGONISTS -STIMULATES NICOTINE RECEPTORS MORE WEAKLY THAN NICOTINE DOES (REDUCING CRAVINGS) -assess for nicotine withdraw wuch as depression, agitation, diarrhea, increased appetite and might EXACERBATE PREEXISTING MENTAL HEALTH DISORDERS -ex; varenicline (think very declined version of nicotine) disclaimer: do not cure them of addiction tendancies or underlying psychological disorders

Nicotine Pathophysiology/ etiology Risk factors Diagnostic tests

Pathophysiology: Effects of nicotine: activate receptors in the brain, carotid body, aortic arch and CNS -causes relaxation and decreased anxiety Can stimulate brain to release dopamine, epinephrine which causes vasoconstriction (this results in increased heart rate, blood pressure and vascular resistance which increases the heart workload)--it relaxes muscles and airways and aids in acute stress response hence why heart rate increases -this increases gastric acid secreation and increases tone and motility of gi (causes nausea and increased risk of vomiting) THINK STIMULATES SOME STRESS RESPONSES AS A FORM OF RELIEF (NAUSEA ACCOMPANIES STRESS) -cns: nicotine increases mental alertness but eventually depresses the responses -think about how it blocks acetylcholine and dopamine which aid in attention******* -because of vasoconstriction: tissue oxygenation can be impaired in areas that are narrowed (atherosclerosis which can increase risk for impaired perfusion) -think about how because of the vasoconstriction an dhardening, can participate in resp disease (bronchiolitis obliterans which obliterates the bronchioles and is called popcorn lung) NICOTINE IS A STIMULANT=SLEEP DEPRIVATION/ INSOMNIA WITHDRAWAL: craving, nervousness, restlessness, irritability, impatience, increased hostility, insomnia, impaired concentration (think about how it blocks the receptors for acetycholine and dopamine), increased appetite (think n/v decreased) and weight gain MANIFESTATIONS: CANCER (MAKES SENSE SINCE IT DAMAGES THE AIRWAYS AND THE CARDIOVASCULAR SYSTEM AND OTHER TISSUES), HEART DISEASE, EMPHYSEMA, HTN AND DEATH -also think about how when chewed it can irritate oral mucosa ETIOLOGY: can be caused by socioeconomic facors (availability, family h/x, coping mecchanisms) -social pressure, alcohol use, lack of edu and age YOUNG ARE MORE LIKELY TO USE (ESPECIALLY BECAUSE THEY ARE LOW-COST) -WHEN THEY HAVE siblings that smoke, when they struggle in school and friends struggle in school (think about how lack of success impairs overall motivation), are not engaged in religious activities or school (incentivices) or uses other substances like marijuana or alcohol. INDIVIDUALS LOWER IN SOCIOECONOMIC STATUS ARE MORE LIKELY BECAUSE OF AVAILABILITY, LACK OF ADEQUATE HEALTH CARE/ EDU ON THE RISKS

Diagnostics for substance abuse:

Positive protein derivative is a frequent finding Hematology: mild anemia, macrocytosis (rbcs larger than normal), folate deficiency, thrombocytopenia, granulocytopenia, abnormal liver function tests, hyperuricemia and elevated triglycerides (think about how this causes increased risk for blood clot formation) -drug abuse screening test -addiction severity index -michigan alchol screening test -recovery attitude -cage-aid test chest x=rays for inhaled substances (indication of emphysema or damage to airways), eval of the heart (since alcohol use can cause an irregularly shaped heart), organ biopsies r/t to damage, urine, saliva, and serum testing for substance metabolites (PPD). -hair testing can be done to assess for drug use within 90 days (hence why chronic marijuana users cant go through detox for drug tests)

teaching about nicotine for pregnant women

Smoke is more likely to cause cleft lip and developmental malformations (increased carbone monoxide which has high affinity=less oxygen for fetus) -smoking can cause tissue damage to baby (lungs an dbrain) -can cause infertility (think about thyroid problems, changes in menses, etc) MORE LIKELY TO DELIVER PRETERM (SIDS, AND DISEASE/ DISABIITY) -1 out of 5 are more likley to have low birth weight -babies born are three times more likely to die from sids -exposed to second hand smoke=weaker lungs -can cause cancers in the unborn child (think of the 40 carcinogens that can damage tissues) damage to placenta=lower birth rate and malformation, can result in changes in cognition an dbehavioral consequences (more aggressive, attention deficits, issues with learning and memory, increased impulsivity and speech and language impairments)

Etiology early and late manifestations Smoking Chewing tobacco

Smoking: Early: vasoconstriction, increased gi motility, increased heart rate and respiratory rate -increased wrinkles in the skin (the constriction of the blood vessels reduces blood flow to the skin--which reduces nutrients provided and causes more wrinkles)*** -yellowing of fingers and nails (radiation--think about how the harmful substances when smoking is in direct contact with fingertips) -decreased sense of smell (think about how it damages the respiratory passageways which results in inflammation and decreased absorption of nutrients=harder to smell) -also think about how the smell is so strong which can further impact ability to smell -restlessness when unable to smoke (think about withdrawal symptoms: agitation, difficulty paying attention, restlessness) LATER MANIFESTATIONS: lung, stomach, bladder, oral or laryngeal cancers (think about increased gastric acid can become corrhosive to the lining, think about how oral cancer can be from damage to tissues when smoking, larynx deals with smoke which makes sense why that causes cancer) COPD, CAD, cancer, popcorn lung, increased mucus production (think about the inflammation that is occuring in the nasal passageway, the airway and the gi tract) Interventions: bronchodilators (help with copd and inflammation in the lower airway), expectorants (t/x cough and congestion caused by common cold, bronchitis and others) --think about how they eventually have a permanent cough and increased mucus production which requires this -oxygen therapy (think about diagnosis of copd and how airways need to be inflated r/t inflammation -coughing and deep breathing (helps move extra mucus out of the lungs through the airways) -positioning (think about how they want to sit in semifowlers to help open the airway) -smoking cessation (prevents further damage) -nicotine replacement therapy -chemotherapy (for cancer in the mucous membranes, gi tract, bladder, respiratory tract, larynx) -supportive care -pain management

abstinence codependence co-occuring disorders cross-tolerance delirium tremens detoxification -dual diagnosis -korsakoff psychosis -physical dependence -polysubstance abuse psychologic dependence sobriety tolerance wrnicke encephalopathy withdrawal syndrome

abstinence: the willing cessation of drgus or alchol codependence: cluster of maladaptive behaviors exhibited bysignificant others of substance abusing indivvudual that serves to enable and protect the abuse at the expense of living full and satisfying life: CHARACTERISTICS: low self esteem, exaggerated sense of responsibility for others, feel guilty when they assert themselves, deny they have a problem (think it is someone else) -tend to become hurt when efforts arent recognized (think they are searching for validation), need approval, do more than their share of work all the time (having trouble saying no--think people pleasers) -fear of being abandoned -hving difficulty identifying feelings -difficulty adjusting to change -poor communication skills -difficulty making decision, offer advice whether it has been asked for or not -feel like victim -use manipulation, shame or guilt to control (think about jennifer how she was fearful of being alone, would manipulate others by bringing guilt into the relationship) co-occurence disorder: when one diagnosis can cause or exceed the other (think about people who have anxiety disorders r/t chronic marijuana use) cross-tolerance: tolerance to one drug results in tolerance to another (think about how opioid users tend to require more anesthesia) Deleirum tremens: usually occurs for 3-5 days and is after 2-3 days of alcohol withdrawal (increased dillusions and vs) Detoxification: helping through withdrawal -dual diagnosis: when multiple conditions are present (coexistence of substance abuse/ dependence and a psychiatric disorder) Korsakoff psychosis: think of kors he got dementia, he drank soo much alchol and had lack of vitamin b1 (thiamine) which results in cognitive deterioraton, confabulation, peripheral neuropathy and myopathy) physical dependence: bodily system needs it (withdrawal symptoms will occur otherwise) polysubstance: using many substances psychologic depdnecne: need for psychoactive drug --think about how its more of the addiction side of need sobriety: havent had alchol or drugs tolerane: increased tolerance=increased dosage wernicke encephalopothy: lesions of cns after exhuastion of b vitamin reserves (anormal eye movments), ataxia and confusion -think about how these lesions eventually result in korskoff psychosis withdrawal: occurs within dependent individuals

Nicotine

affects nicotinic receptors in the brain, the carotid body, aortic arch and CNS -available as cigarettes and cigars or chewed Effects: relaxation and decreased anxiety Effects: -highly toxic Long-term effects: cardiovascular disease (htn, stroke), respiratory disease (emphysema and lung cancer) -think about how it causes hardening of airways and blood vessels -with smokeless tobacco: irritation to oral mucous membranes and cancer (think about how they are rebuilding cells which could be malignant) Withdrawal manifestations: -abstinence syndrome evidenced by irratitability, craving, nervousness, restlessness, anxiety, insomnia, increased appetite, difficulty concentrating, anger and depressed mood

Interventions for nicotine dependence:

avoiding triggers: cup of coffee (is also a stimulant), break at work, phone call, alcoholic beverages, driving (think requires a lot of attention), having fun with friends Diagnostics: psychological assessment which determines level of dependency Signs of dependency: irritation, agitation, insomnia, difficulty concentrating (remember how its a stimulant), depressed mood, increased appetite, frustration, constipation (since nicotine increases gastric motility) -noticeable impacts on the body/ lungs (coughing, gum recession, yellow teeth or yellow fingers, cardiovascular problems, popcorn lung, damage to tissues in mucus membrane, losing sense of smell or taste -failure to participate in social activities -smoking despite current health problems (sign of addiction, disregarding health consequences) STIMULATES RELEASE OF NEUROTRANSMITTERS (HENCE WHY EPINEPHRINE CAUSES SOME OF THE BODILY RESPONSES) AND release of dopamine which promotes pleasure (why stopping cuase irritation and anxiety) assess for: fluid in the lungs (r/t lung cancer and lung disease), other types of cancer (mouth, esophagus, bladder, pancreas, kidney, cervix) -assess for mass amount of weight loss or potential for graves disease -heart and circulatory problems -diabetes (can cause insulin resistance--think damages receptors which leads to type 2) -eye problems (cataracts -infertility and impotence -complications during pregnancy -colds, flu an dother ilnesses (bronchitis, think about excess mucus production and how that has th epotential for damage) -gum disease

Caffeine

cola drinks, coffee, tea, chocolate intended; increased level of alertness intoxication: greater than 250mg (think about how pregnancy cant have more than 200mg) -tachycardia, arrythmias, flushed face, muscle twitching, diuresis (think about how i have to pee a lot), di disturbances, anxiety and insomnia widhrawal: can occur within 24hr -headache,n/v, muscle pain, irritability, inabiity to focus and drowsiness

DIAGNOSES FOR NICOTINE USERS

risk for injury ineffective denial ineffective coping ineffective airway clearance (proper positioning, bronchodilators and mucosal suppressants) INTERVENTIONS: -assess breathing rate, depth and ease of breathing -monitor and document abgs and pulse ox -assess for restlessness and change in loc -evaluate reaction to activity (might have increased dyspnea) -encourage deep breathing an dpursed-lip -admin supplemental oxygen -encourage oral fluids of 2500mL/day to lossen secretions -assess for pain or discomfort and medicate before exercising (encourage patient to walk and cough effectively) -assess secretions (thick may be dehydrated or red might be bleeding) -admin bronchodilators: -improves airflow -expectorants remove mucus -analgesics for pain especially during exercise -anxiety nurse's role: serve as a role model by not smoking provide edu info regarding dangers of smoking -help make smoking socially unacceptable (no-smoking signs), and suggest resources such as hypnosis, lifestyle training and behavior modification STUDIES SHOW TEENS RESPOND BEST TO TV ADS, AND ADS FOR ADULT AUDIENCES HELP -MAJOR SPORTS LEAGUES ASSIST WITH ANTI-TOBACCO ADS

Opioids:

such as heroin, morphine and hydromorphone which is injected, smoked, inhaled and swallowed effects: euphoria and relief from pain (think about how it mimics endorphins Effects of intoxication: -can cause respiratory depression, slowed pulse, slurred speech, impaired memory, maladaptive behavior (impaired judgment) ANTIDOTE: NALOXONE Withdrawal: sweating and rhinorrhea progressing to piloerection (goose bumps), tremors and irritability by severe weakness, diarrhea,fever, insomnia, pupil dilation (fear and dim light--think limbic system is activated again), n/v, pain in muscles and bones and muscle spasms WITHDRAWAL IS NOT LIFE THREATENING (UNLIKE ALCHOL WHICH IS VERY LIFE THREATENING)**

Amphetamines:

taken orally, injected or smoked -effects: increased energy, euphoria (similar to cocaine) intoxication: since its similar to cocaine -overdose causes: tachycardia, elevated bp, impaired judgment, hypervigilance, extreme irritability and psychomotor agitation (think about how they have hallucination) WIthdrawal: lack of energy, depression, craving, fatigue, sleeping NOT LIFE THREATENING