Drug Abuse I: Basic Considerations EAQ

How does the nurse best describe the schedule class of heroin according to the Controlled Substances Act? A. Able to be dispensed without a prescription B. Able to be refilled only up to 6 months from the date of the original prescription C. Having a high potential for abuse and not being approved for medical use in the United States D. Approved for medical use but having abuse potential and potential for causing physical or psychologic dependence

C. Having a high potential for abuse and not being approved for medical use in the United States Heroin is a Schedule I opioid with a high abuse potential and no approved medical use. Schedule II drugs have a high abuse potential but are approved for medical use. Schedule III drugs can be refilled up to five times within 6 months of the original prescription. Schedule V drugs can be dispensed without a prescription.

A patient is ordered a Schedule III drug. The patient asks the nurse what the schedule designation means. How are schedule drugs classified? A. Risk for toxicity B. Adverse effects C. Potential for abuse D. Pain relief provided

C. Potential for abuse

The nurse knows that which government agency is responsible for carrying out the mandates of the Controlled Substances Act of 1970? A. U.S. Public Health Service B. U.S. Food and Drug Administration C. U.S. Drug Enforcement Administration D. U.S. Department of Health and Human Services

C. U.S. Drug Enforcement Administration

A nurse is preparing a teaching session about factors that contribute to drug abuse. Which information should the nurse include? Select all that apply. A. Social factors B. Drug availability C. High tolerance for frustration D. Vulnerability of the individual E. Difficult procurement of drugs F. Reinforcing properties of drugs

A, B, D, F

Which statement from the patient indicates psychological dependence? A. "I get an intense craving for a particular drug." B. "I experience withdrawal when I don't take the drug." C. "I need increased doses of a drug to get any effect." D. "I depend on another drug because of the effects from the first drug I took."

A. "I get an intense craving for a particular drug." In cases of psychological dependence, the patient feels an intense subjective need or craving for a particular psychoactive drug. Tolerance, which results from regular drug use, can be defined as a state in which a particular dose of drug elicits a smaller response than it did with initial use. As tolerance increases, higher and higher doses are needed to elicit the desired effect. Dependence on another drug because of effects of the primary drug is not a factor for psychological dependence. A withdrawal syndrome is a constellation of signs and symptoms that occurs in physically dependent individuals when they discontinue drug use.

The nurse collects a patient's history of substance abuse on admission to inpatient rehabilitation. The patient reports increasing the drug dosage to get the same effect. What is the patient experiencing? A. Tolerance B. Addiction C. Cross-dependence D. Physiological dependence

A. Tolerance Tolerance results from regular drug use and can be defined as a state in which a particular dose elicits a smaller response than it did with initial use. As tolerance increases, higher and higher doses are needed to elicit desired effects. Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use despite harmful consequences. Physical dependence can be defined as a state in which an abstinence syndrome will occur if drug use is discontinued. Cross-dependence refers to the ability of one drug to support physical dependence on another drug.

The process in which the brain decreases the amount of dopamine produced and the number of dopamine receptors is known as what? A. Tolerance B. Down-regulation C. Drug availability D. Cross-tolerance

B. Down-regulation An important aspect of drug-induced remodeling is a phenomenon known as down-regulation, which serves to reduce the response to drugs. Because drugs release abnormally large amounts of dopamine, the reward circuit is put in a state of excessive activation. In response, the brain (1) produces less dopamine, and (2) reduces the number of dopamine receptors. As a result, responses to drugs are reduced. Drug availability relates to the ready availability of drugs in hospitals and clinics as a major reason for the unusually high rate of addiction among pharmacists, nurses, and physicians. Tolerance is a state in which a particular drug dose elicits a smaller response than it formerly did. Cross-tolerance is a state in which tolerance to one drug confers tolerance to another drug.

A nurse is evaluating the effectiveness of a drug addiction treatment program. Which treatment programs address the complex nature of drug addiction treatment? Select all that apply. A. In the aversion program, threats of incarceration and loss of family support are used to discourage addiction. B. In the comprehensive program, therapy addresses emotional problems, and medications treat drug use. C. In the compassionate care program, treatment centers on group and individual therapy with a focus on becoming whole. D. In the pharmacologic approach program, the director prescribes pharmacologic agents to modify the effects of abused drugs.

B. In the comprehensive program, therapy addresses emotional problems, and medications treat drug use Because addiction is a complex illness that affects all aspects of life, the treatment program must be comprehensive and multifaceted. Techniques with proven success include group and individual therapy directed at resolving emotional problems that underlie drug use, threats and external pressure to discourage drug use, and use of pharmacologic agents to modify the effects of abused drugs. The most effective treatment programs incorporate two or more of these methods. A single focus is ineffective.

The patient who runs out of a prescribed Schedule II drug is upset that an appointment with the healthcare provider is needed in order to obtain a refill. What is the most appropriate response by the nurse? A. "You'll be finished with the medication soon, so don't worry about it." B. "Your provider will want to make sure you aren't abusing your drugs." C. "Insurance companies have specific rules regarding reimbursement." D. "The drug has the potential for psychological or physical dependence."

D. "The drug has the potential for psychological or physical dependence." Assignment to Schedules II through V is based on abuse potential and the potential for causing physical or psychologic dependence. Of the drugs that have medical applications, those in Schedule II have the highest potential for abuse and dependence. The healthcare provider does not have to know how the patient feels; however, a physical assessment is necessary. Insurance companies do have rules regarding reimbursement, but this is not the most appropriate response to make to the patient. The nurse does not know when the patient will be finished with the medication.

A patient who abuses drugs states that it feels so good when using drugs. What transmitter is responsible for this reward effect? A. Heroin B. Nicotine C. Morphine D. Dopamine

D. Dopamine The major transmitter is dopamine. The resultant release of dopamine rewards and reinforces the behavior. Like natural positive stimuli, addictive drugs can also activate the circuit and thus cause dopamine release. In fact, drugs are so effective at activating the circuit that the amount of dopamine released may be 2 to 10 times the amount released by natural stimuli. Morphine, nicotine, and heroin can stimulate dopamine but are not the transmitters responsible for the reward effect.

The nurse prepares to administer phenobarbital. The nurse recognizes that the medication is classified in which schedule? A. Schedule I B. Schedule II C. Schedule III D. Schedule IV

D. Schedule IV

The nurse identifies which appropriate principle of drug addiction treatment based on the guidelines from the National Institute on Drug Abuse (1999)? A. The 12-step program is the best single treatment for drug abuse. B. Medical detoxification is the most important stage of addiction treatment. C. Treatment should focus on drug use, not on other, extraneous life situations. D. The treatment plan must be reassessed continually and modified as indicated.

D. The treatment plan must be reassessed continually and modified as indicated Effective treatment takes time, usually about 3 months or longer; therefore, individual needs will change. The treatment plan should be reassessed and modified regularly. No single treatment is appropriate for all individuals. Treatment must attend to the medical, psychologic, social, vocational, legal, and other problems the patient is experiencing, not just to drug use. Medical detoxification is only the first stage of addiction treatment; by itself, it does little to effect long-term change.