Psych Chapter 24: Medications for substance use disorders

MEDS TO SUPPORT WITHDRAWAL FROM OPIOIDS: Clonidine (catapres): intended effects

-Clonidine (catapres) assist with withdrawal effects r/t autonomic hyperactivity (diarrhea, nausea, vomiting) -clonidine (Catapres) therapy does not reduce craving for opioids

MEDS TO SUPPORT WITHDRAWAL FROM OPIOIDS: Methadone (dolophine) intended effects

-Methadone substitution, a PO opioid agonist that replaces opioid to which pt is addicted -methadone administration prevents abstinence syndrome from occurring and removes need for pt to obtain illegal opioids -methadone substitution used for withdrawal and long term maintenance -dependence is transferred from illegal opioid to legal nmethadone

ABSTINENCE: Disulfiram (antabuse) intended effects

-SID med for aversion (behavioral) therapy -If used concurrently with alcohol--> acetaldehyde syndrome will occur (nausea, vomiting, weakness, sweating, palpitations, hypotension) -acetaldehyde syndrome may progress--> respiratory depression, CV suppression, seizures & DEATH!!

Effectiveness of meds may be evaluated via:

-absense of injury -ongoing abstinence from the substance -regular attendance at a 12 step program

ABSTINENCE: naltrexone (vivitrol) nursing interventions

-address pt hx to determine whether pt is dependent on opioids. concurrent use increases risk for pt overedose of opiates -advise pt to take naltrexone (vivitrol) w/ meals to decrease GI distress -suggest monthly IM injections for pt who have difficulty adhering to medication regimen

Benzo's, nursing intervention/education

-administer ATC or PRN -obtain pt baseline v/s -monitor pt v/s and neuro status ongoing basis -provide for seizure precautions (padded side rails, suction equipment at bedside)

MEDS TO SUPPORT WITHDRAWAL FROM OPIOIDS: Buprenorphine (subutex): intended effects

-buprenorphine (subutex) is an agonist-antagonist opioid used for both detox and maintenance -decreases feelings of cravings and may be effective in maintaining compliance

MEDS TO SUPPORT WITHDRAWAL FROM NICOTINE

-bupropion (zyban) -nicotene replacement therapy(nicotine gum, nicotine patch, nicotine nasal spray) -Varenicline (chantix)

Adjunct meds, intended effects

-decrease in seizures (carbamazepine) depression of autonomic response (Decrease BP & HR) (clonidine & propanolol) -decrease in craving (propanalol)

Disulfiram (antabuse) nursing interventions

-inform pt of potential dangers of drinking alcohol -advise pt to avoid any products with alcohol (cough syrup) -encourage pt to wear medical alert bracelt -encourage pt to participate in 12 step program -advise pt of med effects (acetaldehyde syndrome w/ alcohol!) and will persist 2 weeks post discontinuing disulfiram (antabuse)

MEDS TO SUPPORT WITHDRAWAL FROM OPIOIDS: Buprenorphine (subutex): nursing intervention

-inform pt that med must be administered from approved tx center -administer med sublingualy

MEDS TO SUPPORT WITHDRAWAL FROM NICOTINE Varenicline (chantix) nursing interventions

-instruct pt to take med after meal -monitor BP during tx -monitor pt with DM for loss of glycemic control -follow instructions for titration to minimize adverse effects -advise pt to notify MD if nausea, vomiting, insomnia, new-onset depression, or suicidal thoughts occur -contraindicated in pt with chronic depression, serious mental illness, or suicidal ideation

Benzo's, intended effects

-maintain pt v/s WNL -decrease risk of seizures -decrease in the intensity of withdrawal manifestation

ABSTINENCE: Naltrexone (vivitrol) intended effects

-naltrexone (vivitrol) is a pure opioid antagonist that suppresses the craving and pleasurable effects of alcohol (also used for opiod withdrawal)

MEDS TO SUPPORT WITHDRAWAL FROM OPIOIDS: Clonidine (catapres) nursing interventions

-obtain baseline v/s -advise pt to avoid activities that require mental alertness until drowsiness subsides -encourage pt to chew sugarless gum/suck on hard candy/sip on small amt of h20/ ice chips to tx dry mouth

adjunct meds, nursing interventions

-provide for seizure precautions (padded side rails & suction at bedside) -obtain pt baseline v/s and monitor ongoing

MEDS TO SUPPORT WITHDRAWAL FROM NICOTINE Nicotine replacement therapy; nursing interventions

-use of nicotine gum not recommended >6months -advise pt to: -chew gum slowly and intermittently over 30min -avoid eating or drinking 15min prior or during gum -apply nicotine patch to area of clean dry skin each day -avoid using nicotine products while wearing patch -remove patch and notify MD if skin rxn occurs -remove patch prior to MRI's -nasal spray provides pleasurable effects of smoking due to rapid rise in nicotine in blood level -one spray each nostril delivers amt of nicotine of 1 cig -advise pt to follow product instructions for dosage of nasal spray frequency -nasal spray not recommended for pt with disorders affecting upper respiratory system (chronic sinus problems, allergies, asthma) -avoid using nicotine products while pregnant or breastfeeding

MEDS TO SUPPORT WITHDRAWAL FROM NICOTINE Varenicline (chantix) intended effects

-varenicline (chantix) is nicotinic receptor agonist that promotes the release of dopamine to stimulate pleasurable effects of nicotine -reduces cravings for nicotine & severity of withdrawal maintenance -reduces incidence of relapse by blocking the desired effects of nicotine

Opioid withdrawal

-withdrawal manifestation occur within hours to several days after cessation of opioid use -= agitation, insomnia, flulike manifestations, rinorrhea (nasal cavity filled with mucous), yawning, sweating, diarrhea -NOT life threatening, although suicidal ideation may occur

1. A nurse is providing teaching to a client who has alcohol use disorder and a new prescription for carbamazepine. Which of the following information should the nurse include in the teaching? A. "This medication will help prevent seizures during alcohol withdrawal." B. "Taking this medication will decrease your cravings for alcohol." C."This medication maintains your blood pressure at a normal level during alcohol withdrawal." D."Taking this medication will improve your ability to maintain abstinence from alcohol."

1. A. CORRECT: Carbamazepine is used during withdrawal to decrease the risk for seizures. B. Carbamazepine is used to promote safe withdrawal rather than to decrease cravings for alcohol. C. Clonidine or propranolol is used during withdrawal to depress the autonomic response and its effect on blood pressure. D. Carbamazepine is used to promote safe withdrawal rather than abstinence.

2. A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should anticipate prescriptions for which of the following medications to promote long‑term abstinence from alcohol? (Select all that apply.) A. Lorazepam B. Diazepam C. Disulfiram D. Naltrexone E. Acamprosate

2. A. Lorazepam is prescribed for short‑term use during withdrawal. B. Diazepam is prescribed for short‑term use during withdrawal. C. CORRECT: Disulfiram promotes abstinence through aversion therapy. D. CORRECT: Naltrexone promotes abstinence by suppressing the craving and pleasurable effects of alcohol. E. CORRECT: Acamprosate decreases the unpleasant effects resulting from abstinence.

3. A nurse is evaluating a client's understanding of a new prescription for clonidine for the treatment of opioid use disorder. Which of the following statements by the client indicates an understanding of the teaching? A. "Taking this medication will help reduce my craving for heroin." B. "While taking this medication, I should keep a pack of sugarless gum." C."I can expect some diarrhea from taking this medicine." D."Each dose of this medication should be placed under my tongue to dissolve."

3. A. Clonidine is useful during opioid withdrawal. However, it does not reduce cravings. B. CORRECT: Clonidine commonly causes clients to experience dry mouth. Chewing sugarless gum is an effective method to address this adverse effect. C. Clonidine reduces, rather than causes, diarrhea and other withdrawal manifestations related to autonomic hyperactivity. D. Buprenorphine, rather than clonidine, is administered sublingually.

4. A nurse is teaching a client who has tobacco use disorder about the use of nicotine gum. Which of the following information should the nurse include in the teaching? A. Chew the gum for no more than 10 min. B. Rinse out the mouth immediately before chewing the gum. C. Avoid eating 15 min prior to chewing the gum. D. Use of the gum is limited to 90 days.

4. A. The client should chew the gum slowly and intermittently over 30 min. B. The client should avoid drinking 15 min prior to chewing the gum. C. CORRECT: The client should avoid eating or drinking 15 min prior to and while chewing the gum. D. Use of nicotine gum is not recommended for longer than 6 months.

5. A nurse is discussing the use of methadone with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply.) A. "Methadone is a replacement for physical dependence to opioids." B. "Methadone reduces the unpleasant effects associated with abstinence syndrome." C."Methadone can be used during opioid withdrawal and to maintain abstinence." D."Methadone increases the risk for acetaldehyde syndrome." E. "Methadone must be prescribed and dispensed by an approved treatment center."

5. A. CORRECT: Methadone substitution is an oral opioid agonist that replaces the opioid to which the client has a physical dependence. B. CORRECT: Methadone administration prevents abstinence syndrome from occurring. C. CORRECT: Methadone substitution is used for both opioid withdrawal and long‑term maintenance. D. Disulfiram, rather than methadone, places the client at risk for acetaldehyde syndrome if the client consumes alcohol while taking the medication. E. CORRECT: Due to the risk for physical dependence, methadone is required to be prescribed and dispensed by an approved treatment center

MEDS TO SUPPORT WITHDRAWAL FROM NICOTINE Nicotine replacement therapy: intended effects

= pharmaceutical product substitutes for nicotine for cigarettes/chewing tobacco -rate of tobacco use cessation is nearly doubled w/ use of these nicotine replacements

WITHDRAWAL: Adjunct medications:

Carbamazepine (tegretol) clonidine (catapres) propanolol (inderal)

A nurse working in an outpatient clinic is teaching a client who has tobacco use disorder about the use of varenicline. Use the ATI Active Learning Template: Medication to complete this item. EXPECTED PHARMACOLOGICAL ACTION THERAPEUTIC USES NURSING INTERVENTIONS: Identify at least three.

EXPECTED PHARMACOLOGICAL ACTION: Varenicline is a nicotinic receptor agonist that promotes the release of dopamine to simulate the pleasurable effects of nicotine. THERAPEUTIC USES: Varenicline is used to reduce cravings for nicotine as well as the severity of withdrawal manifestations. Varenicline also reduces the incidence of relapse by blocking the desired effects of nicotine. NURSING INTERVENTIONS ● Instruct the client to take medication after a meal. ● Monitor blood pressure during treatment. ● Assess for diabetes mellitus. ● Monitor clients who have diabetes mellitus for loss of glycemic control. ● Advise the client to follow instructions for titration to minimize adverse effects. ● Advise the client to notify the provider if nausea, vomiting, insomnia, new‑onset depression, or suicidal thoughts occur. ● Determine if the client is a commercial truck or bus driver, air traffic controller, or airplane pilot.

MEDS TO SUPPORT WITHDRAWAL FROM NICOTINE: Bupropion (zyban) intended effects & nursing intervention

Intended effects -bupropion decreases nicotine craving and manifestations of withdrawal nursing interventions -tx dry mouth with sugarless gum/hard candy/ice chips/ freq sm amt h20 -advise pt to avoid caffeine & other CNS stimulants to prevent insomnia

ABSTINENCE: Acamprosate (campral) intended effects & nursing intervention

Intended effects: -acamprosate (campral) taken TID to reduce craving of alcohol Nursing intervention: -inform pt that diarrhea may result, advise pt to maintain adequate fluid intake to prevent dehydration. -advise client to avoid use in pregnancy

MEDS TO SUPPORT WITHDRAWAL FROM OPIOIDS:

Methadone (dolophine) Clonidine (catapres) Buprenorphine (subutex)

Abstinence syndrome

When pt abruptly withdraws from a drug on which he is physically dependent

Tobacco (nicotine) withdrawal

abstinence syndrome= irritability, nervousness, restlessness, insomnia, difficulty concentration

WITHDRAWAL: Meds to detox (Benzodiazepines)

chlorodiazepoxide (librium) diazepam (valium) lorazepam (ativan) oxazepam (serax)

MEDS TO SUPPORT WITHDRAWAL FROM OPIOIDS: Methadone (dolophine) nursing interventions

encourage pt to participate in 12 step program inform pt that med must be administered from an approved tx center

alcohol withdrwawl delirium

may occur 2-3 days post cessation of alcohol, may last 2-3 days = medical emergency!! s/s= severe disorientation, psychotic effects (hallucinations), severe HTN, cardiac dysrhythmias, delirium. MAY PROGRESS TO DEATH

alcohol withdrawal

starts within 4-12 hours of last intake, peaks 24-48 hr, then suddenly disappears unless alcohol withdrawal delirium occurs = n/v, tremors, restlessness, inability to sleep, depressed or irritable mood, incrased HR, BP, RR, and temp, tonic-clonic seizures. illusions are common