Substance Abuse

psychological dependence

-no apparent signs of physical discomfort individual will have an intense craving and display an overwhelming desire to continue using the substance even if there are obvious negative economic, physical, or social consequences

Abused substances belong to many different chemical classes

-some do no require a prescription (alcohol and nicotine) -Others require prescription and have legitimate medical uses: barbiturates benzodiazepines most opioids -others are illegal: heroin and LSD

The pt has developed an opioid addiction. The nurse anticipates that which of the following medications will be used for opioid withdrawal? 1. Methadone 2. Heroin 3. Diazepam (Valium) 4. Alprazolam (Xanax)

1. Methadone

Which of the following would the nurse find when assessing the pt for use of barbiturates? 1. slurred speech, lack of muscle coordination, decreased respirations. 2. euphoria and irritability 3. increased pain threshold and hallucinations 4. increased blood pressure and respirations.

1. Slurred speech, lack of muscle coordination, decreased respirations

The nurse understands that which of the following substances produces little physical dependence or tolerance? 1. Heroin 2. Marijuana 3. Alcohol 4. Cocaine

2. Marijuana

Addictions depend on multiple, complex, and interacting variables

Addiction: an overwhelming feeling that causes someone to cont. taking drugs -health care providers now recognize its relationship to on drug factors, genetic factors, and environmental factors

Variables affecting an individual's potential for addiction:

Agent or drug of abuse: Cost, availability, dose, method, of admin, speed of onset/duration of effect, and length of drug use User factors: genetic factors (metabolic enzymes, natural tolerance), tendency toward risk-taking behavior, prior experiences with drugs, diseases that may require a scheduled drug Environment: Social/community norms (behaviors accepted w/in a community), role models, peer influences, education opportunities

__________ and ___________ are the two most commonly abused substances

Alcohol and nicotine

CNS stimulants increase the activity of the CNS

Amphetamines Methylphenidate Cocaine Caffeine -all increase alertness by stimulating the CNS -Some substances are available by prescription and are used for: narcolepsy, obesity, and ADD. -Caffeine: available in many consumer products: chocolate, coffee, tea, soft drinks, and coffee ice cream -Cocaine: among the most commonly abused substances in America

The nurse assesses the pt and finds the following: increased heart rate, dilated pupils, elevated body temperature, and sweating. The nurse suspects:

Cocaine use

Tolerance occurs when higher and higher doses of a drug are needed to achieve the initial response.

Cross-tolerance: tolerance resulting from prior exposure to a related drug also results in higher doses needed to produce the same effect

Substance dependence is classified as physical dependence or psychological dependence.

Dependence: an overwhelming need to take a drug on a continual basis physical dependence: occurs when the pt exhibits signs of w/drawal after drug is d/c psychological dependence: an intense craving for the drug

Health care providers strive to remain free of impairment due to alcohol and drug addiction.

Health care providers tend to have problems with addiction bc of the demands of the profession: self-reliant social and professional environments, rotating working shifts, and fatigue -Signs of impairment: frequent mood swings, irritability or depressive symptoms, smell of alcohol on the breath, frequent absences, or pts not receiving proper medications

Marijuana produces little physical dependence or tolerance.

Marijuana: the most commonly abused illegal substance produces less physical dependence than most other drugs and produces less tolerance medical value remains controversial Risks: lung cancer, respiratory problems, and lack of motivation

W/drawal symptoms from cocaine and amphetamines

Mental depression, anxiety, extreme fatigue, hunger

W/drawal results when an abused substance is no longer available.

Pts may experience uncomfortable physical symptoms: withdrawal syndrome -Symptoms vary depending on the specific drug and range from mild to life-threatening

The nurse recognizes that methylphenidate (Ritalin) is classified as a:

Schedule II drug

CNS depressants decrease the activity of the CNS.

Substances that make pts feel relaxed and sleepy, and work by generally slowing neuronal activity in the brain include: sedatives, opioids, and ethyl alcohol Examples of sedatives: barbiturates and benzodiazepines: -many of these substances are controlled bc of abuse potential

Physical dependence differs from psychological dependence in that with physical dependence:

The pt exhibits signs of withdrawal after the drug is d/c

tolerance

a biological condition that occurs when the body adapts to a substance after it is repeatedly administered. over time higher doses are needed to produce the initial effect

narcolepsy

a sleep disorder in which people fall asleep unexpectantly

Nicotine is powerful and highly addictive.

a unique, legal, carcinogenic, highly addictive substance -stimulation of the CNS and increases cardiovascular effects

The two most commonly abused drugs are:

alcohol and nicotine

Hallucinogens cause an altered state of thought and perception similar to that found in dreams.

also called psychedelics; have the ability to produce altered states of consciousness and dreams Include: LSD, mescaline, MDMA (Ecstacy), DOM (STP), MDA (love drug), and ketamine (an anesthetic)

physical dependence

an altered physical condition caused by the nervous system adapting to repeated substance use -opioids, morphine, and heroine produce w/drawal symptoms quickly -alcohol, sedatives, and some stimulants, and nicotine create physical dependence with repeated use

The pt has been diagnosed with a narcotic analgesic overdose. Which of the following symptoms are most likely associated with narcotic analgesic overdose?

excessive sweating, agitation, goosebump chills, increased heart rate

W/drawal symptoms of opioids

excessive sweating, restlessness, dilated pupils, agitation, goosebumps, tremor, violent yawning, incrased heart rate and blood pressure, nausea/vomiting, abdominal cramps and pain, muscle spasms wit kicking movements, weight loss

psychedelics

hallucinogens

The nurse educates the pt on disulfiram (Antabuse), saying that

if alcohol is ingested, the pt may experience shortness of breath, nausea/vomiting, and headache

W/drawal symptoms of barbiturates and other sedative-hypnotics

insomnia, anxiety, weakness, abdominal cramps, tremor, anorexia, seizures, hallucinations, delirium

W/drawal symptoms from benzodiazepines

insomnia, restlessness, abdominal pain, nausea, sensitivity to light and sound, headache, fatigue, muscle twitches

W/drawal symptoms of nicotine

irritability, anxiety, restlessness, headaches, increased appetite, insomnia, inability to concentrate, decreased heart rate and blood pressure

W/drawal symptoms from marijuana

irritability, restlessness, insomnia, tremor, chills, weight loss

opioids

narcotic analgesics

alcohol intoxication

occurs when muscle coordination is lost and mental function is effected

W/drawal symptoms from hallucinogens

rarely observed; dependent on specific drug

designer drugs

synthetic drugs that are created in illegal laboratories solely for making money in illegal drug trafficking

tetrahydrocannabinol (THC)

the ingredient in marijuana responsible for most of the psychoactive properties

addiction

the progressive and chronic abuse of a substance, is an overwhelming feeling that drives someone to use a drug repeatedly despite serious health and social consequences

substance abuse

the self-administration of a drug in a way that one's culture or society vies as abnormal and not acceptable Used to: -increase physical or mental performance -cause a relaxed feeling -change a psychological state -fit it -Has a significant effect on economy, society, and public health

When a pt requires a higher dose of the substance to produce the initial effect, this is known as:

tolerance

cross-tolerance

tolerance developed to one substance bc of previous developed tolerance to a similar substance

Withdrawal symptoms of alcohol

tremors, fatigue, anxiety, abdominal cramping, hallucinations, confusion, seizures, delirium

withdrawal symptoms

uncomfortable symptoms that occur when an addictive agent is stopped

substance dependence

when a person has an overwhelming desire to take a drug and cannot stop Two classifications: physical and psychological