chapter 14 - quiz 2

What are the CNS, cardiovascular, sexual and pulmonary effects of stimulants?

*CNS* Stimulation of the CNS results in tremor, restlessness, anorexia, insomnia, agitation, and increased motor activity. Amphetamines, nonamphetamine stimulants, and cocaine produce increased alertness, decrease in fatigue, elation and euphoria, and subjective feelings of greater mental agility and muscular power. Chronic use of these drugs may result in compulsive behavior, paranoia, hallucinations, and aggressive behavior *cardiovascular and pulmonary* Amphetamines can induce increased systolic and diastolic blood pressure, increased heart rate, and cardiac arrhythmias (Publishers Group, 2017). These drugs also relax bronchial smooth muscle. Cocaine intoxication typically produces an increase in myocardial demand for oxygen and an increased heart rate. Severe vasoconstriction may occur and can result in myocardial infarction, ventricular fibrillation, and sudden death. Inhaled cocaine can cause pulmonary hemorrhage, chronic bronchiolitis, and pneumonia. Nasal rhinitis is a result of chronic cocaine snorting. Caffeine ingestion can result in increased heart rate, palpitations, extrasystoles, and cardiac arrhythmias. Caffeine induces dilation of pulmonary and general systemic blood vessels and constriction of cerebral blood vessels. Nicotine stimulates the sympathetic nervous system, resulting in an increase in heart rate, blood pressure, and cardiac contractility, thereby increasing myocardial oxygen consumption and demand for blood flow. Contractions of gastric smooth muscle associated with hunger are inhibited, thereby producing a mild anorectic effect *sexual function* CNS stimulants appear to increase sexual urges in both men and women. Women, more than men, report that stimulants make them feel sexier and have more orgasms. Some men may experience sexual dysfunction with the use of stimulants. For the majority of individuals, however, these drugs exert a powerful aphrodisiac effect

What is the concern with large doses regarding cardiovascular effect? Respiratory Depression? (sedative, hypnotic, and anxiolytics)

*Cardiovascular* - Hypotension may be a problem with large doses. Only a slight decrease in blood pressure is noted with normal oral dosage. High dosages of barbiturates also compromise cardiac contractility and vascular tone, which may result in cardiovascular collapse. Individuals with congestive heart failure are more susceptible to these effects *Respiratory Depression* - Barbiturates are capable of inhibiting the reticular activating system, resulting in respiratory depression, and can be lethal in overdose. In addition, additive effects can occur with the concurrent use of other CNS depressants, also effecting a life-threatening situation

Regarding the central nervous and cardiovascular system, what are the effects?? (opioid)

*Central Nervous system* - All opioids, opioid derivatives, and synthetic opioid-like drugs affect the CNS. Common manifestations include euphoria, mood changes, and mental clouding. Other common CNS effects include drowsiness and pain reduction. Pupillary constriction occurs in response to stimulation of the oculomotor nerve. CNS depression of the respiratory centers within the medulla results in respiratory depression. The antitussive response is due to suppression of the cough center within the medulla. The nausea and vomiting commonly associated with opiate ingestion is related to the stimulation of the centers within the medulla that trigger this response. *Cardiovascular Effects* - In therapeutic doses, opioids have minimal effect on the action of the heart. Morphine is used extensively to relieve pulmonary edema and the pain of myocardial infarction in cardiac clients. At high doses, opioids induce hypotension, which may be caused by direct action on the heart or by opioid-induced histamine release. Although most opioids do not affect cardiac conductivity, "methadone and buprenorphine can prolong QTc, especially when used in patients at risk for QTc prolongation". Abuse of loperamide, an over-the counter opiate-based antidiarrheal, is a growing problem that has been linked to cardiac dysrhythmias and death because at very high doses (needed to achieve other than antidiarrheal effects) this medication is highly cardiotoxic.

What are symptoms of opioid intoxication and withdrawal? Opioid intoxication is treated with what narcotic antagonist????? _______ has been used to suppress opiate withdrawal symptoms. (Important to know). Hint: page 329. This is very critical information.

*Intoxication* - Opioid intoxication constitutes clinically significant problematic behavioral or psychological changes that develop during or shortly after opioid use. Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment. Physical symptoms include pupillary constriction (or dilation due to anoxia from severe overdose), drowsiness, slurred speech, and impairment in attention or memory. Symptoms are consistent with the half-life of most opioid drugs and usually last for several hours. Severe opioid intoxication can lead to respiratory depression, coma, and death. *Withdrawal* -Opioid withdrawal produces a syndrome of symptoms that develops after cessation of or reduction in heavy and prolonged use of an opiate or related substance. Symptoms include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, and insomnia. With short-acting drugs such as heroin, withdrawal symptoms occur within 6 to 8 hours after the last dose, peak within 1 to 3 days, and gradually subside over a period of 5 to 10 days. With longer-acting drugs such as methadone, withdrawal symptoms begin within 1 to 3 days after the last dose, peak between days 4 and 6, and are complete in 14 to 21 days. Withdrawal from the ultra-short-acting meperidine begins quickly, reaches a peak in 8 to 12 hours, and is complete in 4 to 5 days Opiate Intoxication is treated with arcotic antagonists such as naloxone (Narcan) or naltrexone (ReVia, Vivitrol) Clonidine (Catapres) also has been used to suppress opiate withdrawal symptoms

How do barbiturates affect sleep and blood pressure?

*Sleep* - Barbiturate use decreases the amount of sleep time spent in dreaming. During drug withdrawal, dreaming becomes vivid and excessive. Rebound insomnia and increased dreaming (termed REM rebound) are not uncommon with abrupt withdrawal from long-term use of these drugs as sleeping aids *Blood pressure* Hypotension may be a problem with large doses. Only a slight decrease in blood pressure is noted with normal oral dosage.

What are the predisposing factors to substance-related disorders?

*biological factors* 1. genetics 2. biochemical *psychological factors* 1. developmental factors 2. personality factors 3. cognitive factors *sociocultural factors* 1. social learning 2. conditioning 3. cultural and ethnic influences

Alcohol exerts a ____________ effect on the CNS.

*depressant* resulting in behavioral and mood changes

What are the symptoms of intoxication and withdrawal? (stimulants)

*intoxication* 1. amphetamine and cocaine - euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; or impaired judgment. In severe amphetamine intoxication, symptoms may include memory loss, psychosis, and violent aggression. Physical effects include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, cardiac arrhythmias, confusion, seizures, dyskinesias, dystonias, or coma 2. Caffeine - Intoxication from caffeine usually occurs following consumption in excess of 250 mg. Symptoms include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation *withdrawal* 1. caffeine - headache, fatigue, drowsiness, dysphoric mood, irritability, difficulty concentrating, flu-like symptoms, nausea, vomiting, and/or muscle pain and stiffness. 2. nicotine - dysphoric or depressed mood; insomnia; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain. A mild syndrome of nicotine withdrawal can appear when a smoker switches from regular cigarettes to low-nicotine cigarettes

What are the symptoms of cannabis intoxication and withdrawal?

*intoxication* Symptoms include impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment and memory, and social withdrawal. Physical symptoms include conjunctival injection (red eyes), increased appetite, dry mouth, and tachycardia. The impairment of motor skills lasts for 8 to 12 hours and interferes with the operation of motor vehicles. These effects are additive to those of alcohol, which is commonly used in combination with cannabis. Cannabis intoxication delirium is marked by significant cognitive impairment and difficulty performing tasks. Higher doses also impair level of consciousness. *withdrawal* - Irritability, anger, or aggression - Nervousness, restlessness, or anxiety - Sleep difficulty (e.g., insomnia, disturbing dreams) - Decreased appetite or weight loss - Depressed mood - Physical symptoms, such as abdominal pain, tremors, sweating, fever, chills, or headache

List and describe the different phases through which the alcoholic's pattern of drinking progresses.

*phase I. prealcoholic phase* - This phase is characterized by the use of alcohol for its effects in relieving the everyday stress and tensions of life. *phase II. early alcoholic phase* - This phase begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking *phase III crucial phase* - In this phase, the individual has lost control, and physiological addiction is clearly evident *phase IV. chronic phase* - This phase is characterized by emotional and physical disintegration

Define substance intoxication and substance withdrawal.

*substance intoxication* - the development of a reversible syndrome of symptoms following excessive use of a substance *substance withdrawal* - occurs upon abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period

Differentiate between Wernicke's and Korsakoff's. Which is the most serious form of thiamine deficiency in alcoholics??

*wernicke's encephalopathy* - represents the most serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. If thiamine replacement therapy is not undertaken quickly, death will ensue. *korasakoof's psychosis* - is identified by a syndrome of confusion, loss of recent memory, and confabulation in alcoholics. It is frequently encountered in clients recovering from Wernicke's encephalopathy

Cannabis withdrawal symptoms include:

- Irritability, anger, or aggression - Nervousness, restlessness, or anxiety - Sleep difficulty (e.g., insomnia, disturbing dreams) - Decreased appetite or weight loss - Depressed mood - Physical symptoms, such as abdominal pain, tremors, sweating, fever, chills, or headache

What are the traits for fetal alcohol syndrome?

-Abnormal facial features (Fig. 14-1) - Small head size - Shorter-than-average height - Low body weight - Poor coordination - Hyperactive behavior - Difficulty paying attention - Poor memory - Difficulty in school - Learning disabilities - Speech and language delays - Intellectual disability or low IQ - Poor reasoning and judgment skills - Sleep and sucking problems as a baby - Vision or hearing problems - Problems with the heart, kidneys, or bones

Most states consider an individual is legally intoxicated with a blood alcohol level of ___.% Intoxication usually occurs at blood alcohol levels between ___ and ___ mg/dL. Death has been reported at levels ranging from 400 to ____ mg/dL. What are symptoms of alcohol intoxication?

0.08% 100 and 200 mg/dL 700 mg/dL Symptoms of alcohol intoxication include disinhibition of sexual or aggressive impulses, mood lability, impaired judgment, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face

Regarding Alcohol Use Disorder, what are the effects of alcohol on the body? ("Alcohol-itis") 1.Researchers believe neuropathies and myopathies are caused by deficiencies of ___ vitamins. 2. A reddish tinge in the urine is caused by ______, a breakdown of muscle excreted in the urine. 3. Laboratory studies indicate elevations in what enzymes regarding alcoholic myopathy? 4. How does alcohol affect the heart? What cardiac enzymes are changed? What is the treatment? 5. Define steatorrhea, leukopenia and ascites 6. Regarding alcoholic hepatitis, severe cases can lead to cirrhosis or _________ _________. 7. Regarding cirrhosis of the liver, what are the 4 major complications?

1. B vitamins 2. necrotizing myopathy or alcoholic rhabdomyolysis 3. . creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aldolase, and aspartate aminotransferase (AST) 4.The effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition. Laboratory studies may show elevation of the enzymes CPK, AST, alanine aminotransferase (ALT), and LDH. Treatment involves total, permanent abstinence from alcohol. Specific treatment of the congestive heart failure may include rest, oxygen, digitalization, sodium restriction, and diuretics. 5. *steatorrhea* - *leukopenia* - *ascites* - a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal hypertension. The increased pressure results in the seepage of fluid from the surface of the liver into the abdominal cavity 6. hepatic encephalopathy 7. *portal hypertension* - Elevation of blood pressure through the portal circulation results from defective blood flow through the cirrhotic liver. *ascites* - Ascites, a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal hypertension. The increased pressure results in the seepage of fluid from the surface of the liver into the abdominal cavity. *esophageal varices* - are veins in the esophagus that become distended because of excessive pressure from defective blood flow through the cirrhotic liver. As this pressure increases, these varicosities can rupture, resulting in hemorrhage and sometimes death. *hepatic encephalopathy* - This serious complication occurs in response to the inability of the diseased liver to convert ammonia to urea for excretion. The continued rise in serum ammonia results in progressively impaired mental functioning, apathy, euphoria or depression, sleep disturbance, increasing confusion, and progression to coma and eventual death. Treatment includes complete abstention from alcohol; reduction of protein in the diet; reduction of intestinal ammonia using neomycin, rifaximin, or lactulose; and treatment of electrolyte imbalances (sodium and potassium), kidney failure, and infections

Discuss the Chemically Impaired Nurse. 1. What is the value of a peer assistance program? 2. How does one "identify" an impaired nurse? 3. If an impaired nurse is identified in Florida, is it possible for her to continue practice if she successfully passes the impaired nurse program? Is the same true for every state? 4. It is your duty to report! "Any person suspecting impairment of a nurse's ability to provide safe nursing care may report this nurse to the Florida Department of Health (DOH) and/or IPN. Under Florida's Mandatory Reporting Law, all licensed nurses must report any suspected impairment in practice to DOH and/or IPN ."

1. The peer assistance programs strive to intervene early, reduce hazards to patients, and increase prospects for the nurse's recovery. Most states provide either a hot-line number that the impaired nurse or intervening colleague may call or phone numbers of peer assistance committee members, which are made available for the same purpose. Typically, a contract is drawn up detailing the method of treatment, which may be obtained from various sources, such as employee assistance programs, Alcoholics Anonymous, Narcotics Anonymous, private counseling, or outpatient clinics. Guidelines for monitoring the course of treatment are established. Peer support is provided through regular contact with the impaired nurse, usually for a period of 2 years. Peer assistance programs serve to assist impaired nurses to recognize their impairment, to obtain necessary treatment, and to regain accountability within their profession 2. A number of clues for recognizing substance impairment in nurses have been identified (Ellis & Hartley, 2012). Signs of substance impairment are not easy to detect, and they vary according to the substance being used. There may be high absenteeism if the person's source is outside the work area, or the individual may rarely miss work if the substance source is at work. There may be an increase in "wasting" of drugs, increased incidences of incorrect narcotic counts, and a higher record of signing out drugs than for other nurses. Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall usually occur late in the disease process. The person may also have problems with relationships. Some other possible signs are irritability, mood swings, tendency to isolate, elaborate excuses for behavior, unkempt appearance, impaired motor coordination, slurred speech, flushed face, inconsistent job performance, and frequent use of the restroom 3. State boards generally decide each case on an individual basis. A state board may deny, suspend, or revoke a license based on a report of chemical abuse by a nurse. Several state boards of nursing have passed diversionary laws that allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. Some of these state boards administer the treatment programs themselves, and others refer the nurse to community resources or state nurses' association assistance programs

Approximately __% of a single dose of alcohol is absorbed directly and immediately into the bloodstream through the stomach wall. It does not have to be digested.

20

Alcohol withdrawal occurs within ____ to ____ of cessation or reduction in heavy use of alcohol. What are the symptoms of withdrawal? What is alcohol withdrawal delirium?

4 to 12 hours

What three things are important as far as a medication regimen as ordered by a physician? What are the signs of withdrawal?

?? coarse tremor of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood or irritability; transient hallucinations or illusions; headache; and insomnia

Define dual diagnosis

A client has a dual diagnosis when it is determined that he or she has a co-existing substance disorder and mental illness. Treatment is designed to target both problems.

When is someone considered addicted to a substance?

An individual is considered to be addicted to a substance when he or she is unable to control its use, even knowing that it interferes with normal functioning; when more and more of the substance is required to produce the desired effects; and when characteristic withdrawal symptoms develop upon cessation or drastic decrease in use of the substance.

Can barbiturates produce jaundice with large doses?

Barbiturates may produce jaundice with doses large enough to produce acute intoxication

Discuss the Codependent nurse and list treatment considerations for codependency. Not discussed in class but important to know as nurses sometimes are known as "fixers."

Certain characteristics of codependence have been associated with the profession of nursing. A shortage of nurses combined with the increasing ranks of seriously ill patients may result in nurses providing care and fulfilling everyone's needs but their own. Many healthcare workers who are reared in homes with a chemically addicted person or otherwise dysfunctional family are at risk for having unresolved codependent tendencies activated. Nurses who, as children, assumed the "fixer" role in their dysfunctional families of origin may attempt to resume that role in their caregiving professions. They are attracted to a profession in which they are needed, but they nurture feelings of resentment for receiving so little in return. Their emotional needs go unmet; however, they continue to deny that these needs exist. Instead, these unmet emotional needs may be manifested through use of compulsive behaviors, such as work or spending excessively, or addictions, such as to food or substances. Codependent nurses have a need to be in control. They often strive for an unrealistic level of achievement. Their self-worth comes from the feeling of being needed by others and of maintaining control over their environment. They nurture the dependence of others and accept the responsibility for the happiness and contentment of others. They rarely express their true feelings, and they do what is necessary to preserve harmony and maintain control. They are at high risk for physical and emotional burnout. *Treating Codependency* Stage I: The Survival Stage Stage II: The Reidentification Stage Stage III: The Core Issues Stage Stage IV: The Reintegration Stage

Describe "Club drugs"

Club drugs" in this category include gamma-hydroxybutyric acid (GHB) and flunitrazepam (Rohypnol). Like all of the depressants, they can produce a state of disinhibition, excitement, drunkenness, and amnesia. They have been widely implicated as "date rape" drugs, their presence being easily disguised in drinks. They produce anterograde amnesia, the inability to remember events experienced while under their influence.

What physical signs could a nurse observe that may indicate chronic cocaine use?

Euphoria, hyperactivity, restlessness, talkativeness, increased pulse, dilated pupils, rhinitis

Evidence supports that long-term use of marijuana cases what?

Evidence supports that long-term use also impairs cognitive functions of memory, attention, and organization, and these impairments may also contribute to some of the symptoms apparent in amotivational syndrome.

Prenatal exposure to alcohol can cause disorders of the fetus call ________ _________ _________.

Fetal Alcohol Syndrome

What is the only hallucinogenic compound used legally for religious purposes? What is MDMA?

Mescaline is the only hallucinogenic compound used legally for religious purposes today by members of the Native American Church of the United States. It is the primary active ingredient of the peyote cactus. Neither physical nor psychological addiction occurs with the use of mescaline, although, as with other hallucinogens, tolerance can develop quickly with frequent use. MDMA, or ecstasy, is a synthetic drug with both stimulant and hallucinogenic qualities. It has a chemical structure similar to methamphetamine and mescaline, and it has become widely available throughout the world. Because of its growing popularity, the demand for this drug has led to tablets and capsules being sold as "ecstasy" that are not pure MDMA. Many contain drugs such as methamphetamine, PCP, amphetamine, ketamine, and p-methoxyamphetamine (PMA, a stimulant with hallucinogenic properties; more toxic than MDMA). This practice has increased the dangers associated with MDMA use. Because of the rapid increase in recreational use, the DEA imposed an emergency classification of MDMA as a Schedule I drug in 1985

What amount of alcohol is safe in pregnancy?

No amount of alcohol during pregnancy is considered safe, and alcohol can damage a fetus at any stage of pregnancy. Therefore, drinking alcohol should be avoided by women who are pregnant and by women who could become pregnant

Severe withdrawal can cause what symptoms?

Severe withdrawal is most likely to occur when a substance has been used at high dosages for prolonged periods. However, withdrawal symptoms also have been reported with moderate dosages taken over a relatively short duration. Withdrawal symptoms associated with sedative-hypnotics include autonomic hyperactivity (e.g., sweating or pulse rate greater than 100), increased hand tremor, insomnia, nausea or vomiting, hallucinations, illusions, depersonalization, psychomotor agitation, anxiety, grand mal seizures, and delirium

What are symptoms of someone with overdoses from K2 or Spice?

Symptoms include agitation, high blood pressure, shaking and seizures, nausea and vomiting, hallucinations and paranoia, and violent behavior.

What are the symptoms of hallucinogen intoxication?

Symptoms of hallucinogen intoxication develop during or shortly after hallucinogen use. Maladaptive behavioral or psychological changes include marked anxiety or depression, ideas of reference (a type of delusional thinking that all activity within one's environment is "referred to" [about] one's self), fear of losing one's mind, paranoid ideation, and impaired judgment. Perceptual changes occur while the individual is fully awake and alert and include intensification of perceptions, depersonalization, derealization, illusions, hallucinations, and synesthesias. Because hallucinogens are sympathomimetics, they can cause tachycardia, hypertension, sweating, blurred vision, papillary (pupil) dilation, and tremors Symptoms of PCP intoxication are unpredictable. Specific symptoms are dose related and may be manifested by impulsiveness, impaired judgment, assaultiveness, and belligerence, or the individual may appear calm, stuporous, or comatose. Physical symptoms include vertical or horizontal nystagmus, hypertension, tachycardia, ataxia, diminished pain sensation, muscle rigidity, and seizures. Symptoms of ketamine intoxication appear similar to those of PCP General effects of MDMA (ecstasy) include increased heart rate, blood pressure, and body temperature; dehydration; confusion; insomnia; and paranoia. Overdose can result in panic attacks, hallucinations, severe hyperthermia, dehydration, and seizures. Death can occur from kidney or cardiovascular failure

There are two types of toxic reactions from hallucinogens, which are:

The effects of hallucinogens are not always pleasurable for the user. Two types of toxic reactions are known to occur. The first is the panic reaction, or "bad trip." Symptoms include an intense anxiety, fear, and stimulation. The individual hallucinates and fears going insane. Paranoia and acute psychosis may be evident. The second type of toxic reaction to hallucinogens is the flashback. This phenomenon refers to the transient, spontaneous repetition of a previous LSD-induced experience that occurs without taking the substance. The DSM-5 refers to this as hallucinogen persisting perception disorder. Various studies have reported that 15 to 80 percent of hallucinogen users report having experienced flashbacks. These episodes typically last for a few minutes or less.

What is the purpose of AA? AA encourages participants to accept things they can not____

The sole purpose of AA is to help members stay sober. When sobriety has been achieved, members in turn are expected to help other alcoholic persons. The Twelve Steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety. AA encourages participants to accept things they cannot control

Define substitution therapy. What medications are used if the individual has liver disease?

The use of various medications to decrease the intensity of symptoms in an individual who is withdrawing from, or experiencing the effects of excessive use of, substances.

Regarding the GI system, what are the effects? (opioid)

These drugs exert a profound effect on the GI tract. Both stomach and intestinal tone are increased, whereas peristaltic activity of the intestines is diminished. These effects lead to a marked decrease in the movement of food through the GI tract. This is a notable therapeutic effect in the treatment of severe diarrhea. In fact, no drugs have yet been developed that are more effective than the opioids for this purpose. However, constipation and even fecal impaction may be a serious problem for the chronic opioid user

Heavy, long-term cannabis use is also associated with a condition called __________syndrome. What are the symptoms?

amotivational syndrome. amotivational syndrome is defined as lack of motivation to persist in or complete a task that requires ongoing attention

Alcohol interferes with female and male hormones. For women it ______their ability to become pregnant. For men, it may lead to testicular __________. The changes in breasts for a man is called _________.

become pregnant gynecomastia

The most widely used stimulants are _______ and ______.

caffeine and nicotine

How does marijuana affect reproduction? It ______sperm count. In women it _______ovulation, ________the menstrual cycle and causes an alteration in the _________level.

decreases suppresses hormone

With substance -related disorders, what are nursing diagnoses to consider? List rationale and interventions. Is it appropriate to confront the patient regarding their alcohol use?

for diagnoses see table 14-9 pages 316 for rationale and interventions see care plans page 317-320 use confrontation with caring. confrontation interferes with patient's ability to use denial; a caring attitude preserves self-esteem and avoids putting the patient on the defensive.

What is the most potent stimulant? What is "crack.?" What are "uppers" and "downers?" What can inhaled cocaine cause? Nasal rhinitis is a result of chronic cocaine ______.

most potent stimulant is cocaine crack is a street name for cocaine CNS stimulants are uppers and downers are things such as alcohol or sleeping pills snorting

What neurotransmitter is potentiated? (stimulants)

norepinephrine, epinephrine, or dopamine

Discuss Alpha-PVP (AKA "flakka")

synthetic cathinone, alpha-PVP (commonly known as flakka, gravel, $5 insanity, or the zombie drug), whose chemical structure is similar but not identical to bath salts, began to surface in the United States. This drug can be snorted, injected, eaten, and vaporized for inhalation in e-cigarettes, for example. Vaporization is a particularly dangerous route because of its immediate absorption, and deaths have been reported secondary to overdose, suicide, and heart attack. Flakka has been considered a particularly dangerous drug because of reports of violent aggression, homicide, and suicide related to its use. Flakka was considered a significant threat in the United States in 2014 and 2015, but no deaths were reported in 2016 after China (the singular provider of the drug) banned the production and exportation of alpha-PVP

Differentiate between CAGE and the CIWA scale

the CAGE (cut-annoyed-guilty- eye opener) questionnaire used to diagnosis alcoholism. it is a series of yes or not questions. 2 or 3 "yes" answers strongly suggest a problem with alcohol. see box 14-4 page 316. the CIWA (Clinical Institute Withdrawal Assessment of Alcohol Scale) is a withdrawal assessment of alcohol. This assessment for monitoring withdrawal symptoms requires approximately 5 minutes to administer. The maximum score is 67. Patients scoring less than 10 do not usually need additional medication for withdrawal. see box 14-2 page 313-314

Is tolerance possible to hallucinogens?

tolerance for LSD and other hallucinogens develops quickly and to a high degree. In fact, tolerance is complete after 3 to 4 consecutive days of use. Recovery from the tolerance also occurs very rapidly (in 4 to 7 days), so that the individual is able to achieve the desired effect from the drug repeatedly and often

Regarding Opioid addiction, which typical behavior patterns are involved?

two typical behavior patterns 1. The first occurs in the individual who has obtained the drug by prescription from a physician for the relief of a medical problem. Abuse and addiction occur when the individual increases the amount and frequency of use, justifying the behavior as symptom treatment. He or she becomes obsessed with obtaining more and more of the substance and may see several physicians in order to replenish and maintain supplies. 2. The second pattern of behavior associated with addiction to opioids occurs among individuals who use the drugs for recreational purposes and obtain them from illegal sources. Opioids may be used alone to induce the euphoric effects or in combination with stimulants or other drugs to enhance the euphoria or to counteract the depressant effects of the opioid. Tolerance develops and addiction occurs, leading the individual to procure the substance by whatever means is required to support the habit.

Cannabis use usually causes weight __________.

weight loss during withdrawal