Substance abuse

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Substance abuse
2011-11-09 07:05:55
Substance abuse

Substance abuse
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  1. Alcohol
    • Symptoms of withdraw start within 4 to 12 hours of the last intake of alcohol
    • peak after 24 to 48 hours
    • common symptoms nausea, vomiting, tremors, restlessness, and inability to sleep, depressed mood or irritability, increased heart rate, blood pressure, respiratory rate, and temperature, tonic-clonic seizures (may also have illusions)

    Alcohol delirium may occur 2-3 days after cessation of alcohol and may last 2-3 days. this is considered a medical emergency symptoms include severe disorientation, psychotic symptoms (hallucinations), severe hypertension, cardiac dysrhythmias, and delirium. this may progress to death
  2. Detoxification (Medications)
    • Benzodiazepines
    • chlordiazepoxide (Librium)
    • diazepam (Valium)
    • Lorazepam (Ativan)

    • maintain client's vital signs within normal limits
    • decrease in the risk of seizures
    • decrease in the intensity of symptoms

    • Adjunct medications
    • carbamazepine (Tegratol)--decrease seizures
    • clonidine (Catapres)
    • propranolol (inderal)
    • clonidine and propranolol to decrease BP and heart rate
    • propranolol will decrease craving
  3. Disulfiram (Antabuse)
    daily oral medication that is a type of aversion (behavioral) therapy

    • when used with alcohol will cause nausea, vomiting, weakness, sweating, palpitations, and hypotension (acetaldehyde syndrome)
    • this can progress to respiratory depression, cardiovascular suppression, seizures, and death

    TEACH: dangers of drinking alochol, avoid products that contain alcohol (cough syrups, aftershave lotion, mouth wash), wear a medical alert bracelet, encourage the client to participate in a 12-step program, no alochol for 2 weeks after discontinuing
  4. Naltrexone (ReVia)
    pure opioid antagonist that suppresses the craving and pleasurable effects of alcohol (also used for opioid withdrawal)

    assess the client for history of dependent on opioids use of naltrexone will initiate withdrawal syndrome

    Take with meals

    suggest monthly IM injections for clients who have difficulty adhering to medication regimen
  5. Acamprosate (Campral)
    decreases unpleasant effects resulting from abstinence (anxiety, restlessness)

    • diarrhea may result
    • adequate fluid, and rest
    • avoid pregnancy
  6. Methadone (Dolophine) substitution
    Opioid withdrawal
    • replaces the opioid that the patient is addicted to
    • prevents abstinence syndrome
    • remove the need tor the client to obtain illigal drugs
    • used for withdrawal and long-term maintance
    • dependence will be transfered from illegal opioid to metadone

    • TEACH: dose must be slowly tapered during detoxification
    • encourage a 12-step program
    • must be administered from an approved treatment center
  7. Clonidine (Catapres)
    • assists with withdrawal symptoms related to autonomic hyperactivity (diarrhea, nausea, vomiting)
    • does not reduse the craving for opioids

    TEACH:avoid activities that require mental alertness until symptoms of drowsiness subside, encourage patient to chew on gum or hard candy and to sip on small amounts of water suck on ice chips to treat dry mouth
  8. Buprenorphine (Subutex), Buprenorphine combined with Naloxone (Suboxone)
    • used for both detoxification and maintenance
    • decrease feelings of craving and may be effective in maintianing compliance

    TEACH: medication must be administered by a approved treatment center

    administered sublingually
  9. used for long term managment of abstinence from alcohol
    • disulfiram (Antabuse)
    • naltrexone (ReVia)
    • acamprosate (Campral)
  10. Used to treat seizures from alcohol withdrawal
    carbamazepine (Tegretol)
  11. used for alcohol withdrawal
    chlordiazepoxide (Librium)
  12. Used for heroin withdrawal
    Methadone (Dolophine)
  13. Used for nicotine withdrawal
    Bupropoin (Zyban)
  14. Used for alcohol abstinence
    Disulfiram (Antabuse)
  15. Used for morphine overdose
    Naloxone (narcon)