Substance use disorder 2

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  1. Sedative/hypnotic use disorder
    • a profile of substance:
    • barbituarates (phenobarb)
    • non barb hypnotics (sleep aid)
    • antianxiety agents (benzo, valium, ativan)
    • club drugs (rohypnol)
  2. Sedative/hypnotic use disorder
    what they do
    • decrease anxiety, induce sleep, or as an anesthetic by inducing CNS depression
    • the effects of the CNS depressants are addictive with one another and the behavior of the user
    • are capable of producing physiological addiction
    • are capable of producing psychological addiction
    • can be tolerant- one drug lessens the response of the other
    • cross dependent- one drug can prevent withdrawal symptom of the other (librium, ativan, diazpam, can stop withdrawal s/s
  3. Sedative/hypnotic use disorder
    2 patterns of use
    • most widely rx drugs in clinical practice
    • 1. drug rx to treat existing anxiety or sleep disturbance. pt experiences tolerance and requires more to get desired effect. substance seeking behavior is evident by patient, seeking rx from several MD's
    • 2. drugs obtain illegally (usually by youth) and used during recreational gathering to gain euphoria. this intermittent used can lead to extreme levels of tolerance
  4. Sedative/hypnotic use disorder
    effects on the body- general depressant effect body
    • effects on sleep and dreaming (REM rebound)- inhibiting rem sleep
    • respiratory depression- serious ** life threatening
    • CV effects in large doses (hypotension, dec cardiac output, impaired myocardium contraction)
    • hepatic effects (stimulate liver enzymes)- metabolize of system
    • sexual functioning (inc libido, dec performance)
  5. Sedative/hypnotic use disorder
    • with these CNS depressants, effects can range from disinhibition, sexual inapproriate behavior, impaired judgement and aggressiveness, stupor, ataxia to coma and death (w/increasing dosages of the drug)
    • club drugs are CNS depressant which produce disinhibition, excitement, drunkenness, and anterograde (date rape drug) amnesia
  6. Sedative/hypnotic use disorder
    • onset of symptoms depend on the half-life of the drug from which the person is withdrawing
    • severe withdrawal (esp high dosages) from CNS depressants can be life threatening
    • causes automatic hyperactivity with pulse rates over 100, hand tremors, insomnia, hallucinations, psychomotor agitation, anxiety and grand mal seizures
  7. Stimulant Use disorder
    • a profile of the substance
    • amphetamines (adderall) ADHD
    • synthetic stimulants (bath salts, methylone)
    • non-amphetamines stimulants (ritalin, diet pills)
    • cocaine (coke, crack) most potent stimulant from nature
    • caffeine (coffee, tea, cola, chocolate)
    • nicotine (tobacco)
    • incre alertness, dec fatigue
  8. Stimulant Use disorder
    patterns of use
    • effects on the body exciting whole nervous system
    • - cns effects- incre
    • - CV effects- bp inc, tachy, arrythimas
    • - pulmonary effects- relax bronchial smooth muscles
    • - GI and renal effects- dec motility- constipation, no urine- contract bladder sphrincter
    • - sexual functioning- women orgasms, men dysfunction
    • dec fatigue
    • euphoria
    • stronger with muscle powder
    • chronic: paranoia, hallucination, aggressive behavior
  9. Stimulant Use disorder
    • amphetamine and cocaine intoxication produce euphoria, impaired judgement, confusion, changes in vital signs (even coma or death, depending on amt consumed)
    • caffeine intoxication usually occurs following consumption in excess of 250 mg. restlessness and insomniaare the most common symptoms
  10. Inhalant use disorder
    • aliphatic aromatic hydrocarbons found in substance such as fuels, solvents, adhesives, aerosol propellants and paint thinner
    • patterns of use/abuse
    • - amyl nitrate, nitrous oxide are sniffed or huffed (breath in soaked rag) or bagged (inhale substance from plastic bag) often by children or teens (12-17)
    • usage associated with conduct disorder
  11. Inhalant use disorder
    effects on the body
    • CNS effects (neuro damage both CNS and PNS, ototoxicity, parkinsonism and damage to myelin sheaths around certain nerves in brain and PNS- heavy user- slow reactio, ataxia, speech tremor
    • respiratory effects (cough wheeze, pneumonia, death from asphyxiation secondary to plastic inhalation)- emphysema
    • GI effects (pain, n/v)
    • renal system effects (tublar acidosis, hyperkalemia, hematuria, renal failure)
    • rash around mouth
  12. Inhalant use disorder
    • develops during or shortly after use of or exposure to volatile inhalant
    • s/s depend on substance
    • - dizziness, ataxia, muscle weakens
    • - euphoria, excitation, disinhibiton, slurred speech
    • - nystagmus, blurred or double vision
    • - psychomotor retardation, hypoactive reflexes
    • - stupor or coma
  13. Opioid Use disorder
    • opiods of natural origin (opium, morphine, codeine)
    • opiods derivatives (herion, dilaudid, oxycontin, vicodine- make)
    • synthetic opiate- like drugs (demerol, talwin, fentanyl)
  14. Opioid Use disorder
    two patterns
    • 1. rx to treat existing medical problem. abuse happens when pt experiences tolerance and needs more to get effect. substance seeking behavior is evident- multi mds
    • 2. drug obtain illegally
  15. Opioid Use disorder
    effects on body
    • CNS effects- euphoria, mood chx, mental clouding
    • GI effects- constipation
    • CV- hypotension thru direct action of the heart
    • sexual functioning- impotence, decreased libido
  16. Opioid Use disorder
    • symptoms are consistent with half life of most drugs and last for several hrs
    • symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgement
    • severe opioid intox can lead to respiratory depression coma death
  17. Opioid Use disorder
    • from short acting drugs (eg herion)
    • - symptoms occur within 6-8 hours, peak within 1-3 days, and gradually subside in 5-10 days
    • from long acting drug (methadone)
    • - symptoms 1-3 days, peak between 4-6 and subside in 14-21 days
    • from ultra short acting (meperidine)
    • - symptoms begin quickly, peak 8-12 hours and subside in 4-5 days
  18. Opioid Use disorder
    symptoms of opioid withdrawal (abstinence syndrome)
    • dysphoria, muscle aches, n/v, lacrimation or rhinorrhea, pupillary dialtion, piloerection (goose bumps), sweating abdominal cramping, diarrhea, yawning, fever, and insomnia
    • unpleasant but usually not life threatening limited to 7-10 days
  19. Hallucinogen Use disorder
    • naturally occuring hallucinogens (mescaline-peyote cactus & psilocybin- mushrooms & ololiuqui (morning glory seeds)
    • synthetic compounds (LSD, PCP, Ecstasy)
    • the naturally occuring substances are considered poisonous toxins in the way work on the CNS
  20. Hallucinogen use disorder
    patterns of use
    • usually episodic, since cognition and perception markedly effected, user must plan
    • intended use to heighten sense of self and alter perception of color, light, sounds
    • LSD has no addiction or withdrawal but can build tolerance
    • PCP- can have psychological addiction and tolerance building
    • mescaline used by native americans church of USA legally for religious purposes
  21. Hallucinogen use disorder
    more patterns of use
    • most are derivatives of amphetamines such as DOM, STP, MDA, and MDMA (ecstasy)
    • MDMA was placed in the emergency classification of schedule I drug after sudden rise in mid 1980's
    • MDMA has chemical structure of mescaline and amphentamine. can cause hyperthermia, dehydration and seizures
    • tablets of MDMA are not pureĀ  and often contain numerous other agents increasing the effects and dangers of the drugs. death occur from kidney or cardiac failure
  22. Hallucinogen use disorder
    • occurs during or shortly after using it
    • symptoms= perceptual alteration, depersonalization, derealization, slowing of time
    • physical symptoms- tachycardiac, palpitation,chills, tremors, dizzines, elevated blood sugar, sweating, anoerexia
    • symptoms of PCP and ketamine intox include beligerence and assaultiveness and may proceed to seizure or coma
  23. Hallucinogen use disorder
    toxic reactions
    • panic or bad trip- with intense fear of losing mind, anxiety, paranoia, acute pyschosis, ideas of reference
    • flashback tip- which can occur even when no longer on substance. DSM5 calls hallucinogen persisting perception disorder and can occur in 15-50% of users
  24. Hallucinogen use disorder
    • Physiological
    • - n/v
    • - chills, pupil dilation, incre bp, pulse, loss of appetite, insomnia, elev BS, dec respiration
    • Psychological
    • - heighten response to color, light, sounds
    • - distorted vision, slowed time, magnified feelings, paranoia, panic, euphoria, peace, depersonalization, incr libido
  25. Cannabis use disorder
    • mary jane
    • hashish (flower tops of resin)
    • harish oil (boiled and flitered hasish
    • second only to alcohol most widely used drug in us
  26. Cannabis use disorder
    pattern use
    • smoked, eaten (2-3 times amt to get to the same level of smoking
    • highly resembles the effects produced by alcohol and CNS depressants
    • psychological addictive and tolerance have been seen but controversy over whether physical addiction occurs
    • since some research data implicate the possiblity DSM 5 includes cannabis withdrawal as dx
  27. Cannabis use disorder
    effects on the body
    • CV- tachy, orthostatic hypotension
    • respiratory- carcunogen, and tar build up, bronchdilation chronic use causes obstructive airway disease
    • CNS- sensory alterations, time, distance and memory impairment, in higher doses panic and anxiety and shorter term acute psychosis
    • sexual functioning- enhances functions by releasing inhibition
  28. Cannabis use disorder
    • system include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement
    • physical symptoms include conjunctival injection, inc appetite, dry mouth and tacycardia
    • impaired motor skills last 8-12 hrs
  29. Cannabis use disorder
    • occurs upon sensation of cannabis use that has been heavy and prolonged
    • symptoms occur within a week following cessation of use
    • s/s- irritability, anger, aggression, anxiety, sleep disturbances, decreased appetite, depressed mood, stomach pain, tremors, sweating, fever, chills, or h/a
  30. Cannabis use disorder
    medical use
    • dec intraocular pressure in glaucoma
    • incr appetite and reduce nausea during chemo
    • inc brain functioning and memory in alzheimers
    • seizure control
    • boast immune system HIV/AIDS
    • reduce pain, swelling and muscle contractability in certain neuromusclar diseases
  31. application of nursing process
    • nurses- before begin relationship examine own attitudes and personal experiences with substance
    • nurses cannot be empathetic towards pt if they cannot accept who they are and where they are in life
    • nurse- separate pt from behavior and treat with positive regard
  32. application of the nursing process
    • along with physical, psycho-social assessment and mental status exam- pt being tx for SUD should be assess for:
    • level of drug dependency, tolerance
    • full hx of all substances used and last time taken
    • impact of substance use on bio, social, occupational, and family aspect of pt life
    • look at the onset of withdrawal symptoms
    • drug screen results
    • date and time of last use is essential when giving meds that help with withdrawal
  33. nursing assessment more
    assessment tools (various)
    • drug hx and assessment
    • Clinical Institute Withdrawal Assessment of Alcohol Scale CIWA
    • michigan alcholism screening
    • CAGE questionaire
  34. nursing assessment
    • 4 item questionaire thate can inidcate potential problems with alcohol abuse. ans yes or no
    • - have you ever felt you should cut down on your drinking
    • - have people annoyed you by critizing your drinking
    • - have your ever felt bad or guilty about your drinking
    • - have you ever had a drink first thing in the morning to steady your nerve
  35. Dual Dx
    • pt with a SUD and mental dx go somewhere to tx both
    • progam combines special therapies that target both problems. the approach is more supportive and less confrontational than traditional substance abuse programs
    • utilizes both individual and group therapy. relapse prevention, relaxation and cognitive behavioral therapy. acceptance and commitment therapy and fam therapy
  36. nurses dx/outcomes identifications
    • ineffective coping r/t inadequate or undeveloped coping skills and weak ego
    • outcome: pt will be able to demonstrate more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances)
Card Set:
Substance use disorder 2
2016-11-11 23:33:42

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