Psych Nursing: Substance Abuse

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Author:
meganfrances
ID:
8813
Filename:
Psych Nursing: Substance Abuse
Updated:
2010-03-02 11:37:25
Tags:
Psyciatric Nursing substance abuse
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Description:
Effects, Withdrawal Sx, Withdrawal Treatment and Other Notes about Commonly Abused Substances
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  1. Alcohol: Effects
    • Incr GABA
    • Decr glutamate
    • CNS depression
  2. Alcohol: Withdrawal Sx
    • Delirium tremens
    • VS changes
    • Diaphoresis
    • GI & CNS AEs;
    • WERNICKE'S syndrome: oculomotor, ataxia, confusion
    • KORSAKOFF'S psychosis: amnesia, intell func spared
    • confabulation
  3. Alcohol: Withdrawal Treatment
    • Benzos: for tremor (can prevent if given early) and VS changes; long-acting like librium, valium, ativan preferred
    • Long-acting CNS depressants: => sedation, decr anxiety
    • Antipsych meds:
    • B12 & Thiamine: may prevent Wernicke and Korsakoff
  4. Alcohol: Abstinence Drugs
    • Naltrexone: opiate antagonists to diminish cravings
    • Acamprosate: can decr EtOH desire
    • Disulfiram: if combo w/ EtOH => REALLY SICK
  5. Opiates: Effects
    • Pleasure
    • Pain relief
    • Physical dependence develops quickly
  6. Opiates: Withdrawal Sx
    Rebound excitability
  7. Opiates: Addiction Treatment
    • Methadone maintenance (AEs = constip, drowsy, sweating, decr libido)
    • LAAM: q other day (methadone alternative)
    • Naltrexone: opiate antags to decr cravings
    • Buprenorphine: 3x/wk
  8. Opiates: What to give in case of emergency opiate intox?
    NALOXONE!!
  9. Benzos: Efects
    • Enhance GABA
    • Cause CNS depression
  10. Benzos: Withdrawal Sx
    • Can begin as long as 8 days after cessation
    • Anxiety rebound
    • Autonomic rebound
    • Sensory excitement
    • Motor excitation
    • Cognitive excitation
  11. Benzos: Addiction Treatment
    Systematic switch to _____
  12. Cocaine: Effects
    • Block reuptake and cause release of DA, NE, SA
    • Sudden burst of mental alertness, incr confidence, sociability
    • 10 to 20 minute rush, then let down
    • **CNS stimulation followed by depression
  13. Cocaine: Withdrawal Sx
    • NE => sleep 10-12 hrs
    • Sleep disturb
    • Suicidality
    • Anhedonia
    • Poor concentration
  14. Cocaine: Fx of incr doses
    • DEATH due to resp failure
    • Restlessness, tremors/agitation
    • Convulsions
    • CNS depression
  15. Ampetamine/Methamphetamine: Effects & Withdrawal
    • A: blocks reup of NE & DA, little SA
    • M: releases EXCESS DA (HIGHLY ADDICTIVE) => binge/crash pattern
    • Higher & higher doses needed to get pleasure => higher the high, lower the low
    • Withdrawal, possible Long-T fx on DA levels
  16. Nicotine: Effects
    • Incr alertness, conc, attn
    • Appetite suppression (mostly stimulant effect)
    • Mood changes: anx, dep, irrit
    • Physiologic changes: sleep dist, HA, GI, appetite
  17. Nicotine: Withdrawal Treatments
    • Replacements: 4-6wks
    • Buproprion
    • Clonidine (2nd line)
  18. Caffeine: Effects & Withdrawal
    • Stim cortex => incr mental acuity
    • Antag of adenosine receptors => prevent adeno from binding => enhance DA actions
    • Withdrawal: HA, fatigue, impair psychomotor, diff conc, yawn, nausea
    • W/ 300mg: tremors
    • W/ 500mg: incr HR etc
  19. Marijuana: Effects
    • THC: active ingredient
    • Triggers DA release
    • Impairs ability to form memories, recall events
    • Long term use can => amotivational sx
  20. Hallucinogens: LSD & Designer Drugs (MDMA/Ecstasy, Foxy, PCP, etc) -- Effects
    • Euporia, dysphoria
    • Confusion, incoordination
    • Impaired judgment, memory
    • Often come to ED in ACUTE PSYCHOSIS (looks like paranoid schizophrenia)
  21. Hallucinogens: Specific Points about LSD, PCP & Amphetamine
    • LSD: uses on bad trip can often be talked down
    • PCP & Amp: more likely to strike out, panic, may harm selves but not feel pain
  22. Inhalants: Effects and Serious Intoxication
    • = CNS depressants
    • Euphoria, sedation, emotional lability, impaired judgment
    • Intoxication: resp dep, stupor, coma, SUDDEN "SNIFFING DEATH", chronic neuro sx
  23. Steroids: Effects
    • Risk of heart probs, sex AEs
    • Incr in irrit & aggression
    • Euphoria, incr energy, sex arousal, mood swings, distractability, forgetful, confusion
  24. PCP: Specifics
    • Low doses: euphoria, floating, heightened emotionality, incoordination, distorted perceptions, feeling outside body
    • High doses: PSYCHOSIS
    • Pts may become violent towards self or others
    • ***The drug is an anesthetic, so PCP-intox pts feel little or no pain

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