using meds for different reasons than accepted purpose
substance abuse
negative physiologic, physical and psychological reactions; craving for drugs when stopped
Withdrawal
need of drug to avoid withdrawal symptoms
chemical dependence
drug-seeking behaviors; interference with life, relations, and work
addiction
reduction in drug’s effect via persistent use; demands increased dosage
tolerance
use of a substance resulting in maladaptive behavior
intoxication
process of safely withdrawing from a substance
Detoxification
problems associated with addiction tolerance, withdrawal, attempts to stop
substance dependence
continues to function without conscious awareness or memory of actions
blackout episode
after continued heavy drinking, only small amounts can cause intoxication
tolerance break
natural recovery
Spontaneous Remission:
What are the psychologic factors of substance abuse?
People use alcohol as a coping mechanism or to relieve stress and tension, increase feelings of power & decrease psychologic pain.
What are the social & environmental factors of substance abuse?
Influence include cultural, social & availability attitudes, peer behaviors, laws
-Many people view the social use of cannabis, although illegal, as not very harmful.
What are the cultural considerations of substance abuse?
Muslims do not drink alcohol
Native American & Alaska Natives, fifth leading case of death(motor vehicle crashes, alcoholism, cirrhosis, suicide & homicide).
Male Russian have high rated of alcohol abuse, suicide, Smoking, accidents, violence, & cardiovascular disease
Cultural considerations of alcohol
Muslims: no alcohol
Jewish: wine an integral part of religious rites
Some Native American tribes: peyote (hallucinogen)
Japanese: alcohol not a drug
What are the categories of drugs?
Alcohol Sedatives, hypnotics, and anxiolytics Stimulants Cannabis Opioids Hallucinogens Inhalants
considered legally intoxicated for adults operating automobiles
A laboratory blood alcohol concentration(BAC) of 0.08%
Effects of alcohol?
CNS depressant: relaxation/loss of inhibition
Effects of excess: Slurred speech, nystagmus, memory loss, vomiting, decrease level of consciousness( stupor or coma, hypotension, respiratory arrest, peripheral collapse, & death
Chronic alcohol dependence can lead to?
Direct cardiovascular damage, liver damage (ranging from fatty liver to cirrohosis) erosive gastritis & gastointestinal bleeding, acute pancreatitis , sexual dysfunction.
what is the cycle of alcoholism?
1st episode of intoxication—continuing problems with alcohol-first blackout-continued drinking-development of tolerance-tolerance break-continued drinking-functioning becoming affected-periods of abstinence/temporary controlled drinking-escalatin of alcohol intake-more problems-subsequent crises-continuation of cycle
When does withdrawal start to occur?
Onset within 4 to 12 hours after cessation or marked reduction of alcohol intake (see Box 19.2); peaking on second day; complete in about 5 days
What are the s/s of withdrawal?
abdominal cramping; vomiting; tremors; restlessness & inability to sleep; increase heart rate; transient hallucinations or illusions; anxiety; increase blood pressure, respiratory, respiratory rate & temperature; & tonic- clonic seizures
What are some benzodiazepines for safe withdrawal?
Chlordiazepoxide (Librium), Diazepam(Valium) or Lorazepam (Ativan)
What are the complications of alcohol dependence?
impaired memory, CVA, metabolic deficiencies, cardiomyopathy, neurologic disorders, fetal alcohol syndrome
Congestion & venous pathway through increased fluid pressure in the venous pathway through the liver. Signs& symptoms-GI bleed, ascites, encephalopathy, decreased platelets
portal hypertension
dilated, bulging esophageal veins
Esophageal Varices
Alcohol dependence medical management and rehabilitation includes?
- detoxification
- nutritional therapy
- psychotherapy
- drug therapy
- support groups
drug therapy for alcohol dependence includes?
aversion therapy—Disulfiram(Antabuse)
Help’s the patient
cravings for alcohol& decrease the physical & emotional discomfort that occurs first few months
Acamprostate (Campral
alone, with oral overdose rarely fatal; lethargy, confusion
Benzodiazepines ( i.e. Diazepam)
overdose possibly lethal; coma, respiratory arrest, cardiac failure, death; lavage, charcoal and saline cathartic, dialysis
Barbiturate(i.e.Pentobarbital)
cns depressants effects of intoxication
Increased drowsiness & sedation, agitation, slurred speech, uncoordinated motor activity, nystagmus, disorientation, nausea, vomiting, respiratory depression
cns deprssants withdrawal manifestations?
Anxiety, insomnia, diaphoresis, hypertension, possible psychotic reactions, hand tremors, nausea, vomiting, hallucinations, psychomotor agitation, seizure
essential in barbiturates to prevent coma or death
Detoxification via drug tapering
stimulate or excite CNS
cns stimulants
can cause brain damage due to agricultural fertilizer or substances used to make it
Methamphetamine
mild effects of cns stimulants
dizziness, irritability, tremor, blurred vision
severe effects of cns stimulants
hallucinations, seizures, extreme fever, tachycardia, hypertension, possible cardiovascular collapse & death
examples of cns stimulants
amphetamines and cocaine
dysphoria, fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation, depressive symptoms, including suicidal ideation for several days
Withdrawal syndrome
treatment for withdrawal syndrome of cns stimulants?
chlorpromazine (Thorazine)-
antipsychotic controls hallucinations, lowers Bp and relieves nausea
chlorpromazine (Thorazine)-
Onset of withdrawal within hours to several days
Dysphoria, fatigue, unpleasant dreams, insomnia, hyperactivity, increased appetite, psychomotor retardation and agitation
Marked withdrawal- crashing; not treated pharmacologically
CNS stimulants
Withdrawal and Detoxification
Central nervous system (CNS) stimulants: produce extreme pleasure, euphoria, stimulation, increased energy
Cocaine and Methamphetamine Dependence
powder; dissolved; injected
cocaine
purified form of cocaine; mixed with tobacco, marijuana; freebased
crack
combining OTC meds, chemicals; smoked or IV injection
Methamphetamines
effects of intoxication of Cocaine and Methamphetamine Dependence
Mild(dizziness, irritability, tremor, blurred vision :Severe (hallucinations, chest pain, possible cardiovascular collapse & death)
complications of long-term abusers of cocaine and methamphetamines
Anorexia; memory impairment; weight loss, behavioral changes, paranoia, and hallucinations
HTN, seizures, cerebral hemorrhage, MI, respiratory arrest, cocaine bugs;
added risks for methamphetamines include?
contracting HIV, hepatitis B
Medical Management and Rehabilitation for Cocaine and Methamphetamine Dependence
Referral to Cocaine Anonymous; group psychotherapy
Medications: increase, mimic effects of dopamine; antidepressants: relieve dysphoria; amino acid precursors
Excessive use and effects of intoxication of marijuana
Excessive use possibly leads to delirium or cannabis-induced psychotic disorder
Effects of intoxification: ling cancer, chronic bronchitis, increased appetite, dry mouth, tachycardia
defined as an increase in need of opioid dosage to obtain optimum pain relief
opioid dependence
results in increased consumption of opioids to maintain euphoric and erratic mood
opioid addiction
What is The Pasero Opioid- Inducted Sedation Scale
S = sleep, easy to arouse; no action necessary 1 = awake and alert; no action necessary 2= occasionally drowsy but easy to arouse; require no action 3 = frequently drowsy and drifts off to sleep during conversation; decrease he opioid dose 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone
What is the opiate dependence medical management and rehabilitation?
clonidine and methadone
Reality Intended affect: Heightened sense of self & altered perceptions(colors being more vivid while under the influence)
hallucinogens
examples of hallucinogens
ecstasy, PCP, LSD, mescaline
Intoxication from a soaked rag with the compound, from a paper or plastic bag, or directly from the container
Can cause significant brain damage, peripheral nervous system damage, & liver disease
inhalants
Patient can suffer from persistent dementia, psychosis, anxiety,
inhalants
effects of intoxication of nicotine?
increased carbon monoxide blood levels; gastric ulcers; peripheral blood vessel constriction ; overstretched, inelastic alveoli
What is the pharmacologic therapy for nicotine?
Bupropion, Varenicline
substance abuse treatment for alcoholics
Disulfiram (Antabuse) may help deter drinking; Zofran for young males.
reduce cravings and decrease physical and emotional symptoms
Acamprosate (Campral)
used to treat heroin
Methadone , Buprenorphine/ naloxone, Clonidine, or Levomethadyl