disease entities & substance profiles
DESCRIPTION
RNSG 2213 SUBSTANCE-RELATED DISORDERS. DISEASE ENTITIES & SUBSTANCE PROFILES. CNS DEPRESSANTS. ALCOHOL Some Facts. 5-7% of Americans are Alcoholics Every alcoholic touches lives of 5 people - PowerPoint PPT PresentationTRANSCRIPT
DISEASE ENTITIES&
SUBSTANCE PROFILES
RNSG 2213 SUBSTANCE-RELATED DISORDERS
CNS DEPRESSANTS
ALCOHOL Some Facts
5-7% of Americans are Alcoholics 5-7% of Americans are Alcoholics Every alcoholic touches lives of 5 Every alcoholic touches lives of 5
people people A leading cause of death: from medical A leading cause of death: from medical
complications, accidents and suicidescomplications, accidents and suicidesFetal Alcohol Syndrome most common Fetal Alcohol Syndrome most common
cause of mental retardation in children cause of mental retardation in children Potentiates other CNS depressantsPotentiates other CNS depressantsAlcoholism underreported in women Alcoholism underreported in women
and older adultsand older adults
Alcohol: IntoxicationMetabolism of alcohol is increased in
heavy drinkersWomen more easily intoxicated than men.Effects: CNS depression and Peripheral
vasodilationDecreased muscle tension, lowered
anxiety level, disinhibition, impaired judgment, sedation
Toxic effects: stupor, unconsciousness (including blackouts), coma, death Alcohol poisoning s/t large amount
consumed in short period of time
Alcohol WithdrawalUsually develops 4-12 hours after
cessation or reduction of alcohol useRebound phenomenon (CNS irritability)
as drug effects wear off: increased anxiety, tension, psychomotor
activitysweats, tremors, tachycardia, increased
temp. and BPnausea, vomiting, diarrhea
Alcohol Withdrawal, cont’dWithdrawal seizures may occur 7-48
hours after cessation or reductionAlcohol withdrawal delirium (also
known as Delirium Tremens or DTs) may occur 48-72 hours following cessation or reduction- agitation, terror, hallucinations
(A Belgian beer is named for this effect)
Alcohol WithdrawalUse of validated withdrawal assessment
rating scale assists in objective description of withdrawal severity
Validated withdrawal assessment scale: Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)
Alcohol: Interventions for WithdrawalSeizure precautions; anticonvulsants for
DT’sSuicide assessment and precautions, if
necessaryMedications: for withdrawal
Benzodiazepines e.g. chlordiazepoxide (Librium), oxazepam (Serax), diazepam (Valium). Administration may depend on withdrawal rating parameters.
Alcohol: Interventions for RecoveryMedications to promote abstinence after
detox.disulfiram (Antabuse) = Aversive Therapy; produces unpleasant or even harmful effects when alcohol is consumed or absorbed in any form (in foods, fluids, cosmetics, medications, etc.).
naltrexone (ReVia) – opiate receptor antagonist-blocks the “high”
acamprosate (Campral) – reduces cravings
Complications of Alcohol Dependence: PhysiologicEsophagitis and gastritis (ulcers,
hemorrhage)Sexual dysfunctionPancreatitisHepatitisLeukopeniaThrombocytopeniaPeripheral neuritis with LE numbness, pain
ALCOHOLISM: COMPLICATIONSCirrhosis-liver becomes fibrotic,
fatty
complications include portal hypertension, ascites, esophageal varices and hepatic encephalopathy)
Complications of Alcoholism due to Thiamine (B1) Deficiency
Korsakoff’s Syndrome: memory loss, amnesia, psychosis
Wernicke’s Encephalopathy: ataxia, muscle weakness, nystagmus and confusion
Often appear together = Wernicke-Korsakoff Syndrome
Result of toxicity + nutritional deficiency
Alcoholic Cardiomyopathy
SEDATIVES, HYPNOTICS AND ANXIOLYTICS BARBITURATES,BENZODIAZEPINES
•Commonly prescribed for sleep, anxiety, muscle spasms, etc.
• Also used illicitly, including• reducing effects of stimulant (esp.
amphetamine) abuse
• if other narcotics not available
•by sexual predators
Sedatives, Hypnotics, or Anxiolytics Abuse and DependencePotentiate each other and alcoholProduce physiological dependenceProduce psychological dependenceCross-tolerance and cross-dependence
between CNS depressants
Sedatives, Hypnotics and Anxiolytics: Dependence
Withdrawal sx.: anxiety, insomnia, nausea, seizures
Overdose and Fatal effects: respiratory depression, coma, death
Interventions for Sedative W/DQuiet, calm environmentMonitor vital signsTaper dose gradually; may take weeks or
monthsSeizure precautions
InhalentsInorganic and organic volatile substances-
usually cheap and readily availableIntoxication: CNS depression- elevated
mood (silly and happy) and excitability, possible sleepiness and confusion
INHALANTS: Abuse and Dependence
Dangerous due to inability to control amount inhaled
Use is associated with CNS damageRespiratory irritation, distress and depressionGI distressMouth ulcersRenal and hepatic damage Death from asphyxiation or suffocation
OPIOIDSOPIUM and HEROINMORPHINECODEINESYNTHETIC MORPHINE
DERIVATIVES, e.g:OXYCODONE (OxyContin)HYDROMORPHONE
((Dilaudid)HYDROCODONE (Vicodin)MEPERIDINE (Demerol)
OPIOID Abuse and DependenceActivate endorphins, reduce pain and anxietyMany routes of use: po, subcut., IM, IV, inhaledIV use is associated with infection, including
HIV and Hepatitis, bacterial endocarditis, and abscesses
May be prescribed or illicitly obtainedHeroin--highest abuse and dependence
potentialCNS effects, including respiratory depressionGI effects
Opioid IntoxicationInitial euphoria Followed by apathy, dysphoria,
psychomotor agitation or retardationPupillary constrictionDrowsiness (“nodding”), slurred speechImpaired judgment, memory and
concentration
Opioid Overdose Pinpoint pupils Clammy skin Respiratory
depression Coma (pupils will
dilate secondary to anoxia)
Death rapidly follows comaTX of Overdose: Narcotic
antagonist: naloxone (Narcan)
Opioid Withdrawal
Very uncomfortable but rarely dangerous:• Dysphoria, anxiety, cravings• Sweating and chills, piloerection• Lacrimation, rhinorrhea• GI distress (anorexia, n/v, cramping, diarrhea)• Muscle aches, bone pain• Restlessness• Tremors• Sleep disturbances
Interventions for Opioid Withdrawal
Primarily supportive careTreat symptomaticallySpecific pharmacotherapy:
clonidine-for n/v/diarrheabuprenorphine (Buprenex) –reduces
pain and discomfort
Example of clinical assessment tool for opiate withdrawal (COWS)
Interventions for Opioid DependenceMedications which Promote Abstinence:Maintenance Pharmacotherapy to reduce
cravings and block the “high” :naltrexone (Trexan, ReVia) methadone –requires enrollment in
maintenance program (federally controlled supervision)
CNS STIMULANTS
CNS STIMULANTS
CocaineAmphetamines: prescribed or illicit
Non-amphetamine stimulantsCaffeineNicotine
STIMULANTS: Intoxication
Various Effects: Increased alertness, arousal and
enduranceDecreased need for food and sleepHR and BP
Stimulants: Neurobiology
Different for different drugs:facilitate norepinephrine, dopamine
activitynicotinic receptor agonists
adenosine receptor antagonists
STIMULANTS: COCAINEIntoxicationBlocks dopamine reuptake esp. in nucleus
accumbens (“pleasure center”)IV or intranasal route; Crack (dilute) form is
smokedRapid Effects and Rapidly metabolized:
Intense euphoriaIncreased mental alertnessIncreased motor and cardiac activityIncreased muscle strength
Stimulants: Cocaine Dependence
Psychological dependence is even more severe than physical dependence; cravings are intense
Stimulants: AMPHETAMINESIntoxication and DependenceOften are prescribed, widely abusedMethamphetamine: Slower metabolic
effects, often mixed with cocaine (cheaper)Routes: IV, intranasal, po, smokedImmediate intense pleasure, lasting high“Crash” occurs as drug effects wear offIntense cravings promote frequent,
repetitive use Damage to teeth, gums
STIMULANTS: WITHDRAWAL AND COMPLICATIONSToxic effects: Hallucinations and paranoid
delusions Severe hypertension, cardiac ischemiaWithdrawal: severe agitation, anxiety,
depression Death from cardiac arrhythmias, seizures,
suicide, respiratory collapse, stroke
STIMULANTS: Treatment of Overdose
• Induce vomiting, diuretics• Administer IM antipsychotic for drug-
induced psychosis/agitation
HALLUCINOGENS
HALLUCINOGENSNatural or synthetic substancesEffects vary from enhancement of sensory
stimuli to loss of reality and hallucinations (Psychotic symptoms)
Effects highly unpredictable
HALLUCINOGENS: CANNABINOLS (MARIJUANA and Related)
Not strictly a hallucinogenMost widely used illegal drug in USActive Ingredient: THC (delta-9-
tetrahydrocannbinolDetectable in blood and urine for up to 4 weeks
Smoked or ingestedHashish-resinous form“Medical marijuana” antiemetic and for chronic
painLegal RX: drobinol (Marinol) Plant form legal in some states
CANNABIS: INTOXICATION
Euphoria, relaxation, disinhibition Alteration in sensory and time perception Increased appetiteAnxiety Tachycardia and Hypotension
CANNABIS: DEPENDENCE
?Physical?Psychological- tolerance
CANNABIS: COMPLICATIONS AND ADVERSE EFFECTSImpaired memory, concentration Apathy and loss of motivation (heavy users)Pulmonary compromise?Reduced female, male hormones and sperm
count?Paranoia and panicFlashbacks
HALLUCINOGENS: LYSERGIC ACID DIETHYLAMIDE (LSD)Semisynthetic-binds to serotonin
receptorsLSD Intoxication:
Episodic and binge use commonEffects last up to 12 hoursSynesthesia experiences-blending of
sensory perceptions
LSD: ADVERSE EFFECTS
Hypertension and tachycardiaAcute psychosis: delusions, paranoiaFlashbacksPanic
HALLUCINOGENS:PHENCYCLIDINE (PCP)•Synthetic anestheticPCP Intoxication:
Euphoria and relaxationPCP Adverse Effects:
Ataxia, vomitingAgitation, violent outbursts, catatoniaSevere elevations in HR and BP
HALLUCINOGENS: LSD and PCPOverdose and Fatal effects; Complications Psychotic break (persisting psychosis)Perceptual distortions cause client to harm
self/suicide or othersCardiac arrestPCP-seizures
HALLUCINOGENS: LSD and PCP
Psychological toleranceFrequent users-cravingsNo physiologic dependence
LSD and PCPTreatment of Acute Intoxication or
OverdoseDiazepam (Valium) for seizures [PCP], paranoia
and panicIM haloperidol (Haldol) for agitation and
aggression
Comparison Chart