Substance Abuse

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Substance Abuse
Nurs 205
Important Terms

Substance Abuse – The use of mood or
behavior altering substances in a
maladaptive manner
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Physical dependence – physiologic
reliance on a substance


Showing symptoms
Psychologic dependence –strong desire
to obtain and use a substance
Important terms

Addiction – strong physical and
psychologic dependence on a drug or
other psychoactive substance

Withdrawal – A substance specific
mental disorder that follows cessation or
reduction of a substance

Habituation
Situation in which a patient becomes
accustomed to a certain drug (devel)
tolerance…. And may have mild
psychological dependence, but will not
show w.drawl symp
 -13:11
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Commonly abused substances

Major Categories
Opioids
 Stimulants
 Depressants

Commonly abused substances

Specific drugs
Alcohol
 Methamphetamine
 Nicotine
 MDMA
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Opioids

Opioid analgesics – synthetic versions
of pain relieving substances.

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
FDA Aprroved
High chance of addiction
Morphine and Codeine

Synthetic derivatives include: hydromorphone,
hydrocodone, oxycodone, and meperidine
Opioids

Diacetylmorphine (heroin)
Produces an intense euphoric state (rush)
followed by a relaxed contented state that
can last several hours.
 Schedule I drug- no currently accerpted
medical use I US, lack of accepted safty,
and high potential for abuse


No FDA
Opioids

Mechanism of action – Blocks
receptors in the central nervous system,
thus blocking the perception of pain.

Diff forms w/ age and reason
Opioids

Indications


Relieve pain, reduce cough, relieve
diarrhea, and induce anesthesia
Contraindications

Drug allergy, pregnancy, severe asthma
Opioids

Adverse effects –

CNS related factors – nausea, vomiting,
diuresis, respiratory depression

Symp

Decreased respiratory rate
Opioids

Management of withdrawal(opioids)
Peak- 1-3 days
 Duration- 5-7 days
 Signs and symptoms- drug seeking,
mydriasis, diaphoresis, rhinorrhea,
lacrimtion, vim, diarrhea, insomnia, Higher
BP & pulse rate
 Medications- Methadone,
Buprenorphine(Subutex), clonidine,
naltrexone(narcan)

Stimulants

Effect of stimulants include: Mood
elevation, reduction of fatigue, and sense
of increased alertness

Drugs include: Amphetamines, Cocaine,
Methylphenidate (Ritalin),
methamphetamines and MDMA
Stimulants
Stimulants are often used in combination
with alcohol and marijuana
 Restrictions on sales of
pseudoephederine
 MDMA

Stimulants

Legal and illegal use of methylphenidate
ADHD
 Study aide- used to prevent or reverse
fatigue and sleep
 Amphetamine- stimulate respiratory center
 Stimulants used to decrese food intake &
treat obesity

Stimulants

Mechanism of Action – Release of
norepinephrine
Increased BP, pulse, and potential for
cardiac arrythmias
 Physical performance enhancements

Stimulants

Indications


Contraindications


ADD, ADHD, narcolepsy, respiratory
stimulant
Allergy, cardiovascular disorders
Adverse effects

Syncope, tremors, irritability
Stimulants

Withdrawal
Peak and duration
 Signs and symptoms
 Treatment

Depressants

Drugs that relieve anxiety, irritability and
tension
Benzodiazepines
 Barbituates
 Marijuana
 Rohypnol
 GHB- gamma hydroxy butyric acid

Depressants

Mechanism of action – inhibits nerve
transmission to the CNS by increasing
the action of GABA.(Gamma Amino
Butyric Acid- Amino Acid in brain that
inhibit nerve transmission in the CNS).
Causes relief of anxiety, sedation and
muscle relaxation
 Also include amnesia, unconsciousness,
and slight blood pressure decreases.

Depressants

Indications


Contraindications


Anxiety relief, sedation, sleep
Allergy, dyspnea, glaucoma
Adverse effects

Drowsiness, loss of coordination,
hallucinations
Depressants

Withdrawal




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Peak: 2-4 Days for short acting drugs, 4-7 days for
long acting drugs
Duration: 4-7 Days for short acting, 7-12 days for
long acting
Signs: Increased activity, agitation, hyperthermia,
delirium, Higher BP Higher Pulse
Symptoms: Anxiety, depression, tremors, suicidal
thoughts
Treatment: Benzodiazepines (Valium)
Alcohol
Widely available – not illegal (if you are
over 21 
 Mechanisms of action – CNS depression
by altering the lipid matrix in the brain.

May decrease respirations
 Moderate doses cause vasodilation

Alcohol

Indications
Drug solvent in medicinal mixtures
 Topical applications- ethanol is a coolant
 Cold and cough treatments
 Cardiovascular benefits- small lamt of
ethonaol…………………….

Alcohol

Adverse Effects


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Long term effects: Neurologic and mental disorders
Teratogenic effects: on fetus
Nutritional and vitamin deficiencies

Wernicke’s encephalopathy


A neruo disorder charac by apathy, drowsy, ataxia,
nystagmus, and opthalmoplegia
Korsakoff’s psychosis

A syndrome of amnesia with confabulation (making up
stories) associated with c/c alcohol abuse,
Alcohol

Mild and Moderate withdrawal


Elevated bp, temp, pulse, insomnia and
agitation
Severe withdrawal

Delirium Tremens
Alcohol

Withdrawal treatment
Cardiac monitoring
 Benzodiazepines
 Restraints
 B vitamin supplementation

Alcohol

Disulfiram – treatment for alcoholism
Alters alcohol metabolism by causing an
acetaldehyde syndrome(17-2)
 Signs and Symptoms effect
Cardiovascular(Chest pain, hypotension),
CNS(Head ache, sweat, confudion),
GI(nausea, vom) and Respiratory
systems(difficulty breathing)

Nicotine

Tobacco dependence

Tolerance


Need more to produce desired effect
Chemicals and poisons in cigarettes

200 known poisons
Nicotine

Mechanisms of Action – Direct
stimulation of autonomic ganglia
Transient stimulation followed by more
persistent depression
 Stimulates the CNS
 Increased heart rate and blood pressure
 Increased GI activity

Nicotine

Indications
No known therapeutic effect
 May be used to reduce cravings


Adverse effects

Tremors, depression, nausea
Nicotine

Withdrawal management


Symptoms – irritability, restlessness, and
decrease in heart rate and blood pressure
Therapies
Transdermal nicotine
 Antidepressants
 Nicotine agonist

Nursing process

Assessment
Relationship between substance abuse and
other health issues
 Specific questions about substance use
– how often and last time
 Lab work – Liver, renal function and HIV
status
 Observation for withdrawal symptoms

Nursing diagnosis
Low self-esteem
 Deficient knowledge of abusive
behaviors
 Risk of injury

Planning and outcome criteria
Patient regains control of ones own
behavior
 Patient undergoes safe withdrawal
 Patient receives referral

Implementation
Interventions are based on the patient’s
specific physical or emotional problems
 Monitor vital signs, neurological status
and mental status

Evaluation

Patient safety

Recovery and rehabilitation phases

Family support
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