Alcoholism
#1 problem of abuse is denial
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Denial= refusal to accept the reality of the problem
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Treat denial by confronting it
o Pointing out the different between what they say versus what they do
o “you say this….but you do this…”
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Pronouns:
o Bad “you”
o Good “I”
Loos and grief: DABDA
Denial
Anger
Bargaining
Depression
Acceptance

Don’t confront the denial in grief, support it
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Abuse=confront
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Loss=support
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Figure out if the denial is loss or abuse
#2 problem= Dependency is when the abuser gets the significant other to do something
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Abuser is the dependent
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Codependency= the one being abused gets positive self-esteem from making decisions
or doing things for the abuser
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How to treat set limits and enforce them. Have significant other learn to say NO!
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Must work on self-esteem of codependent person or it will never work
Manipulation: when the abuser gets the significant other to do things for them. The nature of
the act is danger and harmful.
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How is manipulation like dependency?
o No harm dependency/ codependency (wife buying alcohol for husband)
o Harmful manipulated (kid buying alcohol for father)

Depends on legal/illegal

No positive self-esteem issue with manipulation= easier to treat
Wernicke’s/ Korsakoff syndrome: Psychosis induced by vitamin B1 or thiamine deficiency

Wernicke’s= encephalopathy

Korsakoff’s= psychosis

Primary s/s: amnesia with confabulation (making up stories and that they believe)
o Can lose entire decades and make up stories what they did in that time

Redirect the patient, don’t present reality!

It is preventabletake vit B1
o It is arrestable (stop it from getting wotse)
o It is irreversible- about 70%
Antibuse (disulfiram): alcoholism medication

Aversion therapy: makes unpleasant reaction to drinking

How long does it take to get into and out of their system= 2 weeks

Patient teaching: avoid ALL forms of alcohol to avoid N/V, death
o no mouthwash, aftershave, perfume, insect repellants, -elixir (robitussin), hand
sanitizer, un cooked icings (vanilla extract)
o they CAN have red wine vinagerette
overdoses/withdrawals: every abused drug is either an upper or a downer

exception not upper or downer= laxatives in the elderly

uppers: caffeine, cocaine, PCP/LSD, methamphetamine, Adderall
o s/s things go up!!

Euphoria, tachycardia, restlessness, irritability, diarrhea, reflex 3-4, spastic
(need suction)

Downers: heroin, alcohol. Marijuana
o s/s things go down!!

Lethargic, respiratory depression, bradycardia, reflex 1-2 (need ambu bag)

First, ask if upper or downer

Second, ask if it is overdose (too much) or withdrawal (not enough)
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“overdosed on an upper” too much upper= pick up s/s
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“downer and intoxication” too much downer= pick down s/s

Too little downer makes everything go up, too little upper makes everything go down

Upper overdose looks like downer withdrawal

Downer overdose looks like upper withdrawal

Highest priority:
o Respiratory depression/arrest: downer overdose/upper withdrawal
o Seizure: upper overdose/ downer withdrawal
Q: over dose on cocaine what do you expect to see?

Upper s/s: irritability, reflex ¾, inc temp, borborygmi
Overdose on cocaine: need RR above 12, need NARCAN
Drug addiction in newborns:

Always assume intoxication, not withdrawal at birth

After 24 hrs can assume it is in withdrawal
Q: caring for a qualude addicted mom 24 hours after birth

Difficult to console

Low core body temp
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Exaggerated startle reflex
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Respiratory depression
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Seizure risk
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Shrill high pitch cry
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Alcohol withdrawals= 24 hr after (stable; not life threatening)  AWS
o Not dangerous to self / others
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Delirium tremens= 72 hours (unstable, deadly) DTS
o Dangerous to self/ others
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Every alcoholic goes through alcohol withdrawal, only some get DTS

AWS always precedes DTS, however DTS does not always follow AWS
AWS: regular diet, semi private anywhere, up ad lib, no restraints
DTS: NPO/clear liquid (seizure), private room/ near nurse station, restricted bed rest (bed pans),
restrained (vest or 2 point locked leathers, 1 arm and opposite legs)

Both AWS and DTS get antihypertensive pill: everything going up w/ downer withdrawal
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Both get tranquilizer because everything goes up
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Both get multivitamin w/ B1 to prevent WKS
Drugs
Aminoglycosides: powerful antibiotics (the BIG GUNS)

Only use as last resort, because dangerous
**Think**: a mean old nycin= treats serious, life threatening, resistant, gram negative
infections

Infections such as TB, septic peritonitis, pyelonephritis, septic shock, etc.

All aminoglycosides end in mycin= mean old mycin
Drugs that are not aminoglycosides: (all have the word “thro” in it)
o Erythromycin
o Zithromycin
o Clarithromycin
If it has thro in it= throw it off the list for “mean old mycin”
Toxic effects of aminoglycosides:

Mycin think mice think big ears OTOTOXIC
o Monitor: hearing, tinnitus (ringing in ears), vertigo

Human ear is shaped like a kidney nephrotoxicity
o Monitor: 24 hr creatinine (best indicator of kidney function)

#8 fits into kidney  think aminoglycosides toxic to cranial nerve #8 and admin the drug
q8h

Route: IM or IV

Do not give PO because not absorbed
BUT give oral mycins to 

hepatic coma (liver): when ammonia level gets too high
o need to get ammonia level down through oral mycin

pre-op bowel surgery (to clean bowel)

give oral aminoglycoside to sterilize bowel = neomycin and canomycin
**think** who can sterilize my bowl?  NEO KAN!
T: TROUGH- when drug is at its lowest
A: administer
P: PEAK- when drug is at its highest
Why do we do a tap?  for narrow therapeutic window= what works/what kills

would do a tap on Dig= .125-.25

-mycins get TAPs drawn
All routes :
Trough= 30 min before next dose
Sublingual: peak= 5-10 min after drug dissolve
IV: peak= 15-30 min after drug is finished
IM: peak= 30-60 min
SQ: see diabetes lecture*
**tip** pick highest value if two are right within the range