Alcohol & Drugs

Newborn Drug Addiction

• Assume intoxication at birth, not withdrawal
• Before 24 hours of age - baby is intoxicated
• After 24 hours of age - baby is in withdrawal
• Signs of withdrawal: irritability, increased temperature, hyperreflexia, increased bowel sounds, decreased respirations, difficult to arouse
• Examples of withdrawal symptoms from opioid addiction: difficult to console, low core body temperature, exaggerated startle reflex, respiratory depression, seizure risk, shrill high-pitched cry

Alcohol Withdrawal Syndrome (AWS) vs. Delirium Tremens (DT's)

• Every alcoholic goes through AWS after 24 hours
• Only a minority experience DT's
• AWS is not life-threatening; DT's can be fatal
• AWS patients are usually stable and not a danger to themselves or others
• DT patients are usually unstable and a danger to themselves or others

AWS Treatment

• Semi-private room on unit
• Regular diet
• Up ad lib (no activity restrictions)
• Do not restrain

DT's Treatment

• Private room near nurse's station
• NPO or clear liquids
• Restricted bed rest (no bathroom privileges, bedpan/urinal)
• Tranquilizer
• B1 multi-vitamin
• Should be restrained using two-point leather restraints (left arm/right leg or right arm/left leg)

Aminoglycosides

• Powerful, life-saving antibiotics (the "big guns")
• Treat serious, life-threatening, resistant, gram-negative infections
• Examples: streptomycin, cleomycin, tobramycin, gentamycin, vancomycin, clindamycin
• NOT all drugs ending in "mycin" are aminoglycosides (erythromycin, zithromycin, clarithromycin)
• Key symptom of Wernicke-Korsakoff Syndrome (WKS): amnesia with confabulation
• Treatment: give B1 vitamins

NCLEX Tip

• Always answer with the majority

Antabuse (Disulfiram)/Revia

• Treats problem drinking by creating an unpleasant reaction to alcohol
• Onset and duration of effectiveness: >2 weeks
• Patient teaching: avoid all forms of alcohol, including mouthwash, aftershaves, perfumes/colognes, insect repellants, OTC elixirs, alcohol-based hand sanitizers, uncooked icings
• Patients CAN have red wine vinaigrette

Overdose/Withdrawals:

• Is the drug an upper or a downer?
• Overdose: too much of the drug
• Withdrawal: too little of the drug
• Upper overdose looks like downer withdrawal
• Downer overdose looks like upper withdrawal
• Highest priority: respiratory depression/arrest (downer overdose/upper withdrawal) and seizure (upper overdose/downer withdrawal)

Toxic Effects of Aminoglycosides

• Ototoxicity: monitor for hearing loss, tinnitus (ringing in ears), vertigo/dizziness
• Nephrotoxicity: monitor creatinine levels (normal range: 0.6-1.2 mg/dL)
• Frequency of administration: every 8 hours
• Route of administration: IM or IV, do not give PO (except for hepatic encephalopathy and pre-op bowel surgery)

Trough and Peak Levels

• T(trough): lowest drug level
• A(administer)
• P(peak): highest drug level
• Why do we draw TAP levels?: to monitor narrow therapeutic range
• Time table for Trough and Peak Levels:
  • Sublingual: 30 minutes before next dose (trough), 5-10 minutes after drug dissolves (peak)
  • IV: 30 minutes before next dose (trough), 15-30 minutes after drug finished (peak)
  • IM: 30 minutes before next dose (trough), 30-60 minutes after drug is given (peak)
  • SubQ: 30 minutes before next dose (trough) - see diabetes lecture (peak)
  • PO: 30 minutes before next dose (trough) - forget about it (peak)

Psychodynamics of Alcoholism

• #1 Problem: denial
• Treatment: confront denial by pointing out the difference between what the person says and what they do
• Support in loss and grief situations, do not confront (5 stages of grief: denial, anger, bargaining, depression, acceptance)
• Dependency: abuser gets the significant other to do things for them or make decisions for them
• Codependency: significant other derives positive self-esteem from doing things for or making decisions for the abuser
• Treatment for dependency/codependency: set boundaries and enforce them (learn to say no), agree in advance on allowed requests and enforce the agreement, work on self-esteem of the codependent person
• Manipulation: abuser gets significant other to do things that are not in their best interest and are dangerous or harmful
• Treatment for manipulation: set limits and enforce them (easier to treat than dependency/codependency because nobody likes to be manipulated)

Wernicke-Korsakoff Syndrome (WKS)

• Neurological disorder caused by thiamine (B1) deficiency
• Thiamine plays a role in metabolizing glucose to produce energy for the brain

Uppers vs. Downers

• Uppers: Caffeine, cocaine, PCP/LSD, Methamphetamines, ADHD medications
• Downers: everything else that is not an upper

Signs and Symptoms

• Uppers (overdose): tachycardia, hypertension, diarrhea, tremors, belligerence, seizures, exaggerated shrill high-pitched cry, difficult to console, euphoria, hyperreflexia
• Downers (overdose): bradycardia, hypotension, constipation, constricted pupils, flaccidity, respiratory arrest, decreased core body temperature, lethargy, hyporeflexia

NCLEX Priorities

• Maslow’s Hierarchy of Needs:
  1. Physiological needs
  2. Safety
  3. Comfort
  4. Psychological
  5. Social
  6. Spiritual
• All psych patients start as medical-surgical patients: rule out all feasible medical answers before picking psych answers