Pharmacology of Opiates and Addiction Treatment

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is a common physiological effect associated with opiate use?

Tolerance and dependence (correct)

Decreased risk of physical injury

Increased sensory perception

Reduced risk of HIV transmission

What is the primary purpose of adding naloxone to buprenorphine in the treatment of addiction?

To enhance the effects of opiates

To quicken the onset of withdrawal symptoms

To prevent the abuse of buprenorphine (correct)

To increase the euphoric effects of buprenorphine

Which of the following is a characteristic of hallucinogens?

Cause disturbances of perception, such as hallucinations (correct)

Primary use as a pain reliever

High risk of physical dependence

Reduced risk of addiction

What is a potential risk associated with intravenous (IV) use of illegal opiates?

Transmission of Human Immunodeficiency Virus (HIV) Signup and view all the answers

What is a common long-term approach for managing opiate addiction?

Psychotherapy and support groups Signup and view all the answers

Which of the following is a typical withdrawal symptom associated with both heroin and prescription opioid use?

Watery eyes and runny nose Signup and view all the answers

Approximately how long after the last dose of fentanyl does withdrawal begin?

12-30 hours Signup and view all the answers

Which symptom is specifically listed as being part of fentanyl withdrawal but not heroin or prescription opioid withdrawal?

Uncontrollable leg movements Signup and view all the answers

What is the typical duration of heroin withdrawal symptoms?

5-7 days Signup and view all the answers

Which medication is NOT listed as a treatment for withdrawal from Fentanyl, prescription opioids or heroin?

Supportive care Signup and view all the answers

When do prescription opioid withdrawal symptoms typically peak?

1-3 days Signup and view all the answers

Which of the following best describes how cocaine affects the central nervous system (CNS)?

It acts as a stimulant, increasing CNS activity. Signup and view all the answers

Which of the following best describes the immediate withdrawal treatment for fentanyl, prescription opioids, and heroin?

Supportive care Signup and view all the answers

Which of the following is a common physical effect associated with cocaine abuse?

Tachycardia (rapid heart rate) Signup and view all the answers

If someone is experiencing muscle pain/cramping, tachycardia, and restlessness, which two of the following substances' withdrawal could they be experiencing? Select two.

Heroin Signup and view all the answers

What is a common method of cocaine administration that can cause nasal tissue damage?

Inhalation through the nose (snorting) Signup and view all the answers

What is a distinguishing characteristic of 'crack' cocaine?

It is the crystallized form of cocaine. Signup and view all the answers

During cocaine withdrawal, which of the following symptoms is commonly observed?

Fatigue, vivid dreams, and increased sleep Signup and view all the answers

Which of the following best describes the concept of tolerance in the context of substance use?

The need for increased amounts of a substance to achieve the desired effect. Signup and view all the answers

Compared to cocaine, what is a key difference in the effects of methamphetamine?

It can lead to 'meth mouth' and other oral issues. Signup and view all the answers

What is the primary difference between substance abuse and drug use according to the provided definitions?

Substance abuse is characterized by harmful usage leading to physical or mental damage, while drug use simply indicates consumption of drugs. Signup and view all the answers

What is the primary way in which opiates affect the body?

By stimulating the release of endorphins. Signup and view all the answers

Which of the following is the most accurate definition of 'craving' in the context of substance use?

A strong, overpowering urge to use a drug. Signup and view all the answers

Which of the following is an important factor in predicting success in treatment for cocaine dependence according to the material?

Personal motivation to recover Signup and view all the answers

According to the data provided, which substance has the highest rate of use in Guam compared to the national rate?

Nicotine Signup and view all the answers

What is meant by 'withdrawal' in the context of substance dependence?

The set of symptoms that occur when a person stops using a substance after prolonged, heavy use. Signup and view all the answers

What is the key difference between 'drug dependence' and 'addiction', as defined in the text?

Drug dependence involves needing a drug to function, while addiction is the inability to abstain from using Signup and view all the answers

Based on the provided data, which of the following statements is true regarding overdose deaths?

Overdose deaths in 2017 were considerably higher than they were in 1999. Signup and view all the answers

Which of the following is NOT a key piece of data to collect when assessing substance use?

The number of children involved. Signup and view all the answers

Which of the following is a symptom specifically associated with alcohol withdrawal?

Tactile hallucinations Signup and view all the answers

What is a common characteristic of cocaine withdrawal?

Extreme depression Signup and view all the answers

A patient is experiencing withdrawal including, hand tremors, disorientation, and hypertension. Which substance is most likely the cause?

Alcohol Signup and view all the answers

How does long-term treatment for benzodiazepine dependence typically differ from that of cocaine dependence?

Benzodiazepines are tapered down, while cocaine use involves antidepressants, as needed Signup and view all the answers

Which of the following best describes the onset of alcohol withdrawal symptoms?

Begins within 2 hours from the last drink and can include delirium tremens in 24-48 hours Signup and view all the answers

Which substance is mentioned as commonly used by adolescents with dependence being uncommon?

Inhalants Signup and view all the answers

What is a common symptom differentiating benzodiazepine withdrawal from cocaine withdrawal?

Anorexia Signup and view all the answers

What is the first line of intervention for withdrawal from any of the listed substances?

Supportive symptom management Signup and view all the answers

Which of the following is a common side effect of marijuana use?

Red eyes Signup and view all the answers

What is a potential long-term effect of chronic marijuana use on males?

Decreased sperm production Signup and view all the answers

Which of the following best describes the psychological effect of cannabis?

Euphoria and psychological dependence Signup and view all the answers

Which medication is NOT used during alcohol withdrawal management?

Subutex Signup and view all the answers

What is a key focus when assessing a client with a substance abuse problem?

Their pattern of substance use Signup and view all the answers

Which of the following goals is NOT typically included in the outcome identification for a client with substance abuse issues?

Client becomes addicted to prescribed medications Signup and view all the answers

What is the impact of codependency in the context of addiction?

It enables the addict to continue abusing substances. Signup and view all the answers

Which nursing theory places importance on the nurse understanding the addict as an individual?

Interpersonal theory Signup and view all the answers

Study Notes

Psychiatric Mental Health Nursing - Chapter 17: The Client Who Abuses Chemical Substances

Student Learning Outcomes: Include identifying substance types, defining tolerance, withdrawal, dependence, and addiction, identifying abuse effects and treatment for nicotine, alcohol, cocaine, and opiate abuse, and understanding nursing/medical management of clients with substance addictions.

Guam Substance Use Statistics

Smoking: 1 in 3 Guam adults smoke, a rate significantly higher than the national average (57% higher). Data shows no change in this rate since 2001.
Heavy Drinking: Guam's heavy drinking rate (7.5%) is higher than the national average (5.2%).
Methamphetamine: The rate of methamphetamine use in Guam (5.7%) is higher than the national rate (4.4%).
Marijuana: Guam's marijuana use rate (23.3%) is significantly higher than the national rate (19.7%).

National Statistics: Death from Overdose

1999: 16,849 deaths from overdose
2017: 70,237 deaths from overdose

Definitions

Drug use: Taking a drug
Substance abuse: Harmful use of drugs causing physical or mental damage. Also called Drug Addiction.
Tolerance: Acquired resistance to drug's effects; needing increasing amounts to achieve the same effect.
Withdrawal: Stopping drug use results in specific symptoms; often caused by prolonged heavy substance use.
Drug dependence (Addiction): Inability to control drug use.

Data Collection

Type of substance: The substance being abused.
Frequency of substance use: How often the substance is used.
Amount used: The quantity of substance consumed.
Age at onset of substance abuse: The age when the issue began.
Previous withdrawal symptoms: Prior experiences with withdrawal.
Date of last substance use: The last recorded date of substance use.
Experience of stressful situation: Possible stressors that contributed to substance abuse.

Abused Substances

Stimulant drugs: Increase alertness, aggressiveness, decrease food intake. Examples: Amphetamines, cocaine, crack, PCP, nicotine, caffeine.
Hallucinogens: Alter perceptions and senses. Examples: LSD, mescaline, MDMA (ecstasy).
Central nervous system (CNS) depressants: Decrease CNS function. Examples: Alcohol, opium, morphine, heroin, barbituates, inhalants.

Client Presentation and Priority Nursing Action

A client unresponsive on a park bench is rushed to the ER. The patient exhibits inconsistent heart rate, low blood pressure, shallow breathing, and pinpoint pupils. The priority action is delivering oxygen and administering naloxone (an opioid antagonist).

Risk Factors

Genetics: Family history of addiction is a significant risk factor (50-75%).
Age of onset: Early initiation of addictive substance use increases risk.
Sociocultural: Certain groups (Native Americans) have higher rates of alcohol dependence, while others (Asian groups) have lower rates.

Psychological Risk Factors

Stress
Impulsiveness
Depression
Anxiety
Eating Disorders
Physical/Sexual/Emotional Abuse
Peer influence
Access to addictive substances

Most Utilized Substances in the U.S.

Caffeine
Nicotine
Alcohol
Marijuana
Volatile inhalants
Cocaine
LSD
Prescription opioids

Substance Control Efforts

Potency and risk: Illegal drugs' continued potency increases risk for mental illness and major medical problems.
Chronic use implications: Chronic use leads to short and long-term brain changes, causing mental illnesses like paranoia, depression, anxiety, and hallucinations.

Signs of Abuse

Low tolerance: The need for higher doses to achieve the same effect.
Need for immediate gratification: The desperate desire to use the substance as soon as possible.

Nicotine

Physiological dependency: Nicotine causes physiological dependence
Withdrawal symptoms: Relaxation and excitement, followed by diverse symptoms when use stops.
Difficulty quitting: Nicotine is notoriously difficult to quit.
High relapse rate: Many smokers relapse after attempting to quit.
Nursing prevention involvement: Nurses play a crucial role in all levels of prevention.

Alcohol

Physiological dependency: Alcohol causes physiological dependence.
Chronic disease: Leads to progressive, often fatal diseases.
Cognitive impairment: Affects motor and cognitive function.
Tolerance development: Tolerance develops over time.
Distorted thinking & denial: A distorted view of reality and denial of problems related to alcohol use.
Sedative tolerance: Alcohol users require increasingly higher doses of sedatives.
Delirium tremens (DTs): Withdrawal symptom, characterized by severe symptoms.
Withdrawal: Withdrawal is characterized by diverse symptoms.

Alcoholism, Alcohol Craving, and Blackouts

Blackouts: Form of amnesia where a person has lapses in memory during intoxication.
Addiction challenges: Blackouts lead to work problems, legal issues, and dangerous practices.
Denial: A major obstacle to recovery.

Support Groups

AA: Recovering alcoholics support each other.
Al-Anon: Family members of alcoholics support each other.

Abrupt Withdrawal of Alcohol

Severe symptoms: Abrupt withdrawal can trigger severe symptoms like headaches and clammy skin.

Nursing Care

Open-ended questions: Eliciting essential information, about alcohol and substance use.
Focus on safety: Prioritizing patient safety during the acute stage of substance abuse.
Safe environment: Implementing precautions that prevent falls and seizures.
Adequate nutrition and fluids: Ensuring the patient's nutritional and hydration needs are met.
Low stimulation environment: Creating a calming environment.
Monitoring for covert substance abuse during detox: Observing patterns and behaviors during detoxification.
Supporting the emotional wellbeing: Emotional and professional support is vital to successful treatment.

Treatment

Detoxification: Withdrawal or delirium tremens (DTs), often involving excessive sweating, rapid pulse, tremor, sleep disorders, and vomiting.
Counseling and group support: Important components of treatment planning.
Alcoholics Anonymous (AA): A popular 12-step support group for recovering alcoholics.
Medications: Benzodiazepines (Valium, Ativan), Librium, Tegretol, are often implemented early in treatment to relieve acute withdrawal symptoms.
Alcohol abstinence (help prevent relapse): Naltrexone (ReVia), and Antabuse are used to support the rehabilitation process.

Cocaine

CNS stimulant: Cocaine affects the central nervous system.
Dependency and tolerance: Cocaine creates dependence with tolerance.
Cocaine over food: Lab rats prefer cocaine over food.
Crack: Crystallized cocaine. Its more potent and addictive form.
Cardiac issues: Tachycardia and elevated blood pressure, common symptoms of cocaine abuse.
Overdose symptoms: Seizures, myocardial infarction (MI), stroke, and perforated nasal septum.
Method of use and potential consequences: Snorting cocaine can damage nasal tissues.

Methamphetamine

Home-made labs: readily created in homemade labs.
Prolonged effects: Same as cocaine. Creates both longer-lasting and substantial health effects.
"Meth mouth": Chronic dry mouth, poor oral hygiene, and impulsive sexual behavior are common among users.

Opiates

Poppy seed pods: Derived from poppy seed pods.
Endorphin stimulation: Opiates mimic endorphins, natural pain relievers.
Euphoric properties: Abused for their capacity to induce pleasure and euphoria.
Addiction: Create intense pleasure, misuse which leads to addiction, high risk of HIV from IV injection.

Treatment (Opiates)

Detoxification: Often involves medications.
Methadone or buprenorphine: Long-acting oral opioid medications.
Psychotherapy: Necessary for managing underlying psychological issues.
Twelve-step group: A group focused on self-help.

Buprenorphine

Natural receptor binding: Latches onto natural receptors similar to heroin etc.
Opioid effects blockage: Naloxone blocks opioid effects limiting abuse.
Withdrawal symptom reduction: Effective in reducing physical cravings caused by withdrawal.
Declining deaths and overdoses: Shown effectiveness in decreasing deaths and overdoses

Hallucinogens

Perception changes: LSD and similar drugs cause perception changes; often characterized by hallucinations.
Rare dependence: Drug dependence is relatively uncommon.
Physical injury risk: The use of hallucinogens increases the risk of physical injury.

Substance Use: Street Names, Risk Factors, and Actions

Table: Provides information on specific substances including street names, risk factors, and associated actions.

Substance Use: Signs, Symptoms of Use and Overdose, and Treatment

Table: Summarizes signs/symptoms of substance abuse and overdose, and available treatment options.

Substance Use: Timing of Withdrawal

Table: Explains the timing of withdrawal symptoms for different substances.

Substance Use: Immediate and Long-term Treatment

Table: Outlines immediate and long-term treatment strategies.

Substance Use: Nursing Management

Table: Details specific nursing management strategies for various substances.

Inhalants

Behavioral and psychological changes: Produce behavioral and psychological problems.
Neurological damage: Cause permanent neurological harm
Specific use demographic: Commonly abused by adolescents.

Cannabis (Marijuana)

Euphoria/mental impairment: Produces euphoria and affects cognitive function.
Psychological dependence: Potential for psychological dependency and not uncommon.

Marijuana Side Effects

Red eyes: Inflammation commonly presents.
Rapid pulse: Common physical effects.
Euphoria and drowsiness: Common perceived effects.
Disinterest in school/work: Frequent implication for daily tasks.

Chronic Uses of Marijuana

Memory and learning impairment: Affects memory and learning abilities.
Reproductive effects: Possible reduced sperm and egg production.

Pharmacological Therapy

Alcohol withdrawal: Medications used to help with withdrawal, like Diazepam, Lorazepam, Librium, Tegretol, and Clonidine.
Alcohol Abstinence: Antabuse, ReVia can assist with abstaining from alcohol
Opioid withdrawal: Clonidine, Subutex
Nicotine withdrawal: Wellbutrin, nicotine gum, and patches can aid in managing withdrawal symptoms.

Drug Abuse and Families

Beyond the abuser: Substance abuse's impact extends to families.
Codependence: Enabling the addict's behavior.
Self-help encouragement: Families encouraged to seek self-help to address the abuse.
Medication removal: Removing prescription medications from the home.
Emotional support: Offering support and resources to families affected by drug abuse.

Nursing and Psychological Theory:

Interpersonal approach: Nurses employ interpersonal nursing to view the patient as an individual and establish a strong therapeutic relationship.
Addiction complexity: Understanding that addiction is complex and requires tailored recovery strategies.

Assessment

Client history: Gathering information about the patient's history, including substance abuse.
Pattern of abuse: Evaluating the frequency and quantity of substance usage.
Withdrawal symptoms: Identifying physical and psychological withdrawal symptoms.
Underlying issues: Determining and treating any underlying mental health issues.

Outcome Identification

Client choice: Emphasis on the client's active participation in recovery.
Lifestyle changes: Adoption of a substance-free lifestyle.
Safe withdrawal: Ensuring a safe experience during the detoxification stage.
Substance abstinence: Continuing to remain free of the substance.
Family support: Essential role of family support.
Coping strategies: The ability to handle stress effectively.

Planning/Interventions

Building a rapport: Establish a trustworthy relationship with clients.
Ensuring safety: Monitoring vital signs and neuro status, ensuring safety measures are in place to prevent harm.
Addressing denial: Challenging problematic views clients might have about their addiction.
Assisting through life changes: Guiding clients as they navigate necessary changes to adjust their lifestyle.

Interventions

Safety and environment: Prioritizing safety and ensuring a safe environment conducive to treatment.
Observation: Monitoring withdrawal symptoms, closely observing patients.
Nutrition and fluids: Meeting patients' nutritional and hydration needs.
Low stimulation: Creating an environment with low stimulation to reduce triggers.
Medication administration: Administering medications as directed for support during the withdrawal period.
Relapse prevention education: Educating patients on how to recognize signs/symptoms of relapse to prevent future problems.

Evaluation

Expected outcomes: Evaluating the success of interventions by analyzing whether patients demonstrate the expected outcomes.
Multiple attempts: Recognizing that multiple attempts at recovery might be necessary.
Client readiness: Responding to client needs in a timely and respectful manner.

Post-Op assessment and Priority Nursing Action

Alcohol use history: Knowledge of an individual's history of alcohol use and how much they drink in a given week and weekend.
Priority: Assessing for bradypnea is the priority as it indicates a potential respiratory crisis
Other Considerations: Paranoia is not an immediate priority in this situation; hand tremors and hypothermia are also not as immediately concerning given the current patient evaluation.

Additional Information

The provided documents contain a multitude of substance abuse related data and considerations pertinent to addressing this issue in a healthcare setting.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the physiological effects of opiates and the treatment approaches for addiction. This quiz covers the characteristics, risks, and management of opiate use and withdrawal. Understand the role of medications like naloxone and the symptoms of addiction.