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