Download Drug Abuse

Chapter 36
Care of the Patient with an
Addictive Personality 3
-Drug Abuse
-Chemically Impaired Nurse
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 1
Drug Abuse
• Illegal Drugs


“Street drugs”
Sold to users by illegal drug dealers
• Manufactured without strict controls
• Illegally obtained prescription drugs
• Drugs not approved for use in the United States
• Prescription or Over-the-Counter Drugs

When a person takes drugs for other than
recommended medical reasons or more than
recommended dosage
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 2
Drug Abuse
• Use of drugs for reasons other than medical or in a
dosage greater than recommended, it is considered
drug of misuse or abuse.
• Club drugs


Taken for euphoric effect at parties, concerts, dance
clubs, or all night raves or “trances”
Street drugs
• Chronic abuse

Lead to psychological and/or physiological dependence
• Act on limbic system and cause permanent damage to
that area
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 3
Drug Abuse
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 4
Drug Abuse: Depressants
• Alcohol
• Sedative-hypnotic medications
• Barbiturates: phenobarbital, Seconal
• Benzodiazepines: flurazepam (Dalmane), diazepam
(Valium), flunitrazepam (Rohypnol)
• Opioid analgesics
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 5
Drug Abuse: Depressants (cont’d)
• Sedative-Hypnotics

Barbiturates
• Introduced in the beginning of 20th century
• Used clinically for:

Sedative, hypnotic, anesthetic, and anticonvulsant
effect
• Side effects:

Respiratory depression, rapid tolerance and
dependency
• Untoward effects

Seizure or status epilepticus associated with sudden
withdrawal
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 6
Drug Abuse: Depressants (cont’d)
• Sedative-Hypnotics

Benzodiazepines
• Introduced in the 1960s
• Safer alternatives to barbiturates
• Valium


Most frequently prescribed agent
In 1981, dropped to 6th most prescribed
• Alprozolam (Xanax)

Most prescribed antianxiety in 1990s
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 7
Drug Abuse: Depressants (cont’d)
• Sedative-Hypnotics
• Benzodiazepines
• Flunitrazepam (Rohypnol)
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Misused in sexual assaults
Referred to as “date rape drug”
Mixed into alcoholic beverage and taken
unknowingly
Effects: muscle relaxation and amnesia
Alcohol increases these effects
Combination of the two can be lethal
Not approved in the US
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 8
Drug Abuse: Depressants (cont’d)
• Sedative-Hypnotics
• Benzodiazepines
 GHB (gamma-hydroxybutyrate)
o Euphoric, sedative, body building (anabolic) effects
o Abused as synthetic steroids at fitness centers and
o
gyms
Associated with club drug use and sexual assault
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 9
Drug Abuse: Opioid Analgesics
• Drugs made from opium poppy
• Laudanum
• Opium compound, most popular medication in
Europe in the 1600s
• Heroin
• Most commonly abuse opioid (opiate)
• Snorted, smoked, injected into vein
• Schedule I drug and has no medical use
• Morphine
• Schedule II drugs
• Taken orally or injected
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 10
Drug Abuse: Opioid Analgesics (cont’d)
• Opioids

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Replace natural endorphins in CNS making these
drugs highly addictive
Pain suppressants, act as cough suppressants,
slow peristalsis in the gut, contract bladder mildly
Three types of opioid abusers
• 1. street abusers who get opioids illegally
• 2. medical abusers who misuse prescription opioids

Middle class older adults, health care professionals,
women and those with chronic pain
• 3. methadone abusers
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 11
Drug Abuse: Opioid Analgesics (cont’d)
• Symptoms of acute opioid overdose

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Severe respiratory depression, pinpoint pupils,
stupor or coma, aspiration
Treatment
• Supporting ventilation and naloxone (Narcan)
• Clonidine (Catapress) to reduce withdrawal
• Withdrawal symptoms (morphine and heroin)


Flu like S/Sx and body aches, watery eyes and
runny nose, dilated pupils, vomiting, cramps and
diarrhea, diaphoresis, tachycardia, HTN, chills
and fever
Intensity peaks 2 to 3 days; subsides 5 to 10 days
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 12
Drug Abuse: Opioid Analgesics (cont’d)
• Methadone (Dolophine)
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synthetic opioid to suppress withdrawal
symptoms in morphine or heroin addict
LAAM (Orlaam)
• Long acting compound of methadone
• Associated with better outcome
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 13
Drug Abuse: Stimulants
• Stimulants
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Caffeine: coffee, tea, chocolate, soft drinks
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Nicotine: tobacco

Cocaine: crack (mixed with baking soda and smoked);
powder (snorted)

Amphetamines
• Methylphenidate (Ritalin)
• Methamphetamine (can be made with household
chemicals)
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 14
Drug Abuse: Stimulants (cont’d)
• Caffeine
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Present in food and OTC medications and
appetite suppressants
Chemically related to theophylline used in COPD
treatment
Mild stimulant effect lasting 5 to 7 hours
Withdrawal symptoms
• Headache, fatigue, irritability

Can aggravate anxiety disorders, schizophrenia,
and heart conditions
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 15
Drug Abuse: Stimulants (cont’d)
• Nicotine

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Found in tobacco
Legally sanctioned form of substance abuse
Increased alertness and concentration, appetite
suppression, vasoconstriction
Heavy smokers stop suddenly, withdrawal Sx occur
that include craving, irritability, restlessness,
impatience, hostility, anxiety, confusion, difficulty in
concentration, disturbed sleep, increased appetite,
and decreased HR
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 16
Drug Abuse: Stimulants (cont’d)
• Nicotine

Treatment:
• Nicotine gum, transdermal patch, nasal spray;
antidepressant, bupropion (Zyban)
• 70% of smokers who quit relapse within 1 year
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 17
Drug Abuse: Stimulants (cont’d)
• Cocaine


White powder used as topical, local, regional
anesthetic and as vasoconstrictor
Crack cocaine
• Inexpensive form of cocaine mixed with baking soda
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Powder cocaine is made into lines and snorted
Can be taken intravenously
Rush is within 30 seconds but effect is very short
Crash following the rush:
• Intense craving, agitation, depression
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 18
Drug Abuse: Stimulants (cont’d)
• Cocaine – cont’d
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Strong CNS stimulant
Chronic use erodes nasal septum, cause sinusitis,
and rhinitis
Smoking freebase can cause bodily injury from burns,
and caustic chemicals used cause hemoptysis and
pneumonitis
Overdose:
• Cause cardiorespiratory distress and seizures

Dopaminergic drugs
• Amantadine (Symmetrel) and bromocriptine (Parlodel)
are used to reduce craving
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 19
Drug Abuse: Stimulants (cont’d)
• Cocaine – cont’d

“crack babies”
• Neonates of addicted mothers
• Swaddling or wrapping the baby snugly can be
comforting
• Stimuli like bright lights, loud noises, excessive handling
should be kept to a minimum
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 20
Drug Abuse: Stimulants (cont’d)
• Amphetamines

Analogs (i.e. methylphenidate [Ritalin]) are club drugs
 Powder that can be snorted, smoked or injected
 Methamphetamine are potent amphetamines that
causes dopamine to be released at high levels
 Depletion of dopamine in the brain leads to
parkinsonian-like symptoms
 Hallucinations and paranoia can occur
 Weight loss and malnutrition occurs due to anorexia
 Overstimulation of heart
• Raise in BP, causing vessel damage, leading to heart
attack or stroke
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 21
Drug Abuse: Stimulants (cont’d)
• Amphetamines – cont’d

Treatment for withdrawal
• Determined by severity of symptoms

Chronic abusers exhibit
• Flat affect, forgetfulness, difficulty in concentration due
to irreversible brain damage after detox
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 22
Drug Abuse: Stimulants
Signs and Symptoms
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Mental alertness
Insomnia
Increased concentration
Delirium and hallucination
Drug induced psychosis
Euphoria
Elation
Anxiety and paranoia
Hostility and anger
Anorexia
Dilated pupils
Bruxism
tachycardia
tachycardia
peripheral vasoconstriction
hypertension
bronchodilation
hyper reflexes
twitching and tremors
nausea
diarrhea
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 23
Drug Abuse: Hallucinogens
• Hallucinogens

Natural or synthetic

Alter perception and thinking, effects last 6 to 12 hours

Death can occur due to altered perception that trigger
fight-or-flight leading to cardiac arrest or dangerously
altered thinking like ability to fly

Phencyclidine (PCP), lysergic acid diethylamide (LSD),
3, 4 methylenedioxymethamphetamine (MDMA)
(ecstasy), Ketamine, Mescaline and psilocybin
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 24
Drug Abuse: Hallucinogens (cont’d)
• PCP
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Came to street onto street scene in the 1960s
Addictive with regular use
Low to moderate dose
• Symptoms of generalized numbness and poor
coordination
• Flushing and sweating with rise and BP and pulse

Overdose
• Symptoms of schizophrenic-like psychosis with extreme
violence or attempted suicide

High dose
• Drop in respiration, pulse, and BP, loss of balance,
blurred vision, N&V
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 25
Drug Abuse: Hallucinogens (cont’d)
• LSD
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Came into the street scene in the 1960s
Effects last for more than 12 hours, an LSD experience
is referred to as a “trip”
Symptoms
• Dilation of pupils, sweating, loss of appetite, dry mouth,
sleeplessness, tremors
• Crossover of sensory perception: “hearing colors”, seeing
sounds
• Altered perceptions like melting walls and fear of insanity
and death triggers panic attacks
• Flashbacks, bad “trip,” lingering mental disorders

Does not produce drug seeking behavior; non addictive
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 26
Drug Abuse: Hallucinogens (cont’d)
• MDMA (ecstasy)
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Club drug since the 1980s
Halucinogenic stimulant that is neurotoxic
Serotonin is released until depleted in brain cells
Altered normal growth and development in adolescent
Physical symptoms of muscle tension, bruxism, nausea,
blurred vision, chilling and sweating, faintness
High doses: triggers malignant hyperthermia, leads to
kidney and heart failure
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 27
Drug Abuse: Hallucinogens (cont’d)
• MDMA (ecstasy) – cont’d

Gives user the feeling of being in love
 Heat exhaustion occurs due to physical exertion and
excess fluid loss
 Effects last 6 hours or longer
 Drug craving and psychologic difficulties like
confusion, sleep disturbance, poor concentration and
anxiety
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 28
Figure 36-2
(From National Institute on Drug Abuse, Bethesda, Maryland, 1999, National Institutes of Health.)
Brain scans: non drug-user (left); ecstasy (MDMA) user (right).
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 29
Drug Abuse: Hallucinogens (cont’d)
• Ketamine
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Anesthetic drug for human and veterinary use
Snorted or injected
Produces dreamlike state with hallucinations
Higher doses: amnesia, impaired motor function,
delirium
Used as date rape drug
Fatal respiratory problem may occur
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 30
Drug Abuse: Hallucinogens (cont’d)
• Mescaline and Psilocybin
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Naturally occurring hallucinogens
Mescaline
• Derived from peyote cactus
• Still used by Apache American Indian tribe

Psilocybin
• Comes from a mushroom
• Produce same types of hallucinations and side effects
as LSD
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 31
Drug Abuse
• Cannabis (Canabis sativa)

Marijuana, hemp
 Hashish is a concentrated resin from plant
 THC (delta-9-tetrahydrocannabinol) is the main active
ingredient
 Smoke in a cigarette (joint or nail) or a pipe or “bong”
 Eaten in food like brownies for longer effects
 THC accumulate in the body because it’s fat soluble
and may remain for months
 Antimotivational cannabis syndrome
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 32
Drug Abuse
• Cannabis – cont’d

Effects
• Distorted perception; difficulty in problem solving,
memory and learning; euphoria; uncontrolled laughter;
dreamy or sleepy affect referred to as “stoned”; anxiety
and panic attacks; dry mouth and dry eyes; increased
sexual interest; loss of coordination; increased HR

Chronic users physical effects
• Stuffy nose, bronchitis and asthma, lung cancer,
abnormal sleeping and eating patterns, decreased
testosterone and sperm count, decreased immune
function

Craving and drug seeking behavior
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 33
Drug Abuse
• Cannabis – cont’d

Psychologic effects
• Panic reactions, hallucinations, delusions from acute
toxicity
• Organic brain syndrome and amotivational cannabis
syndrome

Amotivational cannabis syndrome
• Decreased goal-directed activities, abrupt mood swings,
abnormal irritability and hostility, apathy, and decline of
personal grooming
• Depression, paranoia, suicidal thoughts
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Slide 34
Drug Abuse
• Inhalants
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Volatile chemicals that alter thinking and feeling
Drugs of abuse in ages between 14 and 17
Glue, lighter fluid, cleaning fluids, paint
Rates of use are higher among minorities such as
Mexican-Americans and American Indians
Males > females
Huffing
• Solvents placed on a cloth or in a plastic bag and
passed around
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Slide 35
Drug Abuse
• Inhalants – cont’d

Effects
• Euphoric or intoxicated feeling, auditory hallucinations,
feeling weightless or floating on air, ataxia, slurred
speech, wheezing, cough, photophobia, irregular
heartbeat, anorexia and nausea
• High dose: respiratory arrest and irreversible damage to
brain, kidneys

Fatalities
• Butane, adhesive solvents, cleaning fluid solvents
containing toluene
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Slide 36
Chemically Impaired Nurses
• Thirty-seven states have programs that offer
•
•
•
•
chemically impaired nurses treatment and
rehabilitation in order to keep their license.
Impaired nurses become illogical and careless in
charting and performance of duties.
They may steal medication and report spillage.
Put patients at risk for injury, medication error,
slower recovery
Nursing colleagues must report suspicious behavior
for healing process to begin
•
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Slide 37
Chemically Impaired Nurses
• Peer assistance programs are usually under the
jurisdiction of the state board of nursing.

Contract agreement
• This requires the nurse to undergo treatment and
monitoring for a certain period of time.
• Confidentiality is maintained but employers must be
notified of a nurse in the program
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Slide 38
Chemically Impaired Nurses
• Healthcare Integrity and Protection Data Bank
(HIPDB)

Nursing boards and health agencies are required to
report any actions against a health care provider,
supplier, or practitioner.

This provides incentive for nurse to enter treatment and
avoid any final action that would be reported to the HIPDB
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 39
Chemically Impaired Nurses
• Warning Signs

Alcoholism
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•
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Irritability, mood swings
Elaborate excuses for behavior
Unkempt appearance
Blackouts (temporary amnesia)
Impaired motor coordination, slurred speech, flushed
face, bloodshot eyes
• Numerous injuries, burns, bruises, etc., with vague
explanation
• Smell of alcohol on breath or excessive use of
mouthwash, mints, etc.
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Slide 40
Chemically Impaired Nurses
• Warning Signs (continued)

Drug Addiction
•
•
•
•
Rapid changes in mood and/or performance
Frequent absence from unit; frequent use of restroom
Works a lot of overtime; arrives early and stays late
Increased somatic complaints requiring prescriptions of
pain medications
• Consistently signs out more or larger amounts of
controlled drugs than anyone else; excessive wasting of
drugs
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Slide 41
Chemically Impaired Nurses
• Warning Signs (continued)

Drug Addiction (continued)
• Increased isolation from others
• Patients report that pain medication is not effective or of
not receiving medication
• Excessive discrepancies in signing and documenting
procedures of controlled substances
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Slide 42
Chemically Impaired Nurses
• Warning Signs (continued)

Mental Health Disorder
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•
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•
•
Depressed, lethargic, unable to focus or concentrate
Makes many mistakes at work
Erratic behavior or mood swings
Inappropriate or bizarre behavior or speech
May also exhibit some of the same or similar
characteristics as chemically dependent nurse
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 43