NURS 314 FINAL EXAM
Healthy People 2020 Substance Abuse - Increase:
-the number of admissions to substance abuse treatment for injection drug use
-the proportion of persons who received drug treatment for abuse or dependence on
alcohol or illicit drugs.
-the proportion of persons who are referred to follow-up care for substance abuse after
diagnosis or treatment for one of these conditions in a hospital ER
-the # of trauma centers and primary care settings that implement evidence-based
alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Reduce:
-drug-induced deaths
-the proportion of persons engaging in binge drinking of ETOH
-non-medical use of prescription drugs
-the number of deaths attributable to alcohol
Lifesaver Guidelines for Alcohol and Other Substances - 1. Conduct Initial and ongoing
screening and assessments: Start with SBIRT, NIDA Quick Screen Drug Abuse
Screening Test (DAST), or The Alcohol Use Disorders Identification Test (AUDIT-C)
2. For opioid addiction use Opioid Risk Tool (ORT)
3. To determine opioid withdrawal use Clinical Opiate Withdrawal Scale (COWS)
4. Ongoing assessment and monitoring tools for patients taking opioids
-Clinical Pearl: Focus on functionality vs pain
5. Don't forget to screen for depression, anxiety, PTSD, and sleep apnea
Lifesaver Guidelines: the 4 "P"s - Did your parents use substances?
Does your partner/peers use substances?
Did you use substances in the past?
Do you use any substances in the present?
SBIRT Screening - How many times in the past year have you had x or more drinks in
one day? (with 1 drink = 14 grams of alcohol)
For men, x = 5
For women, x = 4
Positive screen = 1 or more times
1 drink = 12 oz beer, 5 oz wine, 1.5 oz 80 proof liquor)
SBIRT Brief Intervention - 1. Raise the subject: Ask permission, "Would you mind
taking a few minutes to discuss your screening results?"
,2. Provide feedback: Review reported use and refer to lower risk alcohol guidelines.
Discuss possible health and other consequences of use. Express concern. Elicit the
person's response: "What do you think about this information?"
3. Enhance motivation: "On a scale of 0-10 how important is it to you to decrease (or
quit) drinking?" "How does your current level of drinking fit with what matters most to
you?"
4. Negotiate and advise: "What steps are you interested in taking to make a change?"
"What could help you accomplish your goal?
SBIRT Referral to Treatment - Substance Abuse and Mental Health Services
Administration
-helpline
- buprenorphine (opioid partial agonist) treatment practitioner locator
opioid treatment directory
Harm reduction
-syringe access
-health education classes
-testing for HIV, Hep C, Chlamydia, and Gonorrhea
- vein care instruction
Alcohol Withdrawal Syndrome - Minor Withdrawal
-Tremulousness, mild anxiety, headache, diaphoresis, GI upset, palpitations, anorexia
-Normal mental status
-6 to 36 hours
Seizures
- Single or brief flurry of generalized, tonic-clonic seizures, short postictal period
-Status epilepticus rare* (a single epileptic seizure lasting more than five minutes)
-6 to 48 hours
Alcoholic hallucinosis
- Visual, auditory, and/or tactile hallucinations with intact orientation
-normal vital signs
-12 to 48 hours
Delirium tremens
- Delirium agitation, tachycardia, diaphoresis hypertension, fever,
-48 to 96 hours
CDC Guidelines for Prescribing Opioids - 1. Opioids are not first-line or routine therapy
for chronic pain. Use non-opioid and non-pharmacologic therapy first.
2. Establish and measure goals for pain and function
3. Discuss risks and benefits, and non-opioid therapies with patient.
4. Use immediate release formulations when starting
5. Start low and go slow
,6. Do not give long acting opioids for acute pain
6. Follow up and re-evaluate risk of harm; reduce dose or taper and discontinue if
needed
7. Evaluate risk factors for opioid-related harms
8. Check Prescription Drug Monitoring Program (PDMP) for high dosages and
prescriptions from other providers
9. Use urine drug testing to identify prescribed substances and undisclosed use
10. Avoid concurrent benzodiazepine and opioid prescribing
11. Arrange treatment for opioid use disorder if needed.
Opioid Risk Tool (ORT) -
Early Opioid Withdrawal Symptoms - Restlessness, agitation
Anxiety
Muscle aches
Lacrimation, or tearing
Insomnia
Runny nose
Sweating
Yawning
Irritability, aggression
Late Opioid Withdrawal Symptoms - Abdominal cramping
Nausea/vomiting
Diarrhea
Dilated pupils
Goosebumps
Nausea
Vomiting
Paranoia
Hyperactivity/fatigue
Opioid Overdose Symptoms - Myosis, or pinpoint pupils
Loss of consciousness
Unresponsive to outside stimulus
Awake, but unable to talk
Breathing is very slow and shallow, erratic, or has stopped
Bluish purple in lighter skin tones, grayish or ashen for darker skin tones
Choking sounds, or a snore-like gurgling noise (sometimes called the "death rattle")
Vomiting
Body is very limp
Face is very pale or clammy
Fingernails and lips turn blue or purplish black
Pulse (heartbeat) is slow, erratic, or not there at all
, Medication kAssisted kTreatment k(MAT) k- k k30 kmillion kpeople kare kwithout kaccess kto kMAT
ksuch kas kBuprenorphine.
Rural kparts kof kthe kcountry kare kdisproportionately kaffected kby kthe kprovider kshortage,
kparticularly kacross kthe kMidwest
Reports kshow kthat kphysicians kare kshying kaway kfrom kBuprenorphine kcertification kdue kto
klow kreimbursement krates, kstrict kDEA kregulations, kand kstigma.
A k2012 kAHRQ kreport kidentified kthat kAPRNs kare kmostly klikely kto kpractice kin klarge, ksmall
kand kremote krural kcommunities kmost kaffected kby kthe kshortage kof kwaivered kphysicians.
Every kday kpatients kare kturned kaway kfrom ktreatment kand kface klong kwaits kto ksee ka
kprovider krisking koverdose, kexposure kto khepatitis kor keven kHIV.
FDA kapproved kMAT ktreatments k- k k1. kMethadone k- kopioid kagonist. kReduces kwithdrawal
kand kblocks kother kopioid kmedications
2. kBuprenorphine k- kpartial kagonist. kStops kwithdrawal, kwithout keuphoric khigh. kNo kceiling
keffect. kMay kbe kcombined kwith knaloxone
3. kNaltrexone k- kopioid kantagonist. kDoes knot ktreat kwithdrawal ksymptoms kbut
kblocks/supports kabstinence kefforts
Therapeutic kUses kof kCannabis k- k kmood kand kanxiety kdisorders
movement kdisorders ksuch kas kParkinson's kand kHuntington's kdisease
neuropathic kpain
multiple ksclerosis kand kspinal kcord kinjury
cancer k
atherosclerosis
myocardial kinfarction, kstroke k
hypertension k
glaucoma k
obesity/metabolic ksyndrome
osteoporosis
reduce kopioid kabuse kdisorder
Evidence kfor kCannabis kas kTreatment k- k kEvidence kfor: kChronic kpain*, kSpasticity*
k(multiple ksclerosis), kNausea kand kvomiting kd/t kchemotherapy*, kWeight kgain kin kHIV
kinfection, kSleep kdisorders, kTourette ksyndrome
*Moderate kevidence, kThe krest khave klow kquality kevidence
Also kbeing kinvestigated kfor kinflammatory kbowel kdisease, kParkinson's kdisease, kPTSD k&
kepilepsy k(FDA krecently kapproved ka kcannabis-based kdrug kcalled kEpidiolex)
JAMA kCONCLUSIONS kAND kRELEVANCE kThere kwas kmoderate-quality kevidence kto
ksupport kthe kuse kof kcannabinoids kfor kthe ktreatment kof kchronic kpain kand kspasticity. kThere
kwas klow-quality kevidence ksuggesting kthat kcannabinoids kwere kassociated kwith
