NR 547 WEEK 8 2024 QUESTIONS AND ANSWERS (VERIFIED) 100% CORRECT | A+ GRADE

Substance use disorder occurs when: - the recurrent use of a substance, such as alcohol or drugs, causes clinically significant impairment -including health problems, disability, or failure to meet responsibilities at home, work, or school Tolerance - With repeated ingestion of a drug, the drug shows decreased effect. Increasing doses are required to achieve the effects noted with the original administration Dependence - State of adaptation produced with repeated administration of certain drugs so that physical symptoms occur when the drug is discontinued abruptly. Addiction - A change in behavior caused by biochemical changes in the brain after continued substance use characterized by preoccupation with and repeated use of a substance despite of negative outcomes. Withdrawal - Physiological and psychological reactions that occur when the use of a substance is stopped abruptly. Intoxication - Condition following the ingestion of a substance resulting in changes in level of consciousness, cognition, perception, judgment, and behavior. Bernita is a 64-year-old who has been using heroin for 6 years. She is currently unemployed and lives with her daughter in the city center. She does not have health insurance. prescribe the proper medication: Methadone Buprenorphine Buprenorphine plus naloxone (Suboxone) Naltrexone - Methadone Methadone is a full μ-receptor agonist with a long half-life, which can prevent withdrawal symptoms for 24 hours and provide steady control of cravings throughout the day. It is only administered in methadone federally regulated opioid treatment programs (OTP). Methadone clinics incorporate psychosocial interventions and require daily attendance for the first several months, so this is a good option for a client that has the flexibility to attend daily meetings. Use of methadone in MAT for opioid use disorder helps extend client survival. When patients stop methadone, they have a high likelihood of relapsing, even 10 years after starting treatment. Antoine is a 34-year-old who has been abusing prescription oxycodone. He is employed but is on probation at work for increased absenteeism. He desires MAT but is concerned about his roommates stealing his medication to get high. prescribe the proper medication: Methadone Buprenorphine Buprenorphine plus naloxone (Suboxone) Naltrexone - Buprenorphine plus naloxone (Suboxone) In combination with naloxone (Suboxone): naloxone is a mu opioid receptor antagonist and can therefore block the effects of buprenorphine; however, because naloxone has poor sublingual bioavailability, it does not interfere with buprenorphine's effects when used properly. Naloxone does have good parenteral bioavailability; thus, if one tries to administer the buprenorphine/naloxone formulation intravenously, naloxone will prevent any rewarding effects from buprenorphine, making this drug a less desirable street drug. Suboxone is a good option for a client who may not be able to leave work for medication dosing, as it does not need to be taken under direct observation. Lisa is a 29-year-old who admits to using "pills, heroin, and booze" regularly. She lives in a rural area and is employed part-time. She has a history of poor compliance with past treatments. prescribe the proper medication: Methadone Buprenorphine Buprenorphine plus naloxone (Suboxone) Naltrexone - Naltrexone Naltrexone blocks mu opioid receptors, preventing exogenous opioids from binding there and thus preventing the pleasurable effects of opioid consumption. This medication also reduces alcohol consumption through modulation of opioid systems, thereby reducing the reinforcing effects of alcohol. For those patients with alcohol use disorder, who have poor adherence to a regimen, and are unable to maintain abstinence, long-acting injection naltrexone (Vivitrol) administered monthly can be efficacious. Miranda is a 20-year-old who is 18 weeks pregnant and uses heroin. She wants to get clean "for her baby." prescribe the proper medication: Methadone Buprenorphine Buprenorphine plus naloxone (Suboxone) Naltrexone - Buprenorphine Buprenorphine is a partial opioid agonist which binds with strong affinity to the mu opioid receptor, preventing exogenous opioids from binding at the receptor site, preventing the pleasurable effects of opioid consumption. Buprenorphine is the recommended MAT for pregnant women who use opioids. Juan is a 19-year-old who has a history of using oxycodone that he has taken from his grandfather and drinking occasional alcohol. He wants to stop using both substances. prescribe the proper medication: Bupropion Chlorpromazine Disulfiram Methadone Naloxone Naltrexone Varenicline - Naltrexone Naltrexone is a good option for clients who use opioids and alcohol and are committed to abstinence. Nori is a 24-year-old who has a history of abusing opioid medications and binge drinking. She is not committed to abstain from using at this time. prescribe the proper medication: Bupropion Chlorpromazine Disulfiram Methadone Naloxone Naltrexone Varenicline - Naloxone Since Nori is not committed to abstaining at this time, it is important to provide naloxone along with education to help her remain safe from overdose. John is a 56-year-old with a history of seizure disorder who has smoked 1 PPD for 30 years. He has tried to quit using nicotine gum without success. He is committed to quitting smoking but feels he would benefit from medication to help. prescribe the proper medication: Bupropion Chlorpromazine Disulfiram Methadone Naloxone Naltrexone Varenicline - Varenicline Varenicline is an appropriate medication option for clients who want to quit using tobacco products. Bupropion is contraindicated in clients with seizure disorder. Ellen is a 35-year-old who has a history of drinking 4-5 alcoholic beverages per day. She was admitted to the hospital for a respiratory infection and was treated with benzodiazepines using the CIWA-Ar scale. She has abstained from alcohol for 8 days and is committed to maintaining abstinence but would like to take a medication to help her stay away from alcohol. prescribe the proper medication: Bupropion Chlorpromazine Disulfiram Methadone Naloxone Naltrexone Varenicline - Disulfiram Disulfiram creates unpleasant physical symptoms when taken with alcohol. This mild negative stimulus can help reinforce the patient's abstinence from drinking alcohol. of the 20.4 million people 12 and older who had a substance use disorder in 2019: - -14.5 million people had an alcohol use disorder -8.3 million people had an illicit drug use disorder -2.4 million people had both an alcohol use disorder and an illicit drug use disorder the opioid, ______________, and _______________ neurotransmitters are related to the brain-reward circuitry and the development of substance use disorders - catecholamine, and y-aminobutyric acid neurotransmitters Substance-related disorders are divided into two groups: - substance use disorders -diagnostic term for prolonged use and abuse of substances such as alcohol, cannabis, hallucinogens, opioids, sedatives, stimulants, or tobacco substance-induced disorders -include substance intoxication, substance withdrawal, and substance-induced mental disorders substance use disorders (SUDs) - hallmark symptoms -Behavioral, physical, and psychological dependence -dx of SUD is indicated when a person exhibits two or more symptoms within 12 months: -Physical Symptoms • Tolerance • Withdrawal (does not apply to inhalants and hallucinogens) -Behavioral Symptoms • Craving to use • Using more than intended • Stopping or reducing use is difficult • Spending significant time devoted to the substance (using, obtaining, recovering) • Using despite acknowledging associated health problems (physical, mental) Psychological Symptoms • Using despite social, occupational, or other adverse consequences • Neglecting other responsibilities because of use • Neglecting other activities because of use • Indulging in risky or dangerous behaviors or situations because of use eleven features to determine the severity of SUD - -Hazardous use -Social or interpersonal problems r/t use -neglected major roles to use -withdrawal -tolerance -used larger amounts/longer -repeated attempts to control use or quit -much time spent using -physical or psychological problems r/t use -activities are given up to use -craving substance-induced disorders - -Substance Intoxication • symptoms: disturbances in perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behavior • Acute intoxication should only be used as the main dx when intoxication occurs without a persistent SUD -Substance Withdrawal • General features: substance-specific behavioral change, with physical and psychological symptoms, due tO cessation or intake reduction of a substance -Substance-Induced Mental Disorder • potentially severe CNS syndromes that develop because of substance abuse, medications, or toxins -Comorbidity • the occurrence of two or more psychiatric disorders at the same time • People seeking tx for alcohol, cocaine, or opioid dependence have a high prevalence of having additional psychiatric disorders • antisocial personality disorder is one of the most common comorbidities associated with illicit drug use disorder Other SUD specifiers - Early Remission: Full criteria for substance use disorder were previously met, but not for the last 3 months. Sustained Remission: Full criteria for substance use disorder were previously met, but not for the last 12 months or more. Controlled Environment: The client is in a controlled environment where substance access is restricted. Maintenance Therapy: The client is taking medication therapy to treat or reduce substance use. severity of SUD - -Mild substance use disorder: Two or three of the features -Moderate substance use disorder: Four or five of the features without loss of control -Severe substance use disorder: More than six of the features with loss of control Substance-Induced Mental Disorder - diagnosed when the following criteria are met: -the symptoms represent a mental disorder presentation -there is evidence that the substance used is capable of causing the disorder and that the disorder developed within a month of using the substance -there is evidence that the disorder is not likely explained better by the diagnosis of an independent mental condition -the disorder does not occur exclusively during delirium -the disorder causes significant social, occupational, or other impairment in functioning Kiefer is a 22-year-old student who presents to the clinic with complaints of a depressed mood that started two weeks ago. He states that he has stopped playing intramural baseball because of his mood; this is the first time since he was a small child that he has not played a season. He endorses insomnia and fatigue and is having a difficult time concentrating. Kiefer admits to taking methylphenidate "on a pretty regular basis." His use caused him to skip classes and lose a few friends who were not using. He has tried to quit using a few times without success. He was unable to obtain drugs from his normal supplier and has not used them in the past two and a half weeks. Kiefer has no psychiatric history and takes no medications. He denies the use of substances other than methylphenidate and his toxicology screen is negative. Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (APA, 2022) crit - F15.14 Stimulant use disorder, mild Rationale: Kiefer meets diagnostic criteria for major depressive disorder; his depressed mood symptoms started during withdrawal of methylphenidate. He does not have a history of depressed mood. He meets three criteria for substance use disorder (social problems related to use, neglecting major role to use, and repeated attempts to quit). He meets diagnostic criteria for mild methylphenidate use disorder with methylphenidate-induced depressive disorder onset during withdrawal. See DSM criteria doe stimulant use disorder. SBIRT - Screening, brief intervention, and referral to treatment (SBIRT) -a comprehensive and integrated public health approach to identify individuals with substance use disorders and those at risk of developing these disorders -SBIRT model can be executed in primary care settings, emergency departments, trauma centers, and other community settings -a model effective for all types of substance abuse disorders how long substances can be detected in urine - -Cocaine: up to 8 hours -Alcohol: up to 12 hours -Short Acting Barbiturate: up to 24 hours -Codeine: up to 2 days -Benzodiazepine, Methadone, -Amphetamine, Morphine and Heroin: up to 3 days -Methaqualone and Marijuana: up to 7 days The Stages of Behavior Change - -Precontemplation • unaware of the problem -Contemplation • aware of the problem and of the desired behavior change -Preparation • intends to take action -Action • practices the desired behavior -Maintenance • works to sustain the behavior change Types of Substance Use Disorders - -Alcohol Use Disorder -Opioid Use Disorder -Stimulant Use Disorder -Sedative, Hypnotic, or Anxiolytic Use Disorder -Cannabis Use Disorder -Hallucinogen Use Disorder -Other Use Disorders Alcohol Use Disorder - Clinical Features -daily need for a large amount of alcohol to function -pattern of heavy drinking on the weekends -long periods of sobriety interspersed with binges -unable to cut down or stop drinking -blackouts Symptoms of alcohol impairment -slowed motor performance, decreased thinking ability, incoordination, judgment errors, slurred speech, and blackouts. Carrie is a 40-year-old who presents for court-ordered evaluation following a driving under the influence (DUI) conviction. She states that she has been "a drinker" since age 14, but she endorses a significant increase in her alcohol consumption since her divorce 16 months ago. She notes that she will open a bottle of wine with the intent to drink "a glass or two" and instead finish the bottle. She has tried to cut down on her drinking because she feels guilty about her use and the impact it may have on her children. She states she typically doesn't begin drinking until they go to bed, but she fears she would be unable to care for them if they woke up during the night when she is inebriated. Carrie works full time as a stylist and her behaviors have not impacted her employment. Based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (APA, 2022) criteria, which of the following diagnoses is most appr - F10.10 mild alcohol use disorder Rationale: Carrie meets the criteria for F10.10 mild alcohol use disorder based on the following criteria: hazardous use of alcohol, desire to control alcohol use, and drinking larger amounts than intended. Alcohol Withdrawal - symptoms begin to develop 4 to 12 hours after a reduction of alcohol intake -Mild • Anxiety • Irritability • Headache • Insomnia • Tremors • Nausea/vomiting -Moderate • Increased BP • Increased HR • Hypertension • Mild hyperthermia • Rapid breathing -Severe • Hallucinations • Seizures • Disorientation • Impaired Attention • Delirium Tremens • Death Treatment of Alcohol Withdrawal - pharmacologic interventions should be considered for individuals with moderate to severe withdrawal symptoms -use of benzodiazepines on a symptom-triggered regimen -Use CIWA-Ar The Clinical Institute Withdrawal Assessment-Alcohol, shortened version (CIWA-Ar) - a highly regarded standardized instrument used to assess the severity of withdrawal symptoms -directs pharmacotherapy