1. Commonly Abused Substances (p. 98)
Opioids
Stimulants
Methamphetamine
Methylenedioxymethamphetamine (MDMA, “ecstasy”)
Cocaine
Depressants
Benzodiazepines
Barbiturates
Marijuana
Alcohol
Nicotine
Substance abuse affects people of all ages, sexes, and ethnic and socioeconomic groups.
Physical dependence and psychologic dependence on a substance are chronic disorders with remissions and relapses, such as occur with any other chronic illness.
Relapses should not be seen as failures but as indications to intensify treatment.
Opioids are also known as narcotics.
Most are Schedule II because of their high potential for abuse.
NURSING APPLICATION:
Is it possible for a patient of Ms. Jackson's age to be addicted to medication? Why or why not?
Copyright © 2011 by Elsevier Inc. All rights reserved.

2. Opioids (p. 98) Produce Affect areas outside the CNS Normally used to:
Analgesia, drowsiness, euphoria, tranquility, other mood alterations
Affect areas outside the CNS
Skin, GI tract, GU tract
Normally used to:
Relieve pain, reduce cough, relieve diarrhea, and induce anesthesia
Heroin is a commonly abused opioid. It can be injected, sniffed, or smoked.
Opioid analgesics are synthetic versions of pain-relieving substances that were originally derived from the opium poppy plant. The natural plant compounds are called opiates.
Currently heroin remains one of the top 10 most abused drugs in the United States and often is used in combination with the stimulant drug cocaine
NURSING APPLICATION:
Why is heroin still one of the top 10 most abused drugs?
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3. Opioid Drug Withdrawal (p. 99)
Peak period: 1 to 3 days
Duration: 5 to 7 days
Signs
Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated BP and pulse
Symptoms
Intense desire for drug, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise
Medications, such as opioid antagonists, may be used.
NURSING APPLICATION:
What causes withdrawal symptoms? What should the nurse do if she/he suspects a patient is addicted to drugs?
Copyright © 2011 by Elsevier Inc. All rights reserved.

4. Copyright © 2011 by Elsevier Inc. All rights reserved.
Stimulants (p. 99)
Amphetamines
Cocaine
Methylphenidate (Ritalin)
Methamphetamine
Methylenedioxymethamphetamine (MDMA, “ecstasy”)
Others
Often known as “designer drugs”
The abuse of stimulants is related to their ability to cause elevation of mood, reduction of fatigue, a sense of increased alertness, and an increase in aggressiveness.
Methamphetamine is stronger than other amphetamines.
Another stimulant drug of abuse is cocaine, which also produces strong CNS stimulation.
NURSING APPLICATION:
Would a stimulant be helpful for Ms. Jackson? Why or why not?
Copyright © 2011 by Elsevier Inc. All rights reserved.

5. Stimulant Withdrawal: Signs and Symptoms (p. 101)
Peak period: 1 to 3 days
Duration: 5 to 7 days
Signs
Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia
Symptoms
Depression, suicidal thoughts and behavior, paranoid delusions
The CNS-related adverse effects are restlessness, syncope (fainting), dizziness, tremor, hyperactive reflexes, talkativeness, tenseness, irritability, weakness, insomnia, fever, and sometimes euphoria.
Death resulting from convulsions, coma, and cerebral hemorrhage may occur during periods of intoxication or withdrawal.
NURSING APPLICATION:
What nursing actions should be taken if you suspect that Ms. Jackson may be having stimulant withdrawal?
Copyright © 2011 by Elsevier Inc. All rights reserved.

6. Depressants (p. 101)
Drugs that relieve anxiety, irritability, and tension
Benzodiazepines and barbiturates
Marijuana (“pot,” “grass,” “weed”)
Benzodiazepines and barbiturates work by increasing the action of GABA.
GABA is an amino acid in the brain that inhibits nerve transmission in the CNS.
The alteration of GABA action in the CNS results in relief of anxiety, sedation, and muscle relaxation. The effects of depressants are limited primarily to the CNS.
Mixing benzodiazepines with ethanol or barbiturates can be lethal.
NURSING APPLICATION:
Why would depressants be ordered for a patient of Ms. Jackson's age?
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7. Copyright © 2011 by Elsevier Inc. All rights reserved.
Nicotine (p. 104)
Many smoke to “calm nerves”
Releases epinephrine, which creates physiologic stress rather than relaxation
Tolerance develops
Physical and psychologic dependency
Withdrawal symptoms occur if stopped
No therapeutic uses
Nicotine works by directly stimulating the autonomic ganglia of the nicotinic receptors.
Its site of action is the ganglion itself rather than the preganglionic or postganglionic nerve fiber.
The major action of nicotine is transient stimulation.
Cardiac symptoms from nicotine withdrawal resolve in 3-4 weeks, but cigarette cravings may persist for months or years.
NURSING APPLICATION:
What forms of nicotine could Ms. Jackson be consuming besides cigarettes?
Copyright © 2011 by Elsevier Inc. All rights reserved.

8. Abuse of OTC Drugs in Adolescents (p. 109)
Products containing dextromethorphan
High doses
Lead to a “high” accompanied by hallucinations
May cause nausea, hot flashes, reduced mental status, dizziness
Also may cause seizures, loss of consciousness, loss of coordination and balance, brain damage, death
Adolescents also huff volatile solvents, aerosols, gases, and nitrites.
Adolescent patients are exposed to very real drug hazards connected with some everyday products within the home.
Two major problems involving hazardous drug use are seen in this population.
OTC cough medicines are easy to obtain and are often use by adolescents.
NURSING APPLICATION:
Is it possible for Ms. Jackson to become addicted to cough medicine?
Copyright © 2011 by Elsevier Inc. All rights reserved.

9. Nursing Assessment (p. 105)
Assessments should include nonjudgmental and open-ended questions about substance abuse
Be observant for clues to substance abuse so as to avoid withdrawal symptoms (especially delirium tremens)
Establish therapeutic rapport, and use empathy toward the patient
The purpose of substance abuse assessment is to determine whether substance abuse exists, to evaluate the relationship between the abuse and other health concerns, and to begin the implementation of an effective health promotion and health restoration plan.
All patients should be questioned about the use and misuse of substances, because addiction is found across the life span and therefore can be encountered in all clinical specialties.
Nurses are often the first ones to identify risky behavior in a patient.
NURSING APPLICATION:
What questions should be asked of Ms. Jackson's family to determine whether she is addicted to any OTC product?
Copyright © 2011 by Elsevier Inc. All rights reserved.

10. Nursing Implications (cont’d) (p. 105)
Provide monitoring and support as needed throughout the withdrawal process
Educate the patient and family members or significant others about the recovery process
Emphasize that recovery is lifelong
Nursing strategies for meeting actual or potential health problems are implemented for nursing diagnoses generated from assessment data.
Nurses working with substance abuse patients need their own sound knowledge base as well as special understanding and empathy.
Nurses should participate in training, seminars, and education about the process of substance abuse and related lifestyles to assist in understanding the patient and developing a comprehensive plan of care.
NURSING APPLICATION:
What patient education facts should be include when providing information about addiction?
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