Nursing Pharmacology:

Substance Abuse
 Addiction – is an overwhelming compulsion that drives
someone to take drugs repetitively, despite serious health and
social consequences.

Reasons for substance abuse:

 User-related factors – Hx or present medical conditions,
disorders, etc.
 Environmental factors- Societal and community norms, role
models, peer influences, educational level
 Factors related to the agent or drug - Cost, availability, dose,
mode of administration, speed of onset/termination
Physical and Psychological
Dependence
 Substance Dependence - a person has an overwhelming
desire to take a drug and cannot stop
 Physical dependence refers to an altered physical condition caused
by the adaptation of the nervous system to repeated substance use.
 With physical dependence, uncomfortable symptoms known as
withdrawal result when the agent is discontinued. Alcohol, sedatives,
nicotine, and CNS stimulants are examples of substances that with
extended use may easily cause physical dependence.
 Psychological Dependence refers to a condition
in which no obvious physical signs of discomfort
are observed after the agent is discontinued.
 The user will have an overwhelming desire to
continue drug-seeking behavior despite obvious
negative economic, physical, or social
consequences.
 Associated intense craving
Withdrawal Syndrome
 Once a person becomes physically dependent and the
substance is discontinued, withdrawal syndrome may
occur.
 Symptoms of withdrawal may be particularly severe for those who are
dependent on alcohol or sedatives.
 The process of withdrawal from these agents is probably best
accomplished in treatment facility.
 Counselors often encourage users to refrain from associating with
past social contacts or having relationships with other substance
abusers to lessen the possibility for relapse.
Tolerance

 Tolerance is a biologic condition that occurs when the

body adapts to a substance after repeated administration.
Over time, higher doses of the agent are required to
produce the same initial effect.
 CNS Depressants

 CNS depressants are a group of drugs that cause patients

to feel relaxed or sedated.
 Drugs in this group include barbiturates, nonbarbiturate
sedative–hypnotics, benzodiazepines, alcohol, and opioids.
 The majority of these are legal substances so they are
controlled due to their abuse potential.
Sedatives and Sedative–Hypnotics
 Sedatives, also known as tranquilizers, are prescribed for sleep
disorders and certain forms of epilepsy.
 The two primary classes of sedatives are the barbiturates and the
nonbarbiturate sedative–hypnotics
 Overdoses of these drugs are extremely dangerous. They suppress
the respiratory centers in the brain, and the user may stop
breathing or lapse into a coma
 Benzodiazepines are another group of CNS depressants that have
a potential for abuse. They are one of the most widely prescribed
classes of drugs and have largely replaced the barbiturates
Opioids
 Opioids, also known as narcotic analgesics, are prescribed for severe
pain, persistent cough, and diarrhea.
 The opioid class includes natural substances obtained from the
unripe seeds of the poppy plant such as opium, morphine, and
codeine.
 Synthetic drug examples are propoxyphene (Darvon), meperidine
(Demerol), oxycodone (OxyContin), fentanyl (Duragesic, Sublimaze),
methadone (Dolophine), and heroin.
Ethyl Alcohol
 Ethyl alcohol, commonly referred to as alcohol, is one of the most
commonly abused drugs. Alcohol is a legal substance for adults,
and it is readily available as beer, wine, and liquor
 Alcohol is classified as a CNS depressant because it slows the
region of the brain responsible for alertness and wakefulness
 The organ most affected by chronic alcohol abuse is the liver.
Alcoholism is a common cause of cirrhosis, a debilitating and
often fatal failure of the liver to perform its vital functions.
 Delirium tremens (DT) may occur in individuals who have
constantly consumed alcohol for a longer period. Symptoms are
hallucinations, confusion, disorientation, and agitation. Many
patients experience anxiety, panic, paranoia, and sensations of
something crawling on the skin
Cannabinoids
 Cannabinoids are substances obtained from the hemp
plant Cannabis sativa, which thrives in tropical climates.
Cannabinoid agents are usually smoked and include
marijuana, hashish, and hash oil.
 Marijuana - also known as grass, pot, weed, reefer
 Use of marijuana slows motor activity, decreases
coordination, and causes disconnected thoughts, feelings
of paranoia, and euphoria.
Hallucinogens
 Hallucinogens consist of a diverse class of chemicals that
have in common the ability to produce an altered,
dreamlike state of consciousness.
 LSD ( most popular) - Effects from hallucinogens,
however, are highly variable and dependent on the mood
and expectations of the user and the surrounding
environment in which the substance is used.
 Users also report unusually bright lights and vivid colors.
Some users hear voices; others report smells. Many
experience a profound sense of truth and deep-directed
thoughts.
 CNS Stimulants
 Stimulants include a diverse family of drugs known for
their ability to increase the activity of the CNS.
 CNS stimulants are taken to produce a sense of
exhilaration, improve mental and physical performance,
reduce appetite, prolong wakefulness, or simply “get
high.”
 Stimulants include the amphetamines, cocaine,
methylphenidate, and caffeine.
Amphetamines and Methylphenidate
 CNS stimulants have effects similar to those of the
neurotransmitter norepinephrine
 Norepinephrine affects awareness and wakefulness by
activating neurons in a part of the brain called the reticular
formation.
 High doses of amphetamines give the user a feeling of self-
confidence, euphoria, alertness, and empowerment; but just as
short-term use induces favorable feelings, long-term use often
results in feelings of restlessness, anxiety, and fits of rage,
especially when the user is coming down from a “high” induced
by the drug.
 Dextroamphetamine (Dexedrine) may be prescribed for
short-term weight loss
 Methamphetamine, commonly called ice, is often used as
a recreational drug by users who like the rush that it gives
them.
 It usually is administered in powder or crystal form, but it
may also be smoked
Cocaine
 Cocaine is a natural substance obtained from leaves of the coca
plant
 Routes of administration include snorting, smoking, and
injecting.
 In small doses, cocaine produces feelings of intense euphoria, a
decrease in hunger, analgesia, illusions of physical strength, and
increased sensory perception.
 Larger doses will magnify these effects and also cause
rapid heartbeat, sweating, dilation of the pupils, and an
elevated body temperature. After the feelings of euphoria
diminish, the user is left with a sense of irritability,
insomnia, depression, and extreme distrust.
 Some users report the sensation that insects are crawling
under the skin. Users who snort cocaine develop a chronic
runny nose, a crusty redness around the nostrils, and
deterioration of the nasal cartilage.
 Overdose can result in dysrhythmias, convulsions, stroke,
or death due to respiratory arrest
Caffeine
 Significant amounts of caffeine are consumed in
chocolate, coffee, tea, soft drinks, and ice cream
 Caffeine is sometimes added to over-the-counter (OTC)
pain relievers because it has been shown to increase the
effectiveness of these medications. Caffeine travels to
almost all parts of the body after ingestion, and several
hours are needed for the body to metabolize and
eliminate the drug.
 Caffeine has a pronounced diuretic effect. Caffeine is
considered a CNS stimulant because it produces increased
mental alertness, restlessness, nervousness, irritability,
and insomnia.
 The physical effects of caffeine include bronchodilation,
increased blood pressure, increased production of stomach
acid, and changes in blood glucose levels.
 Repeated use of caffeine may result in physical
dependence and tolerance.
 Withdrawal symptoms include headaches, fatigue,
depression, and impaired performance of daily activities.
Nicotine
 Nicotine is sometimes considered a CNS stimulant, and
although it does increase alertness, its actions and long-
term consequences place it in a class by itself.
 Nicotine is unique among abused substances in that it is
legal, strongly addictive, and highly carcinogenic.
 Use of tobacco can cause harmful effects to those in the
immediate area who breathe secondhand smoke
 The Nurse’s Role
in Substance Abuse
 In the case of intravenous (IV) drug users, the nurse must
consider the possibility of HIV infection, hepatitis, and
associated diagnoses.
 A trusting nurse–patient relationship is essential to helping
patients deal with their dependence.
 By using therapeutic communication skills and by
demonstrating a nonjudgmental, empathetic attitude, the
nurse can build a trusting relationship with patients
 The nurse must be firm in disapproving of these activities, yet
compassionate in trying to help patients receive treatment.
 The nurse should attempt to involve family members and
other close contacts in the treatment regimen.
 Educating the patient and family members about the long
term consequences of substance abuse is essential.
 Substance abuse also affects members of the health care
community.
 The nurse should be aware of the ramifications of drug
abuse and the impact this would have on personal goals
and their career.