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  • Not trying to bust your presetnation, because I like it a lot. But here is a note RE: MDMA. On slide #32 you said that it was an appitite surpressant.

    Please see:

    From that referece...

    A German pharmaceutical company, Merck and Company, originally synthesized MDMA in 1914. At the time of patent application, no use was specified for MDMA. Despite reports to the contrary, MDMA was never marketed as an appetite suppressant by Merck or any other company. In the 1950s, the US military added it to a long list of experimental substances as a possible brainwashing and/or chemical agent.'

    I would be suspicious that it was developed for military uses, as the germans were also developing Methaphetamine inthe years that followed, and meth is a close chemical relation to MDMA.

    Just my thoughts. Good luck.

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  • 1. Unit 12: Addiction “The only way to get rid of a temptation is to yield to it.” Oscar Wilde
  • 2. Progression to Addiction
    • Initial use: peer pressure, self medication, curiosity, etc.
    • Transitional use: changes in thinking and behavior
    • Addiction:
  • 3. Mental Mechanisms in Addiction
    • Denial: insistence that there is no problem despite evidence to the contrary--$ crisis, effect on family, job
    • Rationalization: explanations of use—self imposed rules that legitimize use, statements like” everyone needs___”
    • Therapeutic Confrontation: meaningful people present reality in a receivable way.
  • 4. Family Dynamics in Addiction
    • Anger, Loss of Control, Anxiety, Hopelessness
    • Codependent behaviors: enabling, over-functioning, controlling, lonely, hypervigilant, self esteem, not realistic
    • Rescuer/victim relationship
  • 5. Child Roles in Addiction
    • Parentified child “hero”
    • Scapegoat
    • Clown, mascot
    • Lost Child, loner
  • 6. Common Nursing Diagnoses
    • Health Maintenance, ineffective
    • Defensive Coping
    • Family Process, Dysfunctional
  • 7. Nursing Strategies and Issues
    • Aware of your own biases—countertransference
    • Develop trust and rapport before confronting
    • Then present reality and confront discrepancies in thinnking
    • Educate on all aspects of the illness
  • 8. Specific Interventions: assist client to:
    • Catalogue use to decrease denial
    • Avoid situations that trigger use
    • Identify positive coping strategies if craving
    • “ HALT”
    • Identify critical triggers for relapse
    • Set achievable goals
    • Increase self worth
    • Building a non using support network
  • 9. Types of Treatment: 12 Step Programs
    • Self diagnosis
    • Lifetime process
    • Cyclic recovery pattern
    • Social Network
    • No Fee
    • Higher Power
  • 10. Types of Treatment: Group Therapy
    • Members find out they are not alone
    • Group is effective in challenging distortions
    • Group members understand
    • Been there, share pain
  • 11. Behavioral Treatment
    • Part of the disease is avoidance of responsibility for life tasks
    • Decreases repression of feeling
    • Developmental arrest issue: don’t move beyond psychosocial tasks at time of beginning of addiction
  • 12. Other Intervention Strategies
    • Social Skills Training: stress management, assertiveness, feeling expression
    • Cognitive restructuring—for denial and underlying negative self beliefs
    • Family therapy
  • 13. Epidemic of Alcohol Addiction
    • Legal if over 21 in most states
    • Cheap
    • Socially acceptable/sometimes required
    • Family modeling—culture
    • Genetic predisposition to addiction
  • 14. How serious is the alcohol epidemic?
    • 20 million Americans have a serious problem
    • 40% of the population of US have at least one alcoholic family member
    • Contributes to leading causes of death in most age groups
    • Involved in MVAs, homelessness, domestic violence, ER admits
  • 15. Behaviors at Increasing Blood Alcohol Levels (general)
    • 0.1% -- euphoria, flushing, relaxation, slowed reaction time (legally intoxicated)
    • 0.2% -- narcosis, slow voluntary mvmnt., poor comprehension
    • 0.3% -- little control of voluntary movement,
    • 0.4% -- loss of consciousness (pass out)
    • 0.5% -- coma/death
  • 16. Characteristics of Alcohol
    • Small molecule
    • Absorption: 10-20% wall of stomach 80-90% duodenum
    • Excretion: 10% unchanged through lungs/kidneys; 90% metabolized in liver at usual rate of ½ oz per hour
    • 1 beer = 1 oz hard liquor = 1 glass wine
  • 17. Alcohol in the Body
    • C 2 H 3 OH –crosses blood brain barrier, concentrates in areas with high blood concentration.
    • Irritating to gastric mucosa, vomiting protects from overdose at times
    • Provides empty calories
  • 18. Alcohol is a CNS Depressant
    • Synergism with other CNS depressants
    • Chronic use = nervous system metabolism adapts
    • Inhibits production of RNA (protein synthesis), inhibits new learning and memory function
    • Suppresses synaptic activity – increases the inhibitory action of GABA and Decreases the excitatory activity of Glutamate receptors
  • 19. Alcohol in the Liver
    • First metabolized by alcohol dehydrogenase to acetaldehyde (noxious)
    • If drink a lot, this enzyme becomes more available
    • Acetaldehyde metabolized by acetaldehyde dehydrogenase to acetate, which is excreted
  • 20. More about alcohol in the liver
    • Alcohol is a preferential fuel, leaving fat to accumulate, fatty deposits
    • Prolonged alcohol use stimulates pathway that results in high levels of acetaldehyde, damaging cells over time
    • Fatty deposits alter structure and function of liver – cirrhosis
    • Portal hypertension
  • 21. Stages of Alcohol Withdrawl
    • Stage 1 – Tremulous: increased vital signs, tremor, sweating
    • Stage 2 – Minor DT: auditory and visual hallucination, illusion, isolated convulsion 12 – 48 hours post last drink
    • Stage 3 – Major DT: All of above, plus severe motor agitation, after 48 hour
  • 22. Nursing Care for Withdrawl
    • Assess frequently (discuss tools)
    • Know the high risk times (based on time of last drink)
    • Intervene early
    • Use CNS depressant, e.g. Librium
    • Keep calm environment
    • Hydrate, replenish nutritionally (may give vitamins)
    • Encourage rest
    • Seizure precautions
  • 23. Lab findings in Alcoholism
    • Anemia, low WBC,
    • Elevated liver function tests—SGOT, SGPT, etc
    • Elevated prothrombin time
    • Increased uric acid, decreased BUN, Decreased magnesium, decreased calcium
    • ECG—A fib, PVC’s, T and P wave abnormalities; cardiomegaly
  • 24. Factors that affect alcohol metabolism
    • Sex, body weight
    • Food in stomach slows absorption
    • Dilution slows absorption
    • Presence of carbonation speeds absorption
    • Drinking experience
  • 25. Medication management Antabuse: disulfuram
    • Works by blocking a step in the process of alcohol breakdown in the liver:
    • Tips: reaction occurs even with a small amount of alcohol; be off alcohol before starting; can last up to 2 weeks after stop taking it; reaction involves headache, N/V, “sick”, and B/P change
  • 26. Medication Management: Naltrexone
    • Narcotic antagonist--Works by blocking narcotic receptors; so that alcohol does not have an intoxicant effect
    • Be aware that some alcoholics will take in huge amounts of alcohol to try to over ride the medication and this can be very dangerous.
  • 27. Hallucinogen abuse: PCP, mushrooms, mescaline, LSD
    • Not a lot is known with certainty, some effect on serotonin B receptors
    • Intoxication: first nausea, jitters, increased vital signs; then distorted sensory perception (vis), hallucinations, sense confusion (synesthesia)
    • Not physically addicting, after effects include flashbacks, psychosis
  • 28. Stimulant Abuse: “uppers”—cocaine, amphetamines, methamphetamines, Ritalin
    • They prolong activity of neurotransmitters: dopamine, norepi, acetylcholine, serotonin
    • Effect—energy, libido, euphoria
    • Pattern of abuse: tendency to binge and then bottoming up, see nasal ulceration, cough, etc.
    • Intoxication symptoms: anxiety, manicy, combative, vigilant, increased VS, can have seizure,CVA, Cardiac arrest
    • Withdrawl: “bottoming out”
  • 29. Marijuana/Hashish
    • Commonly abused: 10 million regular users in US/5% HS seniors abuse
    • Intoxication effect: euphoria, calmness, drowsiness, dreamlike state
    • Dependence is insidious: leads to amotivation, decreased persistence at tasks, anxiety, respiratory disease, decreased immune function, altered hormone balance
  • 30. Opiate Abuse: Heroin, morphine, fentanyl, codiene, methadone
    • In abuse: stimulates opiate receptors “”endorphins” in brain
    • Effects: respiratory depression, pulmonary edema, pulmonary fibrosis, hepatitis, bacterial meningitis, constipation, lower immune function
    • Intoxication looks like: pinpoint pupils, decreased resps/coma, seizure=give narcotic antagonist
    • Withdrawl looks like: Yawning, tearing, gooseflesh, abdominal and muscle pain, tremors , nightmares
  • 31. Inhalent Abuse: butyl nitrate , amyl nitrate, nitrous oxide, toluene, gas, paint thinner, hairspray, lighter fluid
    • Legal, available, teens at risk, volatile substances
    • Effect: partly depends on substance, all CNS toxic and starve brain of O2, Increase HR, cause lung damage;
    • Drugs can be fatal even without long addiction Hx—stroke, heart attack, brain damage
  • 32. Ecstasy or MDMA
    • MDMA started as an appetite suppresant
    • It is a combination of methamphetamine and mescaline (a stimulant and a hallucinogen)
    • Effects start in 30-60 minutes after ingesting and can last 8 hours
  • 33. Adverse Reactions to Ecstasy
    • Long term cognitive impairment
    • Hyperthermia—can cause rhabdomyolosis
    • Tachycardia—can cause severe cardiac Sx.
    • Can cause “serotonin syndrome”
    • After the “high” person feels depressed, achy, and downright terrible
  • 34. Rohypol: Flunitrazepam
    • “ Roofies,” Date rape drug
    • Odorless and tasteless
    • A potent benzodiazepine, “like Valium but 10x as strong.”
    • Half life is 20 hours, but clinical effects are more short lived
  • 35. Ketamine
    • “ Vitamin K” – Ketamine is a legitimate veterinary medicine
    • It is a derivative of PCP, which is a potent hallucinogen
    • Serious cardiovascular effects
  • 36. GHB
    • This is a naturally occurring fatty acid derivative of GABA (the inhibitory neurotransmitter)
    • It acts as a CNS depressant
    • At high doses, can cause coma/death.