DRUG ABUSE Power Point

8/8/2019 DRUG ABUSE Power Point

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Drug Abuse

I. Definition of drug Abuse

II. Neurobiology

a. brain washb. Tolerance

c. Cueinducive craving

d. Abstinence



III. Overview of Addictive States

a. Intoxication

b. Detoxification

c. Withdrawal Syndrome

IV. Terminology of Drug Abuse (Table

8-12).V. Drug Interactions: Drug Abuse





I. Definition of Herbal Therapy

II. Herbal Preparation

a. Dried Herbs

b. Extracts

c. Fresh Herbs

d. Oils

e. Salves

f. Teas

g. Tinctures



III. Commonly use Herbal Remediesa. Aloe Verab. Chamomilec. Dong Quaid. Echinacea

e. Feverfewf. Garlicg. Gingerh. Ginkgoi. Ginsengj. Golden Seal



k. Kava

l. Licorice

m. Milk Thistle

n. Peppermint

o. St. Johns Worth

p. Saw Palmetto

q. Valerian



I.DRUG ABUSE

The terms drug abuse, drug misuse,addiction, dependence, tolerance,

detoxification, withdrawal, and abstinence.

Describe the neurobiology of addictive drugs.

Identify the physical and psychological

effects of commonly abused central nervous

system stimulants and depressants,cannabis, psychedelic agents, and inhalants.



Identify drugs used in the treatment of

toxicity, withdrawal, and maintenance of abstinence of commonly abused drugs.

II. Neurobiology of addictive drugs

a. Brain reward system

an ancient system that creates the

sensation of pleasure for certain behaviors

necessary for survival, such as eating andsexual behavior.



b. Tolerance

The need for a larger dose of a drug to obtainthe original euphonia, and also reduces the

sense of pleasure from experiences that

previously resulted in positive feelings.

c. cue induced craving

An important type of craving experienced by

addicts occurs in the presence of people,

places taking.



III. Overview of Addictive Statesa. Intoxication

Is a state of being poisoned by a drug or other

toxic substance, in the client who abuses a

drug, intoxication is commonly caused by adrug overdose. The signs and symptoms that

are seen are the toxic effects of the drug

when taken in excessive doses.



b. Detoxification Involves treating an intoxicated client to

diminish or remove drugs or their effects

from the body. Treatments may involve

administration of antagonistic drugs,promotion of metabolism and elimination of

the drug, or intensive supportive care until

the drug is eliminated.



c. Withdrawal Syndrome Is a group of signs and symptoms that occur

in physically dependent persons when druguse is stopped. The symptoms are often

opposite he effects the drug produced beforeit was withdrawn. Opioids, alcohol,barbiturates and anxiolytics cause relativelystrong physical dependence and withdrawalsyndrome. Cannabinoids and amphetaminescause weak physical dependence.



Terminology of Drug Abuse

Abstinence- Avoidance of substance useAddiction- a compulsive , uncontrollable

craving for and dependence on asubstance to such a degree thatcessation cause severe emotional ,mental, or physiologic reactions.

Chemical impairment- the term used bytheprofessionals to describe behaviorsrelated



to the effects of drugs or substancesperformance.

Craving- subjective need far a substance ,usually experienced after decrease use orabstinence.

Dependence- reliance on a substance that has

reached the level that its absence will causean impairments in functionPsychologic-compulsive need to

experience pleasurable response from thesubstance.

Physical- altered physiologic state fromprolonged substance use;



regular use is necessary to prevent withdrawalsyndrome.

Drug misuses- indiscriminate use of a drug forpurposes other than dose for which it isintended.

Relapse- return to substance use duringabstinence ;

Substance- Drug, chemical, or biologicentity.



Tolerance- decrease effect of a substance

that results from repeated exposure.

Withdrawal syndrome- constellation of physiologic and pschologic responses that

occur when there is abrupt cessation or reduceintake of a substance on which an individual

is dependent.



DRUG INTERACTION: DRUG ABUSE

Drug of Abuse

Nicotine/ smoking- interacting dugs areisoproterenol (Isuprel), phenylephrine (

Neo- synephrine) ( increase effects withuse of nicotine/smoking after smokingcessation dosage may need to beincrease).

-Interacting drugs pentazocine( talmin),propoxyphene (darvon), Bezodiazepines,ticyclic antidepressants,



propranolol (inderal), theophylline,

herapin, insulin (decreased effects withuse of nicotine/smokingcessation

dosage may need to be reduced).



Cocaine interacting drugs are

symphathomimetics/adrenomimetics, CNSstimulation, cholinesterase inhibitord. (may

increase CNS & cardiac effects of cocaine.

Interacting drugs are tricyclic

antidepressants, digoxin, methyldopa( mayincrease cocaine induce dysrhyyhmias.

Adrenergic beta- blocker ( cocaine may

decrease effects).



Amphetamines interacting drugs tricyclicantidepressants,

sympathomimetics/adrenomimetrics, CNSstimulation ( increase effects of tricyclics andsympathomimetics increase effect of amphetamines.

GI antacids/urinary alkalinizing agents, MAOinhibitors( increase amphetamine effects ).Meperidine ( Demend) ( amphetamines

increase analgesic effects; mepiridine increaserisk of seizure and vascular collapse.



Thyroid hormone ( reciprocal increase

in effect

s.Adrenergic blockers, antihistamines,antihytensives- amphetamines may

affect decrease.



Alcohol - interacting drugs are other CNS

depressants, sedative- hypnotics, opioids,general anesthetics ( Increase CNS

depression with increase risk of death from

respiratory depression.Nonsteroidal anti-inflammatory drugs

(combines effects increase risk of gastric

bleeding.



Acetaminophen ( increase risk of liver injury ).

Antihypertensives ( decrease effects of anti

Antihypertensives).





Barbiturates- interacting drugs are other CNS

depressants; alcohol, opioids, generalanesthetics, other sedatives/hypnotics MAO

inhibitors, valproic acid ( increase CNS

depression)

Oral anticoagulants, cortico- and other steroidhormones, griseofulvin, doxycycline ( effects

decrease by barbiturates ).



Benzodiazepines- interacting drugs are

other CNS depressants, alcohol, opioids,general anesthetics, sedatives/hypnotics

(increase CNS depressants). Herbs: kava

kava, Valerian



Opioids- interacting drugs are other CNS

depressants, alcohol, opioids, generalanesthetics, sedatives/hypnotics,

phenothiazines, antiemetics ( Increase CNS

depressants).

opioids contd - mixedwith agonist/antagonist

opioids ( reduce the effect of pure opioids

agonist and may precipitate withdrawalsyndrome).



MAO inhibitors, diuretics ( may cause

severe fatal reaction opioids maydecrease effects.

opium pod



M arijuana/hashish interacting drudgs are

CNS stimulants/ sympathomemitics,anticholinergic agents, Tricyclic

antidepressants (additive hypertension,

tachycardia, drowsiness).

CNS depressants ( additive drowsiness andCNS depressions).

Thoephylline ( decrease effects of

thoephylline).



HERBAL THERAPY



H erbal M onographs

Herbal Monographs are therapeuticand qualitative.

Therapeutic monographs contain

information an use, dosage, sideeffects and contraindications

Qualitative monographs have

information on areas such ascompliance with compounding

guidelines and standard of purity.





have a short life. Drying is a means of

preservation.

4. Oils are made by soaking by dried

herbs in olive or vegetables oil and

then heating for an extended time.5. Salves semi solid fatty

preparations are made by melting a

wax in oil and allowing it to cool andharden. If stored correctly , they last

for several months as balms, creams

and ointments.



\6. Teas are made by steeping fresh or

dried herbs in boiling water. Tea

made from bark and roots is often

simmered. Teas maybe used from

drinks added to baths and applied

topically in a compress.

7. Tinctures are commonly made by

soaking fresh or dried herbs in

solvent such as water and alcohol.



8. Syrups are made by adding a

sweetener, usually honey or sugar,

to the herb ant then cooking it.

Syrups are used to treat colds, cough

and sore throats.

9. Capsules are commonly a

powdered form of dried supplement,

but they may hold juices or oils.

10. Tablets are similar to capsules

they are a powder compressed with

stabilizers and binders



Commonly used Herbal Remidies

- most Herbal therapies are used for chronic conditions, are unlikely to cause harm,and may provide some relief in selected

situation.

Aloe Vera

The juice is used externally for treatment of minor burns, insect bites, and sunburn.

there has been some success



with the treatment of dandruff, oily skin and

psoriasis.

Internal use contraindicated if pregnant,lactating, children <12 yrs.old. Consult withHCP before taking if have ulcerative colitis,taking cardiac glycosides, artierrythmics,thiazide diuretics, licorice.

side effect or long term use mat causearrhythmias, neuropathies hematuria,



albuminuria.

for dosage tincture/extracts: 50-300 mg..External- t.i.d PRN

Chamomile ( M

atricaria recu tita) stimulates normal digestion, anti-

inflammatory



antispasmodic, mild sedative, mild diuretic,

mild antibacterial also used anxiety,insomnia, indigestion, inflammatory skin

conditions.

avoid if allergic to daisy family, mayincreased effects of sedatives and interferewith action of anticoagulants.

dosage between meals; cap/tab 2-3g t.i.d

tea; 1-4c/d tincture; max: 1 tsp t.i.d



Dong Quai (Angelica sinesis)

phytoestrogen activity; vasodilation,small muscle relaxation. Decreased Igeantibody production.

use as PMS, menopausal aymptoms,cardiovascular support.

avoid the use of this herb , with

prescription anticoagulants history of bleeding disorders, pregnancy, if at risk



of breast cancer

side effects rash and photosensitivity; feverbleeding.

dosage tea; 1-4 c/d tincuture: ½-4 ml



Echinacea ( Echinaceaangustifolia)

stimulates immune system;antibacterial, antiviral, antipyreticantifungal as topical.

use as a prevention and early treatmentof colds and flu; recurrent respiratory,ear and urinary tract infections.

short term use; 2wks.;8 wks. If lowdose;may be bepatotoxic if takencontinuously. Avoid use with immuno-



suppressants such as corticosteroids; personwith chronic systemic disease of immunesystem, safety not determined in pregnancylactation and children < 2 yrs.old.

side effects, temporary numbness or

tingling of tongue, cross-sensitivity in clients allergic to

daisy family .

dosage tab; 500mg- 1g t.i.d tea; 1-5 c/dtincture; max.2 tsp t.i.d



Feverfew(Chrysanthemum parthenium))

used as prevention and long termmanagement

of migraine headaches, rheumatoid arthritis;menstrual problems; allergies.

may be 4-6 wks. effect; continuous use forbest

outcome avoid with pregnant ,lactation,with

prescription anticoagulants and in children <2y. consult HCP before using herb if taking

prescription.



possible gastric distress or mouth sores if

using raw leaves , muscle stiffness. dosage cap/tab 9at least 2% parthenolide)125

mg/d; increase to 1-2 g with acute attack.



Garlic (Allium sativum)

Frequently called the herb of endurance ported to lower cholesterol and triglyceridelevels decreas blood levels and reduce theclotting capability of blood, act as an

antibiotic to treat infection and wound bothinternal and externally.

Warm garlic oil is used in the ear fir treatment

of earache . avoid using during pregnancy and lactation,

blood



pressure may be decrease in 30min. Andreturn to baseline in about 2hrs

side effects/adverse reaction- heartburn,flatulence, gastric irritation, decrease RBCs,dizziness diaphoresis



Ginger

stimulates digestion, increase bile andmotility. Use for nausea, pregnancy morningsickness, motion sickness, gastric protection.

avoid long term use with pregnancy,thrombocytopia( abortaficiant in large

amounts).

it may cause gastric discomfort; if not takenwith foods; anorexia



take with food cap/tea/tab;2-4 g in 2-3 divided

doses, for motion sickness start 2 d to 2 hr

before travel.



Ginkgo

use for allergic rhinitis, anxiety/stress,dementia, Reynaud's disease, tinnitus,

vertigo, impotence, poor circulation.

effects can seen in 2-3wks; 12 wks. courserecommended , avoid in pregnancy,lactation, children. May increase BP if used

thiazide diuretics.



side/adverse effects initially mild transientheadache that usually stops in 2d; mild

gastric distress Toxicity; vomiting, diarrhea,

dermitis, irritability.



GINSENG

supports adrenal glands,use for colds andflu prevention, adaption to stress, chronic fatigue syndrome, mental and emotional

fat

igue . take for 6-8 wks..then 1 wk. drug holiday

and resume for total of 3 mos.. avoid with

Bp >170/90, pregnancy, lactation,children,

bipolar or psychic disorder.



Side/adverse effect is hypertension,palpitations, occasional diarrhea; possible

insomnia If taken at bed time. Abuse use of ginsengcan lead to edema, insomnia, andhypertonic

And may be life threatening.

asian ginseng



Goldenseal

Stimulates immune system and bilesecretions, use for infection, digestive,

urinary track infection, mucous

membranes.

Avoid with pregnancy , lactation,children, HTN dosing 5-7 d of higher

doses may increase liver enzymes.



Side/adverse effects in higher doses

may be hepapatoxic; Toxicity CNS

depression, restlessness, seizure,

cardiovascular collapse.



K AVA

Use for anxiety, insomnia, skeletal musclespasm, no risk of tolerance.

Avoid with pregnancy, lactation and if taking levodopa; not for young children

also avoid alcohol use and if need to bealert or operate machinery.

Side/adverse effects is unstable gait, numb

tongue, high doses may cause loss of balance, pulmonary hypertension maycause liver toxicity.



licorice

anti-inflamatory, antibacterial, use for viralinfection, upper respiratory infection,inflammation.

Avoid with pregnancy, lactation, children,kidney or liver disorders or if at risk of

hypokalemia.



Milk thistle (Mary thistle wild artichoke)

increase regeneration of liver cells; increase

antioxidants activity.

use as liver disease ( hepatitis ), cholecystitis,psoriasis.

avoid use in pregnant ,lactation, in children,with drugs metabolized by P-450 enzymes.

side/adverse effects can lead to diarrhea first

day of therapy, nausea, vomiting, menstrualchanges.



Peppermint

antispasmodic, increase bile flow,

carminative, external analgesic.

use as IBS, indigestion, cholecystitis, infantscolic, nasal decongestion.

consult HCP before taking if have cholecytitisor obstructed bile duct, no known drug

interactions; may interfere with iron

absorption.



St. Johns wort

use for mood swings, mild to moderate

depression, anxiety, sleep disorder; topicallyBurns/ wounds

Long term use recommended ; effects seen in 4-

8 wks. avoid in pregnancy, lactation, prescription anti

depressants, children < 2y.

side/adverse effects sin photosensitivity,

headache, occasional GI upset, dry mouth,dizziness, confusion.

S l tt



Saw palmetto

decrease size of prostate; increase

breakdown of estrogen, progesterone, andprolactin; antiandrogenic.

Use in BPH, chronic cystitis; sexual

potency.

recommended 45-90 d of treatment, effectsseen in 30 d. If effective, may take long term.

avoid in pregnancy, lactation, on children in

clients with breast cancer. side/adverse effects can be headache,

dysuria, back pain, Gastric disturbance.



Valerian

Use for insomnia, stress, headaches,mild anxiety, muscle cramps and spasm.

effects may be take several doses . Forlong term use, monitor liver function if

elevated, discontinue herb.avoid in pregnant, lactation, children,

with prescription sedative/hypnotics,

anticoagulants.



Increase sedative effects with

barbiturates; negates effects of phenytoin. Foul smell; no dependence

or tolerance.

side /adverse effects anxiety,headache, occasional GI upset and

hang-over effects with high doses,

CNS depression.

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DRUG ABUSE Power Point