MODULE # 5

PHARMACOLOGY NURSING

prepared by:

LHEVINNE P. GENETIALIZA, RN
 1 CORINTHIANS 10:13
No temptation has overtaken
you except what is common to
mankind. And God is faithful;
BIBLICAL VERSE he will not let you be tempted
beyond what you can bear.
But when you are tempted, he
will also provide a way out so
that you can endure it.
LEARNING OBJECTIVES
1. Differentiate among drug abuse, drug misuse & drug
addiction;
2. Describe the short-term and long term effects of drug
addiction;
3. Identify the physical and psychological assessment findings
associated with the use of commonly abused central nervous
system stimulant and depressants;
4. Explain the rationale for the use of pharmacologic treatments
during toxicity, withdrawal and maintenance of abstinence of
commonly abused drugs; and
5. Prioritize appropriate nursing interventions to use during
treatment of patients with substance toxicity and withdrawal.
DIFFERENTIATING TERMS
DRUG MISUSE
 refers to indiscriminate or
recreational use of a
chemical substance or its
use for purposes other than
those for which it is
intended.
DRUG ABUSE
 overindulgence of a
chemical substance that
results in a negative impact
on the psychological,
physical, or social
functioning of an
individual.
DRUG ADDICTION
 considered a complex disease of
the central nervous system
(CNS), characterized by a
compulsive, uncontrolled
craving for and dependence on a
substance to such a degree that
cessation causes severe
emotional, mental, and or
physiologic reactions.
Commonly Misused Drugs:
• Opioids—usually prescribed to treat pain
(codeine, morphine)
• Central nervous system [CNS] depressants (this
category includes tranquilizers, sedatives, and
hypnotics)—used to treat anxiety and sleep
disorders.
• Cough Suppressants- Dextromethorphan (DXM)
 The most commonly abused substances 
1. Alcohol 5. Opioids
2. Sedatives, hypnotics, and 6. Hallucinogen
anxiolytics
7. Inhalants
3. Stimulants
(amphetamines, cocaine)
4. Cannabis
 1. ALCOHOL
Alcohol is a central nervous system
depressant that is absorbed rapidly into
the bloodstream; initially, the effects
are relaxation and loss of inhibition; with
intoxication, there is slurred speech,
unsteady gait, lack of coordination, and
impaired attention, concentration,
memory, and judgment.
 2. Sedatives, hypnotics, and anxiolytics

This class of drugs includes all

central nervous system
depressants, barbiturates,
nonbarbiturates hypnotics, and
anxiolytics, particularly
benzodiazepines; the effects of the
drugs, symptoms of intoxication, and
withdrawal symptoms are similar to
those of alcohol.
 3. CNS Stimulants (amphetamines, cocaine)
  Stimulants are drugs that stimulate or
excite the central nervous system;
intoxication from stimulants develops
rapidly; effects include the high or
euphoric feeling, hyperactivity,
hypervigilance, talkativeness, anxiety,
grandiosity, hallucinations, repetitive
behavior, anger, and impaired judgment.
 4. CANNABIS (Marijuana)

 Tetrahydrocannabinol (THC)
– active ingredient that is
responsible for most of the
psychoactive effects.
 CANNABIS (Marijuana)
 In other country like in North America,
cannabis is sold legally.
 Beneficial effects:
- control nausea & vomiting as a result
from cancer chemotherapy.
- stimulate appetite in patients with
acquired immunodeficiency
syndrome (AIDS).
 CANNABIS (Marijuana)
 When marijuana is smoked,
effects usually occur in 20-
30 minutes, and may last up
to 7 hours.
 Half-life: 2-7 days
 SIDE EFFECTS OF CANNABIS
Usual Effects: Other undesirable effects:
 euphoria  Decreased sperm production
 sedation &  Decreased reproductive hormones both in men and
 Hallucination women

Undesirable Effects:
 Short-term memory loss
 Decreased ability to perform multi-step tasks
 In High doses: cause intense anxiety, delusions,
paranoia and a state of toxic psychosis
SIDE EFFECTS OF CANNABIS
 5. Opioids
Opioids are popular drugs of abuse because
they desensitize the user to both physiologic and
psychological pain and induce a sense of euphoria
and well-being; opioid intoxication develops soon
after the initial euphoric feeling; symptoms include
apathy, lethargy, listlessness, impaired judgment,
psychomotor retardation or agitation, constricted
pupils, drowsiness, slurred speech, and impaired
attention and memory.
 6. HALLUCINOGEN
  Hallucinogens are substances that distort the
user’s perception of reality and produce symptoms
similar to psychosis, including hallucinations and
depersonalization; hallucinogen intoxication is
marked by several maladaptive behavioral or
psychological changes, anxiety, depression,
paranoid ideation, ideas of reference, fear of
losing one’s mind, and potentially dangerous
behavior such as jumping out the window in the
belief that one could fly.
 7. INHALANTS
  Inhalants are a diverse group of drugs that
includes anesthetics, nitrates, and organic
solvents that are inhaled for their effects; the
most common substances in this category are
aliphatic and aromatic hydrocarbons found in
gasoline, glue, paint thinner, and spray paint;
inhalant intoxication involves dizziness,
nystagmus, lack of coordination, slurred
speech, unsteady gait, tremor, muscle
weakness, and blurred vision.
LIMBIC SYSTEM- (PLEASURE CENTER/BRAIN REWARD
SYSTEM)
 PHYSICAL SIGNS OF DRUG ADDICTION

 Cravings and Withdrawal

Addicts go from wanting drugs to needing them in
order to feel well, and if those needs are frustrated they
will begin to experience withdrawal symptoms within a
few hours of their last dosage. Those symptoms can
include panic attacks, insomnia, elevated heart rate,
shakiness or weakness, headaches, nausea, muscle
cramps, and extreme anxiety or nervousness.
 PHYSICAL SIGNS OF DRUG ADDICTION
 Growing Tolerance
As their dependency progresses, person
must consume larger quantities of their drugs
of choice to experience the same effects.
High tolerance can prompt them to consume
dosages that put them at significant risk for
overdose..
 PHYSICAL SIGNS OF DRUG ADDICTION

 Changes in Appearance
   Some of the outward signs of
drug abuse include excessively dry
eyes, dilated pupils, tooth decay,
significant weight loss, pale skin, hair
loss, and the presence of sores that
won’t heal.
 PHYSICAL SIGNS OF DRUG ADDICTION

 More Frequent Illnesses

Drug abuse damages immune system
functioning and alters body chemistry in
multiple ways. This makes addicts more
prone to colds, flus, pneumonia, allergy
attacks, bacterial infections, and a host
of other potential illnesses or diseases.
 PHYSICAL SIGNS OF DRUG ADDICTION
 Chronic Physical Health Conditions
Long-term drug abuse can 
increase risk for numerous physica
l ailments and
conditions. Those who inject drugs
and share needles are at elevated risk
for hepatitis and HIV/AIDS.
 PSYCHOLOGICAL SIGNS
 Abrupt Changes in Mood
As chemical imbalances
develop, drug addicts can
experience feelings of depression,
anxiety, irritability, hostility, and
paranoia that seem to come from
nowhere.
 PSYCHOLOGICAL SIGNS
 Stronger Symptoms of Mental Illness
In 2016, 43.3 percent of people
with drug abuse problems
 also suffered from some form of m
ental illness
, and the s
ymptoms of mental disorders are
likely to intensify when complicated
by substance dependence.
 PSYCHOLOGICAL SIGNS
 Impulsivity
As time passes drug addicts may lose
their inhibitions and suffer from
impaired judgement, which leads them
to make rash and questionable decisions
that may seem completely out of
character.
 SOCIAL RELEVANCE
Why do adolescents indulge
in drug addiction?
 Reasons:
 To fit in  To do better
 To feel good  To experiment

 To feel better
TREATMENT, MANAGEMENT
 COCAINE TOXICITY MANAGEMENT
 Emergency management of cocaine toxicity
depends on the patients findings at the time
treatment.
 There is no specific antidote for cocaine toxicity,
but during the overdose most symptoms can be
controlled with a variety of dugs.
 DRUG THERAPY FOR COCAINE TOXICITY
ASSESSMENT FINDINGS DRUG THEPAPY
Cardiovascular Symptoms:  Establish IV access, and initiate fluid replacement as
 Palpitations appropriate.
 Tachycardia  Anticipate the need for Propanolol (Inderal) or Labetalol
 Hypertension (Normodyne) for hypertension and tachycardia.
 Myocardial ischemia or Infarction  Aspirin may be given to lower the risk for myocardial
infarction.

CNS Symptoms:  Naloxone (Narcan) IV should be given if CNS

 Euphoria depression is present.
 Agitation  Administer diazepam (Valium) for agitation and seizures.
 Combativeness  Administer chlorpromazine (Thorazine) or haloperidol
 Seizures (Haldol) IV for treatment of psychosis and
 Hallucinations hallucinations.
 Confusion
 Paranoia
 Fever
 DRUGS USED IN OPIOD ADDICTION
SIGNS AND SYMPTOMS: DRUG THERAPY

 Respiratory depression  OPIOID ANTAGONIST

 Coma  Naloxone (Narcan): Short-acting and may need to be
repeated until opioid level decreases; too much will cause
withdrawal symptoms.

 Withdrawal Symptoms:  Opioid Substitution

- nausea, vomiting, diarrhea, - Methadone (Dolophine)- An opioid agonist that may be
- abdominal cramping, used to prevent withdrawal syndrome; it is given in
- bone and muscle pain decreasing oral doses over 10-14 days after the patient is
- muscle spasms, tremors, chills, stabilized.
diaphoresis

 Centrally Acting Alpha2-adrenergic Agonist

- Clonidine (Catapres) – effective in decreasing GI
hyperactivity and some other symptoms of withdrawal; does
not reduce craving for the drug.
 DRUG THERAPY

OPIOID ANTAGONIST
- Naltrexone (ReVia, Vivitrol)- blocks
euphoria and all other opioid effects.

AGONIST-ANTAGONIST OPIOID
- Buprenorphine (buprenex)
- used for detoxification and
maintenance therapy.
- this drug can decrease the symptoms
of withdrawal and suppress drug
craving.
 DIAGNOSIS
 The standard urine drug screen can
be used to detect THC metabolites.
  Positive results for THC
carboxylase have been reported up
to 10 days after weekly use and up
to 30 days after heavy daily use.
 DIAGNOSIS
 detection of THC
carboxylase in hair, which
has the benefit of
detection up to 3 months
after use.
 DIAGNOSIS
 Detection of THC can also be
accomplished in the oral fluid within 24
hours of use and in blood within about 14
to 21 days of use.
 Breathalyzer tests have also been
proposed, but since small amounts of
cannabis continue to be released from fat
into the blood long after short-term
impairment wears off, this method has not
been promoted. 
 TREATMENT
Individual using marijuana may seek
treatment for anxiety or mood symptoms.
Thetreatment is directed towards relief of
symptoms.
There is antidote therapy for cannabis
intoxication.
 ACTIVITY
CASE STUDY SCENARIO
 Cocaine Toxicity
 Patient Profile :
Mr. Snor Teng is a 34-year-old man who was admitted to the emergency department with chest pain,
tachycardia, dizziness, nausea, and severe migraine-like headache. Subjective Data • He thinks he is
having a heart attack. • Admits he was at a party earlier in the evening drinking alcohol, smoking pot,
and snorting cocaine. • States he became irritable and restless. • States he has experienced an increased
need for cocaine in the past few months. Objective Data • Appears extremely nervous and irritable •
Appears pale and diaphoretic • Has tremors • BP 210/110, HR 100 bpm, RR 30 bpm.
 Activity
Based on the given data: Deadline: Nov. 12, 2020
1. Create a 2 priority Nursing care plan with 5 nursing interventions.
2. Make used of the right format in making Nursing Care Plan:

CUES Need Nsg. Diagnosis Objective of Care Nsg. Intervention

with Rationale