NR 547 Differential Diagnosis in Psychiatric-Mental Health
across the Lifespan Practicum - Chamberlain
NR 547 Week 8
1. Substance use disorder occurs when:: the recurrent use of a substance, such
as alcohol or drugs, causes clinically significant impairment
-including health problems, disability, or failure to meet responsibilities at home,
work, or school
2. Tolerance: With repeated ingestion of a drug, the drug shows decreased effect.
Increasing doses are required to achieve the effects noted with the original admin-
istration
3. Dependence: State of adaptation produced with repeated administration of cer-
tain drugs so that physical symptoms occur when the drug is discontinued abruptly.
4. Addiction: A change in behavior caused by biochemical changes in the brain
after continued substance use characterized by preoccupation with and repeated
,use of a substance despite of negative outcomes.
5. Withdrawal: Physiological and psychological reactions that occur when the use
of a substance is stopped abruptly.
6. Intoxication: Condition following the ingestion of a substance resulting in
changes in level of consciousness, cognition, perception, judgment, and behavior.
7. Bernita is a 64-year-old who has been using heroin for 6 years. She is
currently unemployed and lives with her daughter in the city center. She does
not have health insurance.
prescribe the proper medication:
Methadone
Buprenorphine
Buprenorphine plus naloxone (Suboxone)
Naltrexone: Methadone
Methadone is a full ¼
re-ceptor agonist with a long half-life, which can prevent with-
drawal symptoms for 24 hours and provide steady control of cravings throughout
the day. It is only administered in methadone federally regulated opioid treatment
programs (OTP). Methadone clinics incorporate psychosocial interventions and
require daily attendance for the first several months, so this is a good option for
a client that has the flexibility to attend daily meetings. Use of methadone in MAT
for opioid use disorder helps extend client survival. When patients stop methadone,
,they have a high likelihood of relapsing, even 10 years after starting treatment.
8. Antoine is a 34-year-old who has been abusing prescription oxycodone. He
is employed but is on probation at work for increased absenteeism. He desires
MAT but is concerned about his roommates stealing his medication to get
high.
prescribe the proper medication:
Methadone
Buprenorphine
Buprenorphine plus naloxone (Suboxone)
Naltrexone: Buprenorphine plus naloxone (Suboxone)
In combination with naloxone (Suboxone): naloxone is a mu opioid receptor antago-
nist and can therefore block the effects of buprenorphine; however, because nalox-
one has poor sublingual bioavailability, it does not interfere with buprenorphine's
effects when used properly. Naloxone does have good parenteral bioavailability;
thus, if one tries to administer the buprenorphine/naloxone formulation intravenous-
ly, naloxone will prevent any rewarding effects from buprenorphine, making this drug
a less desirable street drug. Suboxone is a good option for a client who may not be
able to leave work for medication dosing, as it does not need to be taken under direct
observation.
9. Lisa is a 29-year-old who admits to using "pills, heroin, and booze" regularly.
She lives in a rural area and is employed part-time. She has a history of poor
compliance with past treatments.
, prescribe the proper medication:
Methadone
Buprenorphine
Buprenorphine plus naloxone (Suboxone)
Naltrexone: Naltrexone
Naltrexone blocks mu opioid receptors, preventing exogenous opioids from binding
there and thus preventing the pleasurable effects of opioid consumption. This med-
ication also reduces alcohol consumption through modulation of opioid systems,
thereby reducing the reinforcing effects of alcohol. For those patients with alcohol
use disorder, who have poor adherence to a regimen, and are unable to maintain
abstinence, long-acting injection naltrexone (Vivitrol) administered monthly can be
efficacious.
10. Miranda is a 20-year-old who is 18 weeks pregnant and uses heroin. She
wants to get clean "for her baby."
prescribe the proper medication:
Methadone
Buprenorphine
across the Lifespan Practicum - Chamberlain
NR 547 Week 8
1. Substance use disorder occurs when:: the recurrent use of a substance, such
as alcohol or drugs, causes clinically significant impairment
-including health problems, disability, or failure to meet responsibilities at home,
work, or school
2. Tolerance: With repeated ingestion of a drug, the drug shows decreased effect.
Increasing doses are required to achieve the effects noted with the original admin-
istration
3. Dependence: State of adaptation produced with repeated administration of cer-
tain drugs so that physical symptoms occur when the drug is discontinued abruptly.
4. Addiction: A change in behavior caused by biochemical changes in the brain
after continued substance use characterized by preoccupation with and repeated
,use of a substance despite of negative outcomes.
5. Withdrawal: Physiological and psychological reactions that occur when the use
of a substance is stopped abruptly.
6. Intoxication: Condition following the ingestion of a substance resulting in
changes in level of consciousness, cognition, perception, judgment, and behavior.
7. Bernita is a 64-year-old who has been using heroin for 6 years. She is
currently unemployed and lives with her daughter in the city center. She does
not have health insurance.
prescribe the proper medication:
Methadone
Buprenorphine
Buprenorphine plus naloxone (Suboxone)
Naltrexone: Methadone
Methadone is a full ¼
re-ceptor agonist with a long half-life, which can prevent with-
drawal symptoms for 24 hours and provide steady control of cravings throughout
the day. It is only administered in methadone federally regulated opioid treatment
programs (OTP). Methadone clinics incorporate psychosocial interventions and
require daily attendance for the first several months, so this is a good option for
a client that has the flexibility to attend daily meetings. Use of methadone in MAT
for opioid use disorder helps extend client survival. When patients stop methadone,
,they have a high likelihood of relapsing, even 10 years after starting treatment.
8. Antoine is a 34-year-old who has been abusing prescription oxycodone. He
is employed but is on probation at work for increased absenteeism. He desires
MAT but is concerned about his roommates stealing his medication to get
high.
prescribe the proper medication:
Methadone
Buprenorphine
Buprenorphine plus naloxone (Suboxone)
Naltrexone: Buprenorphine plus naloxone (Suboxone)
In combination with naloxone (Suboxone): naloxone is a mu opioid receptor antago-
nist and can therefore block the effects of buprenorphine; however, because nalox-
one has poor sublingual bioavailability, it does not interfere with buprenorphine's
effects when used properly. Naloxone does have good parenteral bioavailability;
thus, if one tries to administer the buprenorphine/naloxone formulation intravenous-
ly, naloxone will prevent any rewarding effects from buprenorphine, making this drug
a less desirable street drug. Suboxone is a good option for a client who may not be
able to leave work for medication dosing, as it does not need to be taken under direct
observation.
9. Lisa is a 29-year-old who admits to using "pills, heroin, and booze" regularly.
She lives in a rural area and is employed part-time. She has a history of poor
compliance with past treatments.
, prescribe the proper medication:
Methadone
Buprenorphine
Buprenorphine plus naloxone (Suboxone)
Naltrexone: Naltrexone
Naltrexone blocks mu opioid receptors, preventing exogenous opioids from binding
there and thus preventing the pleasurable effects of opioid consumption. This med-
ication also reduces alcohol consumption through modulation of opioid systems,
thereby reducing the reinforcing effects of alcohol. For those patients with alcohol
use disorder, who have poor adherence to a regimen, and are unable to maintain
abstinence, long-acting injection naltrexone (Vivitrol) administered monthly can be
efficacious.
10. Miranda is a 20-year-old who is 18 weeks pregnant and uses heroin. She
wants to get clean "for her baby."
prescribe the proper medication:
Methadone
Buprenorphine
