NurseSavvy Cheat SheetDisease
Other Substance Use
Pathophysiology & Risk Factors
Substance use disorders beyond alcohol and opioids divide into stimulants (cocaine, amphetamines/methamphetamine), sedative-hypnotics (benzodiazepines, barbiturates), hallucinogens (PCP, LSD), cannabis, and inhalants. The master framework is stimulant versus depressant: stimulants drive sympathetic overdrive, while sedative-hypnotic withdrawal mirrors alcohol withdrawal and can seize and kill.
Stimulant vs sedative-hypnotic: intoxication & withdrawal
StimulantSedative-hypnotic
ExamplesCocaine, methamphetamineBenzodiazepines, barbiturates
Intoxication pictureSympathetic overdrive: HTN, tachycardia, hyperthermia, agitationCNS depression: sedation, slowed respirations
PupilsDilated (mydriasis)Normal/sluggish
Withdrawal dangerCrash: fatigue, hypersomnia, depression (not life-threatening)Seizures and death (like alcohol)
Withdrawal managementSupportive, monitor mood/suicide riskGradual taper, never abrupt stop
Stimulant
- Examples
- Cocaine, methamphetamine
- Intoxication picture
- Sympathetic overdrive: HTN, tachycardia, hyperthermia, agitation
- Pupils
- Dilated (mydriasis)
- Withdrawal danger
- Crash: fatigue, hypersomnia, depression (not life-threatening)
- Withdrawal management
- Supportive, monitor mood/suicide risk
Sedative-hypnotic
- Examples
- Benzodiazepines, barbiturates
- Intoxication picture
- CNS depression: sedation, slowed respirations
- Pupils
- Normal/sluggish
- Withdrawal danger
- Seizures and death (like alcohol)
- Withdrawal management
- Gradual taper, never abrupt stop
Signs & Symptoms
Dilated pupils Hallmark
stimulant intoxicationHypertension
stimulant intoxicationTachycardia
stimulant intoxicationHyperthermia
stimulant intoxicationAgitation and paranoia
stimulant intoxicationFormication
methamphetamine: bugs crawling under skinSevere dental destruction
methamphetamineNystagmus Hallmark
PCP, not LSDUnpredictable violence
PCPConjunctival injection Hallmark
cannabis intoxicationImpaired coordination
cannabis intoxicationChemical odor on breath Hallmark
inhalant use in adolescentsDiagnostics & Labs
Diagnostic
Pupil size assessment
pinpoint=opioid, dilated=stimulantUrine toxicology screen
Monitor
Vital sign trends
BP, HR, temp in stimulant overdoseECG
cocaine chest pain = rule out MIWithdrawal severity monitoring
sedative-hypnotic taperInterventions & Priorities
Ensure staff and client safety first
PCP violencePlace in low-stimulation environment
PCP intoxicationContinuous cardiac monitoring
stimulant overdose, cocaineActive cooling for hyperthermia
stimulant overdoseInstitute seizure precautions
sedative-hypnotic withdrawalSubstitute long-acting benzodiazepine
benzo withdrawal with seizuresTreatments & Medications
Long-acting benzodiazepine taper
treats sedative-hypnotic withdrawalSupportive care
stimulant intoxication; no reversal agentMotivational interviewing
OARS; meets pre-contemplation clientPatient Teaching
Never stop benzodiazepines abruptly
taper under medical supervisionCocaine chest pain is an emergency
MI risk even when young and healthyInhalants can cause death on first use
sudden cardiac deathExplore ambivalence without confrontation
open-ended questions, avoid lecturingComplications
Myocardial infarction
cocaine, even in young clientsCardiac arrest
stimulant overdoseWithdrawal seizures
sedative-hypnoticReport Nowescalate immediately
Sedative-hypnotic withdrawal seizures Hallmark
benzo/barbiturate; can be fatalStimulant overdose hyperthermia
temp >39C with seizure/cardiac riskCocaine-associated chest pain
MI in young clientInhalant sudden cardiac death risk
even on first useClinical Pearl
Pupils tell the story: pinpoint means opioids (down), dilated means stimulants (up). And if it sedates, its withdrawal can seize and kill, so never stop benzos or barbiturates cold turkey.