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Pharmacology Exam 3 > Analgesic Agents > Flashcards

Analgesic Agents Flashcards

1
Q

What are A fibers?

A
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2
Q

What is A-delta fibers?

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3
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What are C Fibers?

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4
Q

What is Ergot derivative?

A
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5
Q

Explain the gate control theory

A

●Sensory and emotional experience
●Transmission of these impulses can be modulated or adjusted
●Interneurons can act as “gates”
●Several factors, including learned experiences, cultural expectations, individual tolerance, and the
placebo effect, can activate the descending inhibitory nerves from the upper central nervous system

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6
Q

What is a Migraine Headache?

A
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7
Q

What’s Nociception?

A
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8
Q

What are opioid agonists?

A
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9
Q

What are opioid agonists-antagonists?

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10
Q

What are opioid antagonists?

A
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11
Q

What are opioid receptors?

A
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12
Q

Define pain.

A

Sensory and emotional experience associated with actual or
potential tissue damage

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13
Q

What is the Spinothalamic tract?

A
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14
Q

What is Troptam?

A
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15
Q

What are two times of pain duration?

A

Acute & Chronic

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16
Q

How does drugs used to relieve pain work?

A

Works in the CNS to alter the way pain impulses are
processed.

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17
Q

Why do we use opioids?

A

Opium derivatives used to treat many types of pain

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18
Q

What do we use Antimigraine Drugs for?

A

Reserved for the treatment of migraine headaches.

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19
Q

Where are opioid receptors found?

A

○CNS
○Nerves in the periphery
○Cells in the gastrointestinal (GI) tract
○CTZ - chemoreceptor trigger zone

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20
Q

What are some lifespan considerations that we should keep in mind when administering opioids to children?

A

○Safety and efficacy not established
○Dosage should be carefully
calculated
○Monitor closely for ADE

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21
Q

What are some lifespan considerations that we should keep in mind when administering opioids to adults?

A

○Encourage to request pain medication before pain out of control
○Caution in pregnancy/lactation
○Narcotics used during labor- monitor mom and baby closely for ADE

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22
Q

What are some lifespan considerations that we should keep in mind when administering opioids to older adults?

A

○More likely to experience ADE
○More likely to develop toxicity
○Implement safety measures

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23
Q

Define Opioid Agonists.

A

●Drugs that react with opioid receptors
●Cause analgesia, sedation, or euphoria
●Potential for physical dependence
●Controlled substances
●Rising problem of addiction

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24
Q

What drug classes under Opioid Agonists do we need to know?

A

Morphine, hydromorphone, codeine, oxycodone, fentanyl, hydrocodone

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25
Q

What are the MOA’s for Opioid Agonists?

A

○Act at specific opioid receptor sites in the CNS
○Produce analgesia, sedation, and a sense of well-being

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26
Q

Why would we give Opioids Agonists to patients?

A

○Relief of severe acute or chronic pain
○Analgesia during anesthesia

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27
Q

What are some factors that would contraindicate the use of Opioid Agonists?

A

○Known allergy
○Diarrhea caused by poisons

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28
Q

What pre-existing patient conditions would prompt us to use caution when administering opioid agonists?

A

○Respiratory dysfunction, asthma, emphysema
○Pregnancy, labor, lactation
○GI or GU surgery
○Acute abdomen or ulcerative colitis
○Head injuries, alcoholism, delirium tremens, or CVA

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29
Q

What are some known adverse reactions to opioid agonists?

A

○Respiratory depression with apnea, cardiac arrest,
shock, orthostatic hypotension, nausea, vomiting,
constipation, dizziness
○CNS effect

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30
Q

Are there any DDI’s to opioid agonists, and if so, what are they?

A

○Barbiturate general anesthetics
○SSRIs
○and more

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31
Q

Which are the 3 drug classes that we need to know for Opioid Agonists–Antagonists?

A

Buprenorphine, Butorphanol, Nalbuphine

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32
Q

What are the MOA’s of for Opioid Agonists–Antagonists?

A

Act as partial agonists at the mu-opioid receptors and antagonists at the kappa-opioid receptor in the CNS to produce analgesia, sedation, euphoria, and hallucinations.

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33
Q

Why would we administer Opioid Agonists–Antagonists to patients?

A

○Moderate to severe pain
○Some can be used to treat opioid use disorder

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34
Q

What are some factors that would contraindicate the use of Opioid Agonists–Antagonists in patients?

A

○Known allergy
○Nalbuphine- if sulfite allergy

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35
Q

What pre-existing patient conditions would prompt us to use caution when administering Opioid Agonists–Antagonists ?

A

○Physical dependence on a narcotic
○COPD and disease of the respiratory tract
○Acute MI or documented CAD, HTN
○Renal or hepatic dysfunction
○Pregnancy and lactation

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36
Q

What are some known adverse reactions to Opioid Agonists–Antagonists ?

A

○Respiratory depression
○Nausea, vomiting, constipation, and biliary spasm actions
○Headache, dizziness, psychoses, anxiety, hallucinations
○Ureteral spasm, urinary retention
○Sweating and dependence

37
Q

Are there any DDI’s to Opioid Agonists–Antagonists , and if so, what are they?

A

○Barbiturate general anesthetics
○Narcotic agents

38
Q

For both Opioid agonists & Opioid Agonists–Antagonists, what should we be assessing our patients for prior to administering the drugs?

A

○Assess for contraindications or cautions
○Perform a pain assessment with the patient
○Perform a physical assessment
■Assess orientation, affect, reflexes, and pupil size; monitor respiratory rate and auscultate lungs
■Monitor pulse, blood pressure, and cardiac output
■Palpate abdomen and auscultate bowel sounds; assess urine output and palpate for bladder distension
○Monitor the results of laboratory tests such as liver and renal function tests

39
Q

What nursing diagnoses can be made and anticipated prior to administering Opioid agonists & Opioid Agonists–Antagonists ?

A

○Altered sensory perception (visual, auditory, kinesthetic) related to CNS effects
○Constipation, nausea, vomiting related to GI effects
○Altered gas exchange related to respiratory depression

40
Q

What are some implementations that we should be prepare to do when/after administering Opioid agonists & Opioid Agonists–Antagonists to our patients ? (long answer)

A

○Perform baseline and periodic pain assessments with the patient
○Have an opioid antagonist and equipment for assisted ventilation readily available
○Monitor injection sites for irritation and extravasation
○Monitor timing of analgesic doses
○Use extreme caution when injecting these drugs into any body area that is chilled or has poor perfusion or shock
○Use additional measures to relieve pain (e.g., back rubs, stress reduction, hot packs, ice packs)
○Monitor respiratory status before beginning therapy and periodically during therapy
○Institute comfort and safety measures
○Provide thorough patient teaching

41
Q

What are the 2 drug classes that we need to know for Opioid Antagonists?

A

Naloxone & Naltrexone

42
Q

When would we use Naloxone ?

A

To reverses adverse effects of opioids; diagnoses suspected acute opioid overdose

43
Q

When would we use Naltrexone?

A

Used orally in the management of alcohol or opioid dependence.

44
Q

What are the MOA’s of Opioid Antagonists?

A

Drugs bind strongly to opioid receptors without activating the receptors
Reverse effects of opioids

45
Q

Why would we give Opioid Antagonists to patients?

A

○Reversal of the adverse effects of opioids
○Treat opioid and/or alcoholic dependence

46
Q

What are some factors that would contraindicate the use of Opioid Antagonists in patients?

A

Known allergy

47
Q

What patient condition would prompt the need for increased caution when administering Opioid Antagonists ?

A

Pregnancy and lactation

48
Q

What are some known side effects of Opioid Antagonists?

A

○Acute opioid abstinence
syndrome
○Nausea, vomiting, sweating
○Tachycardia
○Blood pressure changes
○Dysrhythmias

49
Q

Are there any DDI’s related to Opioid Antagonists, and if so, what are they?

A

Larger doses may be needed to reverse effects of opioid agonist-antagonists

50
Q

Prior to administering Opioid Antagonists to patients, what are some things that we need to assess?

A

○Assess for contraindications or cautions
○Perform a physical assessment
■Assess level of orientation, affect, reflexes, and pupil size;
monitor respiratory rate and auscultate lungs
■Monitor vital signs; obtain an electrocardiogram

51
Q

What nursing diagnoses can be made and anticipated prior to giving patients Opioid Antagonists?

A

○Acute pain related to withdrawal and CV effects
○Altered cardiac output related to CV effects
○Injury risk related to CNS effects
○Knowledge deficit regarding drug therapy

52
Q

When/ After we’ve given patients Opioid Antagonists what are some things that we should implements in their care?

A

○Maintain open airway and provide artificial ventilation
○Provide continuous monitoring of the patient
○Ensure that patients receiving naltrexone have been narcotic-free for 7 to 10 days
○If the patient is receiving naltrexone as part of a comprehensive opioid or alcohol withdrawal program, advise the patient to wear or carry a Medic Alert warning
○Institute comfort and safety measures
○Provide thorough patient teaching

53
Q

What causes Migraine Headaches?

A

Activation of trigeminal nerve that causes inflammation within the meningeal blood vessels.

54
Q

What are the symptoms of Migraine Headaches?

A

Severe, throbbing headaches on one side of the head

55
Q

Men or Women more likely to experience Migraine Headaches?

A

Women are 3 times more likely to experience migraine headaches.

56
Q

What are some lifespan considerations that we should take into account when giving antimigraine agents to children?

A

○Not many drugs are recommended
○Treat first with OTC analgesics
○Need to be evaluated for other causes of HA

57
Q

What are some lifespan considerations that we should take into account when giving antimigraine agents to adults?

A

○Need to be evaluated for other causes of HA
○Ergots and triptans contraindicated in pregnancy
○Alternate methods to feed baby

58
Q

What are some lifespan considerations that we should take into account when giving antimigraine agents to older adults?

A

○More likely to have chronic diseases that would be exacerbated by ergots and triptans
○Take the least amount of drug as possible
○Monitor closely for CV effects
○Safety measures

59
Q

How does Ergot Derivatives work?

A

Causes constriction of cranial blood vessels and decrease the pulsation of cranial arteries. As a
result, they reduce the hyper perfusion of the basilar artery vascular bed.

60
Q

What are the two drug classes that we need to know for Ergot Derivatives?

A

Have -ergot in the name
●Dihydroergotamine
●Ergotamine

61
Q

Why would we give a patient Ergot Derivatives?

A

For prevention or abortion of migraine or vascular headaches.

62
Q

What are some factors that would contraindicate the use of Ergot Derivatives in patients?

A

Absolute : Known allergy & CAD, HTN, PVD

Relative : Impaired liver function & Pregnancy or lactation

63
Q

What patient condition would prompt the need for increased caution when administering Ergot Derivatives ?

A

○Pruritus
○Malnutrition

64
Q

What are some known adverse reactions to Ergot Derivatives ?

A

○Numbness, tingling of extremities, muscle pain
○Pulselessness, weakness, chest pain, arrhythmias
○Nausea, vomiting, diarrhea

65
Q

Are there any known DDI’s to Ergot Derivatives, and if so, what are they?

A

○Beta blockers
○Triptans

66
Q

What does Triptans do?

A

Medications that causes cranial vascular constriction and relief of migraine headache pain in many patients.

67
Q

What are the 3 classes of Triptans that we need to know?

A

○Eletriptan
○Sumatriptan
○Zolmitriptan

68
Q

What are the MOA’s of Triptans?

A

Bind to selective serotonin receptors sites to cause vasoconstriction of cranial vessels.

69
Q

Why would we give Triptans to a patient?

A

For treatment of acute migraine and are not used for prevention of migraines

70
Q

What are some factors that would contraindicate the use of Triptans in patients?

A

Known allergy, pregnancy, CAD

71
Q

With what conditions should we exhibit increased caution when administering Triptans?

A

○Elderly
○Risk factors for CAD
○Lactation
○Renal and hepatic dysfunction

72
Q

What are some known adverse reactions to the use of Triptans?

A

Numbness, tingling, burning sensation, feeling of
coldness, weakness, dysphasia, blood pressure
alterations

73
Q

Are there any known DDI’s with Triptans, and if so, what are they?

A

○Ergot-containing drugs
○MAIOs
○SSRIs

74
Q

What are the two sub-categories of CGRP Inhibitors and Serotonin
Agonists?

A

CGRP INHIBITORS & SEROTONIN AGONISTS

75
Q

What are the two drug categories that we need to know for the CGRP Inhibitors?

A

-gepant in the name

●Rimegepant
●Ubrogepant

76
Q

What is the drug class that we need to know for Serotonin Agonists?

A

●Lasmiditan

77
Q

How does CGRP Inhibitors work?

A

Inhibit CGRP, a potent vasodilator chemical released during migraine headache attacks.

78
Q

How does Serotonin Agonists work?

A

Selective serotonin agonist leading to vasoconstriction

79
Q

Why would we give patients CGRP Inhibitors?

A

Acute migraine headache

80
Q

Why would we give patients Serotonin Agonists?

A

Acute migraine with or without aura in adults

81
Q

What would contraindicate the use of CGRP Inhibitors and Serotonin Agonists in patients?

A

Allergy

82
Q

With what patient condition should we exhibit increased caution when administering CGRP Inhibitors and Serotonin Agonists in patients?

A

Pregnancy

83
Q

What are some know adverse reactions to the use of CGRP Inhibitors?

A

Nausea

84
Q

What are some know adverse reactions to the use of Serotonin Agonists ?

A

dizziness, fatigue, paresthesia, and sedation

85
Q

What DDI’s may we see with the use of Serotonin Agonists & CGRP Inhibitors ?

A

○Lasmiditan - CNS depressants, serotonergic medications,
○Lasmiditan and CGRP inhibitors - CYP3A4 agents

86
Q

Before administering antimigraine agents to patients, what should be assessing for?

A

○Assess for contraindications or cautions
○Perform a physical assessment
■Assess level of orientation, affect, and reflexes
■Monitor for complaints of extremity numbness and tingling
■Inspect the skin for localized edema, itching, or breakdown with ergot
derivatives
■Assess vital signs; obtain an electrocardiogram
○Monitor liver and renal function tests

87
Q

What nursing diagnoses may be made prior to administering antimigraine agents to patients, what should we prepare for?

A

○Impaired comfort related to CV and vasoconstrictive effects
○Altered cardiac output related to CV effects
○Altered sensory perception (visual, auditory, kinesthetic, and tactile)
related to CNS effects
○Injury risk related to changes in peripheral sensation, CNS effects
○Knowledge deficit regarding drug therapy

88
Q

What nursing implementations should we expect to do after/while administering antimigraine agents to patients?

A

○Administer the drug to relieve acute migraines based on specific drug
○For abortion of headache, administer at the first sign of a headache and do not wait until it is severe
○Arrange for safety precautions if CNS or visual changes occur
○Provide comfort and safety measures
○Monitor the blood pressure of any patient with a history of CAD, and discontinue the drug if any sign of angina or prolonged hypertension occurs
○Provide thorough patient teaching

Pharmacology Exam 3 (11 decks)

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