Analgesic Drugs Flashcards
When treating severe pain associated with pathological spinal fractures related to metastatic bone cancer, which of the following type of pain medication dosage schedule should be used for best results?
a) As needed
b) Round the clock
c) On schedule during waking hours
d) Round the clock with additional doses as needed for breakthrough pain
d) Round the clock with additional doses as needed for breakthrough pain
A patient is receiving an opioid via PCA pump as part of his postoperative pain management program. During rounds, the nurse notices that his respirations are 8breaths/min and he is extremely lethargic. After stopping the opioid infusion what should the nurse do next?
a) Notify the charge nurse
b) Administer O2
c) Administer opioid antagonist per standing orders
d) Preform a thorough assessment, including mental status examination.
c) Administer opioid antagonist per standing orders
Which of the following is a benefit of using transdermal fentanyl patches in the management of bone pain from metastatic cancer?
a) More analgesia for longer time periods
b) Less constipation and minimal dry mouth
c) Greater CNS stimulation with oral narcotics
d) Lower dependancy potential and no major adverse effects
a) More analgesia for longer time periods
The nurse suspects that a patient is showing signs of respiratory depression. Which of the following drugs could be the cause of this complication?
a) Naloxone
b) Hydromorphone (Dilaudid)
c) Acetaminophen
d) Naltrexone (ReVia)
b) Hydromorphone (Dilaudid)
Several patients have standard prn orders for acetaminophen for pain. When the nurse reviews their histories and assessments, it’s discovered tat on of the patients has a contraindication to acetaminophen therapy. Which of the following patients should receive an alternative medication?
a) A patient who has a fever of 39.7C
b) A patient admitted with sever hepatitis
c) A patient admitted with deep vein thrombosis
d) a patient who had abdominal surgery one week earlier
b) A patient admitted with sever hepatitis
The nurse administers 5mg of morphine sulphate IV to a patient with sever postoperative pain, as ordered. What assessment data should be gathered before and after the administration? Explain.
- The nurse should always assess the patient’s blood pressure, pulse, and respirations before administering any narcotic such as morphine sulfate. This allows comparison of baseline vital signs with those taken after the drug has been administered, as well as allowing assessment of the effect of the drug on the physiological response to pain. For example, as pain decreases, any elevation in vital signs resulting from the experience of pain should return to near normal after the pain has been adequately controlled. However, if vital-sign parameters are falling below normal ranges (i.e., blood pressure, 120/80; pulse, 60 to 100 beats per minute [bpm]; respirations, 16 to 20), then central nervous system [CNS] depression may be occurring. The patient should be monitored closely, and the narcotic should be held until further orders from the physician or the pain management team are received. Also, if the respiratory rate drops below 12, it is often standard practice (check your hospital or facility policy) to hold the opioid to avoid further respiratory depression. In addition, after the drug has been administered, it is important to look for any adverse effects resulting from the narcotic, such as CNS depression and a decrease in blood pressure, pulse, respiration, or level of consciousness, along with any other adverse reactions such as nausea and vomiting.
The patient complains that the drugs he’s receiving for sever pain not really helping. What would be the most appropriate response to this patient?
- It is important to assess the patient and any previous reactions to pain medications; then assess the dose, action, route, and appropriateness of the drug. The patient’s medical history, nursing assessment, and medication history should also be studied carefully because the patient’s diagnosis may not correspond with the type of analgesic ordered. Once it has been determined that the patient is getting the right medication and dosage, it is helpful to educate the patient about pain management (such as teaching the importance of reporting pain—or relief of pain—to the nurse). A scale of 0 to 10 (10 being the worst pain ever and 0 being no pain) is helpful. This should be done before the pain is severe or unbearable because pain becomes more difficult to manage at that point. The nurse should administer the medication at regular intervals as ordered (even if prn) round the clock until an appropriate level of analgesia is achieved without major adverse effects; the nurse should then maintain a level of comfort. The nurse should also always include nonpharmacological methods of pain management, such as massage, relaxation, imagery, splinting the incision site, the use of transcutaneous electrical nerve stimulation (TENS) units, biofeedback, and distraction.
Compare the effectiveness of the following routes of opioid administration, including their ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, adverse effects, and ease of management in the home setting: oral, IM, transdermal.
- Ease of self-preparation:
Oral: Easy if the patient is alert; easy to teach others.
Intramuscular (IM): Not easy to carry out on one’s own; the patient would need assistance from health care personnel or another trained person.
Transdermal: Easy to learn to use and easy to teach to others.
Ease of administration:
Oral: Easy if the patient is alert and able to swallow; easy to teach others.
IM: Easy if a qualified health care professional is present to assist.
Transdermal: Easy to administer and learn how to apply; easy to instruct the patient on application and disposal of the patch.
Onset of therapeutic effects:
Oral: Variable, depending on specific drug properties and the chemical composition of the oral drug; some drugs are predictable and some are unpredictable. Generally, 45 to 60 minutes are required for the onset of effects. Remember that some drugs with longer half-lives may take weeks to have therapeutic effects.
IM: Generally dependable; the onset of therapeutic effects occurs within at least 15 to 30 minutes.
Transdermal: Dependable onset but variable in some of the pharmacokinetics until serum steady states are achieved owing to the nature of topical absorption into the systemic circulation. However, once used for a few days, transdermal patches are very effective in regard to the onset of therapeutic effects.
Serum concentrations:
Oral: Dependent on the drug, its properties, its chemical composition, and the dosage form (i.e., whether enteric-coated). If the oral drug is taken at regular intervals, it may achieve adequate serum concentrations; however, many physiological factors provide barriers to predictable concentrations of the drug in the serum.
IM: Effective serum concentrations.
Transdermal: Effective serum concentrations that remain fairly predictable with routine usage and application.
Degree of sedation:
Oral: Dependent on the dosage and potency of the drug. Drugs such as morphine sulfate and other opioid derivatives are sedating, but the level of sedation depends on the dose and other variables.
IM: Dependent on the drug and dosage. However, because systemic absorption is more rapid, there are more CNS-depressing effects and thus more CNS sedation.
Transdermal: CNS sedation depends on the drug patch and dosage. Often the patient develops some resistance to the sedation, but this is generally seen with lower-dosage forms of the patch.
Adverse effects:
Oral: Opioids usually have many adverse effects and have even more when in oral dosage forms because of gastric upset related to gastric irritation.
IM: Dependent on the drug and dosage, but the effects are generally more profound because of increased absorption. Therefore, adverse effects related to CNS depression, such as sedation and decreased vital signs, are more often associated with this dosage form.
Transdermal: Likely to occur once the steady state of the drug has been achieved. Because of the steady absorption that occurs with consistent dosing, the adverse effects will depend on the dosage and drug.
Ease of home management:
Oral: Easy.
IM: Not easy without medical or nursing assistance.
Transdermal: Easy.
