Analgesic Drugs Chapter 10

Question 1

acetaminophen uses

Answer 1

Therapeutic: antipyretics, nonopioid analgesics

Question 2

acetaminophen dosage

Answer 2

Dosage- PO (Adults) 325-650mg q 4-6 hr or 1g 3-4 times daily. (not to exceed 4g or 2.5g/24 hr in patients w/ hepatic/renal impairment.
PO (Children 1-12 yrs) 10-15 mg/kg dose q 4-6 hr as needed. (not to exceed 5 doses/24hr.

Question 3

acetaminophen adverse effects

Answer 3

Adverse Reaction/Side effect- rash, nausea, and vomiting. Less common are dyscrasias (e.g. anemias), and nephrotoxicities, hepatotoxicity.

Question 4

acetaminophen nursing implications

Answer 4

NI: Assessment- Assess overall health status and alcohol usage before administering acetaminophen. Patients who are malnourished or chronically abuse alcohol are at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug. Assess amount, frequency, and type of drugs taken in patients self-medicating, especially with OTC drugs. Prolonged use increases risk of adverse renal effects.
Lab Test Considerations- Evaluate hepatic, hematologic, and renal function periodically during prolonged, high-dose therapy. May alter results of blood glucose monitoring. May cause falsely decreased values when measured with glucose oxidase/peroxidase method, but probably not with hexokinase/G6PD method. May also falsely increase values LDH (Lactate Dehydrogenase), AST (Aspartate Aminotransferase), ALT (Alanine Aminotransferase), and prothrombin time may indicate hepatotoxicity. If overdose occurs acetylcysteine (Acetadote) is the antidote.

Question 5

acetaminophen interactions

Answer 5

Interaction: DD- Chronic high dose acetaminophen (>2g/day) may increase risk of bleeding with warfarin (INR should not exceed 4). Hepatotoxicity is additive with other hepatotoxic substances, including alcohol. Concurrent use of isoniazid, rifampin, rifabutin, phenytoin, barbiturates, and carbamazepine may increase the risk of acetaminophen-induced liver damage (limit self medication); these agents will also decrease therapeutic effects of acetaminophen. Concurrent use of NSAIDs may increase the risk of adverse renal effects (avoid chronic concurrent use). Propranolol reduces metabolism and may increase effects. May reduce effects of lamotrigine and zidovudine.

Question 6

acetaminophen contraindications

Answer 6

Contraindications- known drug allergy, Products containing alcohol, aspartame, saccharin, sugar, or tartrazine (FDC yellow dye #5) should be avoided in patients who have hypersensitivity or intolerance to these compounds; Severe hepatic impairment/active liver disease.

Question 7

morphine sulfate uses

Answer 7

Therapeutic-opioid analgesics
Pharmacologic- opioid agonists
Schedule II drug
Pregnancy category C

Question 8

morphine sulfate dosage

Answer 8

Dosage- PO Rect (Adults >50kg) 30mg q 3-4 hr
IV, IM, Subcut (Adults >50kg) 4-10mg q 3-4hr

PO, Rect(Adults and children <50kg) 0.05-0.2mg q 3-4 hr, maximum: 15mg dose.

Question 9

morphine sulfate adverse effects

Answer 9

Adverse Reaction/side effects- Hypotension, flushing, bradycardia, Sedation, disorientation, euphoria, lightheadedness, dysphoria, pupilary response (miosis), nausea, vomiting, constipation, biliary tract spasm, Urinary retention, Itching, Rash, wheal formation, Respiratory depression.

Question 10

morphine sulfate nursing implications

Answer 10

NI: Assessment- Assess type, location, and intensity of pain prior to and 1 hr following drug administration.Assess level of consciousness, BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min assess level of sedation. Physical stimulation may be sufficient to prevent signifacant hypoventilation. Subsequent doses may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use.
Lab Test considerations- May increase plasma amylase and lipase levels. If an opioid antagonist is required to reverse respiratory depression or coma, naloxone(Narcan) is the antidote. Dilute 0.4mg ampule of naloxone in 10 ml of 0.9% NaCl and administer 0.5 ml by direct IV push every 2 minutes.

Question 11

morphine sulfate interactions

Answer 11

Interactions- Additive Respiratory depression if used with alcohol, antihistamines, barbituates, benzodiazepines, phenothiazine.

Question 12

morphine sulfate contraindications

Answer 12

Contraindications- known drug allergy, severe asthma, Extreme caution for elevated intracranial pressure (e.g. severe head injury), morbid obesity, sleep apnea, myasthenia gravis, paralytic ileus, pregnancy.

Question 13

naloxone hydrochloride (Narcan) uses

Answer 13

Therapeutic-antidotes (for opioids)
Pharmacologic- opioid antagonist
Pregnancy Category B

Question 14

naloxone hydrochloride (Narcan) dosage

Answer 14

Dosage- IV (Adults): 0.02-0.2 mg q 2-3 min until response obtained; repeat every 1-2 hr if needed.
IV (children): 0.01 mg/kg q 2-3 min until response obtained; repeat every 1-2 hr if needed.

Question 15

naloxone hydrochloride (Narcan) side effects

Answer 15

side effects- VENTRICULAR ARRHYTHMIAS, hypertension, hypotension, nausea, vomiting.

Question 16

naloxone hydrochloride (Narcan) nursing implications

Answer 16

NI- Assessment- Monitor RR, rhythm, and depth; pulse, ECG, BP; and level of conciousness frequently for 3-4 hr after the expected peak of blood concentration.

Question 17

naloxone hydrochloride (Narcan) interactions

Answer 17

Interaction- DD; Can precipitate withdrawal in patients physically dependent on opioid analgesics. Larger doses may be required to reverse the effects of buprenorphine, butorphanol, nalbuphine, or pentazocine. Antagonizes postoperative opioid analgesics.

Question 18

naloxone hydrochloride (Narcan) contraindications

Answer 18

Contraindications- Hypersensitivity. Use cautiously in pt’s physically dependent on opioids, cardiovascular disease.