Analgesics Flashcards
1
Q
Tissue injury causes release of…
A
- bradykinin
- histamine
- potassium
- prostaglandins
- serotonin
2
Q
Adjucant drugs
A
- assisst primary drugs in px relief
- can be NSAIDs, antidepressants, anticonvulsants, corticosteroids
- Amitriptyline
- Gabapentin
3
Q
Schedule I drugs
A
- highest abuse potential
- heroin, LSD, marijuana, Psilocybin
- no accepted medicinal use
4
Q
Schedule II drugs
A
- high abuse potential
- morphine, PCP, cocaine
- accepted medicinal use w/ restrictions
5
Q
Schedule III drugs
A
- medium abuse potential
- some amphetamines, anabolic steroids, codein w/ aspirin
- accepted medicinal use
6
Q
Schedule IV drugs
A
- low abuse potential
- Diazepam, Ambien, Xanax
- accepted medicinal use
7
Q
Schedule V drugs
A
- lowest abuse potential
- OTC prescription drugs containing codeine
- accepted medicinal use
8
Q
Opioid analgesics MOA
A
three classes:
- agonists
- agonist-antagonists
- antagonists (non-analgesic) used to reverse effects of opioid (Narcan)
9
Q
Opioid analgesic agonists MOA
A
- bind to opioid px receptor in brain
- cause analgesic response which is a reduction of the px sensation
10
Q
Opioid analgesic agonist-antagonists MOA
A
- bind to pain receptor
- weaker neurological response than a full agonist
- aka mixed/partial agonists
11
Q
Opioid analgesic antagonists MOA
A
- reverse effects of opioids on px receptors
- bind to px receptor and exert no response
- aka competitive antagonists
12
Q
Hydromorphone (Dilaudid) is ___ times ___ potent than morphine
A
7 times MORE potent
so 1mg of hydromorphone is equivilant to 7mg morphine
13
Q
Opioid analgesics contraindications
A
- severe asthma
extreme caution in: - resp insufficiency
- elevated ICP
- morbid obesity
- sleep apnea
- Paralytic ileus (paralysis of digestive tract)
- Pregnancy
14
Q
Opioid analgesics AE
A
- CNS depression (then resp depress, the most serious AE)
- N/V
- urinary retendion
- sweating and flushing
- miosis
- constipation
- itching
15
Q
Opioid Analgesics Toxicity and OD
A
- Naloxone (Narcan)
- Naltrexone (ReVia)
- opioid antagonists should be given in the event of resp depress REGARDLESS of withdrawal sx
16
Q
Opioid analgesics interactions
A
- alcohol
- antihistamines
- Barbiturates
- Benzodiazepines
- MAOIs
- others
17
Q
Codeine sulfate
A
- opioid agonist
- natural opioid alkaloid from opium
- Schedule II
- less effective
- Ceiling effect (eventually increasing dose does not increase effectiveness)
- combined w/ acetaminophen = schedule III
- usually used as an antitussive
- AE: GI disturbance
18
Q
Fetanyl
A
- synthetic opioid
- schedule II
- moderate to severe px
- parenteral injections
- transdermal patches (Duragesic) for chronic px
- buccal lozenges (Fentora) on stick (Actiq)
- 0.1mg Fetanyl IV = 10mg morphine
19
Q
Carfentanil
A
- synthetic opioid
- white powder (resembling cocaine/heroin)
- mixed with heroin to make it stronger
- 10,000x stronger than morphine
- 100x stronger than fetanyl
20
Q
Hydromorphone (Dialudid)
A
- very potent
- schedule II
Exalgo: - extended release form
- osmotic ER PO
- hard to crush/inject so lower risk for abuse
- around the clock px management
- opioid tolerance
21
Q
Morphine Sulfate
A
- naturally occuring alkaloid derived from opium
- prototype for all opioids
- schedule II
- high abuse potential
- oral, injectable, rectal, or ER forms
- Embeda is morphine and naltrexone
22
Q
Methadone Hydrochloride (Dolophine)
A
- synthetic
- schedule II
- # 1 for detox tx of opioid addicts in “methadone maintenance programs”
- prolonged half-life can cause OD and death
- can cause dysrhythmias and resp arrest
23
Q
Oxycodone hydrochloride
A
- similar to morphine in structure and action
- Schedule II
- w/ acetaminophen = Percocet
- w/ aspirin = Percodan
- extended or immediate release
- hydrocodone is a weaker form combined with acetaminophen (Norco)
24
Q
Opioid analgesics nursing implications
A
- PO take with food
- safety measure (like bed rails)
- tell pt to keep record of px and response to treatment
- ortho hypo
- manage constipation
Withhold if: - pt conditions declines
- abnormal VS
- RR < 10-12
- px continues
25
Q
What does Cyclooxygenase (COX) do in general?
A
- produce prostaglandins (in response to pain)
26
Q
COX-1
A
- maintains homeostasis
- cause blood-clotting
- protects mucosa of the stomach
27
Q
COX-2
A
- causes px and inflammation
28
Q
Acetaminophen
A
- nonopioid
- COX-1 inhibitor
- analgesic and antipyretic
- blocks pain impulses via blocking prostaglandin synthesis
- for mild to moderate pain and fever
- good alternative for aspirin
29
Q
Acetaminophen dosage
A
- max 3000mg/day for healthy adults
- max 2000mg/day for older adults and pt w/ liver disease
- be careful about other medications that may contain acetaminophen
30
Q
Acetaminophen contraindications and interactions
A
- liver dysfunction or failure
- G6PD deficiency (aids RBCs)
- alcohol
- hepatotoxic drugs
31
Q
NSAIDs
A
- inhibit COX-1 and COX-2
- analgesic and antipyretic
- pain, fever, and inflammation
- N Naproxen (Aleve)
- S Salicylate Acid (Aspirin)
- Acetylsalicylic Acid (Aspirin)
- I Ibuprofen and Indomethacin (Indocin)
- D Diclofenac (Voltaren
- K Ketorolac (Toradol)
32
Q
Baclofen
A
- skeletal muscle relaxtant
- AE: drowsiness, dizziness, confusion, N, constipation, weakness
- abrupt discontinuation: seizures and hallucinations
- excreted through kidneys (caution)
33
Q
Cyclobenzaprine (Flexeril)
A
- skeletal muscle relaxant
- AE: dizziness, drowsiness, dry mouth, retention, serotonin syndrome (w/ antidepressants), increased sedation (with depressants)
- Caution: retention, CA glaucoma, increased intraocular pressure, anticholinergics, antidepressants and
CNS depressants
34
Q
Purines
A
- what the body breaks down to produce uric acid, which builds up and causes gout
- purines found in/promoted by red meats, some seafood, alcohol (especially beer), and fructose
35
Q
Allopurinol
A
- antigout
- reduces production of uric acid\
- metabolized in liver
- excreted in kidneys
