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
What does Cyclooxygenase (COX) do in general?
- produce prostaglandins (in response to pain)
26
COX-1
- maintains homeostasis
- cause blood-clotting
- protects mucosa of the stomach
27
COX-2
- causes px and inflammation
28
Acetaminophen
- 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
Acetaminophen dosage
- 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
Acetaminophen contraindications and interactions
- liver dysfunction or failure
- G6PD deficiency (aids RBCs)
- alcohol
- hepatotoxic drugs
31
NSAIDs
- 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
Baclofen
- skeletal muscle relaxtant
- AE: drowsiness, dizziness, confusion, N, constipation, weakness
- abrupt discontinuation: seizures and hallucinations
- excreted through kidneys (caution)
33
Cyclobenzaprine (Flexeril)
- 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
Purines
- 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
Allopurinol
- antigout
- reduces production of uric acid\
- metabolized in liver
- excreted in kidneys
36
Anesthetics
- reduce/eliminate px by depressing nerve function in CNS and PNS
37
General anesthesia
complete loss of consciousness and reflexes
38
Local anesthesia
- no paralysis of respiratory function
- anesthetized nerves eliminate pain specific to those nerves
39
Balanced anesthesia
- general anesthetics and adjuncts
- less of each is needed
- more balanced and controlled state
40
Nitrous oxide
- "laughing gas"
- only gas used for general anesthesia
- but the weakest general anesthetic
- dental procedures
- high concentrations: post op N/V
41
Sevoflurane (Ultane)
- widely used, especially in surgery
- inhaled
- general anesthesia
- nonirritating to airway
- facilitates induction of unconsious state, especially in peds pt
42
Moderate sedation
- aka conscious/procedural
- doesn't cause complete loss of consciousness
- doesn't USUALLY cause resp arrest
- a combination of IV benzo/propofol + opiate analgesic
- reduce benzo dose by 30%-50% when used w/ opioid
- use of alcohol may indicate increased benzo dose
- patient will not recall procedure
43
moderate sedation indications and implications
- pt can still maintain airway and follow commands
- diagnostic and minor surgical procedures
- fast recovery
- safer than general anesthesia
- advanced cardiac life support
- intubution on standby
44
Local anesthetics MOA
In this order:
1. autonomic activity lost
2. pain/sensory functions lost
3. motor activity lost
recovery occurs in reverse
45
Local anesthetics indications
- surgical, dental, diagnostic procedures
- treatment of some chronic px
- spinal anesthesia: surgery and childbirth
46
examples of local anesthetics
- LidoCAINE
- BupivaCAINE
- PriloCAINE
- ProCAINE
47
transdermal Lidocaine
- topical anesthetic
- indicated in postherpetic neuralgia (shingles)
- no longer than 12h
- AE: skin irritation
48
Propofol
- parenteral general anesthetic
- induction and maintenance
- sedation for mechanical ventilation (ICU)
- lower doses for moderate sedation
- lowers BP and supressed breathing
- monitor cardiac function and breathing at all times
49
- highest abuse potential
- heroin, LSD, marijuana, Psilocybin
- no accepted medicinal use
Schedule I drugs
50
- high abuse potential
- morphine, PCP, cocaine
- accepted medicinal use w/ restrictions
Schedule II drugs
51
- medium abuse potential
- some amphetamines, anabolic steroids, codein w/ aspirin
- accepted medicinal use
Schedule III drugs
52
- low abuse potential
- Diazepam, Ambien, Xanax
- accepted medicinal use
Schedule IV drugs
53
- lowest abuse potential
- OTC prescription drugs containing codeine
- accepted medicinal use
Schedule V drugs
54
- bind to opioid px receptor in brain
- cause analgesic response which is a reduction of the px sensation
Opioid analgesic agonists MOA
55
- bind to pain receptor
- weaker neurological response than a full agonist
- aka mixed/partial agonists
Opioid analgesic agonist-antagonists MOA
56
- reverse effects of opioids on px receptors
- bind to px receptor and exert no response
- aka competitive antagonists
Opioid analgesic antagonists MOA
57
7 times MORE potent
so 1mg of hydromorphone is equivilant to 7mg morphine
Hydromorphone (Dilaudid) is ___ times ___ potent than morphine
58
- severe asthma
extreme caution in:
- resp insufficiency
- elevated ICP
- morbid obesity
- sleep apnea
- Paralytic ileus (paralysis of digestive tract)
- Pregnancy
Opioid analgesics contraindications
59
- CNS depression (then resp depress, the most serious AE)
- N/V
- urinary retendion
- sweating and flushing
- miosis
- constipation
- itching
Opioid analgesics AE
60
- alcohol
- antihistamines
- Barbiturates
- Benzodiazepines
- MAOIs
- others
Opioid analgesics interactions
61
- 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
Codeine sulfate
62
- synthetic opioid
- schedule II
- moderate to severe px
- parenteral injections
- transdermal patches (Duragesic) for chronic px
- buccal lozenges (Fentora) on stick (Actiq)
- 0.1mg ________ IV = 10mg morphine
Fetanyl
63
- synthetic opioid
- white powder (resembling cocaine/heroin)
- mixed with heroin to make it stronger
- 10,000x stronger than morphine
- 100x stronger than fetanyl
Carfentanil
64
- 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
Hydromorphone (Dialudid)
65
- naturally occuring alkaloid derived from opium
- prototype for all opioids
- schedule II
- high abuse potential
- oral, injectable, rectal, or ER forms
- Embeda is _____ and naltrexone
Morphine Sulfate
66
- synthetic
- schedule II
- #1 for detox tx of opioid addicts in "________ maintenance programs"
- prolonged half-life can cause OD and death
- can cause dysrhythmias and resp arrest
Methadone Hydrochloride (Dolophine)
67
- 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)
Oxycodone hydrochloride
68
- 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
Opioid analgesics nursing implications
69
- produce prostaglandins (in response to pain)
What does Cyclooxygenase (COX) do in general?
70
- maintains homeostasis
- cause blood-clotting
- protects mucosa of the stomach
COX-1
71
- causes px and inflammation
COX-2
72
- 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
Acetaminophen
73
- liver dysfunction or failure
- G6PD deficiency (aids RBCs)
- alcohol
- hepatotoxic drugs
Acetaminophen contraindications and interactions
74
- 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)
NSAIDs
75
- skeletal muscle relaxtant
- AE: drowsiness, dizziness, confusion, N, constipation, weakness
- abrupt discontinuation: seizures and hallucinations
- excreted through kidneys (caution)
Baclofen
76
- 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
Cyclobenzaprine (Flexeril)
77
- 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
Purines
78
- antigout
- reduces production of uric acid
- metabolized in liver
- excreted in kidneys
Allopurinol
79
complete loss of consciousness and reflexes
General anesthesia
80
- no paralysis of respiratory function
- anesthetized nerves eliminate pain specific to those nerves
Local anesthesia
81
- "laughing gas"
- only gas used for general anesthesia
- but the weakest general anesthetic
- dental procedures
- high concentrations: post op N/V
Nitrous oxide
82
- widely used, especially in surgery
- inhaled
- general anesthesia
- nonirritating to airway
- facilitates induction of unconsious state, especially in peds pt
Sevoflurane (Ultane)
83
- aka conscious/procedural
- doesn't cause complete loss of consciousness
- doesn't USUALLY cause resp arrest
- a combination of IV benzo/propofol + opiate analgesic
- reduce benzo dose by 30%-50% when used w/ opioid
- use of alcohol may indicate increased benzo dose
- patient will not recall procedure
Moderate sedation
84
- pt can still maintain airway and follow commands
- diagnostic and minor surgical procedures
- fast recovery
- safer than general anesthesia
- advanced cardiac life support
- intubution on standby
moderate sedation indications and implications
85
In this order:
1. autonomic activity lost
2. pain/sensory functions lost
3. motor activity lost
recovery occurs in reverse
Local anesthetics MOA
86
- surgical, dental, diagnostic procedures
- treatment of some chronic px
- spinal anesthesia: surgery and childbirth
Local anesthetics indications
87
- Lidocaine
- Bupivacaine
- Prilocaine
- Procaine
examples of local anesthetics
88
- topical anesthetic
- indicated in postherpetic neuralgia (shingles)
- no longer than 12h
- AE: skin irritation
transdermal Lidocaine
89
- parenteral general anesthetic
- induction and maintenance
- sedation for mechanical ventilation (ICU)
- lower doses for moderate sedation
- lowers BP and supressed breathing
- monitor cardiac function and breathing at all times
Propofol
