Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 3303 > Analgesics and Sedative Agents > Flashcards

Analgesics and Sedative Agents Flashcards

1
Q

morphine MOA

A

pure agonist analgesic that acts primarily on mu receptors to mimic endogenous opioid peptide actions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

morphine route

A

PO and parenteral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

morphine indications

A
  • acute and chronic pain relief
  • myocardial infarction
  • pre-op sedation
  • anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

morphine AEs

A
  • respiratory depression and cough suppression
  • constipation, emesis, and urinary retention
  • sedation and increased ICP
  • orthostatic hypotension
  • physical dependence, euphoria, and potential for abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

morphine nursing considerations

A
  • tolerance, monitor for possible physical dependence and abuse
  • assess and reassess pain, resp status, and GI function
  • manage constipation with increased fluid and fiber intake
  • monitor use with other CNS depressants, anticholinergics, antihypertensives, etc.
  • provide ventilatory support and admin antagonist (naloxone) for toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

fentanyl MOA

A

higher potency pure agonist opioid analgesic that acts primarily on mu receptors to mimic endogenous opioid peptide actions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

fentanyl route

A

IM, IV, transmucosal, and nasal spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

fentanyl indications

A
  • acute and chronic pain relief
  • surgical analgesia
  • off-label use of rapid sequence intubation and ICU sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

fentanyl AEs

A
  • resp depression and cough suppression
  • constipation and emesis
  • sedation and inc. ICP
  • orthostatic HOTN
  • physical dependence, euphoria, and potential for abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

fentanyl nursing considerations

A
  • transmucosal for breakthrough pain in pts w/ cancer and opioid tolerance only; monitor for possible physical dependence and abuse
  • assess and reassess pain, resp status, and GI function
  • more effective if admin ATC vs PRN
  • monitor use with other CNS depressants, anticholinergics, antihypertensives, etc.
  • admin antagonist for toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

codeine MOA

A

moderate to strong agonist opioid that acts primarily on mu receptors to mimic endogenous opioid peptide actions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

codeine route

A

PO tab or solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

codeine indications

A
  • mild to moderate pain
  • short-term symptomatic relief of cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

codeine AEs

A
  • similar to morphine, but slightly lesser degree
  • excessive sleepiness, breathing difficulties, lethargy, and poor feeding in infants from nursing mothers on codeine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

codeine nursing considerations

A
  • same considerations as other opioids
  • other formulations include those combined w/ other meds: promethazine, guaifenesin, acetaminophen, or aspirin
  • assess pt’s benefits vs risks due to risk of abuse, misuse, and opioid addiction, leading to OD and death
  • other common PO opioids: hydrocodone, oxycodone and their combo products
  • pts lacking CYP2D6 cannot convert codeine to morphine, therefore don’t experience analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

tramadol (Ultram) MOA

A

centrally acting analgesic with pain relief achieved through weak mu agonist activity and blocking of NE and 5-HT reuptake for the treatment of moderate to severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

tramadol (Ultram) route

A

PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

tramadol (Ultram) indications

A
  • moderate to severe pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

tramadol (Ultram) AEs

A
  • low risk for resp. depression
  • sedation, dizziness, HA, dry mouth, and constipation
  • serotonin syndrome if co-admin w/ agents that enhance serotonergic transmission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

tramadol (Ultram) nursing considerations

A
  • lower abuse potential that pure agents
  • utilized in suicide attempts in combo w/ other CNS depressants
  • closely monitor and educate pt on use with SSRI, SNRI, tricyclic, MAOI, and triptan meds
  • formulations also include combo w/ acetaminophen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

methadone MOA

A

long-acting pure agonist that acts primarily on mu receptors to mimic endogenous opioid peptide actions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

methadone route

A

PO, IM, and IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

methadone indications

A
  • pain relief
  • maintenance treatment of opioid use disorder
  • short-term supervision of opioid withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

methadone AEs

A

similar to morphine and fentanyl plus:
- QT prolongation
- fatal dysrhythmias (Torsades de Pointes w/ higher doses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

methadone nursing considerations

A

same considerations as morphine and fentanyl plus:
- establish baseline ECG, monitor heart rhythm on tele
- thorough history and assessment of opioid abuse prior to use for addiction to ensure proper methadone substitution dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

buprenorphine/naloxone (Suboxone) MOA

A

agonist-antagonist opioid analgesic with both agonist and antagonist actions at mu receptors and antagonist actions at kappa receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

buprenorphine/naloxone (Suboxone) route

A

buccal film, SQ/IM/IV, SL film and tab, subdermal implant, transdermal patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

buprenorphine/naloxone (Suboxone) indications

A
  • acute and chronic pain relief
  • opioid use disorder and opioid withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

buprenorphine/naloxone (Suboxone) AEs

A
  • mild resp depression
  • prolonged QT interval and fatal dysrhythmias
  • Sphincter of Oddi spasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

buprenorphine/naloxone (Suboxone) nursing considerations

A

same as morphine and fentanyl plus:
- establish baseline ECG, monitor rhythm on tele
- thorough history and assessment of opioid abuse prior to use for addiction
- monitor for GI s/s, especially in pts with biliary disease or pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

naloxone (Narcan) MOA

A

competitive antagonist at opioid receptors that blocks opioid actions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

naloxone (Narcan) route

A

IV, IM, SQ, and intranasal routes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

naloxone (Narcan) indications

A
  • opioid OD
  • reversal of post-op opioid effects
  • reversal of neonatal resp depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

naloxone (Narcan) nursing considerations

A
  • will not see reversal if caused by other agent
  • may need repeat dose due to short half-life (0.4 mg q2-5 min. usually)
  • reversal of effects include onset of pain
  • other formulations help with mgmt of opioid-induced constipation and opioid addiction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

ibuprofen (Advil/Caldolor) MOA

A

reversible non-selective cyclooxygenase inhibitor propionic acid class NSAID with inhibition of COX-1 and COX-2 (pain, inflammation, fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

ibuprofen (Advil/Caldolor) indications

A

RA, OA, fever, dysmenorrhea, bursitis, and tendonitis

37
Q

ibuprofen (Advil/Caldolor) AEs

A
  • GI related effects: abd pain, N/V/D, ulcers leading to bleeding and constipation
  • bleeding
  • renal impairment
  • inc risk for thrombotic events
  • SJS (rare!)
38
Q

ibuprofen (Advil/Caldolor) nursing considerations

A
  • take w/ food, milk, or antacid
  • pt education on bleeding and concurrent use with other blood thinners
  • ed on using lowest possible effective dose for the shortest amt of time
  • no CV protection against MI and CVA
  • caution with renal impairment, monitor renal function
39
Q

ketorolac (Toradol) MOA

A

reversible non-selective cyclooxygenase inhibitor with inhibition of COX-1 and COX-2

40
Q

ketorolac (Toradol) indications

A

short term management of acute moderate to severe pain (post-op pts) relief similar to what is achieved with morphine

41
Q

ketorolac (Toradol) AEs

A
  • GI effects
  • bleeding
  • renal impairment
  • inc risk for thrombotic events
  • SJS (rarely)
42
Q

ketorolac (Toradol) nursing considerations

A
  • alternative for severe pain management in pts unable to take opioids
  • med only used up to 5 days
  • no CV protection against MI and CVA
  • caution with renal impairment, monitor renal function
43
Q

celecoxib (Celebrex) MOA

A

2nd generation selective cyclooxygenase inhibitor with inhibition of COX-2 leading to reduction in inflammation and pain

44
Q

celecoxib (Celebrex) indications

A

OA, RA, ankylosing spondylitis, juvenile idiopathic arthritis, acute pain, and dysmenorrhea

45
Q

celecoxib (Celebrex) AEs

A
  • inc risk for MI, CVA, and other CV related events
  • possible cross allergy with sulfa meds
  • renal impairment (dec risk with 2nd gen)
46
Q

acetaminophen (Tylenol/Ofirmev) MOA

A

nervous system COX inhibitor to reduce prostaglandin synthesis

47
Q

acetaminophen (Tylenol/Ofirmev) indications

A

pain and fever

48
Q

acetaminophen (Tylenol/Ofirmev) AEs

A
  • extremely rare at therapeutic doses, including anaphylaxis, SJS, and TENS
  • inc BP with daily use
  • hepatotoxicity w/ excessive dosage or ETOH consumption
49
Q

acetaminophen (Tylenol/Ofirmev) nursing considerations

A
  • assess ETOH consumption
  • educate on RUQ s/s, sources of acetaminophen, and safe 24-hr dosing
  • acetaminophen OD in suicide attempts
  • treat OD w/ acetylcysteine ASAP to prevent liver injury
50
Q

sulfasalazine (Azulfidine) MOA

A

non biologic disease-modifying antirheumatic drug (DMARD) that uses 5-aminosalicylic acid to modulate local chemical mediators of inflammatory response, including leukotrienes

51
Q

sulfasalazine (Azulfidine) indications

A
  • mono or combo therapy for rheumatoid arthritis
  • ulcerative colitis
  • off-label use with psoriatric arthritis, ankylosing spondylitis, and Crohn disease
52
Q

sulfasalazine (Azulfidine) AEs

A
  • GI effects
  • pruritis, rash, and uticaria
  • SJS and TENS
  • hepatitis and bone marrow suppression
53
Q

sulfasalazine (Azulfidine) nursing considerations

A
  • periodic monitoring for hepatitis and bone marrow function q3 months or as clinically indicated
  • assess for sulfa allergy and educate on serious dermatologic side effects
  • space tablets evenly throughout day, preferably after meals
54
Q

etanercept (Enbrel) MOA

A

biologic DMARD that inhibits inflammation by neutralizing tumor necrosis factor (TNF) to prevent TNF from interacting with receptors in synovium for moderate to severe active RA

55
Q

etanercept (Enbrel) indications

A

rheumatoid arthritis

56
Q

etanercept (Enbrel) AEs

A
  • milder AE at injection site including: erythema, itching, swelling, and pain
  • opportunistic and serious infections including: bacterial sepsis, invasive fungal infections, HBV, and TB
  • SJS and TENS
  • HF
  • lymphoma and other malignancies
  • hematologic disorders
  • liver injury
  • CNS demyelination
57
Q

etanercept (Enbrel) nursing considerations

A
  • screen for pre-existing conditions and infections
  • numerous drug interactions (particularly live vaccines)
  • monitor and educate on periodic monitoring and adverse effects
  • proper storage of auto-injectors, prefilled pens, and prefilled syringes in refrigerator and at room temp
58
Q

rituximab (Rituxan) MOA

A

immunoglobulin G1 monoclonal antibody that targets CD20 proteins to deplete positive B cells via phagocytosis, cell lysis, growth arrest, and apoptosis

59
Q

rituximab (Rituxan) AEs

A
  • flu-like syndrome during initial infusion
  • infusion hypersensitivity rxns (HOTN, MI, cardiogenic shock, bronchospasm, angioedema, and hypoxia)
  • SJS and TENS
  • HBV and JC virus reaction
60
Q

rituximab (Rituxan) nursing considerations

A
  • premedicate with IV glucocorticoid, antihistamine, and acetaminophen
  • treat severe rxns w/ glucocorticoids epinephrine, and oxygen
  • screen for HBV infection s/s
  • monitor continuously during infusion with rates ranging from 60-400mg/hr as tolerated
61
Q

abatacept (Orencia) MOA

A

DMARD that selectively binds with receptors on antigen-presenting cells to prevent T cell activation to reduce T-cell proliferation; reduce production of interferon gamma, interleukins, and TNF

62
Q

abatacept (Orencia) AEs

A
  • generally well-tolerated with most AE being HA, URI, nasopharyngitis, and nausea
  • infusion rxns: flushing, HOTN, and dyspnea
  • increased risk risk for infections including: PNS, cellulitis, bronchitis, diverticulitis, pyelonephritis, and UTI
63
Q

abatacept (Orencia) nursing considerations

A
  • live virus vaccines should not be used during treatment and for 3 months after stopping
  • treatments may be periodic infusions, infusions transitioned into SQ therapy, or weekly SQ therapy only
64
Q

colchicine (Colcrys) indication

A

anti-inflammatory agent used for acute gouty attack and prophylaxis of future gout attacks

65
Q

colchicine (Colcrys) MOA

A

inhibits leukocyte infiltration by disrupting microtubules required for cellular motility and cell division

66
Q

colchicine (Colcrys) AEs

A
  • GI effects
  • myelosuppression
  • myopathy and rhabdomyolysis
67
Q

colchicine (Colcrys) nursing considerations

A
  • assess cardiac, renal, hepatic, and GI function in older adult pts
  • monitor for new onset muscle pain and creatinine kinase levels
  • pt education on med regimen differences
68
Q

allopurinol (Zyloprim) MOA

A

urate lowering class agent that inhibits xanthine oxidase enzyme to decrease uric acid production

69
Q

allopurinol (Zyloprim) indications

A
  • chronic management of gout
  • nephrolithiasis
  • prevention of tumor lysis syndrome
70
Q

allopurinol (Zyloprim) AEs

A
  • generally well-tolerated
  • GI effects
  • neurologic effects (drowsiness, HA, and metallic taste)
  • rare hypersensitivity syndrome
71
Q

allopurinol (Zyloprim) nursing considerations

A
  • monitor vision and educate pts on periodic examinations
  • educate on place in therapy
  • increase fluid intake and avoid food triggers
72
Q

probenecid MOA

A

uricosuric class agent that acts on renal tubules to inhibit reabsorption of uric acid; helps increase excretion of uric acid by the kidneys and reduce hyperuricemia

73
Q

probenecid indications

A
  • chronic management of gout
  • pharmacokinetic enhancer to prolong beta-lactam serum levels of cefoxitin or penicillin in gonoccal and neurosyphilis infections
  • off-label cidofovir infusion nephrotoxicity prevention
74
Q

probenecid AEs

A
  • generally well-tolerated
  • GI effects
  • possible renal injury from urate deposition
75
Q

probenecid nursing considerations

A
  • increase fluid intake to reduce risk of renal injury; monitor I/O
  • educate on place in therapy (may exacerbate acute attacks)
  • periodic monitoring of renal function
  • admin with food to min GI effects
76
Q

pegloticase (Krystexxa) MOA

A

uric acid oxidase class agent that converts uric acid to allantoin which is water soluble and readily excreted by kidneys

77
Q

pegloticase (Krystexxa) indications

A

pts not responsive to other PO urate lower therapies

78
Q

pegloticase (Krystexxa) AEs

A
  • may experince gout flare initially during treatment
  • anaphylaxis more common
  • infusion rxns common
79
Q

pegloticase (Krystexxa) nursing considerations

A
  • premedicated w/ antihistamine, acetaminophen, and intravenous glucocorticoid and monitor closely
  • infuse med slowly can help reduce symptom intensity of infusion rxns
  • more costly
80
Q

sumatriptan (Imitrex) MOA

A

abortive triptain class agent that causes selective activation of 5-HT binding to receptors causes vasoconstriction and suppresses release of CGRT to reduce release of inflammatory neuropeptide and neurovascular inflammation

81
Q

sumatriptan (Imitrex) indications

A
  • moderate to severe migraine
  • cluster headache
  • off-label use as abortive therapy of cyclic vomiting syndrome
82
Q

sumatriptan (Imitrex) AEs

A
  • transient chest symptoms, nonischemic related chest pressure and heavy arm sensation
  • coronary vasospasm in pts with CAD
  • teratogenic
83
Q

sumatriptan (Imitrex) nursing considerations

A
  • educate on proper admin for migraine treatment
  • educate pts to avoid triggers and recognize symptoms of aura that occur prior to onset
  • avoid in pts with CAD
  • educate on contraception due to risk of fetal harm
84
Q

alprazolam (Xanax) MOA

A

benzodiazepine agents that potentiates GABA’s effects by increases neuronal membrane permeability of chloride ions

85
Q

alprazolam (Xanax) indications

A
  • anxiety disorder and procedural anxiety
  • off-label for treatment of vertigo
86
Q

alprazolam (Xanax) AEs

A
  • CNS and resp depression
  • anterograde amnesia
  • paradoxical effects
  • abuse and misuse
87
Q

alprazolam (Xanax) nursing considerations

A
  • AEs may be worse with concurrent CNS depressant use
  • admin IV flumazenil as a reversal agent due to its benzodiazepine receptor antagonist effects
  • monitor for anxiety s/s and progression while on pharmacotherapy along with non-pharmacological treatment measures
88
Q

zolpidem (Ambien) MOA

A

hynotic agent that potentiates GABA’s effects via selective agonism at the benzodiazepine-1 receptor to increase chloride conductance to help with insomnia

89
Q

zolpidem (Ambien) AEs

A
  • CNS depression
  • complex sleep behaviors
  • psychiatric and behavioral effects (hallucinations, delirium, and worsening of depression)
  • withdrawal w/ chronic admin

NURS 3303 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions