Analgesics, Anti-anxiety, and Hypnotics

Question 1

Opioid **

Answer 1

general term defined as any drug, natural or synthetic, that has actions similar to those of morphine

Question 2

Opiate

Answer 2

more specific; applies only to compounds present in opium (morphine, codeine)

Question 3

Narcotic:

Answer 3

analgesic, CONS depressant (make you less alert), any drug capable of causing a physical depends

Question 4

opioids are schedule

Answer 4

schedule II drugs

Question 5

physical dependence *****

Answer 5

s state of physiological adaptation manifested by… Abstinence syndrome/withdraw

Question 6

Abstinence syndrome/withdraw

Answer 6

occurs if drug abruptly stopped. yawning, rhinorrhea, sweating, anorexia, n/v, abdominal cramping, tremors, spasming, kicking movements, bone and muscle pain, mental agitation, tachycardia, elevated blood pressure

Question 7

withdraw lasts

Answer 7

approximately 7-10 days

Question 8

to lessen withdraw symptoms then its better to

Answer 8

taper the dosage over 7-10 days

Question 9

typically you will not see a physical dependence when opioids are taken for

Answer 9

acute pain

Question 10

endogenous opioid peptides

Answer 10

our bodies have opioid properties associated with 3 family peptides that are located in both CNA and peripheral tissues: enkephalins, endorphins, dynorphins

Question 11

three main classes of opiod receptors

Answer 11

Mu, Kappa, Delta

Question 12

which opioid receptor is most important and why**

Answer 12

Mu because opioid analgesics activate these

Question 13

when mu receptors are activated:

Answer 13

analgesia, respiratory depression, sedation, euphoria, physical dependence, decreased GI motility (constipation);
so when activated 1. pain goes away 2. respiratory depression

Question 14

adverse effect of opioids:

Answer 14

respiratory depression, constipation, orthostatic hypotension, urinary retention, cough suppression, biliary colic, emesis, elevation of intracranial pressure, euphoria/dysphoria, sedation, neurotoxity, miosis

Question 15

respiratory depression

Answer 15

(adverse effect of opioids) 7 minutes after IV injection, 30 min after IM, effects may persist 4-5 hrs; greater risk for young and old, and those with respiratory disease; greater risk with concurrent use of alcohol, barbiturates, benzodiaepines (don’t take zanax and morphine)

Question 16

if respiratory rate is 12 or less than **

Answer 16

withhold opioid and notify MD

Question 17

constipation

Answer 17

(adverse effect of opioids) encourage fluids, stool-softeners (docusate-Colace), osmotic laxatives (miralax)

Question 18

orthostatic hypotension

Answer 18

(adverse effect of opioids) dilate peripheral arterioles and veins due to histamine release; use much caution when getting pts up instruct them to move slowly when changing positions; antihypertensive drugs will excerbate opioid induced hypotension (so check bp before given)

Question 19

urinary retention

Answer 19

(adverse effect of opioids) morphine tightens bladder sphincter, increases anti-diuretic hormone release; anticholinergics will worsen urinary retention

Question 20

cough suppression

Answer 20

(adverse effect of opioids) watch for increase accumulation of secretions, listen for increased rales

Question 21

biliary colic

Answer 21

(adverse effect of opioids) epigastirc distress

Question 22

emesis

Answer 22

(adverse effect of opioids) means to vomit, triggers chemoreceptor trigger zone in braine; first does the worst; subsides with subsequent doses (so going to get morphine with does of finagrin or zofran)

Question 23

elevation of intracranial pressure

Answer 23

(adverse effect of opioids) with decreased respirations, carbon dixoide levels increase and cause dilation on cerebral vessels; do not administer to brain trauma pts

Question 24

neurotoxicity

Answer 24

(adverse effect of opioids) delirium, agitation, muscle spasms, extreme pain sensitivity

Question 25

miosis

Answer 25

(adverse effect of opioids) keep light low to prevent vision impairment

Question 26

administered

Answer 26

oral, IM, IV, subq, epidural, and intrathecal; crosses blood brain barrier, enters CNS to relieve pain, inactived by hepatic metabolism

Question 27

tolerance

Answer 27

increasing doses required to obtain same response or same analgesia, euphoria, sedation, respiratory depress; cross tolerance exists to other opioid agonists

Question 28

drug interactions with morphine

Answer 28

CNS depressants; anticholingeric drugs (bc of risk of urinary retention), hypotensive drugs (would lower BP), monoamine oxidase inhibitors (combined w/ demerol - excitement, delirium, high fever, convulsions, severe respiratory depression) , agonist-antagonist opioids (Talwin) - will cause withdrawal syndrome, opioid antagonist - narcan

Question 29

Demerol causes

Answer 29

increased hr and breaks down to toxic metabolites

Question 30

toxicity/overdose

Answer 30

clinical manifestations: coma, respiratory depression (2-4 breaths/minute, pinpoint pupils)

Question 31

treatment for overdose**

Answer 31

ventilatory support, Narcan (naloxone), or revex (nalmefene)

Question 32

fentanyl parenteral

Answer 32

induction and maintenance of anesthesia

Question 33

fentanyl transdermal

Answer 33

(duragesic patch) released slowly over time (effective levels in 24 hrs, lasting to 48 hrs) absorbed through the skin

Question 34

CYP3A4 inhibitors (ketoconazole)

Answer 34

transmucosal;;; mepridine - short half life, frequent dosing, multiple interactions, toxic metabolites, use only for 48 hrs and no more than 600 mg/34 hrs

Question 35

codeine

Answer 35

usually given PO, combined with aspirin or acetaminophen for “synergistic” action, also used for cough suppression

Question 36

oxycodone (percodan, percocet)

Answer 36

analgesic actions equivalent to codeine; a long acting analgesic

Question 37

percodan

Answer 37

codeine and aspirin

Question 38

percocet

Answer 38

codeine and tylenol

Question 39

hydrocodone

Answer 39

loratab, vicodin

Question 40

proxyphene

Answer 40

(darvon, Darvocet)

Question 41

dosing guidelines

Answer 41

accomodate to individual variation: 10mg might relive pain for 70% and not other 30%; opiods should be given on a fixed schedule