Analgesics & Musculoskeletal

Question 1

OLDCARTS

Answer 1

Onset
Location
Duration
Character
Alleviating & Aggravating factors
Radiation
Treatments
Severity

Question 2

PQRST

Answer 2

Provoking
Quality
Region & Radiation
Severity
Time

Question 3

Nursing Implementation considerations for administering analgesics

Answer 3

Vital Signs
Pain Scale
Anticipate side effects
Regulations (controlled substances)

Question 4

What and when should nursing evaluation occur after administering an analgesic?

Answer 4

30 to 60 minutes post administration
Rate pain
Evaluate side effects

Question 5

The COX inhibitor (1 or 2) that decreases the production of gastric mucus.

Answer 5

COX 1

Question 6

What are lifespan considerations for acetaminophen?

Answer 6

24 hour limits for geriatrics, alcoholics, and adults

Question 7

To which organ is acetaminophen most toxic?

Answer 7

Liver

Question 8

Why should you advise limiting consumption of acetaminophen to 3 days?

Answer 8

Hepatotoxicity

Question 9

What routes can acetaminophen be administered?

Answer 9

PO
PR
IV

Question 10

Why is it important to know all medications a patient is taking when considering the 24 hour limit for acetaminophen?

Answer 10

Many other medications contain acetaminophen

Question 11

What physiologic effect do NSAIDs posses that acetaminophen does not?

Answer 11

Anti-inflammatory

Question 12

What is the most common side effect of NSAIDs?

Answer 12

GI upset/irritation/bleeding

Question 13

Can you administer an NSAID for a fever?

Answer 13

Yes
Antipyretic

Question 14

What sensory side effect of aspirin would indicate an overdose or potential bleeding?

Answer 14

Tinnitus

Question 15

What additional property does aspirin have that when given in low doses will have a beneficial cardiovascular effect?

Answer 15

Inhibits platelet aggregation

Question 16

When giving aspirin to a person who consumes alcohol, what is the contraindication?

Answer 16

They both cause gastric irritation and can cause GI bleeding

Question 17

What is the youngest age ibuprofen can be administered?

Answer 17

> 6 months of age

Question 18

In what part of pregnancy is ibuprofen contraindicated?

Answer 18

3rd trimester

Question 19

Why should the pt sit upright for 30 minutes after taking an NSAID?

Answer 19

To decrease GI irritation

Question 20

What organ function is most likely to be adversely affected by NSAIDs?

Answer 20

Renal
monitor GFR and BUN and creatinine

Question 21

Do NSAIDs (excluding aspirin) affect platelet aggregation?

Answer 21

Yes but not as strongly as aspirin

Question 22

What ages should you question ketolorac dosing?

Answer 22

No administration for less than 18 years of age
Reduced dosing after age of 65

Question 23

What NSAID can be used for breakthrough pain?

Answer 23

ketolorac

Question 24

What is the Black Box Warning for celecoxib?

Answer 24

Celecoxib
Increases risk for CV events, GI bleeding and GI perforation

Question 25

What conditions contraindicate administering celecoxib?

Answer 25

Hemorrhagic CVA Recent CABG Pre operative

Question 26

What do the Mu receptors affect?

Answer 26

Pain (analgesia) Respiratory Depression Euphoria Depression Sedation

Question 27

What receptors are affected by opioid analgesics

Answer 27

Mu Kappa (mild activation)

Question 28

What type of pain is morphine given for?

Answer 28

Moderate to severe

Question 29

How does morphine (opioid analgesic) affect pain?

Answer 29

Works at CNS level Alters perception and response to pain Primarily affects Mu receptors

Question 30

What affect do opioids have on the GI system?

Answer 30

Slows movement Constipation Delays gastric emptying Causes ileus/obstruction

Question 31

What should you assess before administering an opioid analgesic?

Answer 31

VS Pain Level Site of pain

Question 32

Differentiate between acute and chronic pain

Answer 32

Acute comes on suddenly and is usually caused by something specific; lasts less than 6 months Chronic is ongoing and lasts more than 6 months

Question 33

What are the considerations that increase bleeding when administering NSAIDs?

Answer 33

10.6 > 60 years old previous stomach ulcers or bleeding anticoagulant use steroid use taking other NSAIDs 3 or more alcoholic drinks per day takes medication longer than directed

Question 34

What is the Black Box Warning for ibuprofen?

Answer 34

Contraindicated for perioperative pain after CABGG

Question 35

What is the antidote for opioids?

Answer 35

naloxone

Question 36

What is the risk when giving opioids? HINT- long-term

Answer 36

Misuse and abuse

Question 37

Why are opioids contraindicated in patients with a head injury?

Answer 37

Can elevate intracranial pressure Can mask neuro findings of ICP

Question 38

What is the biggest concern when administering naloxone?

Answer 38

Immediate opioid withdraw

Question 39

What is the half life of naloxone?

Answer 39

About 60 minutes

Question 40

What is the classification of baclofen?

Answer 40

Muscle relaxant & antispasmotic

Question 41

What can happen if you abruptly stop administration of baclofen?

Answer 41

Hallucinations Seizures

Question 42

List signs of baclofen overdose.

Answer 42

vomiting muscle weakness drowsiness eye accommodation disorders coma respiratory depression seizures

Question 43

What are the indications for giving cyclobenzaprine?

Answer 43

Acute muscle spasms

Question 44

What other medications (a patient is taking) would cause you to question giving cyclobenzaprine?

Answer 44

CNS depressants Glaucoma medications Medications that cause constipation Antihypertensive (can cause orthostatic hypotension) Antidepressants (Serotonin Syndrome)

Question 45

Are there any lifespan considerations when administering cyclobenzaprine? If so, what are they?

Answer 45

> 15 years of age Geriatric reduced dosing Renal impairment reduced dosing

Question 46

What side effects of cyclobenzaprine should you provide in your patient education?

Answer 46

Sedation Orthostatic hypotension Dizziness Dry mouth Urinary retention Serotonin Syndrome

Question 47

What is the MOA for allopurinol?

Answer 47

Inhibit uric acid production and inhibition of xanthine oxidase (an enzyme that converts hypoxanthine to xanthine to uric acid)

Question 48

What lab value should you know before administering allopurinol?

Answer 48

Uric Acid level

Question 49

What assessment findings would indicate the effectiveness of allopurinol?

Answer 49

Decreased gout symptoms ( pain, warmth, redness and edema at affected joint)

Question 50

What is the indication for giving tizanidine?

Answer 50

Muscle spasms