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pharm 140 > ch 26 narcotics > Flashcards

ch 26 narcotics Flashcards

1
Q

pain

A

subjective, sensory, emotional experience

a major indicator for drug therapy

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2
Q

transduction

A

initiation of a pain signal

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3
Q

pain receptor

A

found on peripheral end plates of afferent neurons

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4
Q

afferent neuron

A

sensory neurons that carry nerve impulses from sensory stimuli TOWARDS the CNS

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5
Q

efferent neuron

A

motor neurons that carry neural impulses away from CNS and towards muscles

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6
Q

limbic system

A

produces emotional response to physical stimulus of pain

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7
Q

inhibitory substances

A

endogenous opioids, serotonin, norepinephrine, GABA

bind with receptors on afferent neurons to prevent further transmission of painful stimuli

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8
Q

opioid receptors

A

receptor sites that respond to naturally occuring peptides and endorphins

located in CNS, GI tract

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9
Q

nociceptive pain

A

caused by direct stimulus to a pain receptor in response to painful stimuli

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10
Q

neuropathic pain

A

pain resulting from nerve injury

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11
Q

acute pain

A

immediate phase of response to injury from tissue damage

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12
Q

chronic pain

A

may persist well behind actual tissue injury and healing

may interrupt ADLs

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13
Q

nonpharmacologic techniques to control pain

A 
relaxation therapy
guided imagery
biofeedback
music distraction
exercise
TENS
massage
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14
Q

treating pediatric pain

A

codeine
fentanyl (nontransdermal)
hydrocodone
morphine

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15
Q

treating adult pain

A

educate pt about requesting pain meds

pt controlled analgesia pump (PCA)

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16
Q

treating pain during pregnancy

A

morphine and meperidine

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17
Q

treating pain for older adults

A

assess thoroughly for pain
monitor for adverse effects
safety measures in place

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18
Q

narcotic analgesics indications

A

conditions, disorders or treatments that are accompanied by moderate to severe pain

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19
Q

types of narcotic analgesics

A

opiate agonists
mixed agonist-antagonists
opiate antagonists

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20
Q

narcotics are typically

A

UNDER prescribed

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21
Q

morphine indications

A

moderate to severe pain

acute or chronic

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22
Q

morphine pharmacokinetics

A

IV or PO
metabolized in liver
onset 15-30 min, duration 3-7 hrs

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23
Q

morphine pharmacodynamics

A

AGONIST

at mu, kappa, possibly delta opiate receptors

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24
Q

morphine contraindications

A

hypersensitivity
resp conditions
GI obstruction

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25
Q

morphine cautions

A

head injury
increased ICP
hepatic/renal impairment

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26
Q

morphine black box warning

A

risk of overuse and death
risk of death with other depressants
keep out of reach of children

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27
Q

morphine adverse effects

A

physical dependence
dizziness, headache, blurred vision, sedation, seizures
euphoria, hallucinations, anxiety
bradycardia, cardiac arrest, shock, hypotension, peripheral edema
n/v, constipation, anorexia, ileus, urinary retention
thrombocytopenia, anemia, leukopenia
respiratory depression

28
Q

morphine interactions

A

alcohol
benzodiazepines/depressants
general anesthetic/MAO inhibitors (lower dosage of morphine)
serotonergic drugs (may increase risk of serotonin syndrome)

29
Q

morphine nursing dx

A

ineffective breathing pattern (hypoventilation) r/t respiratory depression 2/2 drug therapy
constipation r/t drug therapy
urinary retention r/t anticholinergic effects of drug on urinary sphincters
risk for injury r/t orthostatic hypotension or sedation 2/2 drug effects

30
Q

morphine interventions

A

max therapeutic effects: assess pain prior to and during therapy using a pain assessment tool

min adverse effects: conduct frequent assessment and monitor respirations, provide pain meds for breakthrough pain

31
Q

morphine pt education

A 
constipation as side effect
notify provider if difficulty breathing
incentive spirometry
do not drive while taking drug
do not crush/break/chew drug
stress importance of rating pain accurately
32
Q

morphine nursing considerations

A 
frequent respiratory assessment
thorough pain assessment
monitor for s/s serotonin syndrome
monitor for s/s adrenal insufficiency
keep narcan on hand
stool softener/stimulant lax should also be ordered
33
Q

drug of choice in relieving MI pain

A

morphine

34
Q

mild narcotic agents

A

codeine
hydrocodone
propoxyphene

35
Q

codeine indications

A

mild to moderate pain

36
Q

codeine pharmacokinetics

A

absorbed from GI tract
peaks 1-2 hrs
can be excreted in breastmilk

37
Q

codeine pharmacokinetics

A

acts at specific opioid receptors in CNS to produce analgesia, euphoria, sedation

38
Q

codeine contraindications

A

do not give with other narcotics

39
Q

codeine adverse effects

A

drowsiness, sedation
dry mouth
n/v
constipation

40
Q

codeine interactions

A 
other narcotics
antihistamines
phenothiazines
barbituates
tricyclic antidepressants
cimetidine
alcohol
41
Q

codeine nursing dx

A

disturbed sensory perception r/t drowsiness, sedation

risk for ineffective airway clearance r/t suppression of cough reflex

constipation 2/2 drug therapy

42
Q

codeine interventions

A

max therapeutic effect: ask pt to rate pain before and during therapy

min adverse effect: provide for pt safety, assess resp function, do not administer to pts who must cough to clear airway

43
Q

codeine pt teaching

A

drowsiness and impaired orientation may occur

do not take with other depressants

44
Q

codeine is contraindicated in

A

pt with chest tubes because they will need to cough and breathe deeply to facilitate lung expansion

45
Q

narcotic agonist-antagonists

A

mixed opioid effects
less substance abuse potential than some agonists
prototype pentazocine (Talwin)

46
Q

pentazocine (Talwin) indications

A

moderate to severe pain

often used in surgery pts

47
Q

pentazocine (Talwin) pharmacokinetics

A

oral, SC, IM
metabolized by liver
peak 1-3h, duration 3h

48
Q

pentazocine (Talwin) pharmacodynamics

A

mixed agonist/antagonist
stimulates kappa receptors
weakly antagonizes mu receptors

49
Q

pentazocine (Talwin) contraindications

A

hypersensitivity

50
Q

pentazocine (Talwin) cautions

A

respiratory conditions
hepatic/renal impairments
cardiac issues

51
Q

pentazocine (Talwin) adverse effects

A 
n/v
dizziness, lightheadedness
resp depression/suppressed cough reflex
urinary retention
uteral spasms
52
Q

pentazocine (Talwin) interactions

A

barbiturate gen anesthetics (phenobarbitol) may increase risk of resp depression, hypotension, coma

53
Q

pentazocine (Talwin) pregnancy category

A

category C

54
Q

pentazocine (Talwin) nursing dx

A

disturbed sensory perception r/t dizziness, lightheadedness

imbalanced nutrition 2/2 n/v

ineffective health maintenance r/t abuse of pentazocine

55
Q

pentazocine (Talwin) interventions

A

max therapeutic effect: provide environmental controls to reduce sensory stimuli and aid relaxation

min adverse effect: ensure safety precautions are used, keep narcan on hand

56
Q

pentazocine (Talwin) pt education

A

pt will learn adverse effects and report

importance of proper medication administration

57
Q

hepatic pts and pentazocine (Talwin)

A

liver disease slows metabolism of pentazocine

58
Q

narcotic antagonists

A

bind to opioid receptors but do not activate

blocks effects of too much opioid/opioid overdose

59
Q

naloxone (Narcan) indications

A

reverse effects of opioid agonists

opioid overdose

60
Q

naloxone (Narcan) pharmacokinetics

A

absorbed systemically when given IV
metabolized in liver
excreted in urine

61
Q

naloxone (Narcan) contraindications

A

hypersensitivity

62
Q

naloxone (Narcan) cautions

A

narcotic addiction (will cause wd)
pregnancy/lactation
cardiovascular disease

63
Q

naloxone (Narcan) adverse effects

A 
acute narcotic withdrawal
seizures, tremors
pulmonary edema, tachycardia, hypotension, HTN, v-fib
nasal dryness, congestion
n/v
diaphoresis
64
Q

naloxone (Narcan) interactions

A

methylnaltrexone, naldemedine, naloxegel may enhance risk of opioid withdrawal

65
Q

naloxone (Narcan) nursing considerations

A

monitor pts for resp depression
larger doses required for buprenorphine reversal
only effective for reversing respiratory depression caused by opioids

66
Q

naloxone (Narcan) pt education

A

educate pt/family about s/s of opioid toxicity
instruct person about proper intranasal administration
naloxone may precipitate opiate withdrawal

67
Q

gate control theory

A

asserts that non-painful input closes the nerve “gates” to painful input, which prevents pain sensation from traveling to the central nervous system

pharm 140 (18 decks)

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