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Pharmacology > Chapter 10 > Flashcards

Chapter 10 Flashcards

1
Q

Acute pain

A

pain that is sudden in onset, usually subsides when treated, and typically occurs over less than a 6-week period

  • sudden onset
  • breaking a bone
  • post operative pain
  • kidney stone
  • traumatic injury
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2
Q

Addiction

A

A chronic, neurobiological disease whose development is influenced by genetic, psychosocial, and environmental factors
-same as psychologic dependence)

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3
Q

Adjuvant analgesic drugs and examples

A

Drugs that are added for combined therapy with a primary drug and may have additive or independent analgesic properties
“in addition to analgesic” drugs
-assist primary drugs in relieving pain
-might be able to give less dosage of an opiod and sub with these
-not always labeled as painkillers
-ex: NSAIDs, antidepressants, anticonvulsants, corticosteroids
ex: adjuvant drugs for neuropathic pain: amitriptyline (antidepressant) and gabapentin or pregabalin (anticonvulsants)

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4
Q

Agonist

A

a substance that binds to a receptor and causes a response

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5
Q

agonists-antagonists

A

substances that bind to a receptor and cause a partial response that is not as that caused by an agonist
-aka partial agonists

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6
Q

anelgesics

A

medications that relieve pain without causing loss of consciousness
-“pain killers”

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7
Q

antagonist

A

a drug that binds to a receptor and prevents (blocks) a response

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8
Q

breakthrough pain

A

pain that occurs between doses of pain medication

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9
Q

cancer pain

A

pain resulting from any of a variety of causes related to cancer and/or the metastasis of cancer

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10
Q

central pain

A

pain resulting from any disorder that causes central nervous system damage

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11
Q

chronic pain

A

persistent or recurring pain that is often difficult to treat. It includes any pain lasting longer than 3 to 6 months, pain lasting longer than 1 month after healing of an acute injury, or pain that accompanies a nonhealing tissue injury

  • often difficult to treat
  • tolerance to medicine
  • can develop physical dependence
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12
Q

deep pain

A

pain that occurs in tissues below skin level; opposite of superficial pain

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13
Q

gate theory

A

the most well described theory of pain transmission and pain relief; uses a gate model to explain how impluses from damaged tissues are sensed in the brain

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14
Q

narcotics

A

a legal term that originally applied to drugs that produce insensibility or stupor, especially opiods; currently used to refer to any medically used controlled substance and to refer to any illicit or “street” drug
-however this term is falling out of use in favor of opoid

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15
Q

neuropathic pain

A

pain that results from a disturbance of function in a nerve

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16
Q

nociception

A

processing of pain signals in the brain that gives rise to the feeling of pain

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17
Q

nociceptors

A

a subclass of sensory nerves (A and C fibers)

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18
Q

nonopiod anelgesics

A

anelgesics that are not classified as opiods

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19
Q

nonsteroidal antiinflammatory drugs (NSAIDs)

A

a large, chemically diverse group of drugs that are anelgesics and also possess antiinflammatory and antipyretic activity

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20
Q

opiod anelgesics

A

synthetic drugs that bind to opiate receptors and relieve pain
-there’s currently an opiod problem

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21
Q

opiod naive

A

describes patients who are receiving opiod anelgesics for the first time and therefore are not accustomed to their effects

  • Never taken it/have had minimal exposure to opiods
  • should not load them up on opiods if they have never been exposed
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22
Q

opiod tolerance

A

a normal physiologic condition that results from long-term opiod use, in which larger doses of opiods are required to maintain the same level analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms
-may need different type of opiod or amount

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23
Q

opiod tolerant

A

the opposite of someone who is opiod naive; describes patients who have been receiving opiod anelgesics (legally or otherwise) for a period of time (1 week or longer)

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24
Q

opiod withdrawal

A

the signs and symptoms associated with abstinence from or withdrawal of an opiod analgesic when the body has become physically dependent on the substance

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25
Q

opiods

A

a class of drugs used to treat pain; this term is often used interchangeably with the term narcotic

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26
Q

pain

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

  • “pain is what the patient says it is”
  • cultures and health beliefs influence how pain is expressed
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27
Q

pain threshold

A

the level of stimulus that results in the sensation of pain

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28
Q

pain tolerance

A

the amount of pain a patient can endure without its interfering with normal function

  • varies from person to person
  • subjective response to pain, not a physiologic function
  • varies by attitude/environment/culture
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29
Q

partial agonist

A

a drug that binds to a receptor and causes a response that is less than that cause by a full agonist (same as agonist-antiagonist)

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30
Q

phantom pain

A

pain experienced in the area of a body part that has been surgically or traumatically remove

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31
Q

physical dependence

A

a condition in which a patient takes a drug over a period of time and unpleasant physical symptoms (withdrawal symptoms) occur if the drug is stopped abruptly or smaller doses are given
-if patient does not get drug = miserable

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32
Q

psychological dependence

A

a pattern of compulsive use of opiods or any other addictive substance characterized by a continuous craving for the substance and the need to use it for effects other than pain relief (also called addiction)

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33
Q

referred pain

A

pain occuring in an area away from the organ of origin

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34
Q

somatic pain

A

pain that originates from skeletal muscles, ligaments, or joints

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35
Q

special pain situations

A

the general term for pain control situations that are complex and whose treatment typically involves multiple medications, and nonpharmacologic therapeutic modalities

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36
Q

Superficial pain

A

pain that originates from the skin or mucous membranes; opposite of deep pain

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37
Q

synergistic effects

A

drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone

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38
Q

tolerance

A

the general term for a state in which repetitive exposure to a given drug, over time, induces changes in drug receptors that reduce the drug’s effects
-have to take more and more of the drug to get the same effect

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39
Q

vascular pain

A

pain that results from pathology of vascular or perivascular pain

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40
Q

visceral pain

A

pain that originates from organs or smooth muscles

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41
Q

world health organization (WHO)

A

An international body of health care professionals that studies and responds to health needs and trends worldwide

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42
Q

Never tell a patient…

A

You will not experience any pain

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43
Q

chronic nonmalignant pain

A
  • arthritis

- fibromyalgia

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44
Q

PCA

A

patient controlled analgesia

  • “dope on a rope”
  • nurse interprets order
  • program the pump
  • big syringes
  • there are settings so patient cannot OD
  • relatively safe
  • if patient is hitting the button a lot, the prescription might need to change
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45
Q

PCA by proxy

A

someone else does it for you

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46
Q

Patients are scared of

A

being addicted to pain medicine

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47
Q

If someone has a history of analgesic addiction, and they have been clean

A

potential for addiction is real

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48
Q

breakthrough pain

A

before the next dose is due, patient is in agony

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49
Q

Do we use placebos to manage pain?

A

NO

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50
Q

The nurse is giving the patient gapapentin, even though he does not have seizures. Why is he getting this medicine

A

He has neuropathic pain

51
Q

mild agonists

A

codeine, hydrocodone

52
Q

strong agonists

A

morphine, hydromorphone, oxycodone, oxymorphone, meperidine, fentanyl, and methadone

53
Q

Meperidine

A

not recommended for long-term use because of the the accumulation of a neurotoxic metabolite, normerperidine, which can cause seizures and sedation

54
Q

Which routes can we use

A 
IV oush
IM
SubQ
tablets
elixers
instant relief (IR)
slow release (SR)
55
Q

Why do we use analgesics?

A

moderate to severe pain

  • post op
  • cancer treatment
  • chronic noncancer pain
  • obstetric analgesia
56
Q

Opiods are also used for

A
  • cough center suppression
  • treatment of diarrhea
  • balanced anathesia
57
Q

Lomotil

A

-have opium in it

58
Q

ampule

A

have to break the top

59
Q

patches

A

go on skin, change every 3 days

  • where gloves when you put them on
  • special way to dispose of them, addicts will go through trash and try to find them
60
Q

Equinalgesia

A

ability to provide equivalent pain relief by calculating dosages of different drugs or routes of administration that provide comparable analgesia

61
Q

hydromorophone (dilaudid)

A

seven times more potent than morphine

62
Q

opiod analgesics contraindications

A
  • known drug allergy
  • severe asthma
  • respiratory insufficiency
  • elevated intracranial pressure
  • morbid obesity or sleep apnea
  • paralytic ileus
  • pregnancy
63
Q

paralytic ileus

A
  • when your SI is paralyzed

- if you have this, at risk for drug toxicity

64
Q

adverse effects

A

CNS depression

  • nausea and vomiting
  • urinary retention
  • diaphoresis and flushing
  • pupil constriction (miosis)
  • constipation
  • itching
65
Q

naloxone

A

narcan (reverse the effects of opiods)

-used when patient is having severe respiratory depression

66
Q

naltrexone

A

ReVia

67
Q

toxicity and management of overdose

A

-regardless of withdrawal symptoms, when a patient experiences severe respiratory depression, an opiod antagonist should be given

68
Q

opiod withdrawal/opiod abstinince syndrome manifested

A

within minutes, they are screaming/thrashing/sweating/ in pain but at least they’re breathing

69
Q

opiod analgesics interactions

A

AABBM

  • alchol
  • antihistamines
  • barbituates
  • benzodiazepines
  • monoamine oxidase inhibitors
70
Q

Fentanyl

A
  • synthetic opiod (Schedule II) used to treat moderate to severe pain
  • parenteral injections, transdermal pathces, buccal lozenges (fentora), and buccal lozenges on a stick (Actiq)
71
Q

Morphine

A
  • naturally occuring alkaloid derived from the opium poppy
  • drug prototype for all opiod drugs; schedule II controlled substance
  • indication: severe pain
  • high abuse potential
  • oral, injectable, and rectal dosage froms; also extended-release forms
  • also helps with anxiety
72
Q

Morphine

A
  • naturally occuring alkaloid derived from the opium poppy
  • drug prototype for all opiod drugs; schedule II controlled substance
  • indication: severe pain
  • high abuse potential
  • oral, injectable, and rectal dosage froms; also extended-release forms
  • also helps with anxiety
73
Q

naloxone hydrochloride (NArcan)

A
  • pure opiod antagonist
  • indicated in cases of suspected acute opiod overdose
  • if you suspect it, it never hurts to give it
74
Q

nonopiod analgesics acetaminophen (tylenol)

A
  • analgesic and antipyretic effects
  • little to no inflammatory effects
  • brings down fever
  • available over the counter (OTC) and in combination products with opiods
75
Q

Acetaminpehn: indications

A
  • mild to moderate pain
  • fever
  • alternative for those who cannot take aspirin products
76
Q

acetaminphen: dosage

A
  • 3000 mg/day (most an adult should take)

- sometimes the dosages may be exceeded because not realizing it’s also in their cold medicine

77
Q

Acetaminophen: toxicity and managing overdose

A
  • even though availible OTC, lethal when overdosed
  • overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxocity
  • long-term ingestion of large doses also cause nephronopathy
  • recommended antidote: acetylcysteine regimen (smells like rotten eggs) MUCOMYST
78
Q

Analgesics: Nursing implications

A
  • before beginning therapy, perform a thorough

- see powerpoint

79
Q

What 3 receptors are thought to be involved in pain?

A
  1. Mu receptors in dorsal horn of spinal cord
  2. kappa receptors
  3. delta receptors
80
Q

What is pain peception closely linked to?

A

the number of mu receptors

  • when the number of receptors is high, pain sensitivity is diminished
  • when the number of receptors is low, relatively minor noxious stimuli may be perceived as painful
81
Q

What causes a lowered pain threshold?

A
  • anger
  • anxiety
  • depression
  • discomfort
  • fear
  • isolation
  • chronic pain
  • sleeplessness
  • discomfort
82
Q

What causes a raised pain threshold?

A
  • diversion
  • empathy
  • rest
  • sympathy
  • medications (anelgesics, antianxiety drugs, antidepressants)
83
Q

Acute onset and duration

A

onset: sudden, usually sharp and localized, physiologic response (SNS: tachycardia, sweating, pallor, increased blood pressure)
duration: limited (has an end)

84
Q

Examples of acute pain

A
  1. myocardial infarction
  2. appendicitis
  3. dental procedures
  4. kidney stones
  5. surgical procedures
85
Q

Chronic onset and duration

A

onset: slow (days to months); long duration; dull, persistent, aching
- persistant or recurring (endless)

86
Q

Examples of chronic pain

A
  1. arthritis
  2. cancer
  3. lower back pain
  4. peripheral neuropathy
87
Q

What are potential adverse effects that accompany the use of opiods?

A
  1. constipation
  2. nausea and vomiting
  3. sedation and vomiting
  4. sedation and mental clouding
  5. respiratory depression
  6. subacute overdose
88
Q

Constipation management

A
  • increased intake of fluids
  • stool softeners
  • stimulants (bisacodyl or senna)
89
Q

nausea and vomiting management

A

antiemetics such as phenothiazines

90
Q

Sedation and mental clouding management

A

-safety precautions implemented

91
Q

respiratory depression management

A

for sever respiratory depression, opiod antagonists may be needed

92
Q

subacute overdose management

A

-holding one or two doses of an opiod anelgesic is enough to judge if there is a mental and respiratory depression is associated with the opiod

93
Q

Dilauudid is _____ time more potent than morphine

A

7

94
Q

Guidelines for fentanyl transdermal patches

A
  • only for opiod tolerant patients
  • no heat on patch
  • applied for 72 hours
  • patient should fold in half and throw it down the toilet
95
Q

What are contraindications for anelgesic use?

A
  • known drug allergies

- sever asthma

96
Q

opiod-induced cardiovascular adverse effects

A
  • hypotension
  • flushing
  • bradycardia
97
Q

opiod-induced central nervous adverse effects

A
  • sedation
  • disorientation
  • euphoria
  • lightheadedness
  • dysphoria
98
Q

opiod-induced gastrointestinal adverse effects

A
  • nausea
  • vomiting
  • constipation
  • bilary tract spasm
99
Q

opiod-induced genitourinary adverse effects

A

-urinary retention

100
Q

opiod-induced integumenraty adverse effects

A
  • itching
  • rash
  • wheal formation
101
Q

opiod-induced respiratory adverse effects

A
  • respiratory depression

- possible aggravation of asthma

102
Q

If patient has pain/coughing, you should administer

A

codeine sulfate (D)

103
Q

If patient needs general anesthesia, relief of moderate to severe pain, or relief of chronic pain (including cancer pain), you should administer

A

fentanyl

104
Q

If you need something stronger than morphine, you should administer

A

hydromorphine

105
Q

When should you use meperidine?

A

Trick question! don’t because it has unpredictable effects of neurometabolites at analgesic doses and risk for seizures

106
Q

If patient needs opiod analgesia, relief of chronic pain, opiod addition maintenance, and opiod detoxification you should administer

A

methadone

107
Q

If patient needs an opiod analgesic you should use

A

morphine sulfate

108
Q

If patient needs relief of moderate to severe pain and the medication should not be crushed, ___________ should be administered?

A

morphine sulfate, continuous relief

109
Q

If patient needs relief of moderate to severe pain, you should administer __________

A

oxycodone, immediate release

110
Q

If patient needs relief of moderate to severe pain and the drug cannot be crushed you should use __________

A

oxycodone, continuous release

111
Q

If the patient needs to be treated for opioid overdose and postoperative anesthesia reversal

A

naloxone HCl

112
Q

If the patient needs to be treated for maintenance of an opiod-free state

A

naltrexone HCl

113
Q

If the patient needs relief of mild to moderate pain

A

acetominophen (Tylenol, others)

114
Q

If the patient needs relief of moderate to moderately severe pain

A

tramadol (Ultram)

115
Q

Who should aspirin not be given to? Why?

A

Children and adolescent patients because of the risk of Reye’s syndrome

116
Q

When giving an IV, infuse over the recommended time (usually 3-5 min). Always assess respirations before, during, and after use. Give IM as ordered.

A

buprenorphine and butorphanol

117
Q

Give PO doses with food to minimize GI tract upset; ceiling effects occur with oral codeine resulting in no increase of analgesia with increased dosage

A

codeine

118
Q

Administer parenteral doses over 1-2 minutes as ordered and as per manufacturer guidelines in regard to mg/min to prevent CNS depression and possible cardiac or respiratory arrest. Be sure to remove resifual amounts of the old patch before application of a new patch. Dispose of patches properly to avoid inadvertant contact with children or pets.

A

fentanyl

119
Q

May be given subcut, rectally, IV, PO, or IM

A

hydropmorphone

120
Q

Given by a variety of routes; IV, IM, or PO; highly protein bound, so watch for interactions with toxicity. Monitor older adult patients for increased sensitivity.

A

merperidine

121
Q

Availible in a variety of forms; subcut, IM, PO, IV, extended and immediate release; morphine sulfate for epidural infusion. Always monitor respiratory rate.

A

morphine

122
Q

IV doses of 10 mg given undiluted over 5 min

A

nalbuphine

123
Q

Antagonist given for opiod overdose; 0.4 mg usually given IV over 15 sec or less. Reverses analgesia as well.

A

naloxone

124
Q

often mixed with acetaminophen or asprin; PO and suppository dosage forms. Now availible in both immediate and sustained-release tablets.

A

oxycodone

Pharmacology (19 decks)

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