Chapter 10 Drugs Affecting CNS

Question 1

pain management indications

Answer 1

priority in nursing care, individualized to each patient, ongoing assessment and reassessment

Question 2

nonpharmalogical treatments of pain

Answer 2

Acupuncture, art therapy, behavioral therapy, counseling, meditation, dogs, physical therapy

Question 3

analgesics

Answer 3

medications that relieve pain without causing loss of consciousness

Question 4

classes of analgesics:

Answer 4

-opioid analgesics
-adjuvant analgesics

Question 5

types of pain

Answer 5

somatic, visceral, superficial, deep, neuropathic, phantom

Question 6

gate theory of pain transmission

Answer 6

1. injury - release of substances like bradykinen, histamine, serotonin- stimulates nerve endings to start the pain response
2. nerve impulse enters spinal cord is the “gate” aka Dorsal Horn- regulates the flow of sensory impulses to the brain
3. endorphins are released to fight pain

Question 7

opioid tolerance

Answer 7

can increase 20-40% to manage acute pain

Question 8

breakthrough pain

Answer 8

use of PRN drugs

Question 9

adjuvants

Answer 9

non opioids

Question 10

opioids

Answer 10

synthetic drugs that bind to receptors (opiate) to relieve pain - severe pain

Question 11

3 classifications of opioids

Answer 11

agonists, agonists-antagonists, antagonist

Question 12

equianalgesia

Answer 12

-ability to provide equivalent pain relief by calculating dosages of different medications or routes that provide a comparable analgesia
-opioids given with adjuvants

Question 13

opioid contradictions

Answer 13

allergies, severe asthma, sleep apnea, myasthenia gravis, paralytic ileus, pregnancy

Question 14

opioid adverse effects

Answer 14

black box warnings, strong abuse potential, CNS depression, RESPIRATORY DEPRESSION, histamine release that will cause dilated vessels, itching, rash, flushing

Question 15

toxicity

Answer 15

RESPIRATORY DEPRESSION!!!!!!!
-nalaxone (narcan)- opioid antagonist, can lead to withdrawal, can be given intranasal or IV

Question 16

opioid drug interactions

Answer 16

-alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine
-benzodiazepines have major Black Box Warning with opioids!- Respiratory depression

Question 17

drug examples- opioid agonists

Answer 17

-codeine sulfate (low dose)
-fentanyl (moderate to severe)
-hydromorphone (potent)
-meperidine hydrochloride aka demerol (stops post op shivering, watch kidney function!)
-methadone hydrochloride (used with opioid addicts)
-morphine sulfate
-oxycodone hydrochloride (post op)

Question 18

drug examples- opioid agonists-antagonists

Answer 18

-for patients with history of opioid addiction
-do not give with opioid agonists, they will reduce their effect
-Stadol, Nubain, Talwin

Question 19

drug examples- antagonists

Answer 19

-Nalaxone (Narcan)
-reverses effects of opioid induced respiratory depression
-use in suspected OD, intranasal or IV

Question 20

adverse effects of Narcan

Answer 20

withdrawal, BP changes, dysrhythmias, pulmonary edema, severe vomiting, aggression

Question 21

non opioid analgesic

Answer 21

acetaminophen

Question 22

acetaminophen action

Answer 22

block peripheral pain impulses by inhibiting prostaglandin synthesis, act on hypothalamus to decrease temperature

Question 23

acetaminophen indications

Answer 23

mild pain, fever, minimal to no anti-inflammatory effects

Question 24

acetaminophen contraindications

Answer 24

allergy, severe liver disease, G6PD deficiency (RBC breakdown)

Question 25

Acetaminophen adverse effects

Answer 25

well tolerated, dose max = 4 g/day for a healthy adult

Question 26

Acetaminophen toxicity

Answer 26

hepatic necrosis

Question 27

high dose pain medications means….

Answer 27

FALL RISK