Chapter 11 Flashcards
What are analgesics?
Medications that relieve pain without causing loss of consciousness. “Painkillers”
What is nociception?
the neural processes of encoding and processing noxious stimuli.
Acute pain is
sudden onset
usually subsides once treated
Chronic pain is
persistent or recurring
lasting 3-6 months or longer
often difficult to treat
Tissue injury causes the release of:
bradykinin
histamine
prostaglandins
serotonin
The body has 2 endogenous neurotransmitters:
enkephalins
endophins
Pain transmission are produced by the body to _____ ____
fight pain
Pain transmission bind to _____ _________
opiod receptors
Rubbing a painful area with massage or liniment stimulates large _______ ______
sensory fibers
Rubbing a painful area results in:
recognition of pain reduced
same pathway used by opiates
Opioid ceiling effect is
Drug reaches a maximum analgesic effect & analgesia does not improve, even with higher dose
Pentazocine is a
partial agonist
does not have a ma response to opioid
Nalbuphine is a
partial agonist
does not have a ma response to opioid
Opioid analgesics are
pain relievers that contin opium, derived from the opium poppy or chemically related to opium
Narcotics are
very strong pain relievers
they are opioid
Opioid analgesics MOA
Three classifications based on their actions:
Agonist
Partial agonist
Antiagonist
What does an agonists do:
binds to an opioid pain receptor in the brain, causing an analgesic response
What does an agonists-antagonists do:
Binds to a pain receptor, causing a weaker neurologic response than a full agonist.
Agonists-antagonists is also called ____________ or ________________
partial agonist or mixed agonist
What does an antagonists do?
Reverse the effect of these drugs on pain receptors
Antagonists bind to a pain receptor and exert __ ________
no response
Antagonists are also known as ___________ ___________
competitive antagonists
3 primary opioid receptors
Mu
Kappa
Delta
Main use for an opioid analgesics:
to alleviate moderate to server pain
Opioids are also used for:
Cough center suppression
Treatment for diarrhea
Balance anesthesia
You should not use opioid analgesics if
known drug allergy
severe asthma
Use extreme caution taking opioid analgesics if
respiratory insufficiency elevated intracranial pressure morbid obesity sleep apnea paralytic ileus
Opioid analgesics adverse effects are:
Euphoria CNS depression - leads to respiratory depression & most serious adverse effects Nausea and vomiting Urinary retention Diaphoresis and flushing Pupil constriction (miosis) Constipation Itching
Opiates - Opioid tolerance is
a common physiologic result of chronic opioid treatment
Opioid tolerance results:
larger dose of opioids is required to maintain the same level of analgesia
Opioid physical dependence is
physiologic adaption of the body to the presence of an opioid
Opioid tolerance and physical dependence are expected with ____-____ opioid treatment and should not be confused with psychologic dependence
long-term
Opioid psychologic dependence is a
pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief
When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find?
Decreased peristalsis
Delayed gastric emptying
Urinary retention
A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective dose of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses with that of
morphine.
A patient is admitted to the psychiatric unit for treatment of narcotic addiction. The nurse would anticipate administration of which medication?
Methadone
A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose?
Acute hepatic necrosis
While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which of the following medications to prevent toxicity?
acetylcysteine (Mucomyst)
Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how “rubbing my muscles” will help the pain go away. The nurse responds based on the knowledge that
massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.
When assessing for the most serious adverse reaction to a narcotic analgesic, the nurse is careful to monitor the patient’s
respiratory rate.
Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic?
naloxone (Narcan)
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse’s response is based on knowledge that codeine also has what effect?
Cough suppressant
In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of
chemoreceptor trigger zone.
The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform?
Notify the physician and delay drug administration
A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by
increasing fluid and fiber in the diet.
The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?
Every 72 hours
The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that
pain relief is best obtained by administering analgesics around the clock.
In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority?
Impaired gas exchange related to respiratory depression
