exam 1 Flashcards
2 types of pain pathways
Nociceptive & neuropathic
3 types of opioid receptors
mu, kappa, and delta
receptor stimulated by opioid drugs
mu receptor
adverse effects of mu receptor stimulation
respiratory depression, sedation, physical dependence, euphoria
2nd receptor stimulated by opioid drugs
kappa receptor
adverse effects of kappa receptor stimulation
sedation and psychotomimetic effects
receptor that does not produce any effects when stimulated
delta receptors
what produces cortisol to suppress inflammation
adrenal glands
what do the adrenal glands release to suppress inflammation
cortisol
ACTH
adreno-cortico-tropic hormone
what releases ACTH
pituitary gland
what affects fluid balance in the body
aldosterone
3 types of non opiod analgesics
NSAIDS
Acetaminophe
Centrally Acting Non-Opiods
1st generation NSAIDS
aspirin (ASA)
ibuprofen (advil, Motrin)
2nd generation NSAIDS
celcoxib (Celebrex)
therapeutic uses of NSAIDS
anti-inflammation analgesia mild to mod pain fever reducer dysmenorrhea (cramps) Inhibition of platelet aggregation (ASA)
NSAID contraindications/precautions
pregnancy hypersensitivity to ASA and NSAIDS peptic ulcer disease bleeding disorders children w/ viral infections prior to coronary artery bypass grafting (non ASA NSAIDS)
NSAIDS cause increased risk of bleeding when interacting with
anticoagulants
glucocorticoids
alcohol
NSAIDS interaction with ibuprofen
decreased anti-platelet effects of ASA
NSAIDS interaction with ACE inhibitors and angiotensin
increased risk of kidney failure
ASA cannot be given 1 week before?
surgery
Last choice NSAID for chronic pain because it can cause cardiovascular events
Celecoxib
Client instructions for NSAIDS
take with food etc
dont chew or crush
avoid alcohol
adverse drug reactions of NSAIDS
gastric upset bleeding (non ASA) kidney dysfunction salicylism (ASA) ototoxicity (ASA) Reyes syndrome (ASA)
therapeutic use of acetaminophen
analgesia for mild to mod pain
fever reduction
antidote of acetaminophen
acetylcysteine
adverse drug reactions of acetaminophen
liver damage
hypertension (women)
acetaminophen contraindications/ precautions
pregnancy alcohol use anemia immunosuppression hepatic or kidney disease
acetaminophen interactions
alcohol
warfarin (Coumadin)
cholestryramine (questran)
Tylenol interaction with warfarin
increased bleeding risk
tylenol interaction with cholestyramine
reduces absorption
tylenol client instructions
do not exceed 4g/day
report abdominal discomfort
check BP regularly
centrally acting nonopioids
tramadol (ultram)
adverse drug reactions to tramadol
sedation, dizziness headache nausea respiratory depression seizures urinary retention
contraindications/ precautions of tramadol
alcohol opioids psychotropic drugs seizure disorders liver/kidney disease
administration of tramadol
takes 1 hr to take effect
makes sure swallowed whole
client instructions for tramadol
dont drive sit or lie down increase fluid/fiber take with food report urinary retention
opioid agonists
morphine
therapeutic uses of morphine
mod to severe pain relief
sedation
reduction of bowel motility
cough supression
contraindications of morphine
pregnancy
kidney failure
increased intracranial pressure
biliary colic
morphine interactions
cns depressants anticholinergic agents MAOIS antihypertensives st john wort
adverse drug reactions of morphine
respiratory depression
orthostatic hypertension
urinary retention
giving morphine
get baseline vitals
give iv slowly over 4-5 mins
notify provider if respiratory rate is lower than?
12/min
agonist-antagonist opioids
butorphanol
therapeutic uses of butorphanol
mod to severe pain
treats opioid dependence
adjunct to balanced anesthesia
contraindicatoins/precautions of butorphanol
myocardial infarction
opioid dependence
butorphanol interactions
cns depressants
decreases opioid effects
adverse reactions of butophanol
respiratory depression
increased cardiac workload
abstinence syndrome (withdrawls)
giving butophanol
obtain baseline vitals
have naloxone available
patient instructions for butophanol
use PRN and short term
no driving
dont use for anginal pain
no opiod use
opioid antagonist
naloxone
therapeutic use of naloxone
reverses opiods
reverses neonatal respiratory depression
contraindications/precautions of naloxone
opioid dependence
respiratory depression
interactions of naloxone
opioid effects decrease
pregnancy risk
acute hepatitis or liver failure
adverse drug reactions of naloxone
ventricular arrhythmias increased resp. rate blood pressure heart rate abstinence syndrome
giving naloxone
IM, IV or SC
titrate doses carefully
monitor vitals
adjuvant medications
tricyclic antidepressants anticonvulsants cns stimulants antihistamines glucocorticoids bisphososphonates NSAIDS
antihyperuricemics
allopurinol (zyloprim)
therapeutic use of allopurinol
hyperuricemia due to gout, chemo and blood dyscrasias
contraindications/precautions of allopurinol
hypersensitivity of allopurinol bone marrow depression liver/kidney dysfunction peptic ulcer disease lower GI tract disease
allopurinol interactions
hypersensitivity GI disturbances metallic taste cataracts agranulocytosis
glucocorticoids
prednisone
therapeutic use of glucocorticoids
pain and inflammation skin disorders delays rheumatoid arthritis prevents organ rejection adjunctive therapy for cancer
contraindications/precautions of prednisone
vaccines
fungal infections
cataracts
prednisone interactions
lasix
digoxin
NSAIDS
diabetics
predinisone interacton with lasix
increases risk for hypokalemia
prednisone and digoxin
dysrhythmias
prednisone and NSAIDS
GI bleeding and ulcers
Prednisone and diabetes
decrease insulin and hypoglycemics effects
prednisone and vaccines
decreased antibody response
prednisone adverse drug reactions
adrenal function suppression hyperglycemia myopathy peptic ulcer disease infection fluid/electrolyte imbalance fat redistribution
giving prednisone
taper off
only short term, largest dose on first day smaller doses for next 8 days
take in morning using alternate day dosing for long term use
give more doses in times of stress
prednisone patient instructions
report muscle pain
avoid NSAIDS
take with food
report GI bleeding
