exam 1 Flashcards by Michael Charles

2 types of pain pathways

Nociceptive & neuropathic

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3 types of opioid receptors

mu, kappa, and delta

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receptor stimulated by opioid drugs

mu receptor

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adverse effects of mu receptor stimulation

respiratory depression, sedation, physical dependence, euphoria

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2nd receptor stimulated by opioid drugs

kappa receptor

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adverse effects of kappa receptor stimulation

sedation and psychotomimetic effects

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receptor that does not produce any effects when stimulated

delta receptors

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what produces cortisol to suppress inflammation

adrenal glands

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what do the adrenal glands release to suppress inflammation

cortisol

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ACTH

adreno-cortico-tropic hormone

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what releases ACTH

pituitary gland

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what affects fluid balance in the body

aldosterone

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3 types of non opiod analgesics

NSAIDS
Acetaminophe
Centrally Acting Non-Opiods

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1st generation NSAIDS

aspirin (ASA)

ibuprofen (advil, Motrin)

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2nd generation NSAIDS

celcoxib (Celebrex)

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therapeutic uses of NSAIDS

anti-inflammation
analgesia mild to mod pain
fever reducer
dysmenorrhea (cramps)
Inhibition of platelet aggregation (ASA)

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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)

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NSAIDS cause increased risk of bleeding when interacting with

anticoagulants
glucocorticoids
alcohol

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NSAIDS interaction with ibuprofen

decreased anti-platelet effects of ASA

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NSAIDS interaction with ACE inhibitors and angiotensin

increased risk of kidney failure

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ASA cannot be given 1 week before?

surgery

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Last choice NSAID for chronic pain because it can cause cardiovascular events

Celecoxib

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Client instructions for NSAIDS

take with food etc
dont chew or crush
avoid alcohol

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adverse drug reactions of NSAIDS

gastric upset
bleeding (non ASA)
kidney dysfunction 
salicylism (ASA)
ototoxicity (ASA)
Reyes syndrome (ASA)

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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