EXAM 1 STUDY GUIDE Flashcards
class activities/exam review
Prevented by NOT giving aspirin to children
Reyes
Side effects of opioids
Euphoria
Needs a pregnancy test
Teratogenic
NSAID given via IV/IM/PO route
Ketorolac
Most important assessment when giving opioids
Respirations
Providers order for treatment
Prescription
When a drug needs a higher dose to work
Tolerance
A sign the kidneys are in trouble
Oliguria
Pain that is NOT treated with opioids
Adjuvant
What happens from too much of a drug
Overdose
Substances that are NOT regulated by the FDA
CAMs
Effects of steroids
Hyperglycemia
Medication assisted therapy (not methadone)
Buprenorphine
A method to increase medication compliance
Education
Name for a drug that there can be many of
Trade
Weakest opioid
Codeine
Grouping of drugs by disease they treat
Therapeutic
Test for GI bleed
FOBT (Fecal Occult Blood Test)
Reliever of Pain
Analgesia
How long a drug lasts
Duration
How much of a drug is given
dose
The organ that excretes most medications
Kidney
The organ that metabolizes most medications
Liver
Something that ACTIVATES a receptor in the body
Agonist
When a drug is used for something other than it official indication
OLU (Off-label-use)
When a medication or treatment does NOT work
Refractory
When a drug is placed on a list due to having a high risk for abuse and dependency
Controlled Substance
A term for a medication that is used to treat an overdose
Reversed Agent
When a larger amount of medication is given as the first dose.
Loading Dose
A medication that blocks a receptor in the body.
Antagonist
The correct term for someone that is not allergic to any meds, but is allergic to bees
NKDA
When a medication cannot be given to a patient
Contraindication
How well a medication will work
Efficacy
The range of medication levels in the body between helpful and toxic
Therapeutic range
The term for a medication that is safe to obtain without a prescription
OTC (Over-the-counter)
When a patient needs more and more of a medication to work
Tolerance
When a medication dose is slowly decreased until it is stopped
Taper
The time when a medication begins to help the patient
Onset
The drug name that companies market a medication as
Trade/Brand
An order for a medication or treatment given by a provider
RX (medical prescription)
What needs to be monitored when taking drugs with a narrow therapeutic index
Labs
The term for when the fluid given via the IV route leaks into the local tissue
Infiltration
Place the medication between the cheek and the gums
Buccal
Make sure to rotate sites when using this route
Subcutaneous
You should make sure the skin is clean, dry, and hairless, when using this route
Transdermal
This is considered the most localized route of administration
Topical
The route is used often the least preferred by nurses
Rectal
TB test is one of the only uses for this route
Intradermal
You should advise your patient to let the medication sit and dissolve, they should not swallow it.
Sublingual
Your patient needs to take deep breaths for this route to work
Inhalation
This route requires you to cover one nostril during administration
Intranasal
You may use this route for otitis externa but not otitis media
Otic
This is the most common route of treating conjunctivitis
Ophthalmic
Inject the medication at a 90 degree angle in the muscle
IM (Intramuscular)
Use this route only when you cannot establish IV access in an emergency
IO (Intraosseous - directly into bone marrow)
This route is the most common route of all for medication administration
Oral
This route is used to avoid extravasation
CVC (Central venous catheter)
The fastest route of medication administration
IV
Parenteral route not on this list
Vaginal
The way drugs are grouped by their mechanism of action
Drug class
The way a drug moves through the body
Pharmacokinetics
The way a drug has its effect on the body
Pharmacodynamics
Meds (weakest ———> strongest)
- Ibuprofen
- Ketorolac
- Tramadol
- Codeine
- Morphine
- Hydromorphone
- Fentanyl
Adverse effects of systemic steroids
- weight gain
- mood disorders
- Hyperglycemia
- Hypertension
- Immunosuppression
- Loss of bone density (osteoporosis)
- weakness
- sleep disturbance
What is a common practice in prescribing to address the danger of systemic steroids?
Localized as possible ( Ex: if it’s a rash give a cream vs pill)
Name 2 conditions that opioids are used to treat besides pain?
- Chronic coughing
- Diarrhea
What is the most common side effect of opioids?
Euphoria (getting high)
What is the second most common side effect of opioids?
Constipation
4 recommendations to address constipation
- Increase activity
- Increase Fluids
- Increase fiber
- Last - give stool softener
3 types of pain
- Phantom
- Chronic
- Nociceptive (caused by damage to body tissue. Ex: stubbing your toe)
Which pain is treated different from other pains?
Neuropathic = Adjuvant therapy
(facilitate better pain control w/ a reduction in analgesic consumption)
A patient is dehydrated and receiving fluids. The order is to give 1500ml over 1 hr followed by 250ml an hr. The 1500 is referred to as the _________ dose & the hourly rate is referred to as the _________ dose.
- Loading
- Maintenance
What is the relationship between titrate vs taper?
They are OPPOSITE of each other
Titrate = slow INCREASE of a dose
Taper = slow DECREASE of a dose
What medication routes are ALWAYS SYSTEMIC?
- PO
- IV
- IM
- SubQ
- Rectal
What is the primary indication for administering Naloxone?
Respiratory depression related to an opioid use
What do we use metformin for?
- treat type 2 diabetes
- treat gestational diabetes
How would you address a concern for addiction relating to a prescribed opioid?
- Therapeutic communication
- Patient education
What safety education would you provide to a patient that takes CAMs
- Tell me (your nurse) & provider what you are taking
- Tell patient to take it AS PRESCRIBED on bottle
- Be aware of where they are getting it from & only from REPUTABLE sources
Duration vs. Half life
- Usually the SAME thing
Duration
How long the med & effects last
Half-life
How long a med in the blood DROPS by HALF
2 prescription drug classes that can be used for an acute migraine?
- Ergot Alkaloids
- Serotonin 5ht Agonist
What OTC options are available for acute migraines?
NSAIDS (like Tylenol)
What drug class is most effective for inflammation?
Steroids
What drug is related to Reyes syndrome?
Aspirin
Why is Reyes syndrome uncommon today?
- We DO NOT GIVE aspirin to anyone under 18 yrs old
- NO KIDS
What does synergism mean?
- 2 things together are more than a sums of there parts
- (1+ 1 = 3)
Black box warning vs Contraindication
Black box = Caution
Contraindication = DO NOT GIVE
Ex: of synergism in body
- physicians treat bacterial heart infections with ampicillin & gentamicin
- cancer patients receive radiation & chemotherapy (or more than one chemo drug at a time
What is the HIGHEST PRIORITY nursing assessment for the patient that is treated with an opioid?
Respiratory
2 opioids that are available PO only?
- Vicodin
- Percocet
What medication can cause ringing in the ears
Aspirin
What is the goal in pain relief?
- Minimize
- Not eliminate (we have goals for a reason)
Can a patient that is allergic to naproxen take ibuprofen?
NO - Because same drug class
What is the highest priority question to ask when a patient reports their medication is not working?
Please tell me how you are taking your meds
How should a nurse address a patient refusing their prescribed medication?
- Therapeutic communication
- Patient education
Name the two most significant differences between acetaminophen and NSAIDs
Acetaminophen = Hepatotoxic (liver)
NSAIDs = Nephrotoxic (kidney)
Name 3 patient teaching points for someone prescribed morphine via a PCA pump
- These are gonna give you your meds at fixed
- If you need additional additional medication you can push
- It will not overdose you
What’s the most commonly used NSAIDs?
Ibuprofen
What can be given IV/IM/PO?
Ketorolac
What med is by prescription only?
Indomethacin
What med does not block cyclooxyrgenase?
Celecoxib
Why can come medications NOT BE CRUSHED up for the patient?
- If they are sustained released, extend released or enteric coated can not be crushed
- Protects our stomach from the pill or pill from your stomach.
What are two types of withdrawal a patient may experience with opioid addiction?
- Physical
- Psychological
Which withdrawal is treated with methadone or Buprenorphine?
physical (also called medication assisted therapy)
Which withdrawal is treated with therapy or narcotics anonymous?
Psychological
What would you expect when giving naloxone to a patient that has no opioids in their system.
Nothing - NO effect
What if you do have opioids in their system with naloxone?
- opioid withdrawal syndrome
- S/S - tremors, anxiety, nausea, headache, hypertension
Which drug name does the healthcare system use?
Generic
Which drug name do patients usually use?
Trade or Brand
What two drugs activate opioid receptors without the patient becoming euphoric?
- Methadone
- Buprenorphine
(doesn’t get person high)
Name 4 components of a respiratory assessment?
- lung sounds
- SPO2
- Respiration Rate
- Respiratory Depth
What is the sign that the kidneys are in trouble?
Oliguria + Anuria = med emergency!!!
What is the difference between CAMs and OTCs?
CAMS = Approved as being safe but no proof of efficacy (Not FDA approved)
OTC = Regular meds, safe effective, appropriate/available to the public without prescription
What are 3 contraindications of sumatriptan?
- Patient has uncontrolled hypertension
- Patient has already taken 9 pills
- Patient has certain cardiac disease
What are 5 CAMS and their uses
- Echinacea
- Chamomile
- Ginkgo
- St Johns warts
- Ginger
Can you take more than one drug in the same class?
NO
Name 3 OTC NSAIDS
- Naproxen
- Aspirin
- Ibuprofen
What drug class is known to cause GI bleeding?
NSAIDS
Name 3 ways to assess for GI bleeding?
Sign = Blood & Stool
Symptom = Abdominal pain lab (FOBT)
What is the primary organ of excretion?
Kidney
What is the primary organ of metabolism?
Liver
What is the importance of the kidney and liver working properly?
If not working you need to adjust the dose
You should always use the strongest medication to treat your patient.
False (Most effective, Not most Potent)
You should use therapeutic communication to address treatment refusals
True
The strongest medication is the most effective?
False
A medication that is by prescription is always better than an OTC option?
False
You should still use non pharm interventions if the patient is getting a drug?
True
You do not need to ask patients about their OTC or herbal meds?
False
All drugs have the same potency or efficacy?
False
Holistic treatment may involve prescribing meds?
True
A prescription can be referring to more than just medication orders?
True
The 1st past effect is most significant for medications given via which route?
PO
What is the patient education for a drug that has narrow therapeutic index?
We have to give EXACT RIGHT DOSE
- To little will not do anything
- To much will hurt them
(Frequent Lab testing)
Required assessment for - Sumatriptan?
Hypertension
Required assessment for - Aspirin?
Ringing in the ears
Required assessment for - Morphine?
Bradypnea
Required assessment for - Indomethacin?
Black stool
Required assessment for - Acetaminophen?
Liver failure
What are 3 contraindications for most NSAIDS.
- Antipyretic
- Analgesic
- Anti inflammatory
What enzyme do NSAIDs act on?
cyclooxygenase cox 1
Can a patient take NSAIDs and Acetaminophen?
Yes
What assessments are needed before administering a teratogenic medication?
- HCG = pregnancy test
- Last menstrual cycle = if provider trust patients word
What drug classes might be recommended for someone having 8 migraine per month? (chronic meds)
- Beta blockers
- SNRIs
What are the 6 rights of medication administration?
- Right patient
- Right dose
- Right time
- Right drug
- Right route
- Right documentation.
What are 5 conditions treated with steroids?
- Asthma
- COPD
- Covid 19
- Gout
- Rheumatoid Arthritis
What is half life?
How long does it take until drug levels drop in half
How is half life related to drug dosing frequency?
When drug level drops in half you give there next dose
What assessment is only done after giving a medication, not before?
Assessment related to any side effects that the med can cause.
When to not reposition someone?
Someone you had hip surgery
When to not turn on the news for someone?
3 year old
When to not call the patients family?
Patient hard of hearing
When to not go on a walk in the hall?
Patient that is bed bound
When to not use guided imagery for someone?
Patient who has dementia?
When to not use massage therapy on someone?
- Rash
- Religion
When to not turn off the lights for someone?
Kid afraid of the dark
Pharmacodynamics
How med changes Body
Pharmacokinetics
How drug moves through body
Do oral steroids always need to be tapered?
yes
What is the relationship between alcohol & opioids?
- alcohol = CNS depressant
- Opioids = also CNS
- avoid taking together
- these 2 can have synergistic effect & amplify another
A patient reports they are pregnant and asks about their prescribed daily teratogenic
- Tell doctor immediately
- You are NOT a Dr.
What is the term for a large 1st dose of a med?
Loading dose
What is correct about administering IV opioids?
You need to administer the drug over several mins
What education should the nurse provide when administering naproxen to avoid neg GI effects?
Take with food
_______ is to the US as _______ is to Nevada as ________ is to Vegas
- Therapeutic drugs
- Drug class
- Drug
Onset
When the drug takes effect
Indication
What a drug is used for
First line
The most recommended treatment
Alternative
Other than first line choice
Refractory
Unresponsive to
What enzyme causes inflammation?
Cycoxygenase (through production of prostate gland)
What other chemical in the body is famous for causing inflammation?
Histamine
Agonist
Activates (opioids)
Antagonist
Inhibits (NSAIDs or Naloxone)
Renal function goes down as your age increases
BUN & creatinin will go up
What two assessments are critical before any med admin & what two after?
What are you treating & adverse effects
What is the first step in the process of pharmacokinetics?
Absorption
Wheezing is a ____
Sign of respiratory depression
How long after administering the drug should you monitor for adverse effects
First 15 - 30 mins
Four categories of pharmacokinetics
- Absorption
- Distribution
- Metabolism
- Excretion
Give an example of a drug that is an antagonist
Ex: naloxone/narcan
What is a teratogen?
Substance to which an embryo or fetus is exposed that causes abnormalities or retardation or death.
What is nociceptor pain?
Injury to tissues
Somatic pain
- sharp
- localized sensation
Visceral pain
- dull
- throbbing
- aching pain
Primary use of opioid agonists
- Relieve moderate to severe pain
- Some used for anesthesia
What do opioids put patients at high risk for?
Physical & psychological dependence
Morphine is a _____
opioid analgesic
Naloxone is a _______
treatment pf acute opioid overdose & misuse
Aspirin/Acetylsalicylic
- non opioid analgesic
- NSAID
- Antipyretic
Morphine side effects
- Lethargic
- Dizziness
- itching
- constipation
- nausea/ vomiting
morphine routes for admin?
- PO
- subQ
- IV
- IM
morphine - adverse effects
- restlessness
- anxiety
- hallucinations
- RESPIRATORY DEPRESSION
- CARDIAC ARREST
- death
Naloxone - adverse effects
- increased BP
- hypertension
- nausea/ vomiting
- drowsiness
corticosteroids - adverse effects
- suppression of adrenal gland function
- mood changes
- cataracts
- peptic ulcers
- electrolyte imbalances
- osteoporosis
Sumatriptan/ imitrex
- dizzy
- drowsiness
- warming sensation
If a pt is using this med, they should be monitored for at least 24 hrs if given as an epidural ____
morphine
sumatriptan/imitrex - contraindications
- recent medical information
- hypertension
- diabetes
- acute kidney injury
- hepatic impairment
morphine - contraindications
- can mask or intensify pain of gallbladder disease
- avoid in with acute or severe asthma
- GI obstructions
- severe kidney pr liver impairment
three MAT programs
- methadone
- combination of buprenorphine + naloxone
- naltrexone
MAT programs - methadone
- standard treatment
- will help with withdrawal symptoms, but not with pain
10x stronger than morphine
hydromorphone/dilaudid
100x stronger than morphine
fentanyl
“morphine in PO form”
oxycodone
highest risk of abuse due to potency
fentanyl
naloxone
opioid receptor antagonist
Which of the following meds requires me to educate a patient on diet & exercise / reducing salt?
Steroids
Naloxone should be administered when RR is fewer then ____ breaths/min
10
Is acetaminophen an NSAID?
no
aspirin can reduce fevers
true
aspirin is an NSAID
true
aspirin is a ___
cox inhibitor
aspirin/ acetylsalicylic acid treats ______ pain
mild to moderate
aspirin/ acetylsalicylic -MOA
- inhibits COX
- Inhibits platelet aggregation (anti platelet)
what is the only NSAID that inhibits platelet aggregation
aspirin
what med do you need to STOP 1 week BEFORE surgery
aspirin
Aspirin - Adverse effect
- GI upset (take with food)
- bleeding
What does a positive occult blood test mean?
GI bleed
Aspirin - toxicity / Overdose
tinnitus
what pharmacological class is ibuprofen?
cox inhibitor
Ketorolac (Toradol)
- for pain after surgery
- non - narcotic non habit forming
- IM, PO, IV
Triptans (pharmacological class)
- serotonin agonists
- constricting certain intracranial vessels
Medication is metabolized in the liver causing a reduction in the active drug concentration
first pass effect
This drug is a
- NSAID
- cox inhibitor
- given on empty stomach but can be given w/ food
- taking with aspirin increases GI bleed
Ibuprofen
This med is
- oral opioid
- constipation
- include stool softner
oxycodone
The major route for drug extortion and impaired function will decrease drug excretion
kidneys
Requires a higher dose to achieve a therapeutic effect
oral route
Produces a therapeutic effect at a lower dose
Potency
Most controllable pain?
Localized
This med is a
- NSAID
- Cox inhibitor
- Antiplatelet
- don’t give to kids (Reyes syndrome)
- toxicity - tinnitus
Aspirin
Second opioid when used in combo w/ other opioids will speed up tolerance and increased risk of addiction
Hydromorphone
- Toxic epidermal necrosis
- characterized by blister lesions & skin sloughing
Stevens johnson syndrom
adverse effect thats can cause serious injury or death
black box warning
long term use can cause
- fractures
- osteoporosis
- hyperglycemia (need to increase insulin)
- impaired wound healing
- cataracts
- Cushing syndrome
- taper off
steroids
number 1 side effect of taking morphine (Goldstein lecture)
euphoria
- highest risk of abuse due to high potency
- 100x morphine
Fentanyl
- NSAID
- non habit forming
- come IM/ IV/ PO
Ketoroloac
- better to use this with KIDNEY disease than NSAIDs
- most serious effect from overdose is hepatotoxicity
acetaminophen
- common use is fever
- mild to moderate pain
NSAID
- used as supplest but not replacement for opioids in treating severe cancer pain
- used for neuropathic pain to
adjacent analgesics
maximum response can be produced from a drug
efficacy
rapidly achieves therapeutic response
loading dose
- opioid
- avoid other CNS depressants like alcohol
- adverse is respiratory depression
- naloxone as antidote
- injected over 4 - 5 mins
morphine
an opioid med used to treat opioid dependency because it causes less euphoria
methadone
MAT programs 2 meds
- methadone
- naltrexone
cam therapy safety
- check w provider
- seek info from reputable sources
- take recommended or lower doses
- meds that relieve acute pain for migraine or are abortive therapy
- triptans
- ergot alkaloids
-OTC
those effects after naloxone is administered
- tremors
- vomiting
- increased BP
the elderly have an increased production of auto antibodies
- decreased serum creatinine level
- decreased dermal thickness
- experience blunted responses
- no fever
meds for prophylactic treatment of migraines
- anti seizure meds
- beta adrenergic blockers
- calcium channel blockers
- tricyclic anti depressants
