Exam 2 Flashcards
1
Q
What drugs fall in the class of non-opioid analgesics?
A
- acetaminophen
- 1st gen NSAIDs
- aspirin
- ibuprofen
- naproxen
- indomethacin
- diclofenac
- ketorolac
- meloxicam
- 2nd gen NSAIDs
- celecoxib
2
Q
therapeutic effects of NSAIDs
A
- ↓ inflammation
- relieve pain
- ↓ fever
- ASPIRIN: ↓ risk of MI and stroke
3
Q
How do NSAIDs work?
A
by blocking cyclooxygenase
4
Q
complications of NSAID use
A
↑ risk of
- GI ulcers
- bleeding
- renal impairment
- MI and stroke (except ASPIRIN, but especially CELECOXIB)
5
Q
administering NSAIDs
A
- take with food
- may need adjuvent med to protect GI
- monitor for s/sx of GI bleed
- usually PO, but IV and IM available
- don’t crush or chew enteric-coated pills
- notify provider of
- bleeding
- N&V
- abdominal pain
- increased risk of bleeding with glucocorticoids
- concurrent use of multiple NSAIDs increases risks
6
Q
NSAID precautions
A
- older age
- smoking
- alcohol use disorder
- pre-existing renal or GI issues
- pregnancy
- bleeding disorders
- anticoagulant meds
- stop before surgery
7
Q
complications of aspirin use
A
- Reye syndrome
- salicylism
8
Q
ASA
A
- aspirin
- acetylsalicylic acid
9
Q
Reye syndrome
A
- rare but serious complication when using aspiring to treat fever in children with viral illness
- don’t use ASA to treat pediatric fever
- symptoms
- diarrhea
- tachypnea
- vomiting
- severe fatigue
- fever
- hypoglycemia → confusion, seizures, LOC
10
Q
salicylism
A
- mild ASA toxicity
- stop med and notify provider
- symptoms
- tinnitus
- sweating
- headache
- dizziness
- respiratory alkalosis
11
Q
aspiring toxicity
A
- more serious than salicylism - medical emergency
- max dose: 4 g/day
- s/sx
- high fever
- sweating
- acidosis
- dehydration
- electrolyte imbalance
- coma
- respiratory depression
12
Q
aspirin toxicity Tx
A
- gastric lavage/activated charcoal
- hemodialysis
- cooling with tepid water
- IV fluid correction
- bicarbonate (for acidosis)
13
Q
acetaminophen
A
- therapeutic use
- analgesic
- antipyretic
- MOA: slows production of prostaglandins in CNS
- route
- usually OTC and PO
- comes in IV forms by Rx
14
Q
acute acetaminophen toxicity
A
- rare at therapeutic doses
- max dose: 4 g/day
- causes liver damage
- s/sx
- N&V
- diarrhea
- sweating
- abdominal pain
- hepatic failure
- coma
- death
- antidote: acetylcysteine
15
Q
administering acetaminophen
A
- before giving acetaminophen or meds mixed with it, take LFT in some pts, and PT/INR in those taking warfarin
- teach pt to read med labels to avoid accidental overdose (cold meds, headache meds)
- max dose: 4 g/day
- ask about alcohol use
- max dose with > 2 drinks/day: 2 g/day
- monitor concurrent meds to avoid overdose
16
Q
opioid agonists
A
- prototype: morphine
- fentanyl
- meperidine
- methadone
- codeine
- oxydocone
- hydromorphone
17
Q
morphine SE
A
- rash
- respiratory depression
- bradycardia
- constipation
18
Q
morphine admin routes
A
- PO (TAB, LIQ)
- IV
- IM
- SC
- PR (rectally)
- td
19
Q
ETOH
A
intoxicated pt
20
Q
opioid agonist SE
A
- respiratory depression
- monitor VS
- withhold if RR < 12
- worse with CNS depressants and ETOH
- sedation
- fall risk
- monitor VS
- avoid risky activities
- worse with CNS depressants and ETOH
- constipation
- prevention: fluid and fiber, docusate sodium
- acute Tx: stimulant laxative
- long-term use: opioid antagonist
- N&V: give antiemetic (promethazine = synergist); ondansetron
- orthostatic hypotension
- fall risk
- move slowly
- worse with antihypertensive meds
- urinary retension
- watch I/O
- encourage voiding q4hr
- assess for distention
- worse with anticholinergics and in pts with BPH
21
Q
BPH
A
benign prostatic hyperplasia
22
Q
long-term use of opioid agonists
A
- physical dependence
- ≠ abuse or illicit use, but can lead to both
- withdrawal symptoms when stopped
- must taper dose
- methadone clinics treat this
- tolerance
- ↓ therapeutic response over time
- no relief from normal dose
- no SE from normal dose
23
Q
acute overdose of opioid agonists
A
- s/sx
- respiratory depression
- coma
- pinpoint pupils
- Tx
- D/C med
- CPR
- naloxone
- mechanical ventilation
24
Q
PCA
A
patient-controlled analgesia (pump)
25
Q
patient-controlled analgesia
A
- allows for self-admin
- pt must be awake
- don’t let family push button
- on-demand only or continuous with extra PRN dose
- when switching to PO meds, monitor pain level closely
26
Q
administering opioid agonists
A
- assess pain level and medicate accordingly
- reassess pain in appropriate time for route
- monitor respiratory status
- be careful - don’t overmedicate
- severe, chronic pain: fixed schedule
- acute pain: PRN before pain is severe
27
Q
opioid agonist-antagonists
A
- MOA: agonist for kappa, antagonist for mu receptors
- prototype: butorphanol; used as Tx for opioid abuse
- nalbuphine
- buprenorphine
- penazocine
- treats: moderate to severe pain
- ↓ effective than agonists
- ↓ respiratory depression and risk of abuse
- ideal for labor pain
28
Q
opioid agonist-antagonist SE
A
- sedation
- respiratory depression (↓ than agonists)
- dizziness - fall risk, avoid machinery
- headache
- interacts with ETOH and other sedating meds
- abstinence syndrome
29
Q
abstinence syndrome
A
- ↓ activity of mu receptors → withdrawal in opioid dependent pts
- s/sx
- cramping
- HTN
- vomiting
- fever
- anxiety
- contra: in pts with opioid use disorder
- caution: head injury, chronic dz
30
Q
opioid antagonists
A
- MOA: compete for opioid receptors to block action
- prototype: naloxone
- naltrexone
- alvimopan
- reverse repiratory depression, euphoria, constipation, and pain control
- complications
- tachycardia
- tachypnea
- contra: opioid dependency, except for OD
31
Q
WHO three-step analgesic ladder
A
- mild pain: non-opioid ± adjuvant
- persisting/increasing mild-moderate: opioid + non-opioid ± adjuvant
- persisting/increasing moderate-severe: opioid ± non-opioid ± adjuvant
