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Intro to Adult health > Exam 2 part 2 > Flashcards

Exam 2 part 2 Flashcards

1
Q

Know the difference between visceral pain, vascular pain, neuropathic pain and somatic pain, and acute pain and chronic pain

A
  • Visceral pain – Pain that originates from organs
  • Vascular pain – Pain that results from pathology of the vascular or perivascular tissues
  • Neuropathic pain – Pain that results from disturbance of function or pathologic change in a nerve (tingling, numbness, pins and needles)
  • Somatic pain – Pain that originates from skeletal muscle, ligaments or joints
  • Acute pain – pain that is sudden in onset and when treated usually resides less than 6 weeks
  • Chronic pain – Persistent or recurring pain that is often difficult to treat; includes any pain lasting longer than 3 to 6 months
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2
Q

KNow the meaning of opioid tolerance

A

• Opioid tolerance – normal physiological condition that results in long term opioid use in which larger doses of opioids are required to maintain the same level of analgesia and immediately withdraw can result in withdrawal symptoms

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3
Q
  1. Before administering an opioid analgesic what is the baseline data that the nurse must collect before administering this medication
A

• Check BP, respirations, bowel sounds (check every shift), pain level, LOC, allergies

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4
Q
  1. Why is meperidine (Demerol) not used in children and the elderly?
A

seizures

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5
Q

what is the receptor for opioids

A

MU

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6
Q
  1. What is a common adverse effect of opioids which is caused by histamine release?
A

itching

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7
Q
  1. What is the most serious adverse effect of opioids?
A

respiratory arrest

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8
Q

antidote for opioids

A

narcane (naloxone)

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9
Q
  1. Why might narcane(naloxone) be administered more than once in a patient who has overdosed on methadone or fentanyl patches?
A

• Narcane is short acting (short ½ life) so a 2nd dose may be required with opioids that have a long ½ life or that are delayed release or delivered through a patch form

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10
Q

Why should Demerol not be given to a patient taking selegiline(MAOI)?

A

• Seizures, respiratory depression, and hypotension

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11
Q
  1. Why should a patient who is opioid naïve not take fentanyl? What is a definition of opioid tolerant?
A

• Fentanyl could kill an opioid naïve patient. See above for opioid tolerant

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12
Q
  1. What is daily limit of the dose of Tylenol(acetaminophen)?
A

4 g (4000 mg)

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13
Q
  1. What are contraindications for acetaminophen?
A

• Contraindications for Tylenol are: liver disease, alcoholic, G6PD and the antidote for Tylenol is Acetylcysteine(mucomyst).

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14
Q

What is the medication that is used for a benzodiazepine overdose?

A

flumazenil

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15
Q
  1. What is the drug food interaction that needs to be avoided with benzodiazepines?
A

• Grapefruit juice and grapefruits should be avoided because of their interaction with the cytochrome P 450 enzyme in the liver would could increase the risk of toxicity for Tylenol. Also, alcohol is contraindicated.

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16
Q
  1. What are the adverse effects for the elderly who are taking benzodiazepines?
A

falls

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17
Q
  1. What is the primary inhibitory neurotransmitter of the brain?
A

GABA

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18
Q
  1. What is the main adverse effect of ambien?
A

sleep walking and sleep driving

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19
Q
  1. Is Ramelteon(Rozerem) a controlled substance and what hormone is this medication related to?
A

no. melatonin

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20
Q
  1. What are the major contraindications for muscle relaxants such as Baclofen(Lioresal)?
A

drug allergy and renal impairment

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21
Q
  1. How do amphetamines and phenidates increase the effect of norepinehphrine and dopamine?
A

• Amphetamines and phenidates increase the release and block the reuptake of dopamine and norepinephrine

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22
Q

When educating a family member on the drug methylphenidate (Ritalin), what time should the patient take this medication?

A

at least 6 hours before bedtime

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23
Q
  1. What is the drug that is non-controlled that can also be used for ADHD?
A

antomoxetine (strattera)

24
Q
  1. What are the two main contraindications for the use of caffeine as an analeptics?
A

• Cardiac, peptic ulcer disease, and allergy

25
Q
  1. Why would a COPD patient take an analeptic such as theophylline after surgery?
A

• Decrease the risk for respiratory arrest or depression

26
Q
  1. What is meant by abortive therapy of migraines and what is the 1st line medication given for treatment of migraines?
A

• Abortive therapy stop the migraine after it has started. Triptans are the first line therapies

27
Q
  1. What adverse effect can occur with the overuse of abortive therapy for migraines?
A

rebound headaches

28
Q
  1. What is status epilepticus?
A

• A seizure disorder characterized by generalized tonic-clonic convulsions that occur repeatedly, medical emergency

29
Q
  1. Why is it important for patient to have good oral hygiene when taking the medication Dilantin(phenytoin)?
A

gingivival hyperplasia

30
Q
  1. What is the drug of choice for status epilepticus?
A

diazepam

31
Q
  1. What Vitamin supplement should be given to patients on long term Dilantin(phenytoin) use?
A

• Long term Dilantin patients should take Vitamin D to help prevent osteoporosis

32
Q
  1. Why should Dilantin be dosed at a lower level for malnourished patients or patients with a low albumin level?
A

• Dilantin is protein bound, if don’t have a lot of protein → more risk of becoming toxic; having toxic levels of Dilantin

33
Q
  1. What is the miscellaneous drug used for neuropathic pain and for epilepsy? What precautions should the patient be placed on if they are newly started on this drug?
A

• Gabapentin (Neurontin); fall precautions

34
Q
  1. What is the advantage of valproic acid(Depakote Sprinkles)
A

• Depakote sprinkles (capsule) can be opened and sprinkled over food

35
Q
  1. What is main activity that epileptic patients can no longer participate in? How long do they need to be seizure free before they can be allowed to do this activity again?
A

• Driving – 6 months to a year seizure free (depending on your state of residence)

36
Q

What are the diet restrictions for carbidopa/levodopa?

A

high protein diet

37
Q
  1. How does B6(pyridoxine) interact with carbidopa/levodopa?
A

• B6 can reduce the effectiveness of Sinamet

38
Q
  1. The anticholinergic drug Benztropine(Cogentin) is used in Parkinson’s as an adjunct medication to treat ___________.
A

tremors

39
Q
  1. The antihistamine drug with anticholinergic properties used to treat SLUDGE in Parkinson’s patients is ____________.
A

• Antihistamine drug with anticholinergic properties used to treat SLUDGE in Parkinson’s patients is Benadryl.

40
Q
  1. In elderly patients what anticholinergic adverse effects must be monitored?
A

• Dry mouth, urinary retention, constipation, dry eye, dry skin, decreased sweating (hyperthermia)

41
Q
  1. Indirect-Acting Dopaminergic drugs such as MAOIs (Monoamine oxidase inhibitors) such as selegiline are more selective and less likely to cause the cheese effect. What does selegiline protect from breaking down and what is the cheese effect?
A

• MAOIs prevent the breakdown of dopamine. The cheese effect can occur if the patient eats foods or beverages with tyramine that could cause a hypertensive crisis 210/110. Foods in this group include beer, wine, cheese, aged or smoked meats. Table 16-7 on page. 264 gives a more complete list of the tyramine containing foods. Seligiline is selective so has less of a risk for this occurring but education must be given to the patient regarding this food restriction.

42
Q
  1. Selegiline is contraindicated for what opioid analgesic drug because of risk for hyperpyrexia and delirium?
A

demerol

43
Q
  1. What antiviral medication was found to be useful in treating the early stages of Parkinson’s disease?
A

• Amantadine (symmetrel)

44
Q
  1. What is the main disorder that lithium is used for?
A

bipolar disorder

45
Q
  1. What lab must be checked before administering lithium?
A

sodium level

46
Q
  1. What is the most serious adverse effect of lithium toxicity?
    •
A

Cardiac dysrhythmias

47
Q
  1. What are the signs and symptoms of serotonin syndrome?

• Box 16-1 (page 265)

A
  • Common symptoms: delirium, agitation, tachycardia, sweating, myoclonus (muscle spasms), hyperreflexia, shivering, coarse tremors, extensor plantar muscle (sole of foot) responses,
  • In more severe cases: hyperthermia, seizures, rhabdomyolysis, renal failure, cardiac dysrhythmias, disseminated intravascular coagulation
48
Q
  1. What foods must be avoided with MAOIs?
A

• Aged mature cheeses, smoked or pickled meats, aged or fermented meats, yeast extracts, red wines, Italian broad beans

49
Q
  1. What benzodiazepine is also indicated for panic disorder?
A

xanax

50
Q
  1. What is an anxiolytic drug?
A

anti-anxiety

51
Q
  1. The TCA (Amitriptyline) Elavil can block the muscarinic receptors and cause potent ____________ effects that can cause constipation and urinary retention.
    •
A

Anticholinergic

52
Q
  1. TCAs and what drink will cause overdose resulting in death in 70-80 percent of patients before they reach the hospital?
A

alcohol

53
Q
  1. What is the antidote for TCA poisoning?
A

• None, supportive care – activated charcoal, Sodium Bicarb, diazepam for seizures, antidysrhythmics

54
Q
  1. When a MAOI is given with a TCA drug what crisis may occur?
A

• MAOI with TCA can cause hyperpyretic crisis (high fever)

55
Q
  1. What antidepressant is also used for smoking cessation?

•

A

Zyban

56
Q
  1. Adverse effects of antipsychotic drugs include neuroleptic malignant syndrome, tardive dyskinesia, and extrapyramidal symptoms. Define these 3 adverse effects?
A

• Neuroleptic malignant syndrome – adverse effect of antipsychotic drugs – fever, cardiovascular instability, and myoglobinemia
Tardive dyskinesia – serious adverse drug effect characterized by abnormal and distressing involuntary body movements and muscle tension
Extrapyramidal symptoms – adverse effect of certain antipsychotic drugs and are similar in to various motor disorders seen in Parkinson’s disease

57
Q
  1. QT elongation (bradycardia) occurs with all antipsychotics, what test must the nurse recommend to the prescriber and what electrolyte panel before the administration of an antipsychotic drug such as Haldol?
A

EKG and potassium and magnesium levels

Intro to Adult health (1 decks)

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