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Pharmacology > EXAM 3 Pain Management Opioid > Flashcards

EXAM 3 Pain Management Opioid Flashcards

1
Q

Opioid receptors are located where

A

Opioid receptors are located in the brain, brain stem and spinal cord

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2
Q

Normally, when pain impulses are transmitted along sensory pathway, neurotransmitters are

A

are released to carry the pain impulse to the CNS

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3
Q

When opioid receptors are occupied (by an opioid), then the neurotransmitters are

A

are not released = which creates a decreased pain interpretation.

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4
Q

Opioid Agonist what do they do

A
  1. occupying same opiate receptors as Endorphins (natural painkiller)
  2. Prevents release of neurotransmitters
  3. Elevates pain threshold (decreased pain interpretation)
  4. Bind well to the receptor site-causes a response
  5. Alters perception of pain, which causes a reduction in pain sensation
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5
Q

Opioid Agonist Examples

A

Demerol and Fentanyl

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6
Q

Opioid Agonist-antagonist are referred to

A

mixed agonist (has properties of both the agonist and antagonist)

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7
Q

What Occupies opioid receptor sites while blocking transmission of pain sensation and Actually causes a weaker neurologic response than a full agonist.

A

Opioid Agonist-antagonist

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8
Q

Examples of Opioid Agonist-antagonist

A

Stadol and Nubain

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9
Q

What counteract the effects of opioid analgesics

A

Opioid Antagonists

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10
Q

Antagonist compete with who and reverse what?

A
  • Compete with opioids at receptor sites
  • Reverse depressant effects of the opioid analgesics, not only will reverse side effects but will reverse pain control as well.
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11
Q

Opioid Analgesics are______substances used to treat ___________.

A
  1. controlled

2. moderate to severe pain

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12
Q

Major adverse reaction of opioids

A

depressant effect on CNS, especially the respiratory system

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13
Q

Opioids are_________ that must be regulated by the____________

A
  • controlled substances

- FDA to prevent over-prescribing

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14
Q

Controlled Substances are considered

A

Habit forming and addictive substances.

Can cause physical and psychological addiction.

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15
Q

Opioid Analgesics

A

come from raw opium

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16
Q

Examples of Opioid Analgesics

A

Morphine, Codeine, and drugs as a result of chemically altering Morphine.

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17
Q

Action and Examples of Semi-synthetic and Synthetic Analgesics

A

Similar Action to Morphine, just not a morphine derivative.

Examples = Demerol, Fentanyl, Methadone

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18
Q

Morphine Sulfate is a Prototype or

A

“model” opioid

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19
Q

Opium Sulfate route of admission

A

PO, IV, IM, SC , PR and Transdermal

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20
Q

Most common drag for PCS because it maintains even pain control is

A

Morphone Sulfate

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21
Q

Side effects of Morphine Sulfate

A

Rash, Respiratory Depression, Bradycardia and Consitpation

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22
Q

What is natures way of controlling pain

A

Opium Poppy/ Morphine Sulfate

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23
Q

Uses of Opioids

A
  1. Effective for moderately severe to severe pain
  2. Relief of Severe cough (Codeine)
  3. Pulmonary Edema (Morphine)
  4. Obstetric Analgesia
  5. Pre-operative to lessen anxiety and sedate
24
Q

Actions of Morphine on CNS

A

drowsiness, euphoria, sedation, mental clouding (degree depends on dose)

25
Q

Actions of Morphine on eye

A

Miosis = pupil constriction (pinpoint)

26
Q

Actions of Morphine on Respiratory

A

depression of rate and depth of respirations and aggravation of asthma

27
Q

Actions of Morphine on Cough reflex

A

suppress cough (especially Codeine)

28
Q

Actions of Morphine on GI Tract

A

Slow peristalsis in stomach, small and large intestine

Decrease in gastric, pancreatic and biliary secretions

29
Q

Actions of Morphine on Gallbladder

A

possible spasm (especially Morphine)

30
Q

Actions of Morphine on GU Tract

A

Spasms or contraction of bladder (urinary retention

31
Q

Actions of Morphine on Integumentary

A

itching and rash

32
Q

Opioid Adverse Reaction

A

Physical dependence
Withdrawal symptoms.
Opioid tolerance
Due to legal and ethical obligation, we need to address the patient’s pain because it takes priority over concerns about drug addiction or physical dependence.

33
Q

Adverse Reactions symptoms of withdrawal early signs

A

Yawning, perspiring, tearing, nasal drainage

34
Q

Adverse Reactions symptoms of withdrawal later signs

A 
Gooseflesh
Abdominal cramps
Bone and muscle pain (rebound pain)
N,V,D
Mydriasis (dilation of pupil)
Intense craving for drug
Agitation
Elevated blood pressure, tachycardia
Seizures
35
Q

Contraindications opioids

A

Known hypersensitivity
Acute bronchial asthma or upper airway obstruction
.

36
Q

Opioids use cautiously in individuals with

A

Head injury, morbid obesity, and sleep apnea.

37
Q

Opioid Precautions

A
  1. Caution in the elderly can cause extreme confusion and hallucinations
  2. Patients with undiagnosed abdominal pain
  3. Liver disease
38
Q

Opioids cause increased CNS depressant when given with:

A 
Alcohol
Antihistamines
Antidepressants
Sedatives
Phenothiazines
39
Q

Respiratory depression risk after

A

general anesthesia if medicated too soon

40
Q

Nursing Process - Opioids

Assessment

A

Health history, allergy history, current meds

Type, location, intensity of pain

Blood pressure, pulse, respiration
Location and type of pain important

If on Patient controlled analgesia (PCA) make sure patient understands how it works.

41
Q

Withhold med if Respiratory rate is

A

10/min or below, significant decrease in BP or increase in Pulse rate

42
Q

Nursing DX

A

Pain
Risk for injury (elderly)
Constipation (if there is)

43
Q

Nursing Process Planning (Goals)

A 
Relief of pain
Understanding use of PCA device
Absence of injury
Adequate nutrition intake
Understanding of compliance of Rx regimen
44
Q

Interventions –Relieving Pain

A

Assess patient about 30 min after med

Optimize pain relief period
Good time for getting patient out of bed, ambulating, coughing, leg exercises

45
Q

Nursing Process Interventions

Relieving Chronic Severe Pain

A

Morphine = most widely used
30-60 mg orally q 4 hr (less resp depression
with oral form)

Fentanyl patch (72 hr patch)

Brompton cocktail (mixture of oral narcotic and other meds

In severe pain concern should be relieving pain not preventing addiction.

46
Q

Encourage to cough and deep breathe ______ (post op patients) to prevent_________

A
  1. Every 2 hours

2. Pooling of secretions, hypostatic pneumonia

47
Q

Monitor for resp rate of

A

10/min or below

48
Q

Oral route and patches have a slower or faster build up

A

slower buildup

49
Q

What can be used to reverse respritory depression

A

Narcan available to reverse resp depression

50
Q

Monitor for orthostatic hypotension, what are some nursing processes

A
  1. Dizziness when rising or ambulating
  2. Assist patient to ambulate
  3. Have patient seek assistance when getting out of bed
  4. Check for constipation = (stool softener, ambulation)
  5. Watch for loss of appetite
51
Q

PCA machine Patient Education

A

Location of buttons
Regulation of dose and time interval
Assure machine will not deliver dose until correct time
Pain relief should occur shortly after pushing button
Inform nurse if pain not relieved after two doses

52
Q

Patient Teaching = home use

A

Drug may cause drowsiness, dizziness

Caution with driving

Avoid alcohol

Take med as directed

Explain how to put on patch

53
Q

Patient with Respiratory Depression Assess

A

Resp, Pulse, BP q 5-15 min

54
Q

Nursing Dx Patient with Respiratory Depression

A

Ineffective Airway Clearance r/t Overdose

Risk for Impaired gas exchange r/t decreased resp rate

55
Q

Plan Patient with Respiratory Depression

A

Respiratory rate, rhythm & depth

return to baseline (normal)

56
Q

Patient with Respiratory Depression Implementation

A

Cardiac monitor

Suction equipment handy

Keep patent airway

Monitor VS

Have Narcan available (antagonist)

Monitor fluid intake and output

57
Q

Patient with Respiratory Depression Evaluation

A

Therapeutic effect is achieved

Respiratory rate, rhythm & depth return to baseline (normal)

Clear Airway is maintained

Pharmacology (10 decks)

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