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Pharmacology > Exam 4: Analgesics > Flashcards

Exam 4: Analgesics Flashcards

1
Q

Describe three characteristics of pain.

A

1) sensory & emotiobnal experience 2) subjective and personal 3) with/without tissue injury

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2
Q

List 4 nursing implications on pain managemennt?

A

1) Planning MUST include the patient 2) Assess and document PROPERLY 3) reassess after admin. analgesic for improvement, side effects, adverse effects 4) manage w/ non-pharmcological along with pharmacological

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3
Q

What is the assessment acronym FLACC and when is this assessment used?

A

Face, Legs, Arms, Crying, Consolability - used w/ infants unable to vervablize pain

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4
Q

What two scales are used to help children communiate their level of pain?

A

“Oucher Scale” and Wong-Baker Faces

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5
Q

What is the assessment acronym PAINAD, when is it used, and how do you interpret the score?

A

It is a scale used for dementia that looks at: Breathing, Vocalization, Face, Body Language, and Consolabiltiy. The scale is on a 0-10 range, with the previous listed five sections; a score of 4 or greater must be treated.

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6
Q

What is the of treatment pain when patients are on palliative care? What is the main tool for ensuring patient is comfortable during palliative pain management?

A

the goal is to achieve comfortable and dignified death; the main tool is to assess breathing and facial/body langauge - VS are NOT checked.

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7
Q

List the 3 NONopioid analgesics

A

1) NSAID 2) corticosteroids 3) acetaminophen (APAP)

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8
Q

What is tha MOA of acetaminophen and what does it NOT do?

A

it is an analgesic and antipyretic (w/o the negative side effects of NSAIDs) - is is NOT an anti-inflammatory.

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9
Q

What is the max daily dose of acetaminophen and why is this the max dose?

A

4000mg/24 hours and to avoid hepatic failure (see code phrases)

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10
Q

How should a nurse calculate the daily dose?

A

check the last 24 hour to calculate

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11
Q

What is the max daily dose of acetaminophen for malnourished patients? and why is this the max dose?

A

3000mg/24 hrs - bc BMI and albumin are low

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12
Q

What is the max daily dose of acetaminophen for ETOH use > 2 drinks/day?

A

2000mg/24 hrs

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13
Q

What is an acetaminophen OD managed by?

A

acetylcysteine

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14
Q

Describe opioid’s general action

A

Block CNS receptors and prevent pain sensation

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15
Q

Describe opioids (narcotics, opioid agonists) MOA?

A

Activate the same receptors that endorphins activate in the CNS = CNS depressant

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16
Q

What do opioid analgesics do to the respiratory system and what two nursing/patient implications are associated?

A

Respiratory SUPPRESSION.1) monitor resp. rate, depth, oxygenation 2) caution wtih resp. disorders

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17
Q

What do opioid analgesics do to the cough and gag reflexes and what two nursing/patient implications are associated?

A

LOSS of cough and gag reflexes. 1) monitor for silent aspiration 2) understand that the drug is used as an antitussive

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18
Q

What do opioid analgesics do to the ANS control and what three nursing/patient implications are associated?

A

SUPPRESS ANS control. 1) monitor VS for LOW HR & BP 2) caution with cardiac disorders, dysrhythmias 3) monitor for orthostatic hypotension (FALL)

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19
Q

What do opioid analgesics do to the GI control and what four nursing/patient implications are associated?

A

SUPPRESS GI motility. 1) monitor bowel sounds for HYPOactive bowel sounds 2) monitor for CONSTIPATION, ilues, bowel obstruction, anorexia 3) ALWAYS use prophylactic laxative 4) increase fluid/fiber & activity

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20
Q

What do opioid analgesics do to CTZ in the brain and what nursing implication is associated?

A

It stimulates CTZ in the brain and causes nasuea/vomiting. The nurse should prophylactically manage w/ an antiemetic.

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21
Q

What do opioid analgesics do to the CNS and what three nursing implications are associated?

A

SUPPRESS CNS = sedation, hypnotic effect. 1) monitor for drowsiness (rish of FALL) 2) understand the indication use for anesthesia 3) assess home med list for any other drug affecting CNS (stimulants, suppressants, ETOH, illicit drugs)

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22
Q

What do opioid analgesics do to the bladder muscles and what nursing implications is associated?

A

RELAXES the baller muscles. Monitor for URINARY RETENTION (NOT fluid retention unless in RF or AKI)

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23
Q

What do opioid analgesics do to the pupils and what two nursing implications are associated?

A

RELAXES the pupil. 1) miosis (PINPOINT PUPILS) even in dim light 2) poor vision in dim light = FALL risk

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24
Q

What similar effects oto things that cause substance abuse do opioid analgesics have? What are four nursing implications associated?

A

Euphoria, DEPENDENCE, TOLERANCE, ABUSE DISORDERS. 1) check history for use 2) cross-tolerance 3) taper-off to avoid w/d symptoms (however, still may have to give naloxen (opioid antagonist) but be aware of w/d) 4) assess for chronic pain and how it is managed

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25
Q

What do opioid analgesics do to intracranial pressure and what nursing implications are associated?

A

INCREASE intracranial pressure. Contraindicated after head trauma/injury or hemorrhagic CVA is suspected or increased ICP

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26
Q

What does chronic use of opioids due to the hypothalamic-pituitary-gonadal axis. What does this impact androgen. What are the side effects?

A

DECREASE in hpyo-pit-gona-axis = DECREASE androgen. Side effects: low libido, impotenance, erectile dysfunction, amenorrhea, infertility

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27
Q

Need a larger dose to remain functional

A

Dependence

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28
Q

Need a larger dose to produce the expected outcome

A

Tolerance

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29
Q

Drug seeking behaviour despite knowing neg side effects and using irrational actions to gain access

A

Use Disorder

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30
Q

Unintentional inappropriate use of medications

A

Misuse

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31
Q

Intentional inappropriate use of medications

A

Abuse

32
Q

Cardiopulmonary Depression & Death / peristalsis depression & severe constipation

A

Overdose (OD)

33
Q

116 death per day/2016 - leading to heroin use / USDHHS declared in 2017

A

Opioid Epidemic

34
Q

Which opioid analgesics is used for the indications: PRN for cough, diarrhea, mild pain

A

codein sulfate

35
Q

Codeine sulfate - what is the pro-drug?

A

drug metabolite is morphine

36
Q

What two mg combinations are there for acetaminophen/codeine?

A

300/30mg Rx and 300/60 mg Rx

37
Q

Which opioid analgesics is used for the indication: PRN moderate pain

A

hydrocodone (PO only)

38
Q

What is the main combination drug for hydrocodone?

A

hydrocodone/acetaminophen (others: hydro/aspiring & hydro/ibuprofen)

39
Q

Which FAST ACTING opioid analgesics is used for the indication: PRN moderate pain

A

oxycodone

40
Q

What is the main combination drug for oxycodone?

A

oxy/acetaminophen (5, 7.5, 10) (others: oxy/aspiring & oxy/ibuprofen)

41
Q

Which drug is used for around the clock moderate pain management?

A

tramadol (PO, scheduled IV)

42
Q

What is the daily max dose of tramadol?

A

300mg/24 hrs

43
Q

Tramadol - what is the pro-drug?

A

drug metabolite is morphine (opioid-like, weaker w/ similar properties/effects)

44
Q

Which opioid analgesics is used for the indication: PRN for severe pain

A

morphine

45
Q

What route can morphine not be given?

A

subQ

46
Q

What is morphine strength compared to tramadol?

A

10x stronger

47
Q

Which opioid analgesics is used for the indication: PRN for severe pain - AND is stronger than morphine?

A

hydromorphine

48
Q

What is hydromorphone strength compared to morphine?

A

6x stronger

49
Q

Which opioid analgesics has a SHORT duration of action - henced used in the OR?

A

meperidine

50
Q

What are three MOA aspects important to know for meperidine?

A

1) anticholinergic w/ secondary analgesic effects 2) less resp/GI/GU side effects 3) patients allergic to opiates

51
Q

Whare are the two main side effects of meperidine?

A

neurotoxicity (delirium, seizure) and dysrhythmias

52
Q

What is the main contraindication for meperidine?

A

RF

53
Q

Which opioid analgesics has a SHORT duration of action of 30-60 minute for severe pain w/ an immediate onset?

A

fentanyl

54
Q

What is the indication for fentanyl in the route form of IV, IM?

A

anesthesia

55
Q

What is the indication for fentanyl in the form of a transdermal patch 12.0-100mch/h?

A

chronic pain

56
Q

What is the indication for fentanyl in the form of an oral trans-mucosal lozenge?

A

acute pain in the ED

57
Q

How much more potent is fentanyl than morphine?

A

50-100x

58
Q

Which opioid analgesics is used for the indication: heroine detoxification and maintenance programs?

A

methadone

59
Q

What is MOA of methadone?

A

long acting, reduces craving

60
Q

How is methadone obtained?

A

ONLY through certified pharmacies

61
Q

What two things should a nurse assess in regards to analgesic usage?

A

1) what patient HAS DONE prior to current presentation for their pain 2) baseline VS and side-effects

62
Q

What three categories of pain are managed with analgesics?

A

1) chronic (scheduled) 2) acute pain 3) breakthrough pain (PRN)

63
Q

When properly administrating analgesic via IV Push - what should the nurse do?

A

4-5 min push and DILUTE! (NS mixture)

64
Q

When properly administrating analgesic what should the nurse generally know at their facility of employment?

A

the reversal policy

65
Q

What drug is used for analgesic reversal?

A

naloxone

66
Q

What should the nurse education the patient on when taking analgesics?

A

1) side effects 2) risk of: tolerance, depedence, use disorder

67
Q

What should a nurse monitor closely in pediatrics and geriatrics?

A

organ immaturity and dysfunction

68
Q

What should a nurse monitor closely in obese patients?

A

opioid retention in adipose tissue & prolonged effects

69
Q

What are three situations to monitor as the result of the Rx for anagelsics?

A

1) misuse 2) abuse 3) diversion

70
Q

Who can a nurse consult should questions arise regarding specific questions about analgesic usage?

A

pain management specialists

71
Q

Which opioid analgesics is used for the indications: 1) treatment of opioid OD by competing for opioid receptors 2) reverse resp & CNS depression rapidly (regain consciousness and breathing)

A

naloxone - EMERGENCY medicine

72
Q

Since naloxone has no effects in the absence of opioids - what is it used for?

A

as a TEST to understand the cause of CNS depression

73
Q

List ACUTE W/D symptoms to monitor in using naloxone

A

abrupt onset of pain, abdominal cramps, N/V, anxiety, nervousness, sweating, HA, depression, SI, anorexia and dysrhythmia

74
Q

How is naloxone half life in comparison to opioids? Therefore, what should be monitored?

A

it is SHORTER; monitor for recurrance of resp. depression and may need multiple doses.

75
Q

Remember, Naloxone is used to reverse the effects of opiates while ______ is used to reverse the effects of benzodiazepines.

A

Flumazenil

Pharmacology (7 decks)

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