LA 2 Flashcards
What is the purpose of a “drug holiday” with clients who are taking narcotics on a long-term basis?
With narcotics, especially stronger agents, that are used long-term (e.g., ms contin, transdermyl fentanyl), a 3-day drug holiday (or as ordered by the physician) every month has shown evidence of increasing the sensitivity of the client to specific narcotics, as now the receptors have also become more sensitive.
true or false and explain your answer:
Cancer clients should never receive strong narcotics at the beginning of any pain experience because of the fear of addiction
False. With cancer pain, a client’s quality of life is far more important than the fear of addiction. Clients who are living with cancer need to experience comfort and maintain quality of life as much as possible. Addiction should not even be a concern for these clients because quality of life is so important for those afflicted with the illness.
You administer 100 mg meperidine (Demerol) intramuscularly to a client in severe post-operative pain, as ordered. What assessment data should be gathered before and after administering this drug? Explain your answer.
The nurse should always assess the client’s blood pressure, pulse, and respirations before administering any narcotic or, in this situation, meperidine. This allows comparison of baseline vital signs to those taken after the drug has been administered, as well as the assessment of the effect of the drug on the physiological response to pain.
Your client complains that the drugs he is receiving for severe pain are really not helping. What should be the most appropriate response to this client?
- First, it is important to assess the client and his or her previous reactions to pain medications and then assess the dose, action, route, and appropriateness of the agent.
- The client’s medical history, nursing assessment, and medication history should also be studied carefully because the client’s diagnosis may not match up with the type of analgesic ordered.
- Once it has been determined that the client is getting the right medication and dosage, then education about pain management
- The nurse should administer the medication at regular intervals, as ordered
- The nurse should also always include non-pharmacological methods of pain management
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of self-preparation:
Oral:
Very easy if alert; easy to teach others.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of self-preparation:
IM:
Not easy to carry out on own; would need assistance from healthcare personnel or other trained person
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of self-preparation:
Transdermal
Easy to learn to use and easy to teach to others.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of administration:
Oral:
Very easy if alert; easy to teach others.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of administration:
IM:
Easy to administer medication by this route if qualified healthcare provider is there to assist
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of administration:
Transdermal
Easy to administer and learn how to apply. Very easy to instruct on application and administration of patch.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Onset of therapeutic effects:
Oral:
Varies depending on specific drug properties and chemical composition of the oral drug; some very predictable and some very unpredictable. Generally speaking, 45 minutes to 1 hour for onset of effects. Remember that some drugs with longer half-lives may take weeks to have therapeutic effects
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting
Onset of therapeutic effects:
IM
Generally dependable; onset of therapeutic effects within at least 15 to 30 minutes
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Onset of therapeutic effects:
Transdermal
Dependable onset but is variable in some of the pharmacokinetics until serum steady states are achieved because of the nature of topical absorption into systemic circulation. However, once used for a few days, transdermal patches are very effective in their onset of therapeutic effects.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Serum concentrations:
Oral
Serum concentrations are dependent on the drug, its properties, chemical composition and dosage form (i.e., if enteric-coated. If the oral drug is taken at regular intervals, it may achieve adequate serum concentrations; however, many physiological factors provide barriers to predictable concentrations of the drug in the serum.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Serum concentrations:
IM
Very effective serum concentrations.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Serum concentrations:
Transdermal
Very effective serum concentrations that remain fairly predictable with routine usage and application.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Degree of sedation:
Oral:
Degree of sedation is dependent on dosage of drug and the potency of the drug. Medications such as morphine and other opioid derivatives are very sedating, but again, level of sedation depends on dose and other variables.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Degree of sedation:
IM
: Once again, the degree of sedation depends on drug and dosage, but because systemic absorption is more rapid, there are more CNS-depressing effects, and thus more CNS sedation
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Degree of sedation:
Transdermal
CNS sedation depends on drug patch and dosage. Often the client builds up some resistance to the sedation, but this is generally seen with lower dosage forms of the patch.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Side-effects:
Oral:
Narcotics usually have many side effects, and even more with oral dosage forms owing to gastric upset related to gastric irritation.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Side-effects:
IM
Side effects depend on drug and dosage but with IM route, the effects are generally more profound because of increased absorption. Therefore, the side effects related to CNS depression, such as sedation and decreased vital signs, are more often associated with these dosage forms.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Side-effects:
•Transdermal
Side effects are very likely to occur with transdermal patches once the steady state of the drug is achieved. Because of steady absorption with consistent dosing, the side effects will depend on the dosage and drug.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of home management:
Oral
Very easy.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of home management:
IM
Not easy without medical or nursing assistance.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of home management:
Transdermal
Very easy.
When is spinal anesthesia the method of choice?
There are many conditions besides labour and delivery for which spinal anaesthesia would be indicated.
Conditions for which one might have a “spinal” rather than general anaesthesia include any that would be exacerbated, causing possible harm to the client—such as a client with severe respiratory or cardiac disease who could not tolerate the effects of general anaesthesia.
It is important to remember that spinal anaesthesia is often used with specific types of surgeries or in clients in poor health or with conditions/diseases that would be exacerbated by general anaesthesia.
What is the purpose of adding epinephrine to a local anesthetic?
Epinephrine is added to topical and local anesthetics to enhance blood vessel constriction at the area and decrease the risk of possible systemic absorption.
What are potential complications of local anesthetics used in dental offices, such as lidocaine with epinephrine, in a client with a variety of cardiac or vessel diseases?
there is concern regarding the absorption of epinephrine, which could lead to blood vessel constriction and rapid elevation in blood pressure and pulse.
For the “at-risk” client who might have vessel disease and weakened vessels, there is concern regarding the subsequent rupture of a vessel and cerebrovascular accident or death.
Rapid acceleration of pulse rate could also be detrimental to at-risk clients because of the potential for ischemia from excessive oxygen demand oversupply
pain that originates from organs or smooth muscles
visceral pain
pain that originates from skeletal muscles, ligaments, or joints
somatic pain
pain that is psychological in nature but is truly pain in terms of actual pain impulses that travel through nerve cells
psychogenic pain
pain experienced in a body part that has been surgically or traumatically removed
phantom pain
pain that results from a disturbance of function or pathological change in a nerve
neuropathic pain
Enflurane is a(n) ______ anaesthetic.
inhalation general
Halothane is a(n) ____________ anaesthetic.
inhalation general
Nitrous oxide is primarily indicated for use in __________?
dental procedures (such as removal of “wisdom teeth”) or as a useful supplement to other, more potent anaesthetics.
Three major complications of general anaesthesia include _____________________
respiratory and/or cardiac depression, cardiac and/or respiratory arrest, irregular heart rhythms, malignant hyperthermia, aspiration pneumonia, and central nervous system depression
pain that results from any disorder that causes central nervous system damage
central pain
These contraindications are for???
i) known drug allergy
ii) severe asthma or other respiratory insufficiency, especially in the absence of resuscitative equipment,
iii) conditions involving elevated intracranial pressure, and
iv) pregnancy, especially in long-term or high doses
Narcotics
An antidote to an overdose of morphine is ____________________.
naloxone hydrochloride
Opioid analgesics bind to an opioid pain receptor in the brain and cause an analgesic response—the reduction of the pain sensation.
mechanism of action of the opiates
What are the neurotransmitters that are produced by the body to fight pain. They bind to opioid receptors and inhibit the transmission of pain by closing the “GATE” to the pain impulse
Endogenous enkephalins and endorphins
Any of a group of highly addictive analgesic drugs derived from opium or opium like compounds. Narcotics can cause drowsiness and significant alterations of mood and behavior.
Narcotic
Medications that relieve pain without causing
loss of consciousness (sometimes referred to as painkillers).
Analgesic
Any of various sedative narcotics containing opium or one or more of its natural or synthetic derivatives. or A drug, hormone, or other chemical substance having sedative or narcotic effects similar to those containing opium or its derivatives: a natural brain opiate. Also called opioid
Opiate
Is it a narcotic and non-narcotic analgesics?
-Acts centrally-
Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Does not produce CNS depression
Non-Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Cause addiction
Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Produce CNS depression
Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Do not produce gastric irritation
Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Has anti-inflammatory effect
Non-Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Act peripherally
Non-Narcotic Analgesics
A synthetic analgesic drug that is used as a substitute to treat morphine and heroin addiction
Methadone
pain that continues or recurs over a prolonged period, caused by various diseases or abnormal conditions. Chronic pain may be less intense than acute pain. The person with chronic pain does not usually display increased pulse and rapid respiration because these autonomic reactions to pain cannot be sustained for long periods. Some factors that can complicate the treatment of persons with chronic pain are scarring, continuing psychologic stress, and medication
Chronic Pain