Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology - CNUR 202 > Module 2 - opioid analgesics > Flashcards

Module 2 - opioid analgesics Flashcards

1
Q

Analgesic

A

A medication that relieves pain without causing loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Classes of Analgesics

A

1) opioid analgesics
2) nonsteroidal anti-inflammatory drugs (NSAIDS)
3) non-opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what do opioids do?

A
  • relieve moderate to severe pain
  • suppress medullary cough centre –> cough suppression (use codeine but only with non-productive coughs
  • treat diarrhea (diphenoxylate/atropine (Lomotil))
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

where do opioids come from?

A

opium plant - synthetic pain reliever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

types of opioids

A

1) Agonists
2) partial agonists (agonist-antagonist)
3) antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Opioid Agonists

A

completely bind to opioid receptors in the brain and cause an analgesic response resulting in reduction of pain sensation
ex) morphine, fentanyl, hyrdromorphone, oxycodone, meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Opioid partial agonists

A

bind to pain receptors but cause a weaker neurological response
ex) buprenorphine, butorphanol, nalbuphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

opioid antagonists

A

bind to pain receptor but does not reduce pain signal

ex) Narcan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Analgesic Ceiling effect

A
  • occurs when a drug at a specific dosage produces a maximal analgesic effect that does not improve even if dosage is increased (dangerous, unpredictable, and has no benefit if increased further)
  • associated with agonist-antagonists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

opioid receptors

A 
-5 types  in body
 most responsive to drug therapy : opioids bind to reduce pain
-µ (mu)
-ƙ (kappa) 
-δ (delta)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

opioid antidote

A

Naloxone (Narcan) - (antagonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

diphenoxylate

A

structurally related to opioid analgesics but has no analgesic properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

opioid contradictions

A

-Severe asthma
-Extreme caution needed with:
respiratory insufficiency (including COPD)
elevated intracranial pressure
(ICP) (d/t increased drowsiness)
morbid obesity (sleep apnea, increased and tissue puts pressure on lungs)
myasthenia gravis
paralytic ileus (decreased bowel motility)
pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

opioid allergies

A

rash, swelling, Angioedema (swelling of mucous membranes – mouth and eyes, throat)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why do you have to be cautious with opioids, especially µ-receptor opioids

A

increased potential for psychological and physical dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the result of opioid tolerance

A
  • Diminished drug effects over time

- Common with addiction or use for control of severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

µ (mu) receptors

A

drugs: morphine, codeine
onset: rapid and produce marked euphoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

signs of psychological dependence

A

impaired control over drug use, compulsive use and craving, continued use despite harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

signs of physical dependence

A

physiological adaption, will cause withdrawal syndrome if: abrupt cessation, rapid dose reduction, decreasing blood levels of the drug or administration of an antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

tolerance

A

the client requires higher drug dosages to reach therapeutic effects, risk of withdrawal also greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

opioid side effects

A

opioids release histamine thought to be responsible for side effects.

1) Flushing (redness) and orthostatic hypotension
2) CNS depression, may lead to respiratory depression
3) Sedation and euphoria
4) Nausea and vomiting
5) Urinary retention
6) Itching
7) constipation (esp c/ codeine)

22
Q

treating opioid side effects

A

nausea (d/t gi tract irritation) - gravol
itching (d/t histamine)- benadryl
constipation (slowed peristalsis and increased absorption)- laxitives, fibre
urinary retention(increased bladder tension) - catheterization or bethanechol (a cholinergic agonist – relaxes bladder)

23
Q

opioid adverse effects

A

RESPIRATORY DEPRESSION
monitor resps and LOC prior to administration and during.

Know antidote - narcan

24
Q

how does Naloxone work to reverse opioid effects?

A

Will bind to opioid receptor sites and reverse respiratory depression (will also reverse pain control)

****usually only lasts about 1 hour, so if the Narcan wears off before the opioid is eliminated from the body, the respiratory depression will reappear - RE-ADMINISTER

25
Q

Opioid naïve

A

describes patients who are receiving opioid analgesics for the first time and who therefore are not accustomed to their effects.

GIVE LOWEST DOSE

26
Q

what causes additive depressant effects when administered with opioids

A 
alcohol
Antihistamines
Barbiturates
benzodiazepines
phenothiazine
other CNS depressants
27
Q

Codeine

A 
10-20 mg q4-6h when used alone
When mixed with Tylenol: 
-Tylenol #1: 8 mg of codeine
-Tylenol #2: 15 mg of codeine
-Tylenol #3: 30 mg of codeine
-For all above: 1-2 tablets q4-6h
-Tylenol #4: 60mg of codeine (1 tablet q 4-6 h)
Available as injectable, usually only used in oral form (tablets and available as syrup)

**T3 - used for moderate pain

28
Q

Morphine

A

IV for PRN pain: 1-10 mg
SC: 1-8 mg q3h
Rectal: 10–20 mg every 4 hours (not a common route)
Oral immediate release (MS-IR): 2.5-20 mg q3h
Oral slow release (MS Contin): 15-30 mg q8-12h
Oral slow release (Kadian): 10-100 mg q24h

29
Q

MS-IR

A

oral immediate release

30
Q

MS Contin

A

oral slow release

Morphine MS Contin: is available in 60 mg, 100 mg and 200 mg tablets as well, higher doses usually for those who are opioid tolerant and/or with severe chronic pain (i.e. cancer patients).

31
Q

Kadian

A

oral slow release; Once Daily dosing

NOT interchangeable with Contin

32
Q

Administration routes of morphine

A

oral
IV
SubQ
_not often gave IM due to tissue injury and pain (histamine release)

33
Q

HYDROmorphone (Dilaudid)

A

**7-10x stronger than morphine

Oral immediate release: 0.5-4 mg q 3h
-Up to 8 mg per dose for some patients

Oral slow release (Hydromorph Contin):

  • Initially 3 mg q8-12h
  • Can titrate up to 30 mg q12h

IV hydromorphone: 0.25-2 mg

SC: 0.25-2 mg q3h

oral to SC dosage formulations varies from 4:1 to 2:1

34
Q

parenteral

A

injection meds

35
Q

Fentanyl

A

route: IV/ transdermal patch (changed Q3D)

should not be given to opioid naive pt’s

36
Q

where should transdermal patches be places?

A
  • Patches can be applied to intact, non-irritated, dry skin on flat surface: chest, back, flank or upper arm
  • Irritation or skin damage will cause more drug to be absorbed
  • Fatty sites causes less to be absorbed

sites must be rotated, old patch removes, watch skin for contact dermatitis

37
Q

Meperidine (Demerol)

A
  • usually only used with morphine allergies
  • long term use not recommended d/t toxin metabolite normeperidine build up
  • used to treat rigours (shaking)
38
Q

oxycodone (Oxy IR, OxyNEO, Percocet)

A
  • high potential for abuse
  • treat moderate to severe pain
  • long-acting or time-released pain medication
  • could impair judgment
39
Q

Opioid Nursing Process

A

1) Assess: allergies, pain (intensity (0-10), character, location), LOC (sedation scale), vitals, route and time of last administered dose, kidney status, presence of head injury (med masks change in LOC)

40
Q

Mornitoring When administering Dilaudid or MORPhine by the PO, PR, SC or IM route

A
  • Baseline RR, sedation scale, and pain scale

- Check RR, sedation and pain scales at 45-60 minutes after every dose

41
Q

Monitoring when administering Dilaudid or MORPhine by the IV route:

A
  • Baseline RR, sedation scale, and pain scale

- Check RR, sedation & pain scale at 5, 15 and 30 minutes after every dose

42
Q

sedation scale

A 
s- normal sleep, easy to rouse
0- alert
1- sometimes drowsy
2- frequently drowsy, easy to rouse
3- somnolent, difficult to round
43
Q

analgesic used for mild to moderate pain

A

nonopioids (tylenol)

NSAIDS

44
Q

analgesic used for moderate to severe pain

A

moderate - codeine

moderate to severe pain - morphine, hydromorphone, meperidine

45
Q

when do you administer opioids?

A

before pain becomes too severe, when pain is beginning to return.
know onset, peak, and duration

46
Q

when shouldn’t opioids be administered

A

pt is in respiratory depression or vitals are decreased

47
Q

SR

A

sustained release

48
Q

why are opioids given with NSAIDS or Tylenol?

A

NSAIDS - analgesic and anti-inflammatory effects

Tylenol - synergistic effects–> coordinated or correlated action of two or more agents so that the combined action is greater than the sum of each acting separately

49
Q

what do you do if opioids aren’t managing pain?

A

other drugs:
-corticosteroids–> antiinflammatory, antiemetic and appetite stimulation effects
-Anticonvulsants
ex)gabapentin treats neuropathic and phantom limb pain
-Tricyclic antidepressants for neuropathic pain and opioid potentiating effects
ex) Amnitriptaline (blocks receptors)
-Hydroxyzine (Atarax)
antianxiety, antihistamine and antiemetic properties, muscle spasms

50
Q

Adjuvant

A

that which assists; esp. a drug added to a prescription to hasten or increase the action of a principal ingredient.

51
Q

Equianalgesic dose

A
  • a dose of one form of analgesic drug equivalent in pain-relieving effect to another analgesic.
  • switch drugs to avoid undesired side effects from another.
  • important to know to adequately control pain, nd avoid OD
52
Q

immediate release and a slow release pain medication be given at the same time

A

relieves immediate pain as well as pain later on.

Pharmacology - CNUR 202 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions