Module 6 Nervous System Flashcards
Weak compared to morphine, opioid agonist, usually combined
Oxycodone
Oxycodone + ASA
Percodan
Oxycodone + Acetaminophen
Percocet
Oxycodone + Motrin
Combunox
Oxycodone is available as a __________ and is given q ___
Sustained release q 12 hrs
Hydrocodone + Tylenol
Vicodin
Hydrocodone + Ibuprofen
Vicoprofen
Hydrocodone + Codeine
Antitussive
Where does morphine sulfate come from
White poppy plant
What is the drug of choice for post MI, PE
Morphine Sulfate
Short acting Morphine Sulfate lasts for how long
4-5 hrs
How long does the sustained release form of Morphine Sulfate last
(Roxanol) 8hrs
MS contin 12 hrs
4 Side effects of Morphine Sulfate
decreased CNS
Euphoria
Paradoxical excitement
Pinpoint pupils
What is another word for pinpoint pupils
Myosis
What are 3 cases where Morphine Sulfate is contraindicated
COPD
Head injury
Tolerance
Mu, Kappa, and Delta are examples of
Narcotic Analgesics
Works by binding to opiate sites
Narcotic Analgesics
Agonists __________ while Antagonists _________
elicit a response
Do not
An example of an Opioid Agonist is
Morphine
An example of an Opioid Agonist/Antagonist is
Talwin
And example of an Opioid Antagonist is
Narcan
Mimics the neurotransmitter endorphin and Enkephalin that are the bodies natural analgesic to increase pain threshold
Narcotic Analgesics
Drug group that works by changing perception of pain
Narcotic Analgesics
What does morphine attach itself to in the body
the mu receptor site
Narcotic Analgesic Withdrawal can lead to (3)
Diarrhea, large pupils, stomach cramps
Talwin attached itself to
Kappa and Delta sites
When are Agonists-Antagonists used
when patient cant tolerate Agonist
What are 3 side effects of Agonists-Antagonists
Vertigo, euphoria, hallucination
What are 2 advantages of Agonists-Antagonists
less resp depression and less dependency
Pentazocine + ASA
Talwin
Prevents or reverses opiate effects
Antagonist
Salicylates, NSAIDS, and Tylenol are examples of
Analgesic Non-narcotic
What are Analgesic Non-narcotic used for usually
migraine
blocks impulse within the sympathetic nervous system - produces vasoconstriction
Ergot Derivatives
Used to reduce frequency and intensity of migraines
Ergot Derivatives
Bind with vascular receptors to produce vasoconstriction
Triptans
What is a major side effect of Triptans
Fibrosis in heart and lungs (stroke)
How frequent do we administer Triptans
Give for 1 mo, then rest for 4-6 mo
Ergot + Caffeine
Cafergot
Hold drugs when resp is below
12
Pin point pupils are a sign of
toxicity
Allays fear and excitement
Sedatives
Induces sleep
Hypnotics
When are Sedatives / Hypnotics used
Insomnia
What are two types of Sedatives / Hypnotics
Barbiturates and Non Barbiturates
Inhibit the uptake of Gamma aminobutyric Acid
Barbiturates and Non Barbiturates
How are Barbiturates classified
based on onset of action and duration
GABA is a
CNS neurotransmitter
What is the antidote for Barbiturates
Flumazenil (Romazicon)
Up to how long should Barbiturates be used
2 weeks
Barbiturates should not be used to mask pain as it has no
has no analgesic effect
What are the 4 stages in order of Anesthesia
Analgesia
Excitement/Delirium
Surgical Anesthesia
Medullary paralysis
Gases for Anesthesia are usually combined with
Oxygen
What are two drugs that help to balance Anesthesia
Cyclopropane
Nitrous Oxide
General Anesthesia by injection is preferred _____ to gases
prior
Neuroleptanalgesia (Innovar) is used for
moderate to deep sedation
What is a major side effect of Anesthesia
Malignant hyperthermia
Temp 105+ , tachycardia, cardiac arrest are signs of
Malignant hyperthermia
What is the tx for Malignant hyperthermia
Dantrolene (Dantrium)
Used to change permeability of nerve cell, alter nerve conduction
Local Anesthetics
Local anesthetics come from
coca plants
Spinal Anesthesia is given where
into the subarachnoid space between 2nd and 4th
Epidural Anesthesia is given where
epidural space L1 - L2
What are 4 things we must do before inducing Anesthesia
Empty bladder
Ensure post voiding
Baseline B/P, RR
Ensure return of sensation
Pre anesthetic drugs are used to
Decrease anxiety, secretions, and chance of N&V
Abnormal disturbance in electrical activity of the brain means pt. may be experiencing a
seizure
Used to stabilize nerve cell against hyperexcitability
Hydantoins
Used for seizures that are hard to control, also used in children
Barbiturates
Used for all types of seizures including status epilepticus
Benzodiazepines
Used for Petit-Mal seizures when safer drugs are not effective
Oxazolidinediones
Used for a general Petit-Mal Seizure
Succinimides
Used for obesity, and appetite suppression
Anorexiants
When should anorexiants be used
30-60min b4 meals
Counteracts the effects of narcotics, increases wakefulness, used for ADHD
Non-Anorexiants
Non-anorexiants can only be used in children (age)
6+
Narcotic Analgesics that are delta only affect the
Spinal Cord
Antagonists do not elicit a response they
block, reverse the effects
Narcotic Analgesics do not affect nerve ending and do not decrease sensation so how do they help the pain
Pain threshold is increased altering their emotional needs
Narcotics should be around the clock for the best ________ response
therapeutic
After first 24 hours, Narcotic Analgesics should be administered
PRN 24 hrs
Opioids can also be used adjuvantly for
Anti-diarrheal (not morphine - codeine
What do we give a patient that needs relief of anxiety and fear of death in MI and PE
Codeine
of tylenol and Codeine combination indicates what
Codeine x 7.5 (amount)
How long is Transdermal Duragesic patch good for
72 hrs
What vital sign will drop with use of demerol
B/P
Demerol can be given PO and is a drug that goes through
First pass effect
When do we give Methadone (Dolophine)
For people who depend on opioid substance. For abuse. When they want to ween off from opioids
Alfentanil (Alfenta) is used to _______ while Sufentanil (Sufenta) is used for __________
induce
balance
intrathecal morphine lasts for
24hrs
Tolerance is usually the first sign of
dependency
Naltrexone (Revia,trexan) can be used to
decrease cravings of alcohol
Where is Buprenorphine (Buprenex) used
Behavioral health setting
Where is Nalbuphine (Nubain) used
Peds setting
Rush of blood flow to the brain, where cranial blood vessels are dilated results in a
Migraine
Triptans were developed specifically for
Migraines Acute attacks
If on Triptans or migraine medications for more than 10 days what can happen when they d.c. med
rebound h/a
Beta Blocker used for migraines
Propranolol
How are PCA safe so they pt. cannot Overdose the drug
Lockout mechanism
An adjuvant med that is used for Neuropathic pain is
Gabapentin (Neurontin)
Lancinating pain is
stabbing pain
Sedatives in a severe case can be given as a
tranquilizer
Intermediate acting barbiturates are also called
Anticonvulsants
What must we assess before baseline data for Barbiturates
PERLA
CNS depressants can also be called
Barbiturates
How should patients take ambien
W/O food, before sleep
How do we give Chloral Hydrate (Noctec)
Dilute with milk or juice
The only way to take away sensation is to induce
anesthesia
To block nerve conduction without loss of consciousness is called
Local / Regional anesthesia
If general anesthesia is administered by inhalation pt. will not need
Life support
Most common used gas for weak anesthesia
Nitrous Oxide
Volatile liquids _______ on exposure
Evaporate
Ketamine (Ketaject) “Special K” can be used for
Conscious anesthesia where we don’t need deep sedation
What is a side effect of Ketamine (Ketaject) “Special K”
hallucinations
Pandemonium Bromide can be used to treat
Malignant hyperthermia
Most local anesthetics end in
ane
Before a Spinal Anesthesia is given what are two things we must do
Baseline B/P
lay pt flat
How is pt. positioned when given nerve blocks
sitting or side lying
What happens when patients miss there anti-seizure meds
status epilepticus
Dilantin is a drug commonly prescribed as a
anticonvulsant
Long term use of anticonvulsants can lead to
Gingival Hyperplasia
Benzodiazepines are similar to barbiturates in ONE way and that is
both decrease GABA, increasing relaxation
Drug of choice to treat static epilepticus
Lorazepam (ativan)
Succinimides work by
increasing seizure threshold
What are 2 major side effects of Oxazolidinones
Pancytopenia and nephrosis
Pancytopenia is the
suppression of RBCs
Oxazolidinones are used when
other meds are unsuccessful
When CNS stimulants are wearing off what is a major side effect
drowsiness
Anorexiants should only be used for
1-5mo
Methylphenidate (Ritalin) is a
CNS Stimulant Amphetamines
Hydromorphone HCL (Dilaudid) is a
Opioid Analgesic Agonist
Meperidine (Demerol) is a
Opioid Analgesic Agonist
Methadone HCL (Dolophine Methadose) is a
Opioid Analgesic Agonist
Butorphanol (Stadol) is a
Opioid Analgesic Agonist-Antagonist
Oxycodone + ASA
Percodan
Naloxone is a
Opioid Analgesic Antagonist
Gabapentin (Neurontin) is a
Anticonvulsant
Gabapentin (Neurontin) is used adjuvantly for
peripheral neuropathy
Secobarbital (Seconal) is a
barbiturate
Triazolam (Halcion) is a
Sedative / Hypnotic (Benzodiazepines)
Phenytoin (Dilantin) is a
Anticonvulsant
What is the therapeutic level for Phenytoin (Dilantin)
10-20mcg
Carbamazepine (Tegretol) is a
Anticonvulsant
Valproic Acid (Depakene) is a
Anticonvulsant
Valproic Acid (Depakene) is used for
Static epilepticus long term proph.
Carbidopa-Levodopa (Sinemet) is a
Anti-parkinsons
Trihexyphenidyl HCL is used for
Cholinergically blocking drugs for Parkinsons disease
Alprazolam (Xanax) is a
Benzodiazepine
Alprazolam (Xanax) is used for
Anti-anxiety
Zolpidem tartrate (Ambien) is used for
Sedative/Hypnotic Nonbenzodiazepine
Fentanyl Transdermal System (Duragesic) is a
Opioid Analgesic Agonist
Each time a patient requests a opioid analgesic, the nurse must
determine the exact location and intensity of the pain
When administering an opioid analgesic what is an adverse affect we must mointor for
Confusion
What opioid is prescribed for a patient who is experiencing an overdose
Naloxone
How long before surgery should anesthetics be given
30min
What is the most common drug used for general anesthesia
Nitrous Oxide
What two drugs accomplish Neuroleptanalgesia
Fentanyl + Droperidol
Xanax is contraindicated in a patient with a
psychotic disorder
What side effect should nurse monitor for Opioid Analgesics that indicates allergic reaction
Urticaria
For a patient on Opioid therapy, also prescribed Barbiturates what side effect is most likely to occur
Resp Depression
Which body system does not adapt and compensate for the secondary effects of opioids
GI system
Lactating females should wait how long before breastfeeding infant
4-6 hrs
An opioid antagonist is most commonly prescribed to
reverse the effect of pain medication
What is the onset of Narcan when its use is for reversing Opioid induced Resp depression
1-2min
Which stage of general anesthesia begins with a loss of consciousness
Analgesia
Preanesthetic drugs are contraindicated in patients over
60
What drug group should be administered with pre anesthetic drug to decrease upper respiratory tract secretions
Cholinergic-blocking drug
What is an example of a regional anesthesia
Spinal anesthesia
CNS stimulants for ADHD should be administered
30 min before breakfast
Before administering non barbiturate what allergy should we check for
Egg or soybean
