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MSK- Exam 1 Flashcards

1
Q

World Health Organization Analgesic Ladder (3 Steps)

A

Step 1: Mild to moderate pain
Step 2: More Severe pain
Step 3: Severe Pain

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2
Q

Reason behind Adjuvants?

A

Used to complement the effects of opioids; not used as substitutes
Help manage concurrent symptoms that exacerbate pain

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3
Q

What do cycloxygenase inhibitors do?

A

They are NSAIDS that block COX 1 and/or COX 2 (the enzyme that converts arachidonic acid to prostaglandins)

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4
Q

Abbreviation of Aspirin

A

ASA

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5
Q

4 A’s of Aspirin usage?

A

Analgesics: Blocks prostaglandin pain messenger info
Anti-Inflammatory: Prevents vasodilation and capillary permeability
Anti-pyretic: Blocks prostaglandins from relaying message to hypothalamus (thermostat) fever prevention
Anti-Platelet: Blocks thromboxane (platelet aggregration)

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6
Q

What to be mindful of with someone taking Aspirin medication in terms of possible upcoming procedure/bleed risk?

A

Stop taking aspirin at least 7-10 days prior to surgery, because of the anti platelet effect, this will cause you to bleed very easily and platelet life span is 7-10 days. Irreversible

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7
Q

Pharmacokinetics Aspirin Distribution? Why important?

A

Extensively protein bound. Malnutrition patients will have a greater amount of the drug in system due to protein deficiency. Causing you to see exaggerated effects of drug (bleeding more easily).

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8
Q

Importance of acid excretion of aspirin?

A

Aspirin is heavily influenced by PH. Meaning if you have acidic urine, you cant just dump hydrogen ions, drug will stay in system longer.

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9
Q

Aspirin dosage, high and low

A

Low dose: 81 mg (preventative for heart attack/stroke, clot prevention in relation to platelets)
High dose: 325 mg (Headache)

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10
Q

Why do doctors prescribe aspirin post hip or knee surgery?

A

Prevention of DVT’s, 325 mg utilized as an anti platelet drug in prevention of thrombus.

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11
Q

Adverse Effects of Aspirin?

A

Reyes Syndrome: Child recovering from viral infection, takes aspirin, blood sugar drops and then the acidity and ammonia level in blood increases. Death and/or brain damage
Salicylism: Poisoning

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12
Q

Common Side Effects of Aspirin- What does Aspirin come in, in the military?

A

Brown BAG:
B- Bleeding (platelet)
A- Affects renal function (Prostaglandin blockage in afferent and efferent of kidneys, bouncer in the club is broken)
G- Gastric Upset (blocked prostaglandins)

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13
Q

1st Generation Non-NSAID

A

Ibuprofen

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14
Q

Key difference between aspirin and ibuprofen?

A

Reversibly inhibits COX 1 and COX 2, so not used to prevent MI or CVA because after 24 hours, the anti platelet effect is gone.

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15
Q

Non-Aspirin NSAID 2nd Generation

A

Celecoxib (Celebrex)

Last choice drug for long term management of pain

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16
Q

Why is Celecoxib prescribed? Key difference?

A

Blocks COX 2: Suppresses Inflammation, pain and fever, but spares COX 1 causing less gastric ulceration. Can be prescribed to those with ongoing stomach issues.

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17
Q

Two risks of Celecoxib?

A

Can actually increase the risk of CVA and MI because it does not affect platelet aggregation, and since it suppresses inflammation still- the vessels are not dilating and becoming leaky- causing higher risk of CVA and MI.

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18
Q

Allergy related to Celecoxib?

A

Sulfa Allergies will have a reaction

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19
Q

Pre-Administration Thoughts for COX inhibitors?

A

Assessment: any indications of anemia or bleeding
MAR: Anticoagulants; Glucocorticoids; EtOH; Meds that impair renal function
History: Liver issues; renal issues; < 18 yo [ASA]; pregnant; Alcohol use;
Allergies: Sulfonamide [Celebrex]

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20
Q

Administration Consideration of COX Inhibitors

A

To avoid gastric upset, encourage enteric coated, drink a full glass of water or take with food

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21
Q

Ongoing Evaluation and Interventions for COX Inhibitors

A

Assess for efficacy
Be able to identify s/s of salicylism [ASA]
Tinnitus, sweating, headache, and dizziness; Respiratory alkalosis
Can lead to poisoning (hospitalization/ slow infusion of bicarbonate)

Assess for s/s of cerebral vascular accident (CVA) or myocardial infarction (MI) [Celebrex]

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22
Q

Acetaminophen (Tylenol) Taken for What and Why

A

Pain and Fever, Only blocks prostaglandins in CNS. Zero Anti Inflammatory Effects

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23
Q

Tylenol is metabolized where?

A

Liver. Harsh on liver, cognizant of.

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24
Q

Dosing of Acetaminophen?

A

2g (Liver issues), 3g, 4g

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25
Adverse Effects of Acetaminophen? Common and Serious
Common: Very few at normal doses Serious: Steven Johnson Syndrome, overdose can lead to hepatotoxicity, treatment for overdose is acetylcysteine
26
Pre Administration Considerations for Acetaminophen?
Assessment: LFTs MAR: Any hidden acetaminophen (tyllenol) (cold remedies; pain formulations) ; History: Liver issues; Undernourished; Alcohol use
27
Administration Considerations of Acetaminophen?
``` Do not exceed recommended doses Common routes (PO & PR) ```
28
Evaluation/Intervention of Acetaminophen
Assess for efficacy: reduction in pain and/or fever Assess for liver toxicity. Early symptoms: Nausea and vomiting, diarrhea, sweating, abdominal pain Educate client that if rash or blisters appears, this may be a medical emergency. Notify us immediately
29
What type of drug is Aspirin?
First generation NSAID, COX Inhibitor
30
What type of drug is Ibuprofen?
First Generation NSAID, COX Inhibitor
31
What type of drug is Celecoxib (celebrix)
Second Gen NSAID, COX 2 Inhibitor
32
Acetaminophen is an NSAID, True or False
False, Analgesic and anti pyretic
33
Glucocorticoid drugs MOA? Corticosteroids
Dumb down immune system by reducing inflammatory response
34
Dosing of Glucocorticoids
Low and Slow, also discontinue low and slow for cortisol production to come back up
35
Common adverse effects of Glucocorticoids?
I FEAR GLUCOSE INTOLERANCE AND PSYCH PATIENTS Infection, fluid and electrolyte imbalances, glucose intolerance (diabetic patients), Psychologic disturbances
36
Long term effects of glucocorticoids?
Cushings like symptoms osteoporosis, muscle wasting and thinning of the skin, peptic ulcer disease Serious: Sudden adrenal insufficiency
37
Im a nurse and Im going to administer cortisone or prednisone- what am i thinking about? What am I telling the patient
1. NO compromise of immune system (live virus vaccine or fungal infection) 2. Check the route- multiple modes of administration 3. If you discontinue fast it will be bad 4. This revs you up so take in morning and earlier in the day the better 5. Assess for hypokalemia because it will lower potassium levels
38
Morphine Use
Relief of moderate to strong pain
39
MOA of morphine
Mimics actions of endogenous opioid peptides, primarily at mu receptors
40
Common Side affects of morphine
Think anti-cholinergic. Blocks rest and digest | Constipation, urinary retention, sedation (earliest indicator of overdose), nausea, hypotension, cough suppression.
41
Serious adverse effects of morphine
Respiratory addiction then overdose | Respiratory depression, addictive, overdose
42
Clinical Manifestation of overdose
CPR | Coma, Pinpoint pupils, respiratory depression
43
Naloxone
Narcan IM, IV, SQ. No oral due to extensive 1st pass and its an emergency drug... No adverse Pure opioid antagonist by blocking receptor sites
44
Tramadol brand name
Ultram
45
Tramadol use
moderate to severe pain
46
Tramadol MOA
Blocks uptake of serotonin and norepinephrine
47
Tramadol adverse common effects
Think anti- cholinergic effects | Sedation, constipation, headache, dry mouth, dizziness
48
Is tramadol an opioid
No, its a non opioid centrally acting analgesic
49
Why do opioids cause nausea, how do we treat
stimulate chemoreceptor trigger zone in the medulla to cause intense nausea and vomiting. Treat with antiemetics
50
Why do opioids cause constipation
activation of mu receptors.
51
Why opioids cause orthostatic hypertension? how we treat
inhibits the baroreceptor reflex and by causing peripheral vasodilation. Assess BP before ambulation, position changes slowly, assist with ambulation
52
Opioid can cause respiratory depression why and how we treat?
Activation of mu receptors. Monitor frequently, sedation is earliest indicator of respiratory depression, RR less than 12 use reversal agents, practice pulmonary toileting- deep breathing coughing all that nurse stuff
53
Tramadol main things to be aware of (2)?
Suicide vehicle- be aware and also seizures are a serious adverse effect
54
Hard no on tramadol for pre administration?
If patient is prescribed MAOI thats a no. You will have two drugs as CNS depressant. Also any other CNS depressants, SSRIs, etc.
55
Pre-Assessment of Tramadol
Pain assessment and RR
56
Tramadol Patient history BE AWARE
History of addiction, alcohol abuse, depression
57
Tramadol Ongoing evaluation
Pain Falls Mental state
58
Purpose of antidepressants with with Opioids for pain
Analgesic effect, lower need for opioids
59
Purpose of analgesic antiseizure drugs
Reduce nerve firing
60
Purpose of local anesthetics like lidocaine with Opioids
Blocks pain channel from transmitting at site of injury
61
Signs of hypokalemia- possible glucocorticoid side effect
muscle weakness and/or irregular pulses
62
Early signs of Opioid physical dependence?
Anorexia, irritability, tremor and gooseflesh (going cold turkey)
63
Peak sign of physical dependence on opioids
violent sneezing, weakness, Nausea/vomiting, diarrhea, abdominal cramps, kicking movements (kicking the habit)
64
Nursing implications Opioids pre administration assessment
Pain assessment, respiratory rate, mental status, BP
65
Opioid pre-administration MAR
CNS depressants, anti-cholinergics, hypotensive agents
66
Admin of Morphine in minutes
4-5 minutes slowly IV
67
Ongoing eval and interventions for morphine
Pain assessment Monitor respiration Educate on fall risk (proactive toileting) Increase fluid and fiber for constipation coughing
68
Opioid tolerant definition
Patient taking at least 60 mg of morphine or another equal opioid for a week or longer
69
Opioid naive definition
Patients who have not had the amount listed for opioid tolerate in a week or more
70
PCA is what and used for what
Patient controlled Analgesia, used for short term post surgical pain
71
PRN used for what
Break through pain
72
Fixed scheduled drugs used for what
Routine pain management approach
73
DMARDS stands for
Disease-modifying anti-rheumatic drugs
74
Purpose of taking Methotrexate and when to start taking it
Reduce joint destruction and slow disease progression, take within 3 months of diagnosis
75
MOA of methotrexate
Blocks folic acid which results in suppression of DNA, RNA, and protein synthesis
76
What three drugs do we take for treatment of RA
NSAIDS Glucocorticoids DMARDS
77
Methotrexate is non-biologic or biologic
Nonbiologic
78
Methotrexate reduces activity of what lymphocytes, further acting as an immunosuppressant
B and T lymphocytes
79
Adverse effects of methotrexate
1. Liver damage (hepatic toxicity) 2. bone marrow suppression (tired/pale/sob) low platelets so possible bleeds, infection due to decrease in WBCs 3. GI ulceration 4. Pneumonitis- inflammation of lung tissue 5. Cap it all off with reduced life expectancy
80
Uses of Methotrexate besides RA
Abortion pill, Cancer, Crohns, Psioriasis
81
Dosing of methotrexate routes
PO, IM, SUBq (for treatment of RA)
82
Hard no with Methotrexate (1)
Pregnancy
83
Pre admin for nurse of methotrexate
Routine blood work, CBC, testing liver and kidney function
84
Etanercept (Enbrel) "intercept"
MOA: Suppresses inflammation by neutralizing (intercepting) tumor necrosis factor Route: Sub Q Common Adverse effect/patient teaching: Injection site reactions Serious adverse: Infections especially TB, increased risk for lymphoma, liver injury
85
5 Hard nos for Enbrel
1. HPV or TB 2. Demyelinating disorders 3. Infections 4. Live vaccines 5. Severe HF patients
86
What is acute Ghout (attacks per year) Vs Chronic gout
Acute- fewer than 3 times per year | Chronic- Greater than 3 times a year
87
Acute gout drug
Colchicine (Colcrys)
88
Use of Colchicine
Acute gouty arthritis
89
Colchicine is metabolized by what
Liver
90
Colchicine testing pre admin
CBC, renal, and hepatic function testing
91
Colchicine can cause suppression of this and 1 more thing
Bone marrow suppression and Rhabdo
92
DO not drink this with colchicine
Grapefruit juice (CYP3A4)
93
Colchicine can cause rhabdo so dont take with this drug that also causes rhabdo
Statins
94
Chronic gout management drugs
Allopurinol and Probenecid
95
Allopurinol Use, MOA, Adverse effect(s)
Use- Drug of choice for chronic gout, can reverse existing tophi also for cancer with hyperuricemia
96
Long term adverse affect of Allopurinol
Cataracts
97
Probenecid Use, MOA
Use: Urate lowering drug, prevents and decreases tophi MOA: promotes renal uric acid excretion through inhibition of tubular reabsorption of uric acid
98
Serious adverse effect of Probenecid
Renal injury
99
Trifecta pre admin of any bone related drug like Allopurinol or Probenecid
CBC, renal and hepatic function test
100
DO not take aspirin with Allopurinol or probenecid
Probenecid- possible kidney damage
101
Which Chronic gout drug can i take during active flare up?
Allopurinol but not probenecid
102
How do i take Probenecid or Allopurinol
PO
103
Education for each drug Allopurinol and Probenecid
P- Fluids while taking this med and and do not start during acute episode A- If rash then stop taking A and P- Acute gout flare up may occur
104
Calcitonin Use, MOA, and Dosing routes
Use: Osteoporosis treatment not prevention MOA: Mimics calcitonin by inhibiting osteoclast activity and promoting renal excretion of calcium Dosing- Intranasal, IM, or SUB q
105
Alendronate (Fosamax) is what type of drug
Bisphosphonate
106
What is Alendronate (Fosamax) used for
Prevention and treatment of osteoporosis in both men and women, as well as bone cancer and pagets disease
107
MOA of Alendronate
Suppresses bone reabsorption decreasing osteoclast activity
108
2 big nos for fosamax
Pregnancy and any issues swallowing
109
Instructing someone taking fosamax
Take intact tablet in the am on an empty stomach, remain upright for 30 minutes
110
Serious effects of of fosamaxx
``` Esophagitis Atypical femoral fractures Renal Pre admin- look for NSAId use **Only bone drug not required to do CBC, Liver, and kidney tho** ```
111
SERM
Selective Estrogen Receptor Modulator
112
Raloxifene or Evista USE
Osteoporosis, preserves bone density and breast cancer
113
MOA of Evista
Structurally similar to estrogen, binds to estrogen receptors- can behave as antagonist and agonist
114
Things to be aware of for Evista and patient-
May increase hot flashes and leg cramps along with thromboembolic events
115
Before I give Evista I want to look at patients
Bone Mineral density
116
2 Hard nos to Evista
Pregnancy and history of VTE
117
Ongoing eval and intervention for Evista
1. If client will experience prolonged immobility, discontinue this med 3 days prior 2. Minimize periods of inactivity, do not want clot to form 3. Assess client for signs of any clot that either traveled up to pulmonary or they have any signs of dvt (swelling, weakness on one side, pain, warmth, cant breathe)
118
Teriparatide (Forteo)
- First and only drug used for osteoporosis that increases bone formation - It is synthetic PTH essentially - Drawback- increases risk for bone cancer
119
Denosumab (Prolia)
RANKL inhibitor - post menopausal osteoporosis - Side effects include: hypocalcemia, infections, skin reactions, osteonecrosis of the jaw
120
Baclofen Use/MOA/Peak/Administration
- Used for spasticity r/t MS or spinal cord injuries - Suppresses hyperactivity/structural analog of GABA - Peaks 1 hour post PO - PO administration or Intrathecal
121
Serious side effects of Baclofen
Withdrawal- Seizures or hallucinations- especially with intrathecal admin
122
Baclofen is a CAMRS
Centrally Acting muscle relaxer for Spasticity
123
Adverse affects of Baclofen
Anti cholinergic symptoms (headache, N/V, constipation) also is a CNS depressant- Urinary retention
124
Baclofen meds you should be aware of in the patients MAR
Opioids, benzos, anticholinergics (double whammys)
125
History of any of these in patients history for Baclofen
Outpatient alcohol use, BPH (related to urinary retention), schizophrenia
126
How is Baclofen administred
PO
127
Ongoing eval and interventions for Baclofen
Monitor for improvement in ROM Educate on falls Do not stop medication suddenly (seizures and hallucinations)
128
Dantrolene
Acts directly on skeletal muscle by suppressing release of calcium from Sarcoplasmic reticulum
129
Dantrolene is commonly used for
Spasticity Malignant hyperthermia Rigidity (emergency reduction in rigors)
130
Is dantrolene toxic on liver
YEs
131
Monitor what test for dantrolene
LFTs and avoid with anyone that has liver impairment
132
Common adverse effect of dantrolene
flushing when taken IV, muscle weakness, drowsiness, diarrhea
133
Cyclobenzaprine (Flexerel) Use
Relief of muscle spasms
134
Dantrolene is a DAMR
Direct acting muscle relaxer for localized muscle
135
Flexeril adverse effects
CNS depressant and anticholinergic effects
136
Pre admin/Administrate how/Ongoing eval and interventions Flexeril
Assess ROM and dexterity, Orally, Assess improvement of ROM, possible anticholinergic effects (urinary retention and constipation) assess and educate on falls, chew gum to relieve dry mouth
137
Flexeril Peaks when and what is it metabolized by
4 hours and liver
138
Flexerel can have adverse reactions when taken with
CNS depressants, antidepressants, other anticholinergic drugs
139
Be aware of patient that has history of ____ and ____ for administering Flexeril
Alcohol outpatient use and BPH (due to urinary retention)

Pharmacology (6 decks)

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