NEURO - pain medications

Question 1

exemplary drug for first generation NSAIDs

Answer 1

IBUPROFEN (aspirin can be in here)

Question 2

route for IBUPROFREN

Answer 2

PO

Question 3

reasons of use for IBUPROFEN

Answer 3

reduces inflammation & treats MILD pain

Question 4

pharmacological action of IBUPROFEN

Answer 4

inhibits COX 1 & 2 –> inhibits prostaglandin synthesis (what perceives pain) –> reduces pain, inflammation & fever @ site of injury
- COX 2 is responsible for the responses we are trying to reduce
- non selective,

Question 5

adverse reactions of IBUPROFEN

Answer 5

inhibiting COX 1: reduces gastric mucosa protection, decreased platelet aggregation & impaired renal perfusion
- risk for ulcers
- not for long term use, no high doses

Question 6

nursing interventions for IBUPROFEN

Answer 6

• monitor for bleeding – esp GI system
• monitor for renal function

Question 7

client education for IBUPROFEN

Answer 7

• drug taken with food, milk or minimum of 8 oz of water to decrease GI effects
• monitor for bleeding

Question 8

interactions with IBUPROFEN

Answer 8

lithium: increase risk of nephrotoxicity

Question 9

exemplary drug of second generation NSAIDs

Answer 9

CELECOXIB

Question 10

route of CELECOXIB

Answer 10

PO

Question 11

uses of CELECOXIB

Answer 11

reduce pain & inflammation

Question 12

pharmacological action of CELECOXIB

Answer 12

inhibits production of JUST COX 2, inhibits prostaglandin synthesis –> reduced pain @ site of injury (fewer adverse effects than first gen NSAIDS)

Question 13

adverse reactions of CELECOXIB

Answer 13

• severe platelet aggregation & vasoconstriction –> HTN, stroke, & MI
• diarrhea & gastric ulceration
• teratogen

Question 14

nursing interventions for CELECOXIB

Answer 14

monitor for CV & renal issues

Question 15

client education for CELECOXIB

Answer 15

• take with food
• avoid alcohol
• monitor for CV manifestations
• must be prescribed
• do not use long term

Question 16

interactions with CELECOXIB

Answer 16

• decrease diuretic effects of FUROSEMIDE
• FLUCONAZOLE can increase CELECOXIB levels
• decreases effects of ACE inhibitors

Question 17

exemplary drug for acetaminophen

Answer 17

ACETAMINOPHEN

Question 18

route for ACETAMINOPHEN

Answer 18

PO, IV & suppository

Question 19

uses for ACETAMINOPHEN

Answer 19

reduces pain & fever

Question 20

pharmacological action for ACETAMINOPHEN

Answer 20

COX inhibitors but specifically in the CNS
- DOES NOT relieve inflammation or alter platelet aggregation

Question 21

biggest difference with ACETAMINOPHEN, IBUPROFEN, & CELECOXIB

Answer 21

ACETAMINOPHEN inhibits COX in the CNS, NSAIDS inhibits COX in BODY

Question 22

adverse reactions of ACETAMINOPHEN

Answer 22

liver dysfunction

Question 23

nursing interventions for ACETAMINOPHEN

Answer 23

monitor for manifestations of liver failure

Question 24

client education for ACETAMINOPHEN

Answer 24

• monitor for liver dysfunction
• know importance of knowing what is in medications to ensure that there is not an accidental overdose

Question 25

interactions with ACETAMINOPHEN

Answer 25

- alcohol: increases likelihood of liver dysfunction (bc they have the same enzymes) - increases action of warfarin

Question 26

exemplary drug for dual mechanism agents

Answer 26

TRAMADOL

Question 27

route for TRAMADOL

Answer 27

PO

Question 28

uses for TRAMADOL

Answer 28

relieves pain

Question 29

pharmacological action of TRAMADOL

Answer 29

binds to opioid receptors (Mu receptors) to mimic natural pain modulators --> blocks reuptake of norepinephrine & serotonin --> inhibit transmission of pain in spinal cord --> X feeling pain

Question 30

adverse reactions of TRAMADOL

Answer 30

when used in high doses: - sedation - nausea - constipation - seizures - respiratory distress

Question 31

nursing interventions for TRAMADOL

Answer 31

monitor neurological status & respiratory status

Question 32

client education of TRAMADOL

Answer 32

- won't feel effects until 1 hour of administration - avoid activities that require mental alertness - monitor for constipation

Question 33

interactions with TRAMADOL

Answer 33

- MAOIs: risk for HTN crisis - SSRIs, TCAs, & MAOIs: increase risk for serotonin syndrome all block reuptake of serotonin & norepinephrine --> increase them in total

Question 34

exemplar drug for opioid agonist

Answer 34

MORPHINE

Question 35

routes for MORPHINE

Answer 35

PO, IV & IM

Question 36

uses for MORPHINE

Answer 36

relieves MODERATE to SEVERE pain

Question 37

pharmacologic action of MORPHINE

Answer 37

bind to Mu receptors on opioid receptor sites --> mimics actions of naturally occurring pain modulators (endorphins, enkephalin & opioids)

Question 38

adverse reactions of MORPHINE

Answer 38

euphora INTO: - sedation - respiratory depression - dizziness - constipation - n/v - urinary retention - cough suppression

Question 39

nursing interventions for MORPHINE

Answer 39

- monitor V/S (esp BP & RR) - monitor for constipation, nause & UOP

Question 40

client education for MORPHINE

Answer 40

- opioids only be taken SHORT TERM - avoid when need to be mentally alert - take fiber (to decr constipation risk) - increase fluids

Question 41

interactions with MORPHINE

Answer 41

- CNS depressants - anticholinergic agents - antihypertensives

Question 42

exemplar drug for opioids antagonist

Answer 42

NALOXONE

Question 43

routes for NALOXONE

Answer 43

IV, IM, SQ & intranasal

Question 44

uses for NALOXONE

Answer 44

reverse effects of opioids -- respiratory depression & sedation

Question 45

pharmacologic action of NALOXONE

Answer 45

block opioid receptors --> keeps opioids from being able to act on those same receptors - works immediately - stops respiratory depression - from sedation to consciousness

Question 46

adverse reactions of NALOXONE

Answer 46

- increased HR & RR - dysrhythmias - severe agitation - RETURN OF PAIN!!!

Question 47

nursing interventions of NALOXONE

Answer 47

monitor VS - heart rhythm

Question 48

client education for NALOXONE

Answer 48

if client is awake - tell that pain will return

Question 49

interactions with NALOXONE

Answer 49

decreases effects of opioids