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NURS 305 - Exam 4 > Neuro - Part 1 > Flashcards

Neuro - Part 1 Flashcards

1
Q

Describe acute pain

A

Sudden onset - subsides with treatment

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2
Q

Describe chronic pain

A

Persistent - lasts > 3 - 6 months

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3
Q

Describe breakthrough pain

A

Abrupt episode of pain while on medication to treat chronic pain

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4
Q

Which types of pain respond best to opioids? (2)

A
  • Visceral pain
  • Superficial pain
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5
Q

Which type of pain responds best to non-opioids / NSAIDs?

A

Somatic pain

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6
Q

Describe the steps of the pain response (4)

A
  • Nociceptors stimulated
  • Pain transferred to brain / spinal cord
  • Sensation of pain occurs
  • Pain interpretation depends on pain threshold
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7
Q

Describe the components of a typical pain assessment (2)

A
  • OLDCARTS
  • 1 - 10 severity scale
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8
Q

What is the purpose of the FLACC scale?

A

Assessment of pain in patients who are unable to self-report pain (infants / children / non-verbal)

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9
Q

Non-opioids have a ______

A

Ceiling effect

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10
Q

What is the ceiling effect?

A

Drug reaches a max analgesic effect - does not improve pain with higher doses

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11
Q

What are the types of non-opioid analgesics? (4)

A
  • Acetaminophen
  • Tramadol (Ultram)
  • Transdermal lidocaine
  • NSAIDs
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12
Q

______ is the most commonly used OTC analgesic

A

Acetaminophen

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13
Q

What is the drug class of acetaminophen?

A

Centrally acting non-opioid analgesic

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14
Q

acetaminophen has NO ______

A

Anti-inflammatory effects

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15
Q

Describe the MOA of acetaminophen (2)

A
  • Decreases prostaglandins - blocks peripheral pain
  • Acts on hypothalamus - regulates temperature
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16
Q

What are the indications of acetaminophen? (2)

A
  • Mild - moderate pain
  • Fever
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17
Q

What is the maximum dose of acetaminophen?

A

4 grams / 24 hours

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18
Q

Name some examples of acetaminophen-containing drugs (2)

A
  • Percocet
  • Vicodin
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19
Q

What is the primary risk associated with acetaminophen?

A

Hepatotoxicity - avoid alcohol

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20
Q

What is the antidote / reversal agent of acetaminophen?

A

acetylcysteine

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21
Q

Describe the characteristics of acetylcysteine (3)

A
  • Bad taste
  • Smells like rotten eggs
  • Can cause vomiting
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22
Q

What action should be taken in the case of vomiting from acetylcysteine?

A

Repeat dose in 1 hour

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23
Q

What is the drug class of tramadol (Ultram)?

A

Centrally acting non-opioid analgesic

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24
Q

Describe the MOA of tramadol (Ultram)

A

Inhibits norepinephrine / serotonin

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25
Q

tramadol (Ultram) has ______ opioid receptor activity

A

Weak

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26
Q

What is the primary indication of tramadol (Ultram)?

A

Moderate - severe pain

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27
Q

tramadol (Ultram) is metabolized in the ______

A

Liver

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28
Q

tramadol (Ultram) is excreted by the ______

A

Kidneys

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29
Q

tramadol (Ultram) can be mixed with acetaminophen to make ______

A

Ultracet

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30
Q

What are the side effects of tramadol (Ultram)? (2)

A
  • Dry mouth
  • Constipation
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31
Q

Avoid use of ______ with tramadol (Ultram)

A

Alcohol / CNS depressants

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32
Q

What is the primary contraindication of tramadol (Ultram)?

A

History of drug abuse

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33
Q

Describe the education associated with tramadol (Ultram)

A

Increase fiber / activity to prevent constipation

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34
Q

What is the drug class of transdermal lidocaine (Lidoderm)?

A

Topical anesthetic

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35
Q

Describe the MOA of transdermal lidocaine (Lidoderm)

A

Blocks sodium channels in nerve membranes

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36
Q

What is the primary indication of transdermal lidocaine (Lidoderm)?

A

Neuralgia

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37
Q

What is the primary side effect of transdermal lidocaine (Lidoderm)?

A

Localized skin irritation

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38
Q

Describe the nursing considerations of transdermal lidocaine (Lidoderm) (3)

A
  • Place on painful areas
  • Up to 3 patches in one area
  • DO NOT wear > 12 hours - risk of systemic absorption (can lead to dysrhythmias)
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39
Q

Opioids have NO ______

A

Ceiling effect - titrate dosage to desired effect

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40
Q

Which types of opioids are from unripe poppy seeds? (2)

A
  • Morphine
  • Codeine
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41
Q

What is the biggest concern associated with opioids?

A

Respiratory depression - opioids cause cough suppression

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42
Q

RR of ______ is a concern when taking opioids

A

< 8

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43
Q

What factors are important to monitor with opioid use? (2)

A
  • LOC
  • RR
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44
Q

______ bind to opioid receptors in the brain to reduce pain sensation

A

Opioid agonists

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45
Q

Opioid agonists are schedule ______

A

II

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46
Q

______ suggests that not every opioid acts equally

A

Equianalgesia

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47
Q

What are the contraindications of opioids? (5)

A
  • ICP
  • Sleep apnea
  • Severe asthma
  • Morbid obesity
  • Myasthenia gravis (MG)
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48
Q

______ is NOT a contraindication of opioids

A

Nausea

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49
Q

What are the CV side effects of opioids? (3)

A
  • Bradycardia
  • Hypotension
  • Flushing
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50
Q

What are the CNS side effects of opioids? (5)

A
  • Euphoria
  • Sedation
  • Disorientation
  • Pupil dilation
  • Unresponsiveness
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51
Q

What are the GI side effects of opioids? (2)

A
  • N / V
  • Constipation
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52
Q

What is the primary GU side effect of opioids?

A

Urinary retention

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53
Q

What are the integumentary side effects of opioids? (2)

A
  • Itching
  • Rash
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54
Q

What are the respiratory side effects of opioids? (2)

A
  • Asthma exacerbation
  • Respiratory depression
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55
Q

It is important to start treatment of _______ with the first opioid dose

A

Constipation

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56
Q

If a patient prescribed opioids has not voided in 6 hours, what assessment should take place?

A

Bladder scan

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57
Q

What characteristic of opioids is most likely to cause opioid abuse?

A

High affinity for mu receptors - causes marked euphoria

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58
Q

Describe the nursing considerations for opioids with high abuse potential (2)

A
  • Keep medications secure
  • Have reversal agent available
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59
Q

______ is expected especially with morphine

A

Itching - due to histamine response

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60
Q

Morphine releases a ______ response

A

Histamine

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61
Q

What is the drug class of morphine sulfate?

A

Natural opioid agonist

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62
Q

What types of morphine sulfate are extended release? (2)

A
  • MS Contin
  • Kadian
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63
Q

What type of morphine sulfate is a concentrated solution for SL use?

A

Roxanol

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64
Q

Roxanol has a ______ onset

A

Rapid

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65
Q

What is the primary indication for Roxanol?

A

Hospice patients for fast relief of symptoms

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66
Q

What is the primary contraindication of morphine sulfate?

A

Renal impairment

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67
Q

What is the drug class of fentanyl?

A

Synthetic opioid agonist

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68
Q

What dosage of fentanyl is equal to morphine?

A

0.1 mg IV fentanyl = 10 mg IV morphine

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69
Q

What is the primary indication of fentanyl?

A

ICU for sedation during mechanical ventilation - injectable form

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70
Q

What is Duragesic?

A

Topical fentanyl patch

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71
Q

What is the primary indication of Duragesic?

A

Chronic pain

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72
Q

What is the primary contraindication of Duragesic?

A

Opioid-naive patients

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73
Q

Describe opioid-naive patients

A

Patients who have not received opioids on a daily basis within the previous 30 days

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74
Q

What is the onset of steady state of relief for Duragesic (fentanyl patch)?

A

6 - 12 hours

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75
Q

Describe the education associated with Duragesic (fentanyl patch)

A

Remove / reapply every 72 hours

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76
Q

What is the drug class of methadone?

A

Synthetic opioid agonist

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77
Q

What are the indications of methadone? (3)

A
  • Heroin / opioid withdrawal
  • Neuropathic pain
  • Cancer pain
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78
Q

What is the unique characteristic of methadone?

A

Half-life is longer than duration

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79
Q

Why is the half-life longer than the duration of methadone?

A

Binding in liver, kidneys, and brain

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80
Q

With repeated dosing, methadone builds up and is slowly released. This allows for ______

A

24-hour dosing

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81
Q

methadone is eliminated by the ______

A

Liver - safe for patients with renal impairment

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82
Q

What is the primary concern associated with methadone?

A

Dysrhythmias

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83
Q

What is the drug class of oxycodone?

A

Semi-synthetic opioid agonist

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84
Q

oxycodone is similar to ______

A

Morphine

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85
Q

What are some examples of oxycodone drugs? (4)

A
  • percocet
  • percodan
  • oxycontin XR
  • oxycodone IR
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86
Q

______ is more potent than morphine

A

hydromorphone (Dilaudid)

87
Q

What is the drug class of hydromorphone (Dilaudid)?

A

Semi-synthetic opioid agonist

88
Q

What is the dosage of hydromorphone (Dilaudid)?

A

0.2 - 1 mg

89
Q

What is the primary concern associated with hydromorphone (Dilaudid)?

A

Commonly mistaken with morphine - risk of accidental overdose due to increased potency

90
Q

Signs of opioid withdrawal occurring within 24 - 48 hours from last dose are due to ______

A

Physical dependence

91
Q

What are the manifestations of opioid withdrawal? (12)

A
  • Anxiety
  • Abdominal cramping
  • Confusion
  • Chills
  • Diarrhea
  • Diaphoresis
  • Hot flashes
  • Irritability
  • Joint pain
  • Lacrimation
  • Nausea / vomiting
  • Rhinorrhea
92
Q

______ bind to opioid receptors in the brain to reduce pain sensation in LOWER amounts than opioid agonists

A

Opioid agonist-antagonists

93
Q

Name some examples of opioid agonist-antagonists (2)

A
  • butorphanol (Stadol)
  • buprenorphine (Buprenex, Subutex)
94
Q

Opioid agonist-antagonists have a …

A

Lower risk of addiction

95
Q

What is the primary indication of butorphanol (Stadol)?

A

Short-term pain - often used for labor

96
Q

What is the primary indication of buprenorphine (Buprenex, Subutex)?

A

Treatment of opioid addiction / withdrawal

97
Q

______ bind to opioid receptors in the brain but DO NOT reduce pain sensation

A

Opioid antagonists

98
Q

Name an example of an opioid antagonist

A

naloxone (Narcan)

99
Q

Describe the MOA of naloxone (Narcan) (2)

A
  • Competes for opioid receptor sites
  • Reverses effects of opioid agonists
100
Q

naloxone (Narcan) has a ______ half-life

A

Short - may need to be re-administered after 1 hour

101
Q

What manifestations of opioid withdrawal may occur after administration of naloxone (Narcan)? (4)

A
  • Tachycardia
  • Tremors
  • Sweating
  • Nausea / vomiting
102
Q

What are the routes of naloxone (Narcan)? (3)

A
  • IM
  • SQ
  • Intranasal
103
Q

______ is required for naloxone (Narcan)

A

NO prescription

104
Q

naloxone (Narcan) is used by ______

A

First responders

105
Q

Describe patient controlled analgesia (PCA) (3)

A
  • Patient can press a button to receive analgesic dose
  • Epidural / IV
  • Requires verification from 2 nurses
106
Q

What are the possible orders of PCA? (4)

A
  • Bolus dose
  • Basal rate
  • PRN meds
  • Lock out
107
Q

What are the advantages of PCA? (3)

A
  • Avoids dosing delays
  • Less total dose needed to control pain
  • Sense of control for patient
108
Q

What prophylactic measures should be considered during pain management? (2)

A
  • PT
  • Dressing changes
109
Q

______ are drugs that eliminate pain by depressing nerve function in the CNS / PNS

A

Anesthetics

110
Q

What is the drug class of nitrous oxide?

A

Inhaled general anesthetic

111
Q

Nitrous oxide is also known as ______

A

Laughing gas

112
Q

What are the uses of nitrous oxide? (2)

A
  • Dental procedures
  • Supplemental to more potent anesthetics
113
Q

Nitrous oxide has a ______ onset

A

Rapid

114
Q

What is the drug class of isoflurane?

A

Inhaled general anesthetic

115
Q

What is the use of isoflurane?

A

Start / maintain anesthesia

116
Q

What is the primary side effect associated with isoflurane?

A

Airway irritation

117
Q

General anesthetics are used during surgical procedures to produce what effects? (3)

A
  • Unconsciousness
  • Skeletal muscle relaxation
  • Visceral smooth muscle relaxation
118
Q

General anesthetics may be used for ______ for depression treatment

A

Electroconvulsive therapy

119
Q

What is the primary concern / risk that can occur during / after general anesthesia?

A

Malignant hyperthermia

120
Q

Malignant hyperthermia is a ______

A

Life threatening emergency

121
Q

What are the manifestations of malignant hyperthermia? (4)

A
  • Tachypnea
  • Tachycardia
  • Muscle rigidity
  • Sudden fever > 104°F
122
Q

Malignant hyperthermia is primarily ______

A

Genetic

123
Q

Describe the treatment of malignant hyperthermia (2)

A
  • Cardiorespiratory supportive care
  • Dantrolene (skeletal muscle relaxant)
124
Q

Describe the MOA of local anesthetics

A

Block nerve transmission to specific areas of the body WITHOUT loss of consciousness

125
Q

______ is the most common local anesthetic

A

lidocaine (Xylocaine)

126
Q

lidocaine (Xylocaine) can be used alone or in combination with ______

A

Epinephrine

127
Q

What are the topical / transdermal formulations of lidocaine (Xylocaine)? (2)

A
  • EMLA
  • Lidoderm
128
Q

______ administration of lidocaine (Xylocaine) is used to treat dysthymias

A

Parenteral

129
Q

What is infiltration anesthesia?

A

Injection of local anesthetic solution to create numbness

130
Q

Describe the MOA of neuromuscular blocking drugs (NMBD)

A

Block nerve transmission in specific muscles, resulting in paralysis

131
Q

What are the indications of NMBDs? (3)

A
  • Controlled ventilation during procedures
  • Endotracheal intubation
  • Eliminate muscle contraction in an area that needs surgery
132
Q

What is the drug class of pancuronium (Pavulon)?

A

NMBD

133
Q

Describe the MOA of pancuronium (Pavulon) (2)

A
  • Blocks acetylcholine
  • Causes flaccid paralysis
134
Q

What must take place when NMBDs are used?

A

Secure an airway / initiate mechanical ventilation

135
Q

Describe the effects of NMBDs (2)

A
  • Paralysis while conscious
  • Inability to breathe independently
136
Q

NMBDs do NOT cause ______

A

Sedation / pain relief

137
Q

Describe the sequence of action of NMBDs (3)

A
  • Muscle weakness followed by total flaccid paralysis
  • Small, rapidly moving muscles affected first (fingers, eyes)
  • Intercostal muscles / diaphragm affected last - respirations stop
138
Q

After use of NMBDs, muscle soreness may develop due to ______

A

Transient muscle fasciculations (twitching)

139
Q

What is the primary adverse effect of NMBDs due to muscle cell injury?

A

Hyperkalemia (release of K+)

140
Q

What is the drug class of midazolam (Versed)?

A

Benzodiazepine

141
Q

Describe the MOA of midazolam (Versed)

A

Enhances GABA - causes sedation

142
Q

What is the primary indication of midazolam (Versed)?

A

Pre-op to prepare for general anesthesia

143
Q

What are the side effects of midazolam (Versed)? (4)

A
  • Bradycardia
  • Bronchospasm
  • Hypotension
  • Syncope
144
Q

Describe the MOA of propofol (Diprovan)

A

Enhances GABA - causes sedation

145
Q

What is the primary indication of propofol (Diprovan)?

A

ICU sedation / induction of anesthesia

146
Q

What are the side effects of propofol (Diprovan)? (2)

A
  • Bradycardia
  • Involuntary muscle movements
147
Q

What are the adverse effects of propofol (Diprovan)? (2)

A
  • Asystole
  • Seizures
148
Q

Describe the monitoring associated with propofol (Diprovan)

A

Triglyceride levels - lipid-based drug

149
Q

What is the drug class of zolpidem (Ambien)?

A

Short-acting non-benzo hypnotic

150
Q

Describe the MOA of zolpidem (Ambien)

A

Enhances GABA - causes sleepiness, muscle relaxation, and decreased anxiety

151
Q

What is the primary indication of zolpidem (Ambien)?

A

Insomnia

152
Q

Avoid use of ______ with zolpidem (Ambien)

A

Alcohol / CNS depressants

153
Q

What are the contraindications of zolpidem (Ambien)? (3)

A
  • Sleep apnea / respiratory impairment
  • Hepatic impairment
  • Elderly patients
154
Q

What are the side effects of zolpidem (Ambien)? (4)

A
  • Depression
  • Suicidal thoughts
  • Hallucinations
  • Amnesia
155
Q

What is the primary adverse effect of zolpidem (Ambien)?

A

Angioedema

156
Q

What is the max dosage of zolpidem (Ambien)?

A

Women: 5 mg

Men: 5 - 10 mg

157
Q

Describe the education associated with zolpidem (Ambien) (2)

A
  • DO NOT exceed max dosage - risk of impairment in the next morning
  • DO NOT stop abruptly
158
Q

What is the primary risk associated with extended-release zolpidem (Ambien CR)?

A

Sleepwalking

159
Q

What is the site of action of muscle relaxants?

A

CNS

160
Q

Most muscle relaxants are ______

A

Centrally acting

161
Q

Muscle relaxants are also known as ______

A

Spasmolytics

162
Q

Describe the MOA of muscle relaxants

A

Inhibit neuron activity in brain / spinal cord

163
Q

What is the primary indication of muscle relaxants?

A

Muscle spasms

164
Q

What conditions are indications of muscle relaxants? (2)

A
  • Multiple sclerosis
  • Cerebral palsy
165
Q

Muscle relaxants are most effective when used in conjunction with ______

A

Physical therapy

166
Q

cyclobenzaprine (Flexeril) acts similarly to ______

A

Tricyclic antidepressants

167
Q

What is the drug class of diazepam (Valium)?

A

Benzodiazepine

168
Q

Describe the MOA of diazepam (Valium)

A

Enhances GABA - muscle relaxation

169
Q

What is the primary indication of diazepam (Valium) regarding muscle relaxation?

A

Skeletal muscle relaxation after ortho injury / surgery

170
Q

What can occur if diazepam (Valium) is discontinued abruptly?

A

Rebound insomnia

171
Q

Avoid use of ______ with diazepam (Valium)

A

Alcohol / CNS depressants

172
Q

Describe the monitoring associated with diazepam (Valium) (2)

A
  • Liver function
  • Renal function
173
Q

______ is the primary inhibitory neurotransmitter for the CNS

A

GABA

174
Q

What is the function of GABA?

A

Inhibits nerve transmission - decreases excitability

175
Q

Describe the MOA of antiepileptics (3)

A
  • Increase seizure threshold
  • Decrease speed of conduction
  • Limit spread of nerve impulses
176
Q

Antiepileptics are also known as ______

A

Anticonvulsants

177
Q

What is the primary indication of antiepileptics?

A

Prevention / control of seizure activity

178
Q

What is the primary side effect of antiepileptics?

A

Drowsiness

179
Q

What is the primary safety concern of ALL antiepileptics?

A

Suicidal thoughts

180
Q

Describe the primary nursing intervention associated with anticonvulsants

A

Must ask directly - “do you have thoughts of harming yourself?”

181
Q

Antiepileptics including phenytoin (Dilantin), carbamazepine (Tegretol), and valproic acid (Depakote) are all ______

A

Highly protein bound - many drug interactions

182
Q

What are the general adverse effects of antiepileptics? (2)

A
  • Bone marrow suppression
  • Hepatotoxicity
183
Q

______ antiepileptics have an increased risk of toxicity

A

1st generation

184
Q

What is the drug class of phenytoin (Dilantin)?

A

1st generation antiepileptic

185
Q

Describe the MOA of phenytoin (Dilantin)

A

Blocks sodium channels - stabilization of cell membranes

186
Q

What is the primary indication of phenytoin (Dilantin)?

A

Tonic-clonic / partial seizures

187
Q

What is the primary contraindication of phenytoin (Dilantin)?

A

Bradycardia

188
Q

What is the primary side effect of phenytoin (Dilantin)?

A

Gingival hyperplasia

189
Q

Describe the nursing considerations associated with phenytoin (Dilantin) (3)

A
  • IV route requires cardiac monitoring
  • Use filter - risk of precipitation
  • Long half-life - daily / BID
190
Q

Avoid use of ______ with phenytoin (Dilantin)

A

Alcohol / CNS depressants

191
Q

What are the signs of phenytoin (Dilantin) toxicity? (4)

A
  • Ataxia
  • Dysarthria
  • Nystagmus
  • Encephalopathy
192
Q

What are the therapeutic levels of phenytoin (Dilantin)?

A

10 - 20 mcg / mL

193
Q

IV phenytoin (Dilantin) is a ______

A

Vesicant

194
Q

What is the drug class of carbamazepine (Tegretol)?

A

1st generation antiepileptic

195
Q

carbamazepine (Tegretol) is used as ______

A

Monotherapy

196
Q

Describe the MOA of carbamazepine (Tegretol)

A

Blocks sodium channels - stabilization of cell membranes

197
Q

What is the primary indication of carbamazepine (Tegretol)?

A

Tonic-clonic / partial seizures

198
Q

What is the primary contraindication of carbamazepine (Tegretol)?

A

Myoclonic / absence seizures - may worsen

199
Q

What are the side effects of carbamazepine (Tegretol)? (2)

A
  • Weight gain
  • Blurred vision
200
Q

What is the primary adverse effect of carbamazepine (Tegretol)?

A

Stevens-Johnson syndrome

201
Q

Describe Stevens-Johnson syndrome (3)

A
  • Begins with flu-like symptoms
  • Painful rash / blisters develop
  • Top layer of affected skin dies / sheds
202
Q

Describe the monitoring associated with carbamazepine (Tegretol) (2)

A
  • Renal function
  • Sodium levels - risk of hyponatremia
203
Q

What is the drug class of levetiracetam (Keppra)?

A

2nd generation antiepileptic

204
Q

Describe the MOA of levetiracetam (Keppra)

A

Inhibits pre-synaptic calcium channels

205
Q

What are the indications of levetiracetam (Keppra)? (2)

A
  • Adjunct for partial seizures
  • Prevention of seizures after head injury / hemorrhagic stroke
206
Q

What is the drug class of valproic acid (Depakote)?

A

2nd generation antiepileptic

207
Q

What are the indictions of valproic acid (Depakote)? (5)

A
  • Absence seizures
  • Myoclonic seizures
  • Tonic-clonic seizures
  • Partial seizures
  • Bipolar disorder
208
Q

What is the primary contraindication of valproic acid (Depakote)?

A

Impaired urea metabolism - inability to excrete ammonia

209
Q

What are the side effects of valproic acid (Depakote)? (2)

A
  • Weight gain
  • Transient hair loss
210
Q

What is the therapeutic level of valproic acid (Depakote)?

A

50 - 100 mcg / mL

211
Q

Describe the monitoring associated with valproic acid (Depakote) (2)

A
  • Liver function
  • Ammonia levels
212
Q

Describe the education associated with valproic acid (Depakote) (2)

A
  • Take with food to minimize GI upset
  • DO NOT mix syrup with carbonated beverages - risk of mouth / throat irritation
213
Q

What is the primary indication of diazepam (Valium) regarding seizure disorders?

A

Status epilepticus

214
Q

What is the primary contraindication of diazepam (Valium) regarding seizure disorders?

A

Narrow-angle glaucoma

NURS 305 - Exam 4 (2 decks)

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