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Pharm Final > Nonopioid and Opioid Analgesics > Flashcards

Nonopioid and Opioid Analgesics Flashcards

1
Q

Pain

A

Classified by origin

Somatic
Neuropathic pain

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2
Q

Nociceptors

A

Pain receptors (mechanical, thermal, chemical)

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3
Q

Somatic Pain

A

Structural pain from tissue injury

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4
Q

Neuropathic Pain

A

Sensory disturbance involving neural hypersensitivity

Burning, tingling, or electric shocks (diabetic neuropathy)

Anticonvulsants can help stabilize pathways and decrease pain

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5
Q

Natural Suppressors of Pain

A

Endorphins (these are opioids)
Cortisone

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6
Q

Under Treated Pain Sxs

A

Tachycardia, increased respiratory rate, increased stress response, urinary retention, fluid overload, electrolyte imbalance, hyperglycemia, infection

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7
Q

Nonopioid Analgesic Prototype

A

Acetaminophen (Tylenol, Robigesic)

Decreases pain and fever

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8
Q

Acetaminophen (Tylenol, Robigesic) Pregnancy Category

A

Pregnancy category B

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9
Q

Acetaminophen (Tylenol, Robigesic) Route

A

PO/PR (rectal)

There is also now an IV form but it is not used often

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10
Q

Acetaminophen (Tylenol, Robigesic) Sxs

A

Anorexia, N/V, rash

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11
Q

Acetaminophen (Tylenol, Robigesic) Adverse Reactions

A

Severe hypoglycemia, oliguria, urticarial

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12
Q

Acetaminophen (Tylenol, Robigesic) Life-threatening Reactions

A

HEPATOTOXICITY

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13
Q

Acetaminophen (Tylenol, Robigesic) Contraindications

A

Severe hepatic or renal dx, alcoholism, hypersensitivity

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14
Q

Acetaminophen (Tylenol, Robigesic) Drug Interactions

A

Increased effect with caffeine
Decreased effect with contraceptives, anticholinergics, cholestyramine, and charcoal

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15
Q

Nonopioid Analgesic (Acetaminophen) Nursing Considerations

A

Keep out of reach from children (high dose will cause hepatoxicity)
Do not take longer than 10 days, 5 days for children
Call poison control when child has taken large or unknown amount
Death from hepatoxicity within 1-4 days
Do not take more than 3,250 mg/day (adults)

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16
Q

Acetaminophen (Tylenol, Robigesic) Antidote

A

Acetylcysteine

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17
Q

Opioid Analgesic Prototype

A

Morphine Sulfate (MS Contin, Roxanol)
Depression of CNS and pain impulse
CCS II
Check I-STOP (all opioid medication info related to pt in EMAR, like a digital footprint for nurses as well)

High incidence of addiction
Do not use for more than 3 days

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18
Q

Morphine Sulfate (MS Contin, Roxanol) Pregnancy Category

A

Pregnancy category C/D

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19
Q

Morphine Sulfate (MS Contin, Roxanol) Routes and Onsets

A

IV onset rapid
IM peak 0.5-1 hour
PO peak 1-2 hours

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20
Q

Morphine Sulfate (MS Contin, Roxanol) Sxs

A

Dizziness, drowsiness, sedation, confusion, urinary retention, constipation, N/V

Basically a lot of CNS depressant sxs

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21
Q

Morphine Sulfate (MS Contin, Roxanol) Adverse Reactions

A

Hypotension, rash, seizures

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22
Q

Morphine Sulfate (MS Contin, Roxanol) Life-threatening Reactions

A

Respiratory depression and increased intracranial pressure

23
Q

Morphine Sulfate (MS Contin, Roxanol) Drug Interactions

A

Increased effects with ETOH, sedatives, hypnotics, antipsychotics, anticonvulsants, and muscle relaxants

Basically other things that do CNS depression

24
Q

Morphine Sulfate (MS Contin, Roxanol) Contraindications

A

Pts with asthma or respiratory depression, increased intracranial pressure, or shock (morphine will drop pt’s BP even more)

Caution: Respiratory, renal, or hepatic dx, MI (occasionally used in MIs), older adults, young children

Crosses placenta and is excreted in breast milk

25
Q

Morphine Sulfate (MS Contin, Roxanol) Nursing Considerations

A

Administer before pain reaches its peak
Monitor VS, especially respiratory rate (less than 10 can indicate distress)
Monitor for hypotension
Measure urine output (urinary retention)
Monitor for constipation
Narcan is an antidote for overdose
Avoid ETOH and other CNS depressants

26
Q

Morphine Sulfate (MS Contin, Roxanol) Antidote

A

Narcan

27
Q

2nd Opioid

A

Meperidine (Demerol)

Pain relief, beneficial in GI procedures due to less constipation and urinary retention

28
Q

Meperidine (Demerol) Routes

A

PO/IV/IM

29
Q

Meperidine (Demerol) Nursing Considerations

A

Do not use in liver pts
Do not use for longer than 48-72 hours (applies to all opioids but especially this one)
Monitor for hypotension (will often see NS bag available in case of hypotension)

30
Q

Semisynthetic Opioid

A

Hydromorphone (Diluadid)

Analgesic effect 6x more potent than morphine, fewer hypnotic effects and less GI distress

31
Q

Hydromorphone (Diluadid) Routes and Onsets

A

PO/SQ/IM/IV

Faster onset and shorter duration of action than morphine

Gradual tolerance increase

32
Q

Hydromorphone (Diluadid) Nursing Considerations

A

Gradual tolerance increase
IV 2 mg or less over 2-5 minutes
Monitor respirations and adequate hydration

33
Q

Opioid Agonist-Antagonist Prototype

A

Naluphine (Nubain)

Relieve moderate to severe pain
Inhibition of pain impulse

34
Q

Naluphine (Nubain) Pregnancy Category

A

Pregnancy Category B/D

35
Q

Naluphine (Nubain) Routes and Onsets

A

IV 2-3 minutes
IM 15 minutes

36
Q

Naluphine (Nubain) Sxs

A

Dizziness, confusion, hallucinations

Basically CNS depression sxs

37
Q

Naluphine (Nubain) Adverse Reactions

A

Bradycardia, tachycardia (tends to come when pt has hypotension), respiratory depression, hypotension

38
Q

Naluphine (Nubain) Life-threatening Reaction

A

Respiratory depression

39
Q

Naluphine (Nubain) Contraindications

A

Hypersensitivity

Caution: high incidence of drug abuse, increased intracranial pressure, impaired respirations, renal or hepatic dx

40
Q

Naluphine (Nubain) Drug Interactions

A

CNS depression with ETOH or other CNS depressants

41
Q

Patient Controlled Analgesia (PCA)

A

Morphine, fentanyl, and dilaudid

IV route
Patient controlled
Lock-outs for patient to prevent overdose
Maintains constant analgesic level, avoiding episodes of severe pain and over sedation

42
Q

Transdermal Opioid Analgesic

A

Duragesic (Fentanyl)

For chronic pain
24 hour pain control
Change patch every 24 hours
Also available IV/IM

43
Q

Migraine

A

Unilateral throbbing head pain with N/V and photophobia
Last 2-24 hours
Caused by inflammation of blood vessels in cranium
Thought to be a serotonin imbalance
2/3 of women between 20-30 yrs old, decreases during pregnancy and menopause

Triggers: red wine, cheese, and chocolate

44
Q

Cluster Headache

A

Severe unilateral non-throbbing pain usually around eye
Occurs in clusters of severe attacks for several days over several weeks
Occurs in men more commonly than women

45
Q

Prevent Migraines

A

Beta blockers (Inderal, Tenormin)
Anticonvulsants (Valporic Acid), Neurontin
TCA (Elavil, Tofranil)

46
Q

Cessation of Migraines

A

Analgesics, opioid analgesics, ergot alkaloids, SSRA (Triptans)

47
Q

5-HT1 Receptor Agonist Prototype

A

Sumatriptan (Imitrex)

Treat migraines and cluster headaches
Causes vasoconstriction of cranial arteries

48
Q

Sumatriptan (Imitrex) Pregnancy Category

A

Pregnancy Category C

49
Q

Sumatriptan (Imitrex) Routes and Onsets

A

PO 30 min
SQ 10 min
Intra nasal 15 min

50
Q

Sumatriptan (Imitrex) Sxs

A

Dizziness, fainting, tingling, N/V/D, abdominal cramps

51
Q

Sumatriptan (Imitrex) Adverse Effects

A

HTN (more common than hypotension), hypotension, angina, dysrhythmias, thromboembolism (due to vasoconstriction)

52
Q

Sumatriptan (Imitrex) Life-threatening Reactions

A

Coronary artery vasospasm, MI, cardiac arrest

53
Q

Sumatriptan (Imitrex) Contraindications

A

Cardiovascular pts, HTN, DM, smoking, CAD, liver or renal dx

Pharm Final (5 decks)

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