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Pharmacology > Nurs 605 Module 4 > Flashcards

Nurs 605 Module 4 Flashcards

1
Q

What is acute pain?

A

Acute pain: most common experience by patients, short term and temporary, lasting minutes or weeks

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2
Q

What is chronic pain?

A

Chronic pain: pain that lasts beyond tissue healing time or pain that lasts > than 3 months

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3
Q

What is nociceptive pain?

A

pain of the muscles, can be divided into somatic and visceral pain
somatic is localized where visceral is deep organ pain

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4
Q

What is neuropathic pain?

A

pain described by a compression of the nerves

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5
Q

What is the mechanism of action of acetaminophen and what is the maximum adult dose? what is the max dose for chronic pain?

A 
anti-pyretic
analgesic
no anti-inflammatory effects
max dose in adults 4000mg/day
max dose with chronic pain 3200mg/day
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6
Q

What is the mechanism of NSAIDS?

A

antipyretic
analgesic
anti-inflammatory affects
inhibits prostaglandins, causes GI side effects
equally potent to opioids
inihibits COX pathways that decreases pain

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7
Q

What are some classes of NSAIDS and what are the common NSAIDs/

A 
salicylates-ASA
COX 2 inhibitors-celecoxib
proprionic-ibuprofen, naproxen
indoles-indomethacin
others-ketoralac, diclenofonac
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8
Q

Describe COX 1 and why is it important? How do NSAIDS work on COX 1?

A 
COX 1- inhibits prostaglandins; decreased platelet aggregation = increased GI side effects and thinning of blood 
most adverse effects are from COX 1
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9
Q

What is COX 2?

A

another production of prostaglandin

increased platelet aggregation-better GI symptoms buit increased cardiovascular risk

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10
Q

What are some adverse effects of NSAIDs?

A

CNS: tinnitus, headache
Renal: renal insufficiency
GI: abdo pain, nausea/vomiting, ulcers

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11
Q

How would you manage the GI side effects of NSAIDs?

A 
stop the drug if needed
misoprostol-decreases risk of GI ulcers
PPIs
antacids
rantidine
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12
Q

Why can you not take lithium with NSAIDs?

A

medication interaction, lithium levels can increase in the serum levels with use of NSAIDs

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13
Q

Opioid vs. opiate

A

opiate- natural derivative of the opium poppy

opioid- synthetic creation of opiates such as hydromorphone

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14
Q

How is codeine made?

A

derived from morphine in the opium poppy

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15
Q

Describe the mechanism of action of opioids

A

works on the Mu receptor in the brain

gives the morphine like effects: sedation, analgesia, respriatory depression, bradycardia, euphoria

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16
Q

What dosage would you start on someone who is opoioid naive?

A

morphine2.5mg-10mg PO q 4 hours

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17
Q

What is incident pain?

A

predictable pain that may worsen with activity or movement

short in duration, acute and severe

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18
Q

What can you provide prior to incident pain?

A

fentanyl or sufentanil transmucosal

very potent, very quick acting

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19
Q

What can you provide prior to incident pain? What is the suggested dose?

A

fentanyl or sufentanil transmucosal
fentanyl 25-50mcg SL
sufentanil 12.5mcg SL
very potent, very quick acting

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20
Q

A patient is not responding to pain, what may be some factors contributing to this?

A 
pain is greater than estimated
not adherent
genetics-low levels of CYP 2D6 which cannot activate codeine into morphine=no levels of analgesic
interactions
intolerative
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21
Q

What are some adverse effects with opioids?

A 
resp depression
pruritis
constipation
nausea/vomiting
sedation
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22
Q

Describe how to manage respiratory depression in a patient taking opioids?

A

could be opiate naive
could be increasing in metabolites because of decreased renal clearance
excessive doses

stop offending drug, nalaxone if needed

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23
Q

Why does nausea and vomiting occur in individuals taking opiiods?

A

decreased gastric motility
tolerance develops in 3-4 days
can take antiemetics

24
Q

Describe neurotoxicity and How would you manage neurotoxicities?

A

increased metabolites in the system
causes CNS changes-confusoin, hallucinations
incresaing pain despite increasing opioid

discontinue or lower the opiod dose

25
Q

Why does constipation happen with opioids and how would you manage it?

A

opioids causes decreased peristalsis and increased water absorption
not a tolerance
needs to give laxatives such as senna or lactulose with opioids

26
Q

Which opioid most commonly causes pruritis and how woul dyou manage it?

A

morphine

can take hydroxyxine or diphenhydramine for relief

27
Q

Opiods cause sedation, why does this happen?

A

may be a successful analgesic dose
persistent sedation may indicate another concern
tolerance builids in 3-4 days

28
Q

Describe some adjuvant analgesics

A

adjuvant analegesics used alongside the opioid for pain

29
Q

What would you use in bone pain as an adjuvant analgesic?

A

NSAIDs
just as good as opioids, may be able to decrease the opioud dose
use lower risk medications such as ibuprofen, naproxen

30
Q

When would you use trycylcic analgesics as an adjuvant analgesic?

A

neuropathic pain

amytriptyline, nortryptyline

31
Q

What are some tools used to manage opioid use?

A

UDS, questionnaires
limited prescribing
using a contract, goal setting with patient

32
Q

Describe the process in an opioid trial?

A

opiiouds should only be prescribed short term
assess for benefit-will be noticed early in 2-6 weeks
risks of addiction

33
Q

How would you evaulate an opioid trial?

A

Trial success? benefits noticed, improvements in function, decreased pain, safety maintained, little to no side effects

Failed: signs of misuse, harm or diversion, no reduction in pain, no increase in function, intolerance to opioids

34
Q

What are some factors to consider prior to prescribing opioids?

A 
patient safety
efficacy of the drug
goal setting 
drug interactions
prepare to stop or change if not helping
35
Q

Describe some considerations of codeine

A

weak Mu agonist
CYP 2D6 inhibitor and/or inducer
1-10% of population either rapid or slow metabolizers
slow metabolizers don’t get analgesic effect, cant conver to morphine; can lead to toxicity
rapid metabolizers - cant also get opioid toxicity as rapid metabolism

36
Q

Descrive some considerations of oxycodone/oxycontin

A

mu, delta, kappa receptor
CYP 2D6/3A4 inhibitor or inducer (messy metabolism)
not tamperproof, addictive
considerations when taking-gels when gets wet, don’t lick
take with full glass of water
contraindicted in those who can’t swallow

37
Q

Describe considerations of fentanyl

A

very potent
do not use in opoiod naive patients as can be difficult to convert
patches can have residual medication on them, handlw e with care
clean with water only, no alcohols or soaps as this can add to residual effect
renal and heptatotoxic-contraindicated and cautioned in elderly and renal/hepatotixc concerns
serotonin toxicity

38
Q

How long does it take for fentanyl patchesto reach steady state?

A

6 days

39
Q

What are some risks when prescribing buprenorphine patches?

A

can precipitate opiate withdrawl
morphine equivalen to <30mg if switching
qT prolongation
naloxone not effective to reverse overdose
increased drug interactions-can’t use if using MAOi’s in 14 days

40
Q

Is tramadol an opioid? what are the adverse effects of tramadol?

A

yes! different prescribing rules
many mechanisms of action
nalaxone in OD may cause seizures
serotonin toxicity

41
Q

What is serotonin toxicity and what drugs can cause this?

A

SCAN can be caused by increase of opioids plus other serotonin reuptake drugs
fentanyl, tramadol, bupenorphine
serotonin toxicity
consciousness- anxiety, agitation, delirium, hallucinations
autonomic- hypertension, nausea, vomiting, diaphoresis
neuromuscular-rigidity, tremors, jerks

42
Q

What are the benefits of suboxone?

A

any NP can prescribe as long as they take a course=greater access
decreased risk of drug interactions
quicker to get to therapeutic dose
decreased risk of respiratory depression

43
Q

Describe the mechanism of action of suboxone

A

split into bupenorphine and naloxone

bupenorphine: partial opioid agonist; ceiling effect; higher affinity to receptors; binds to the mu receptors to prevent withdrawl but also maintain comfort
naloxone: specially as a deterrant for aberrant behaviours; injection can cause full withdrawl; opooid antagonist

44
Q

What is the route of administration of suboxone and why?

A

SL route only, needs to activate through the mucousal membrane
cannot inject as nalaxone is in it as a deterrent
oral route of this drug means no therapeutic effect

45
Q

What are the indications for use of suboxone

A

opooid use disorder only

46
Q

What assessment is required for suboxone initiation?

A 
health and medical assessment
UDS
substance use history
drugs
labs
47
Q

What are the contraindications for use of suboxone?

A

respiratory depression
liver dysfunction
ETOH use
delirium tremens

48
Q

What are the drug interactions when using suboxone?

A

ETOH
benzos, CNS depressants
MAOIs esp within 14 days
herbal, st johns wort

49
Q

What are the doses of suboxone available in Canada?

A

subxone 2mg/0.5mg
8mg/2mg
12mg/3mg
16mg/4mg

50
Q

You want to start a suboxone induction on a patient; why do patients have to be in moderate withdrawl prior to starting suboxone?

A

must be in withdrawl 12-24 hours

can be put into precipitated withdrawl if lots of opioids are still in their system

51
Q

What tool do you use in clinic to start suboxone on a patient?

A

COWs scale

measures their state of withdrawl

52
Q

What score on a COWs scale warrants a suboxone start? what dose would you give them? What if their score is greater than 24?

A

> 12 can start suboxone
start with 2mg/0.5mg or 4mg/1mg (if at risk of precipitated withdrawl, start with 2mg)
24 give 6mg/1.5mg dose

53
Q

What is the maximum amount of suboxone you can give on day 1 of induction? day 2? day 3?

A

day 1: 12mg/3mg
day 2: 16mg/4mg
day 3: 24 mg/6mg

54
Q

Your patient has taken their maximum dose of suboxone on day 1 but is still having withdrawl symptoms; what would be your next step?

A

can’t give anymore
attempt to give medications to make them more comfortable until next day
clonidine, antiemetics, antidiarrheals, analgesics etc

55
Q

What is the dosage of suboxone used to titrate patients up?

A

2mg/0.5 or 4mg/1mg

56
Q

You and a patient agree to do a home induction of suboxone; what score must the patient be at for their SOWs prior to starting suboxone?

A

> 17

start with 2mg/0.5mg

57
Q

What dose of suboxone will you give your patient if they missed their 16mg/4mg suboxone 4 days ago?

A

same dose if 5 days or less

if greater than 7 days cut by half or consult

Pharmacology (13 decks)

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