pain drugs Flashcards
6mg morphine IVP for pain post op : what are two assessment prior and immediately after admin that are important:
a) cap refil
b) BP
c) constipation
d) body temp
e) respiratory rate
blood pressure & respiratory rate
pt takes opioid for prolonged periods can develop tolerance. for which side effects might the pt develop a tolerance?
a) analgesia
b) constipation
c) euphoria
d) respiratory depression
analgesia and euphoria , respiratory depression
what is an example of cross tolerance
if you are tolerant to hydrocodone at a certain dose you are tolerant to oxycodone at the equivalent dose as well
what actions might minimize the risk of constipation with oxycodone:
ambulation, drink lots of water, provide stool softeners, include fiber in their diet
T/F: pts taking opioids should avoid repeated used of anticholinergic drugs (antihistamines, tricyclic antidepressants) because these drugs can exacerbate opioid induced constipation and urinary retention
true
pt is admitted for pacreatitis, he is moaning and cries out in pain, 9-10 pain. “morphine has made me feel nauseous can i plz have something different” What would you do?
- you could throw on on medication for nausea
- you could ask the provider if you could switch to something else like Diluadid, Fentanyl
pt in bike crash and have a deep soft tissue injury to the calf. What would you suggest for pain medication for the complex wound care he has today?
-make sure to give him pain medication before his wound care, and something for the rest of the day
a pt has been taking methadone for 5 months. what are indications for use of methadone:
a) acute pain after trauma or surgery
b) nerve pain related to spinal cord injury
c). oral pain r/t oral surgery
d) back pain after strenous activity
e) chronic pain
f) long lasting pain
g) in treatment of heroin addiction
chronic pain, in treatment of heroin addiction
pt has been taking methadone for 5 months: the nurse should monitor patient for which of the following changes:
a) elevated QRS
b) prolonged QT interval
c) prolonged PR
D) AV block
prolonged QT
what is the best way to provide methadone on an outpatient basis for someone with addiction
direct observation therapy (DOT)
Why is Meperidine out of favor for general pain management?
a) short acting
b) only works for minimum pain levels
c) toxic metabolites leading to toxicity
d) bad taste
e) drug interactions
toxic metabolites , drug interactions, short action requires repeated dosing
pt just returned from surgery and shivering uncontrollably. warm blankets provide no relief. What is the drug that the student recommends for “drug induced rigos”
Meperidine
in what case might the nurse avoid a pain medication with combined opioid and acetaminophen (ex Vicodin)
a) pt states pain of 9/10
b) pt was admitted for cellulitis
c) pt was admitted for suicidal ideation
d) pt was admitted for HF
cellulitis –> Tylenol/acetaminophen can mask fever, and cellulitis is an infection
(T/F) Pentazocine and other agonist-antagonist produce less analgesia than morphine and have a lower potential for abuse
True – the
can you still get respiratory depression with agonist antagonists?
yes
what drug do we give for opioid induced constipation?
Methylnaltrexone (it triggers specifically the receptors in the gut)
what drug treats Opioid induced sedation/respiratory depression
Naloxone (narcan)
what drug treats Benzodiazepine induced hypotension/respiratory depression
Flumazenil (Romazacon) - it is a benzo antagonist
what is acetylsysteine used for
acetiminophen/tylenol overdose
a pt is brough into ED resrpiatry rate 6-7 pinpoint pupils, partying and schooms and everything
after ABCs, what mediation with the nurse administer?
a) charcoal and flumazenil
b) iv acetylcysteine
c) glucophage and insulin
d) naloxone
e) flumazenil
try naloxone first
what type of drug is Ketorolac?
IV/IM NSAID
aspirin
first gen NSAID
diclofenac
1st gen NSAID
acetaminophen
non narcotic with no anti-inflammatory effect
celecoxib
2nd gen NSAID
when would you not add an NSAID
bleeding or kidney injury
what are our non selective cox 1 and cox 2 nsaids?
aspirin, ibuprofen
what NSAIDS only inhibit Cox 2
celecoxib
COX1
platelet aggregation, support renal function, gastric protection
COX 2
mediates inflammation, sensitized receptors to pain, mediates fever
aspirin adrs
gastric distress, bleeding, reyes syndrome (dont give aspirin to kids), renal impairment , hypersensitivity, erectile dysfunction
pt has 2nd alcohol related fall and is drinking a lot. pt insists tylenol works for them and they have pain. with the pts alcohol how much acetaminophen can be safely used to treat pain related to the fall ?
4gms a day is the max for healthy people
-people with hepatic dysfunction you can give max 2gm a day
T/F:
Cox-1 inhibitors protect against myocardial infarction and stroke
true
why does acetaminophen not cause gastrointestinal upset?
it has minimal effects at peripheral sites, it mostly works in the CNS
an adolescet took a whole bottle of acetaminophen what are we gonna give em?
acetylcysteine (mucomyst)
what are qualities that describe Benzodiazepines
-lower abusive potential than barbiturates
-less tolerance than barbituates
-lower dependence than barbituates
-reversal agent (flumazicon) is available
** we dont use barbiturates anymore **
can you die from a benzodiazepine withdrawl?
yes you will seize and die
indications for benzodiazepines
relieve anxiety, anti seizure, induction of anesthesia
how does Lorazepam work
potentiates the action of GABA
what is used for both difficulty falling asleep and difficulty maintaining sleep
extended release Zolpidem (Ambien)
