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Pharm Exam 3 > Pain Management > Flashcards

Pain Management Flashcards

1
Q

what is nociceptive pain?

A

pain from physical damage or potential damage to the body
somatic - tissue damage like surgery, injury, infection, or inflammation
visceral - related to internal organs

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2
Q

what is neuropathic pain?

A

damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles, and other parts of the body - diabetes, shingles, chemo, poor response to opioids

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3
Q

what is the management strategy for pain?

A
  • ask about pain regularly
  • believe the report of pain
  • choose appropriate pain control
  • deliver timely and logical interventions
  • empower patients and pts
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4
Q

what is a nonverbal pain scale used for?

A

children and pts who can’t communicate

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5
Q

what kind of interventions are there for pain?

A
  • physical/psychosocial interactions
  • nonopioid analgesics
  • adjuvant analgesics
  • opioid analgesics
  • nonopioid centrally acting analgesics
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6
Q

what are examples of physical interventions for pain?

A
  • heat
  • ice
  • massage
  • position
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7
Q

what are examples of psychosocial interventions for pain?

A
  • distractions
  • music
  • yoga
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8
Q

what are two examples of nonopioid analgesics?

A
  • non-steriodal anti-inflammatory drugs (NSAIDs - aspirin, ibuprofen)
  • acetaminophen
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9
Q

what precautions should be known about acetaminophen?

A
  • overdose - no more than 4000mg a day

- liver failure

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10
Q

what is Percocet made of? what teaching is needed?

A

oxycodone and Tylenol

  • oxycodone doesn’t have a limit but Tylenol does
  • watch for overdose, pt can’t take extra Tylenol or any other drug that contains acetaminophen
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11
Q

what are adjuvant analgesics?

A

drugs not designed for pain management but can be used for pain control

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12
Q

what are the three examples of adjuvant analgesics are used for neuropathic pain and what is their original use?

A

all three are used for neuropathic pain

  • amitriptyline (Elavil) - tricyclic antidepressant
  • Gabapentin - anti-seizure drug
  • lidocaine - local anesthetics/antidysrhythmics
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13
Q

what is the purpose of a CNS stimulant as an adjuvant analgesic?

A

enhance opioid analgesia and counteract sedation

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14
Q

when are bisphosphonates used as an adjuvant analgesic?

A

when pain is caused by a tumor-induced bone resorption

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15
Q

why would aspirin not be used for pain management?

A

risk for bleeding

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16
Q

why would a patient be prescribed nonopioid analgesics on top of opioid use?

A

it will spread out the amount of time between opioid use

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17
Q

why are antihistamines used as adjuvant therapy? give an example of the drug name

A
  • hydroxyzine (Vistaril) or Benadryl

- promotes drowsiness and reduces and anxiety

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18
Q

why would glucocorticoids be used as adjuvant therapy? give an example of the drug name

A

prednisone or hydrocortisone

  • reduce cerebral and spinal edema
  • improve general sense of wellbeing
  • improve appetite
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19
Q

what is an analgesic?

A

a category of drugs that relieve pain without causing loss of consciousness

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20
Q

what is the most common group of analgesics?

A

opioids (most effective pain relievers)

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21
Q

what is an opioid defined as?

A

a general term defined as any drug, natural or synthetic, that has actions similar to those of MORPHINE

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22
Q

what are Mu receptors?

A

related to dependence

- when activated it causes analgesia, respiratory depression, euphoria, sedation and decreased GI motility

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23
Q

what are Kappa receptors?

A

when activated it causes analgesia, sedation, and “psychotomimetic” effects

  • hallucinations
  • anxiety
  • nightmares
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24
Q

what receptor is associated with dependence?

A

Mu receptor

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25
Q

what are pure opioid agonists?

A

they active both Mu and Kappa to produce analgesia and sedation
- strong opioid agonists

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26
Q

what are agonist-antagonist opioids?

A

an agonist to one receptor (usually kappa) and an antagonist to one receptor (usually mu)

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27
Q

what are pure opioid ANTAGONIST?

A
  • blocks the agonist
  • reversal effect of pure opioids
  • naloxone (Narcan)
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28
Q

what are examples of pure opioid agonists?

A
  • morphine
  • codeine
  • meperidine
  • fentanyl
  • dilaudid
  • methadone
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29
Q

when would you use pure opioid agonists?

A
  • postoperative pain
  • obstetric analgesia
  • myocardial infarction
  • head injury (use with caution due to respiratory depression)
  • cancer-related pain
  • chronic non-cancer pain
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30
Q

where does morphine come from?

A

poppy plant

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31
Q

what does opium contain?

A

morphine and codeine

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32
Q

which receptors does morphine work on? what does it do?

A

mu and kappa

- blocks transmission of pain

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33
Q

what do endorphins relate to?

A

euphoria

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34
Q

what are the routes for morphine?

A

oral, IM, IV, subcutaneous, epidural, rectal, and intrathecal

35
Q

how is morphine absorbed?

A

depends on the route

  • need a much larger dose of morphine to be effective when PO
  • IV morphine would need a much smaller dose to be effective
36
Q

what does “first pass” mean when referring to morphine?

A

it is inactivated by the hepatic metabolism

  • the first pass through the liver inactivates much of the orally ingested drug on its way to the systemic circulation
  • PO could be like 30mg
  • IV could be like 4mg
37
Q

what is a serious adverse effect of morphine?

A

respiratory depression

38
Q

what could cause an increase of respiratory depression with a patient on morphine?

A

on patients using/taking other CNS depressants

  • alcohol
  • barbiturates
  • benzodiazepines
  • or patients with preexisting respiratory conditions
39
Q

what are the adverse effects of morphine? (more than just respiratory depression)

A
  • euphoria/dysphoria
  • sedation
  • miosis (constriction of the pupil)
  • neurotoxicity
  • adverse effects from prolonged use is CONSTIPATION (would need a laxative and doesn’t get better with time)
40
Q

what are the problems with the long-term use of morphine?

A

tolerance and physical dependence

- side effects will begin to decrease

41
Q

what is the most common bothersome side effect of morphine

A

constipation - would require a laxative daily if a patient is on morphine for a prolonged period of time, doesn’t get better with time

42
Q

what happens if a pt is dependent on morphine and stops taking them suddenly?

A

withdrawal symptoms

- unpleasant

43
Q

what are the signs and symptoms of morphine toxicity?

A

classic triad

  • coma (decreased level of consciousness)
  • respiratory depression
  • pinpoint pupils
44
Q

what is the classic triad?

A

signs and symptoms of morphine toxicity

  • coma (decreased level of consciousness)
  • respiratory depression (less than 12)
  • pinpoint pupils
45
Q

what is the treatment for morphine toxicity?

A
  • ventilatory support

- antagonist - naloxone (Narcan)

46
Q

what types of people require a lower dose of morphine?

A

children and elderly

47
Q

what is naloxone (Narcan) used for?

A
  • used for overdoses of narcotics
  • injected as IV push
  • given for respiratory depression
48
Q

before administering morphine, the nurse must…

A

check heart rate, respiration rate, and blood pressure

49
Q

what teaching is needed with a patient-controlled anesthesia pump?

A
  • know how to use and have it reachable
50
Q

what is the nurse’s role with a patient-controlled anesthesia pump?

A

check vital signs more frequently

51
Q

education needed for a pt discharge going home on a narcotic?

A
  • taper down dose at home
  • signs and symptoms of overdose
  • manage constipation with prescriptions of high fiber diet
52
Q

what is fentanyl?

A

an opioid 100 times more potent than morphine

53
Q

what are the routes for fentanyl?

A
  • intranasal
  • parenteral IM/IV sublimaze
  • transdermal (duragesic)
  • transmucosal (Actiq - narcotic on a lollipop)
54
Q

what is the most common form of fentanyl? what it used for?

A

transdermal (duragesic)

  • it is patch that manages baseline pain and takes hours to work
  • heat accelerates use
55
Q

what is meperidine (Demerol)?

A

a rarely used strong opioid agonist

- doesn’t work well in everyone (tends to be a genetic predisposition)

56
Q

what is methadone? what is an adverse effect?

A

a treatment pain and opioid addicts

  • prevents withdrawals
  • prolongs QT interval: risk for dysrhythmias
57
Q

what advocation is needed by nurses in relation to pain management?

A

nurses should advocate for different medications for their patients if the medication is not working

58
Q

what is the name of two moderate to strong opioid agonists?

A

codeine and oxycodone

59
Q

how are codeine and oxycodone similar to morphine?

A

produce analgesia and sedation

60
Q

how are codeine and oxycodone different from morphine?

A

produce less analgesia and less respiration depression

- a little bit lower risk for abuse

61
Q

what are the side effects of codeine and oxycodone?

A
  • respiration depression
  • constipation
  • urinary retention
  • cough suppression
62
Q

what is the antagonist for codeine and oxycodone?

A

Narcan

63
Q

what route is codeine given?

A

only PO

64
Q

what is the action of codeine?

A
  • 10% of the dose converts to morphine in the liver
  • mild to moderate pain and cough
  • lower dose helps cough suppression
65
Q

what drugs are combination drugs containing oxycodone?

A
  • percodan
  • percocet
  • combunox
66
Q

what is the immediate release form of oxycodone?

A

oxycodone

67
Q

what is the controlled release (long-acting) form of oxycodone?

A

OxyCotonin

68
Q

what are the side effects of oxycodone?

A
  • valvular heart injury
  • tissue necrosis
  • pulmonary granulomas
69
Q

what is hydrocodone used for?

A

used for pain and cough suppression

- often combined with nonopioid drugs

70
Q

what is one problem with hydrocodone?

A

wide spread abuse

71
Q

when should naloxone (Narcan) be administrated?

A

give immediately for decreased respirations to reverse opioid effects

72
Q

what are two nonopioid centrally acting analgesics?

A
  • tramadol

- clonidine

73
Q

what is the action of tramadol?

A

combination of opioid and nonopioid mechanisms

74
Q

what are the uses for tramadol?

A
  • pain

- restless leg syndrome

75
Q

what are the adverse effects of tramadol?

A
  • sedation
  • dizziness
  • dry mouth
  • constipation
76
Q

what drugs should not be taken with tramadol?

A
  • CNS depressants
  • no alcohol
  • no benzodiazepines
77
Q

what is the abuse like with tramadol?

A

relatively low, doesn’t cause euphoria

78
Q

what form does tramadol come in?

A

immediate and extended release

79
Q

what is the mechanism of action for clonidine?

A
  • decreased norepinephrine

- alpha 2 adrenergic agonist (blocks the nerve pathway)

80
Q

what are the two approved uses for clonidine?

A
  • used for pain in combination with opioid analgesics

- also used for hypertension (oral or patch)

81
Q

what are the adverse effects of clonidine?

A
  • severe hypotension
  • rebound hypertension
  • bradycardia
  • nightmares
  • psychodynamic effects
82
Q

when shouldn’t clonidine be used?

A

in hemodynamically unstable patients

83
Q

Clients diagnosed with chronic pain should be given what information regarding opioids’ effectiveness?

A

They should be given on a regular schedule, around the clock.

84
Q

What would occur if you stop the administration of an opioid antagonist in a client who is physically dependent on opioids?

A

withdrawal symptoms

Pharm Exam 3 (5 decks)

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