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Pharm Mastery > Pain Management > Flashcards

Pain Management Flashcards

1
Q

What are 6 major adverse effects of NSAIDs ?

A

G.I discomfort ( abdominal pain, heartburn, dyspepsia, and nausea)

G.I Bleed ( dark colored stool, hematemesis, )

Renal dysfunction: NSAIDs are nephrotoxic( increase BUN & Creatinine, decrease urine output and weight gain)

Salicysm: from taking aspirin.
S/S : THD SR
: tinnitus ( ear ringing); Headache, Dizziness, Sweating; Respiratory Alkalosis

Reye syndrome

Aspirin toxicity

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2
Q

What causes Reye syndrome and who is at risk?

A

Reye syndrome is cause by giving aspirin to children who have a viral illness such as chickenpox or flu.

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3
Q

What are s/ s of aspirin toxicity ?

A

Sweating, hyperthermia( fever), respiratory depression, respiratory acidosis, dehydration

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4
Q

What are two major classes that you should avoid giving NSAIDs with and why?

A

Warfarin & Stetoids because they both increase the risk for bleeding?

  • check PT & INR!!! & report s/s of bleeding.
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5
Q

How should patient take NSAIDs to decrease G.I discomfort ?

A

With food, fluids or milk to prevent G. I discomfort.

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6
Q

Why Nsaids discontinued before surgery and when should it be discontinued?

A

NSAIDs just like warfarin increased the risk for bleeding during surgery. NSAIDs should be discontinued 1 week before surgery.

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7
Q

What is the 1 major adverse effect of acetaminophen and how can it be prevented?

Hint: dose!!!!

A

Liver toxicity( abdominal pain, jaundice, N/VD) It can be prevented by not drinking alcohol with acetaminophen and not to exceed the dose greater than 4g/ day.

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8
Q

What is the antidote for acetaminophen?

A

Acetylceistine ( mucomyst)

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9
Q

What one drug interacts with acetaminophen and how?

A

Warfarin. Acetaminophen slow the metabolism of warfarin and increased the risk of bleeding

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10
Q

What are two major nonopiod classes?

A

Acetaminophen ( Tylenol)

NSAIDS.

  • aspirin
  • keterolac
  • ibuprofen( Motrin/ Advil)
  • Celecoxib (Celebrex )
  • Naproxen
  • indomerhacin ( Indocin)
  • Diclofenac
  • Meloxicam
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11
Q

What are the Opiod agonist?

A 
Morphine
Fentanyl (sublimaze )
Oxycodone
Hydromorphone 
Meperidine( Demerol)
Methadone( Dolophine)
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12
Q

Opioids are indicated for what kind of pain?

A

Moderate to severe pain such as post-operative pain, cancer pain, and myocardial infarction

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13
Q

What are adverse effects of Opiod agonist? What are some intervention for each ?

A

Respiratory depression:

  • assess for 12 RP/ min
  • have Narcan & Oxygen available

Constipation

  • increase fiber and fluid
  • administer laxative & stool softeners
  • give methylnaltrexone for people with constipation not reverse with laxative

Urinary Retention

  • encourage patient to void every 4 hrs
  • monitor I&O
Cough suppression ( oxycodone)
- encourage cough

Sedation
- avoid driving cars at night / hazard activities

Biliary colic
- do not give morphine to patients with biliary tract disease/ surgery

Nausea/ vomiting
- give antiemetics

Pinpoint pupils

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14
Q

What is a major adverse effect of Meperidine ( Demerol) ?

A

Seizures !!! Due to repeated doses or renal failure.

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15
Q

How should morphine be given IV

A

Morphine is given IV push slowly over 4-5 min. With Narcan and oxygen available.

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16
Q

How should Opiod agonist be discontinued for people with physical dependence & why?

A

Opiod agonist should be tapered slowly over 3 days to prevent abstinence syndrome

17
Q

What are s/ S of abstinence syndrome ?

A

Cramping, fever, vomiting, anxiety, and hypertension.

18
Q

What are the 4 Opiod agonist & antoginst ? What are their advantages over Opiod agonist?

A

Butorphanol( stadol)
Nalbuphine ( Nubain)
Buprenorphine ( buprenex)
Pentazocine( talwin)

They cause less addiction & adverse effects

19
Q

What are the main side effects of opioid- agonist / antagonist?

A

Abstinence withdrawal symptom: / pt. should discontinue opiod agonist before taking them

Headache

Respiratory depression

Sedation

Dizziness

20
Q

What the are the 3 opiod antagonist ?

A

Narcan
Naltrexone
Methylnaltrexone

21
Q

What is the specific indication for methylnaltrexone?

A

To reverse constipation that are caused opiod but can not relieved with laxatives etc.

22
Q

How should morphine be administered to cancer patients?

A

On a fixed schedule

Ex: every 3-4hrs instead of PRN

23
Q

How long does it take for Fentanyl patch to take action? When should it be replaced or changed

A

Up to 24hrs to take therapeutic effects.

Changed every 72hrs ( 3dys)

24
Q

Adverse effects of opiod antagonist?

A

Tachycardia, tachyapnea, abstinence withdrawal syndrome

Pharm Mastery (5 decks)

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