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Pharm > Pain Relief > Flashcards

Pain Relief Flashcards

1
Q

Examples of non-opioids:

A

— NSAIDS: ibuprofen, aspirin
— Acetaminophen (Tylenol)

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2
Q

What are risks with NSAIDS with children?

A

Aspirin: risk of Reye syndrome (neurological deficits)
— NSAIDS are approved for children 6+ mo.
* acetaminophen is the safest use for children

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3
Q

What is acetaminophen?
What is the max dose?

A

NOT AN NSAID
Max dose is 4g/day (4000mg/day)

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4
Q

What are the effects of cyclooxygenage-1? (Cox-1)
Do we want to block this enzyme pathway?

A

enzyme pathway for NSAIDS:
— promotes inflammation
— maintains renal function
— provides gastric mucosa integrity
— promotes vascular hemostasis
— assists in fever
* WE WANT TO BLOCK THIS PATHWAY = issues
* blocking this pathway leads to AE in our NSAIDS
AE:
— sodium retention
— edema
— HTN
— GI erosion
— bleeding

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5
Q

What are the effects of cyclooxygenage-2? (Cox-2)

A

— increase pain and inflammation
— vasodilation
— blocks platelet clumping
* pathway gets blocked resulting in AE

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6
Q

What are the indications of NSAIDS?
What is an NSAID?

A

— pain
— fever
— musculoskeletal disorders/inflammatory
Non-steroidal anti-inflammatory drug

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7
Q

What are the AE when taking NSAIDS?

A

— nausea
— vomiting
— gastritis
— epigastric pain
— peptic ulcers
— upper GI bleeding
* HARSH ON KIDNEYS
THINK RENAL

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8
Q

What are drug-drug interactions with NSAIDS?

A

— do not take other NSAIDS
— corticosteroids: hard on the stomach, GI problems
— anticoagulants: increased risk for bleeding
* NSAIDS help decrease clotting/inflammation

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9
Q

What is aspirin?

A

Risk for salicylate toxicity
Baby aspirin: 81 mg
Dark stools indicate upper GI bleeding

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10
Q

What is salicylate toxicity? Is it rare?

A

Yes, it is rare
— greater risk if taking 4g+/day
*monitor: tinnitus (ringing in ears); hearing loss

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11
Q

What is ibuprofen?

A

NSAIDS: toxic to the kidneys

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12
Q

What do you assess in your patients taking NSAIDS?

A

— baseline history + allergies
— focus on pain, fever, GI
— only monitor labs if bleeding + toxicity is expected

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13
Q

What are adjuvant drugs?

A

— often used for chronic pain
CAUTION: sedation
Examples:
— antidepressants
— anticonvulsants
— corticosteroids
— antihistamines
— sedatives
— benzodiazepines
— antispasmodics
— muscle relaxants

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14
Q

What is gabapentin?

A

Neuropathic pain
GABA = inhibitory neurotransmitter; slows brain activity (initially used for seizure disorders)

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15
Q

What is baclofen?

A
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16
Q

The nurse is reviewing a medication list for a client. The combination of which medications causes concern for the nurse?

A. Lispro and glargine
B. Loratadine and pseudoephedrine
C. Acetaminophen and aspirin
D. Ibuprofen and prednisone

A

D. Ibuprofen and prednisone

  • taking an NSAID with prednisone increases the risk of GI irritation, GI ulcers and GI bleeding.
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17
Q

What type of medications do you need to waste if not taken by the patient?

A

Opioids/narcotics
— oxy
— morphine
— fentanyl
* requires a witness

18
Q

What are opioids used for and what is the MOA?

A

Used for:
— mild to severe pain
— acute or chronic pain
— Antitussive effects
— adjuvant for anesthesia
MOA:
Interacts with opioid receptors to inhibit pain pathways in CNS

19
Q

What are AE with taking opioids?

A

Urgent:
— SEDATION
— RESP DEPRESSION
Common:
— constipation
— urinary retention
— nausea/vomiting
— hypotension
— itching
Less likely to occur:
— euphoria (abuse)
— hallucinations
— bradycardia

20
Q

What are opioid cautions?
What are contradictions?

A

Cautions:
— hypersensitivity
— opioid naive (someone that is not used to taking a lot of opioids)
— resp disease: asthma, COPD, PNA
— pregnancy: medication can cross placental barrier and affect baby
Contradictions:
— resp depression
— severe heart disease
— substance abuse

  • some patients will ask you to push IV opioids faster = be aware patient may be abusing or have hx of opioid abuse
21
Q

What are drug-drug interactions with opioid agonists?

A

CNS depressants — alcohol, sedatives, antipsychotics, skeletal muscle relaxants, benzodiazepines

  • start with low dose if opioid naive
  • discontinue gradually after long-term use to avoid withdraw
22
Q

Your patient is prescribed opioids, after administering you go in to check on your patient and witness less than 10 breaths/minute. What are the next steps?

A

— assess VS, apply O2 if low saturation
— hold next dose
— consider antidote/antagonist

23
Q

How will you manage constipation with your patient?

A

— plenty of fluids
— high fiber diet
— exercise
— stool softeners

24
Q

How will the nurse manage nausea and vomiting with their patient?

A

— take medication with food
— medication to relieve n/v

25
Q

How will the nurse manage itching with their patient?

A

— lotions, cool compresses
— medication to relieve itching: loratadine (Claritin)

26
Q

What are the least to most potent opioids?

A

LEAST POTENT
Codeine: PO
Oxycodone: PO
Morphine: PO, IV, SL
Fentanyl: IV, SL, transdermal
MOST POTENT

27
Q

What is important to know about PO opioid medications?

A

They are extended release - cannot crush or alter

28
Q

Why is it important to know the doses of NSAIDS and acetaminophen?

A

— reduce overdose
— combination PO opioids are combined with a non-opioid component
Ex: oxycodone + acetaminophen

29
Q

What is codeine?

A
30
Q

What is oxycodone?

A
31
Q

What is morphine?

A
32
Q

What is fentanyl?

A
33
Q

What is a PCA?
What are indications for PCA use and contraindications?

A

— allows patient some control of pain administration at need
— less sedation, less opioid consumptions, decrease post-op complication
*Indications:
— post-surgical pain
— trauma
— cancer pain
— sickle cell crisis
— burns
*Contraindications:
— cognitive problems
— hypoventilation syndromes
— extremes of age

34
Q

What is naloxone?

A
35
Q

The nurse would expect to administer morphine as the analgesia of choice for which clients? SATA

A. A client with severe post-op pain
B. A client with severe bronchitis
C. A client with cancer and severe bone pain
D. A client with chronic leg pain from peripheral neuropathy
E. A client with chronic pain unresponsive to NSAIDS and adjuvants

A

A. Severe post-op pain
C. Cancer and severe bone pain
E. Chronic pain unresponsive to other meds

36
Q

The nurse knows that constipation could be caused by which medication?

A. Gabapentin
B. Acetaminophen
C. Oxycodone
D. Ibuprofen

A

C. Oxycodone

37
Q

The nurse is caring for a client prescribed oxycodone and baclofen. The nurse should prioritize which assessment?

A. Bowel sounds
B. LOC
C. I&O
D. Range of motion

A

B. LOC
* combination of these drugs causes drowsiness; increased risk for falls

38
Q

What is the mistake with the following?
Oxycodone/acetaminophen 5mg/325mg. Take 2 tabs PO every 3 hours.

A

Every 6 hours
Exceeds 24-hour acetaminophen limit

39
Q

What is the mistake with the following?
Fentanyl 50mg. Administer via IVP q 2 hours PRN

A

Fentanyl should be mcg

40
Q

What is the mistake with the following?
Oxycodone 60mg ER. Administer tablet via PEG tube every 12 hours.

A

Extended release - cannot crush

41
Q

What is the mistake with the following?
Morphine 10mg. Administer via IVP 1 min every 3 hours PRN

A

Push slowly (4-5 min) to decrease damage to vein

Pharm (16 decks)

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