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NSG > Pharm #5 > Flashcards

Pharm #5 Flashcards

1
Q

Body’s Protective response to tissue injury and infection

A

Inflammation Patho

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2
Q

A vascular reaction occurs causing fluid, blood, leukocytes, and chemical mediators to accumulate at the injured site

A

Inflammation Patho

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3
Q

3 Chemical Mediators

A

Histamine, Kinins, and Prostaglandins

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4
Q

Not all inflammations caused by ___

A

illness

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5
Q

anti-inflammatory med goal is to-

A

decrease and inhibit mediators from occurring

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6
Q

Cardinal signs of inflammation

A

Erythema, Edema, Heat, Pain, Loss of function

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7
Q

Erythema-

A

Redness occurs in first phase of inflammation

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8
Q

Edema-

A

Swelling, 2nd phase of inflammation.
Plasma is leaking into the tissues at the site of injury

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9
Q

Heat-

A

resulting from increase blood at the site

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10
Q

Pain-

A

resulting from swelling and chemical mediators

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11
Q

Loss of function-

A

resulting from pain and swelling that occurs at the site.

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12
Q

Inflammatory phases

A

Vascular phase
Delayed phase

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13
Q

Occurs 10 to 15 minutes after injury

A

Vascular phase

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14
Q

Associated with vasodilation and increased capillary permeability

A

Vascular phase

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15
Q

Fluid and blood substances move to injured site

A

Vascular phase

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16
Q

Leukocytes infiltrate inflamed tissue

A

Delayed phase

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17
Q

Converts arachidonic acid into prostaglandins (causing vasodilation, papillary permeability, and sensation that causes pain)

A

Cyclooxygenase (COX) enzyme

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18
Q

Cyclooxygenase (COX) enzyme has two forms:

A

COX-1
COX-2

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19
Q

Protecting lining of the stomach and regulating platelets. Inducing clotting.

A

COX-1

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20
Q

Trigger inflammation and pain.

A

COX-2

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21
Q

Anti-inflammatory drug groups (4 major drug groups)

A

Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Disease-modifying antirheumatic drugs (DMARDS)
Antigout drugs

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22
Q

Inhibit COX enzyme which increases biosynthesis of prostaglandins- by inhibiting the enzyme it decreases pain.

A

Action of NSAIDs

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23
Q

Analgesic effect- Primary use is to relieve inflammation and pain

A

Action of NSAIDs

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24
Q

Antipyretic effect- can decrease fever

A

Action of NSAIDs

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25
Q

Inhibit platelet aggregation

A

Action of NSAIDs

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26
Q

Mimic effects of corticosteroids

A

Action of NSAIDs

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27
Q

Inhibit COX enzyme

A

Action of NSAIDs

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28
Q

First generation NSAIDS-

A

Aspirin- anticoagulant. Help prevent MI or stroke

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29
Q

Over the counter NSAIDS- ____
Other NSAIDs require prescription

A

aspirin, ibuprofen and naproxen

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30
Q

First-generation NSAIDs-

A

not selective.
When inhibit cox enzyme it inhibits 1 and 2.
Can cause GI upset and bleeding which is why it is required to be taken with food.

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31
Q

Second-generation NSAIDs-

A

not causing GI upset or bleeding.
Selective COX-2 inhibitors

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32
Q

Oldest anti-inflammatory drug. Goes back from 1899.

A

Aspirin (acetylsalicylic acid) (ASA)

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33
Q

Aspirin (acetylsalicylic acid) (ASA) action

A

Anti-inflammatory, antiplatelet, antipyretic effects

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34
Q

Aspirin (acetylsalicylic acid) (ASA) Therapeutic serum salicylate level

A

15 to 30 mg/dL

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35
Q

Aspirin (acetylsalicylic acid) (ASA) Toxic serum salicylate level Mild toxicity—

A

Greater than 30 mg/dL

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36
Q

Aspirin (acetylsalicylic acid) (ASA) Toxic serum salicylate level Severe toxicity—

A

Greater than 50 mg/dL

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37
Q

Inhibiting prostaglandins which decreasing inflammation.

A

Aspirin (acetylsalicylic acid) (ASA)

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38
Q

Inhibiting both cox 1- decreasing platelet aggregation, given with cardiac, causes.

A

Aspirin (acetylsalicylic acid) (ASA)

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39
Q

Downside- GI irritation,

A

Aspirin (acetylsalicylic acid) (ASA)

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40
Q

Upside- aspirin is a weak acid drug it will not cause as much GI upset as normal ibuprofen or cerebrovascular disorders to prevent clotting

A

Aspirin (acetylsalicylic acid) (ASA)

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41
Q

Prevents cox 2

A

Aspirin (acetylsalicylic acid) (ASA)

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42
Q

Gives 81 mg maintenance dose to prevent

A

Aspirin (acetylsalicylic acid) (ASA)

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43
Q

Decrease irritation- enteric coated

A

Aspirin (acetylsalicylic acid) (ASA)

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44
Q

Increased bleeding with anticoagulants and other NSAIDs

A

Salicylates drug interaction

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45
Q

Risk for hypoglycemia with oral antidiabetics (Metformin)

A

Salicylates drug interaction

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46
Q

Increased gastric ulcer risk with glucocorticoids

A

Salicylates drug interaction

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47
Q

Decreased effects of ACE inhibitors, loop diuretics, probenecid

A

Salicylates drug interaction

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48
Q

Salicylate (aspirin) effects are decreased by corticosteroids

A

Salicylates drug interaction

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49
Q

Increase PT, bleeding time, INR, uric acid

A

Salicylates Labs

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50
Q

Decrease cholesterol, T3 and T4 levels,

A

Salicylates Labs

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51
Q

Foods containing salicylates

A

Prunes, raisins, licorice
Certain spices such as curry and paprika

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52
Q

Do not take with other NSAIDs- it will increase risk for side effects

A

Aspirin Caution

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53
Q

Avoid during the last trimester of pregnancy- can cause premature closure of the ductus arteriosus (allows blood to bypass they lungs and closes right after birth)

A

Aspirin Caution

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54
Q

Do not give to children with flu or virus symptoms as it may lead to Reye syndrome- swelling of the liver and brain and can become fatal.

A

Aspirin Caution

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55
Q

Aspirin Side effects

A

Dizziness, drowsiness, headache, flushing, visual changes, tinnitus, hearing loss, GI distress, ulceration, bleeding, seizures, Reye syndrome
bronchospasm

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56
Q

Early signs of aspirin side effects

A

Dizziness, Tinnitus, Bronchospasm

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57
Q

Salicylates Assessment

A

Medical history- GI disorders, try not to increase risk for GI upset

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58
Q

Salicylates Nsg interventions

A

monitoring salicylate level.
Observe for s/sx of bleeding- dark tarry stools, bleeding gums, petechiae, ecchymosis and purpura

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59
Q

Do not to take aspirin with alcohol or other drugs that are highly protein bound specifically warfarin.

A

Salicylates Education

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60
Q

Tell dentist if they are on high doses of aspirin bc of increased bleeding, decrease risk of infection.

A

Salicylates Education

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61
Q

If someone has surgery they need to discontinued at least 7 days before.

A

Salicylates Education

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62
Q

If they have enteric coated aspirin it cannot be crushed- helps decrease breakdown in stomach.

A

Salicylates Education

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63
Q

Not administering this to children.

A

Salicylates Education

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64
Q

Talk to clients about taking aspirin for menstrual cycle.

A

Salicylates Education

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65
Q

Report changes is LOC, hearing, vision, potential side effect or toxicity at an early level

A

Salicylates Education

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66
Q

Para-Chlorobenzoic Acid Examples

A

Indomethacin, sulindac, tolmetin

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67
Q

First classification developed and can cause severe GI distress

A

Indomethacin

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68
Q

New drugs in classification, do have less adverse reactions.

A

Sulindac and Tolmetin

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69
Q

Para-Chlorobenzoic Acid Action

A

Inhibits prostaglandin synthesis

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70
Q

Para-Chlorobenzoic Acid Use

A

Rheumatoid arthritis, osteoarthritis, gouty arthritis

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71
Q

Para-Chlorobenzoic Acid Side effects/Adverse effects

A

Dizziness, headache, weakness
GI distress and bleeding
Sodium and water retention- increase in BP
Hypertension

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72
Q

Group of NSAIDS

A

Para-Chlorobenzoic Acid

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73
Q

First generation NSAIDs- cox 1 and 2 inhibitor

A

Para-Chlorobenzoic Acid

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74
Q

If Indomethacin does not work can switch to __

A

Sulindac and Tolmetin

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75
Q

Phenylacetic Acid Derivatives Examples

A

Ketorolac (Toradol)

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76
Q

Prototype drug.
Good analgesic effects.
Benefit vs opioid.
PO, intranasally, IM and, IV.
Similar side effects to NSAIDs- GI distress

A

Ketorolac (Toradol)

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77
Q

Phenylacetic Acid Derivatives Action

A

Inhibits prostaglandin synthesis

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78
Q

Phenylacetic Acid Derivatives Use

A

Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and pain
No antipyretic effect
Primary use is to relieve inflammation and pain

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79
Q

First generation NSAIDs

A

Phenylacetic Acid Derivatives

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80
Q

Reducing pain and inflammation in this drug

A

Phenylacetic Acid Derivatives

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81
Q

Often used for post op and post-partum pain

A

Phenylacetic Acid Derivatives

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82
Q

Short term pain reliever. Not longer than 5 day use

A

Phenylacetic Acid Derivatives

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83
Q

When used for postop or postpartum pain they are giving different NSAIDs such as ibuprofen

A

Phenylacetic Acid Derivatives

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84
Q

Phenylacetic Acid Derivatives Side effects/Adverse effects

A

Dizziness, drowsiness, Weakness, headache, GI distress, GI bleeding/perforation

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85
Q

Phenylacetic Acid Derivatives- Ketorolac

A

Is recommended for short-term management of pain

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86
Q

Propionic Acid Derivatives Examples

A

Ibuprofen (prototype and commonly used in the drug class) & Naproxen

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87
Q

Propionic Acid Derivatives Action

A

Inhibit prostaglandin synthesis

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88
Q

Propionic Acid Derivatives Use

A

Pain, osteoarthritis, rheumatoid arthritis

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89
Q

NSAIDs - New group

A

Propionic Acid Derivatives

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90
Q

Effects like aspirin but stronger and less GI irritability

A

Propionic Acid Derivatives

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91
Q

S/E similar to salysilates but less chance of GI distress and bleeding

A

Propionic Acid Derivatives

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92
Q

Give caution to give this with a blood disorder.

A

Propionic Acid Derivatives

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93
Q

Need to know drug history. ibuprofen and warfarin increases risks for bleeding

A

Propionic Acid Derivatives

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94
Q

Propionic Acid Derivatives Side effects

A

Drowsiness, dizziness, headache, confusion, Insomnia, dreams, blurred vision, tinnitus, gastric distress and bleeding, edema

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95
Q

Propionic Acid Derivatives Drug interactions

A

Increased bleeding with warfarin
Increased effects with phenytoin, sulfonamides, warfarin, cephalosporins
Hypoglycemia with oral hypoglycemics

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96
Q

Ibuprofen Assessment

A

Medical and drug history
Specific allergies to NSAIDs
Contraindicated with severe renal or liver disease and peptic ulcers. Caution with bleeding disorders.
S/E: GI distress and peripheral edema

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97
Q

Ibuprofen Nsg interventions

A

Monitor for bleeding, PT INR prolonged- removing NSAID.
Report if GI discomfort

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98
Q

Avoid alcohol, it will cause increase in GI distress.

A

Ibuprofen Education

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99
Q

Tell dentist about NSAIDs if taking frequently.

A

Ibuprofen Education

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100
Q

Menstruation- want females to avoid ibuprofen 1-2 days before menstruation.

A

Ibuprofen Education

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101
Q

To avoid increasing menstrual flow.

A

Ibuprofen Education

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102
Q

Should be avoided during pregnancy can cause congenital abnormalities and increase in bleeding at delivery.

A

Ibuprofen Education

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103
Q

For arthritis- it takes a few weeks for steady state to tx symptoms.

A

Ibuprofen Education

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104
Q

Take with food to decrease GI upset

A

Ibuprofen Education

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105
Q

Fenamates Examples

A

Meclofenamate sodium & mefenamic acid

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106
Q

Fenamates Action

A

Inhibits prostaglandin synthesis

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107
Q

Fenamates Use

A

Osteoarthritis, rheumatoid arthritis

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108
Q

Fenamates Side effects/Adverse effects

A

Dizziness, headache, tinnitus, pruritus
GI distress/bleeding, edema

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109
Q

First generation group most oftenly used to treat arthritis- cause GI distress

A

Fenamates

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110
Q

Oxicams Examples

A

Meloxicam

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111
Q

Oxicams Action

A

Inhibits prostaglandin synthesis

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112
Q

Oxicams Use

A

Osteoarthritis, rheumatoid arthritis

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113
Q

Oxicams Side effects/Adverse effects

A

Dizziness, headache
GI distress/bleeding, edema
Well-tolerated

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114
Q

Will or can cause GI distress but less severe

A

Oxicams

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115
Q

Has a long half life

A

Oxicams

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116
Q

Selective COX-2 Inhibitors Example

A

Celecoxib (Celebrex)

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117
Q

Selective COX-2 Inhibitors Action

A

Selectively inhibits COX-2 enzyme without inhibition of COX-1

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118
Q

Selective COX-2 Inhibitors Use

A

Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, pain, dysmenorrhea

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119
Q

Selective COX-2 Inhibitors S/E

A

Dizziness, headache, sinusitis
Peripheral edema, hypertension

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120
Q

2nd generation NSAIDs

A

Selective COX-2 Inhibitors

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121
Q

Most recently new to drugs

A

Selective COX-2 Inhibitors

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122
Q

Only one still left is Celebrex

A

Selective COX-2 Inhibitors

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123
Q

Drug interactions more common due to number of drugs taken

A

Selective COX-2 Inhibitors- NSAIDs in older adults

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124
Q

Greater incidence of GI distress, ulceration

A

Selective COX-2 Inhibitors- NSAIDs in older adults

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125
Q

Reduced dose decreases risk of side effects

A

Selective COX-2 Inhibitors- NSAIDs in older adults

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126
Q

Increase fluid intake for adequate hydration

A

Selective COX-2 Inhibitors- NSAIDs in older adults

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127
Q

Arthritis reason for older adults

A

Selective COX-2 Inhibitors- NSAIDs in older adults

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128
Q

Evaluate renal function bc can cause renal toxicity

A

Selective COX-2 Inhibitors- NSAIDs in older adults

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129
Q

Use the lowest most effective dose possible- go low start slow

A

Selective COX-2 Inhibitors- NSAIDs in older adults

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130
Q

NSAIDs- hepatotoxic

A

Selective COX-2 Inhibitors- NSAIDs in older adults

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131
Q

Corticosteroids examples

A

Prednisone, prednisolone, cortisone, methylprednisolone

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132
Q

Corticosteroids Action

A

Control inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site

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133
Q

Corticosteroids Use

A

Arthritic flare-ups
Not the drug of choice for arthritis because of their numerous side effects

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134
Q

Corticosteroids Discontinuation

A

Taper off over 5-10 days

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135
Q

Short term for arthritic flare ups

A

Corticosteroids

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136
Q

Avoiding long term use due to side effects- adrenal insufficiency, osteoporosis, infection, hyperglycaemia, fluid and electrolyte imbalance, growth delay in children and peptic ulcer disease.

A

Corticosteroids

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137
Q

Dose strength and duration is dependent on the pain

A

Corticosteroids

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138
Q

Disease-Modifying Antirheumatic Drugs Types

A

Immunosuppressive agents
Immunomodulators
Antimalarials

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139
Q

Disease-Modifying Antirheumatic Drugs Use

A

Refractory rheumatoid arthritis that does not respond to other tx- invasive way.
Osteoarthritis, ankylosing spondylitis
Psoriatic arthritis, severe psoriasis
Crohn disease, ulcerative colitis

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140
Q

DMARDs

A

Disease-Modifying Antirheumatic Drugs

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141
Q

Slow or stop inflammatory process associated with rheumatoid arthritis

A

Disease-Modifying Antirheumatic Drugs

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142
Q

Including drugs that suppress or regulate the immune system

A

Disease-Modifying Antirheumatic Drugs

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143
Q

Including antimalarial drugs

A

Disease-Modifying Antirheumatic Drugs

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144
Q

Disease-Modifying Antirheumatic Drugs Side effects

A

Infection, peripheral edema, hypertension, hypercholesterolemia, headache, fever, chills, insomnia, oral ulcerations, nasopharyngitis, Influenza, sinusitis, GI distress, fatigue, Injection site reaction, Increase risk for infection

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145
Q

Immunosuppressive Agents Example

A

Methotrexate

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146
Q

Immunosuppressive Agents Action

A

Suppress inflammatory process

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147
Q

Immunosuppressive Agents Use

A

Refractory rheumatoid arthritis that does not respond to other anti-inflammatory tx

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148
Q

First type of DMARDs used

A

Immunosuppressive Agents

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149
Q

Immunomodulators Classifications

A

Interleukin 1 (IL-1) receptor antagonists
Tumor necrosis factor (TNF) blockers

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150
Q

Immunomodulators Examples

A

Anakinra & infliximab (remicade)

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151
Q

(Interleukin 1 receptor antagonist)- sydopine that contributes to the inflammation in the synovial joint and destruction.
Antagonist blocks from occurring

A

Anakinra

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152
Q

TNF blocker tumor necrosis factor contributes to synovitis- inflammation of synovial joint. By blocking it, it blocks from occurring.

A

Infliximab (remicade)

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153
Q

Immunomodulators Action

A

Disrupt inflammatory process
Delay disease progression`
Neutralize TNF

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154
Q

Immunomodulators Use

A

Rheumatoid arthritis, psoriatic arthritis, psoriasis, spondylitis, ulcerative colitis, Crohn disease

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155
Q

Modulating

A

Immunomodulators

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156
Q

Disrupting inflammatory process and delaying progression of the inflammatory disease

A

Immunomodulators

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157
Q

Risk for infection

A

Immunomodulators

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158
Q

Need to have a negative TB test

A

Immunomodulators

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159
Q

Monitoring for early S/sx of infection

A

Immunomodulators

160
Q

Monitoring for neutropenia, blood dyscrepancies

A

Immunomodulators

161
Q

Monitoring liver and renal functions

A

Immunomodulators

162
Q

Antimalarials Examples

A

Hydroxychloroquine

163
Q

Antimalarials Action

A

Unclear
Effect may take 4 to 12 weeks to become apparent

164
Q

Antimalarials Use

A

Refractory rheumatoid arthritis When other tx are not effective

165
Q

Combing these with nsaid to be effective.

A

Antimalarials

166
Q

Inflammatory disease of joints, tendons, and other tissues

A

Gout pathophysiology

167
Q

Usually occurs in great (Big) toe

A

Gout pathophysiology

168
Q

Defect in purine metabolism leads to uric acid accumulation due to ineffectiveness of purines in someone’s body and insufficient extretion of them

A

Gout pathophysiology

169
Q

Foods containing Purine should be avoided-

A

organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer)

170
Q

Effects feet/toes

171
Q

When taking antigout meds-

A

Educating about increasing fluid intake to help excretion of med and uric acid that is being broken up into the body.
Helps prevent getting renal calculi.

172
Q

Antigout Drugs

A

Colchicine, Uric acid inhibitors, Uricosurics

173
Q

Colchicine Action

A

Inhibits migration of leukocytes to inflamed site
Alleviates gout symptoms

174
Q

Colchicine Side effects

A

GI distress (nausea, vomiting, diarrhea, abdominal pain)
Taken with food to avoid GI distress

175
Q

Colchicine Contraindications

A

Severe renal, cardiac, or GI problems

176
Q

Decreases inflammation associated with gout

A

Colchicine

177
Q

Used to treat an acute gout attack not to prevent

A

Colchicine

178
Q

Uric acid inhibitors Examples

A

Allopurinol (common) & febuxostat-prototype for this class

179
Q

Uric acid inhibitors Action

A

Decreases uric acid synthesis- lowering uric acid serum levels
Prevents gout attacks- prophylactically

180
Q

Uric acid inhibitors Side effects

A

Dizziness, headache, GI distress
GI bleeding/perforation
Arthralgia, fatigue
Bradycardia, peripheral neuropathy

181
Q

Not to be used for an acute attack

A

Uric acid inhibitors

182
Q

Should be used w caution for someone with decreased renal function

A

Uric acid inhibitors

183
Q

Allopurinol Assessment

A

Main labs- renal function labs. Serum uric acid levels.
If meds are effective.
Hx: kidney stone or renal calculi.
Record and monitor urine output.

184
Q

Allopurinol Nsg Interventions

A

Reporting changes in urine output, monitoring intake and output, monitoring labs

185
Q

Allopurinol Education

A

Need to have yearly eye exam.
Meds can decrease visual activity.
Prolonged use can cause decrease in vision
Increase fluid intake, eliminate or avoid caffeine and alcohol intake bc it can increase uric acid levels.
Vitamin C can cause kidney stone when taken with alopurinol.
List of food vitamin C reduce or eliminate from diet.

186
Q

Uricosurics Action

A

Blocks reabsorption of uric acid which promotes its excretion

187
Q

Uricosurics Example

A

Probenecid

188
Q

Uricosurics Side effects

A

Flushed skin, fever
Dizziness, headache
GI distress, kidney stones(uric acid does not get excreted)

189
Q

Increasing the excretion of uric acid

A

Uricosurics

190
Q

Used for preventing a gout attack

A

Uricosurics

191
Q

Can be taken with colchicine

A

Uricosurics

192
Q

A 35-year-old woman diagnosed with rheumatoid arthritis has been prescribed infliximab. The nurse identifies infliximab as which type of medication?

A

Immunomodulator

193
Q

The nurse identifies Infliximab as useful in the treatment of rheumatoid arthritis as well as

A

Crohn disease.

194
Q

A patient has been advised to take ibuprofen. When teaching the patient about ibuprofen, which instruction should the nurse include? (Select all that apply.)

A

Avoid taking aspirin with ibuprofen.
Take with food to reduce GI upset.
Monitor for bleeding gums, nosebleeds, black tarry stools.

195
Q

An older adult patient takes tolmetin for arthritis pain. Which statement made by the patient is of most concern to the nurse?

A

“My stomach aches and burns.” (GI upset)

196
Q

A 65-year-old man has been diagnosed with chronic gout. The nurse anticipates that the patient will be treated with

A

allopurinol.

197
Q

Level of stimulus needed to create painful sensation (differs)

A

Pain threshold

198
Q

Affected by genetic makeup.

A

Pain threshold

199
Q

May have different pain receptors with different sensitivities

A

Pain threshold

200
Q

Amount of pain able to endure without interfering with normal functioning

A

Pain tolerance

201
Q

Analgesics to relieve pain

A

Opioid and Nonopioid

202
Q

Opioid-

A

moderate to severe pain- narcotics

203
Q

Nonopioid-

A

mild to moderate pain

204
Q

Reliving pain, subjective and objective pain-

A

Everybody’s pain tolerance is different.

205
Q

Open-minded about pain towards

206
Q

5th vital sign-

207
Q

Assess pain, manage pain and document

A

pain and interventions

208
Q

0-10 scale typical or

A

faces scale

209
Q

Sudden onset
Short duration (<3 months)

A

Acute pain

210
Q

Gradual onset
Prolonged duration (>3 months) Ex: arthritis

A

Chronic pain

211
Q

Results from injury to tissues

A

Nociceptor pain

212
Q

Results from injury to peripheral or central nervous system

A

Neuropathic pain- nerve

213
Q

Pain Classified by duration-

A

frequent, constant, sudden

214
Q

Pain Classified by origin-

A

nociceptor or neuropathic

215
Q

Tissue injury activates nociceptors (pain receptors) in the periphery

A

Gate control theory

216
Q

Causes release of chemical mediators (Histamine, Kinins, and Prostaglandins)

A

Gate control theory

217
Q

Mediators transmit pain signal along sensory nerve—sensitize pain receptors

A

Gate control theory

218
Q

Pain signals begin in periphery—move to CNS

A

Gate control theory

219
Q

Endorphins- Endogenous

A

Body naturally producing and
Naturally suppress pain conduction

220
Q

Controlling pain sensation by blocking the signal that occurs.

A

Dependent on where it is address the pain

221
Q

Opioids working on same receptors on endorphins to reduce pain-

A

exogenous pain control, opioids

222
Q

Acute pain definition

A

Occurs suddenly, short duration, responds to treatment

223
Q

Acute pain treatment

A

Mild: Nonopioid drugs
Mod: Combo
Severe: Potent opioids

224
Q

Chronic pain definition

A

Pain persists for > 3 months, difficult to control

225
Q

Chronic pain treatment

A

Nonopioids suggested first
Opioids should meet criteria*

226
Q

Cancer pain definition

A

Pain occurs from pressure on organs and nerves, blocked blood flow, or metastasis to bone

227
Q

Cancer pain treatment

A

NSAIDS and opioids may be given by any route

228
Q

Somatic pain definition

A

Pain in skeletal muscle, ligaments, and joints

229
Q

Somatic pain treatment

A

Nonopioids: NSAIDs and muscle relaxants

230
Q

Superficial pain definition

A

Pain from surface – skin or mucous membranes

231
Q

Superficial pain treatment

A

Mild: Nonopioids
Mod: combo

232
Q

Vascular pain definition

A

Pain occurs from vascular tissues – headaches or migraines

233
Q

Vascular pain Treatment

A

Non-opioids

234
Q

Visceral pain definition

A

Pain is from smooth muscle and organs

235
Q

Visceral pain treatment

236
Q

Drug Criteria-

A

Route: Orally or Transdermally?
Durations of action- Long or short?
Minimal respiratory depression

237
Q

____ is a major issue in health car

A

Undertreatment of pain

238
Q

Reasons for under-treatment-

A

not acknowledging pain
fear of addiction
nsg provider not assessing pain correctly or not offering pain meds, nurses not believing reports of pain, negative attitude of HC team against opioid use

239
Q

Effects of unrelieved pain-

A

Increase RR, BP, Pulse, Stress response (hyperglycemia) increase in stress hormones, urinary retention, constipation, atelecesis and pneumonia, confusion, extended hospital stays, remissions, increased outpatient visits.

240
Q

Balance between of underdosing and overdosing

A

Undertreatment of Pain

241
Q

Bias vs actual issue

A

Undertreatment of Pain

242
Q

__ of people in client population still have untreated pain

243
Q

Adds 200 billion dollars a year to HC costs just in pain relief alone

A

Undertreatment of Pain

244
Q

Nonopioid Analgesics use

A

Mild to moderate pain

245
Q

Dull, throbbing pain

A

Nonopioid Analgesics effective for

246
Q

Headaches, dysmenorrhea, minor abrasions

A

Nonopioid Analgesics effective for

247
Q

Inflammation, muscular aches, pain

A

Nonopioid Analgesics effective for

248
Q

Mild to moderate arthritis

A

Nonopioid Analgesics effective for

248
Q

Nonopioid Analgesics action site

A

Peripheral nervous system at pain receptor sites

249
Q

Nonopioid Analgesics Examples

A

Acetaminophen, ibuprofen, aspirin, naproxen

250
Q

Less potent than opioids

A

Nonopioid Analgesics

251
Q

Antipyretic effect- reducing body temp

A

Nonopioid Analgesics

252
Q

OTC NSAIDS available:

A

Aspirin
Ibuprofen
Naproxen

253
Q

NSAIDs action

A

Analgesic
Antipyretic
Anti-inflammatory effects

254
Q

prostaglandin synthesis- production of what signals body pain is present

255
Q

Aspirin—Nonopioid Analgesic Action

A

Inhibits biosynthesis of prostaglandins
Inhibits COX-1 & COX-2 (non-selective)

256
Q

Aspirin—Nonopioid Analgesic Use

A

Drug of choice for pain and arthritic inflammation
Analgesic, antipyretic, anti-inflammatory
Decreases platelet aggregation

257
Q

First generation NSAID-

258
Q

Bleeding concern

259
Q

High doses for pain= GI irritation, lead to gastric ulcers

259
Q

Aspirin – Nonopioid Analgesic S/E/adverse reactions

A

GI distress
Excess bleeding due to decrease platelet aggrigation
Tinnitus(Common), vertigo, bronchospasm, possible metabolic acidosis, hyperventilation
Reye’s syndrome- do not give to children

260
Q

Aspirin Therapeutic serum level:

A

15-30mg/dL

261
Q

Take with food and/or full glass of water to help reduce GI upset
Applies to all NSAIDs

262
Q

Avoid beginning of female menstrual cycle bc of increased bleeding

263
Q

Acetaminophen—Nonopioid Analgesic action

A

Inhibits prostaglandin synthesis

264
Q

Acetaminophen—Nonopioid Analgesic Uses

A

Muscular aches and pain
Fever

265
Q

Acetaminophen—Nonopioid Analgesic Maximum dose

A

4g/day if taken infrequently
3g/day if taken frequently
2g/day for heavy drinkers

265
Q

Acetaminophen—Nonopioid Analgesic Drug interactions

A

Caffeine- increased effect
Common ingredient in OTC combo meds- educate to pay attention for daily usage.

266
Q

Acetaminophen—Nonopioid Analgesic Therapeutic Range

A

10-20 mcg/mL

267
Q

Not an NSAID
Not an anti-inflammatory

A

Acetaminophen

268
Q

1-3 hrs half life- can take every 4-6 hrs

A

Acetaminophen

269
Q

Hepatotoxic- increase consumption of alcohol, liver failure risk

A

Acetaminophen

270
Q

Headache pain- ephedrine- acetaminophen, caffeine, and aspirin

A

Acetaminophen

271
Q

Safest OTC analgesic for children.

A

Acetaminophen

272
Q

Monitor for pts taking prolonged time and renal function due to excretion

A

Acetaminophen

273
Q

Acetaminophen S/E

A

Rash, headache, insomnia
Low incidence of GI distress

274
Q

Acetaminophen Toxic effects/excess dosing

A

Hepatotoxicity(Liver function) if over use, renal failure
Thrombocytopenia
Hemolytic anemia
Agranulocytosis
Leukopenia, neutropenia

275
Q

Acetaminophen Antidote

A

Acetylcysteine- smells and tastes like rotten eggs given inhalation, iv or oral. Orally dilute with flavored drink or coke to minimize bad taste.

276
Q

Acetaminophen- Assessment

A

Monitor liver function, need baseline. Med and drug history, assessing severity of the pain. Ongoing pain assessments with documentation. Monitor liver enzymes and serum acetaminophen levels

277
Q

Acetaminophen Nursing Interventions

A

teach parents to keep med out of reach and do not overdose.

278
Q

Acetaminophen Education-

A

Direct parents to contat poision control if overdosed and if does not know how much they took. Adults should not self medicate for longer than 10 days consistently. If still requiring pain relief they must be presquibed. For children not be on longer than 5 days.

279
Q

Opioid Analgesics examples

A

Morphine (prototype drug), hydromorphone (Dilaudid), codeine, hydrocodone, meperidine (Demerol), oxycodone, fentanyl, methadone

280
Q

Opioid Analgesics uses

A

Moderate to severe pain
Many have antidiarrheal effects
Some used to help relieve cough

281
Q

Opioid Analgesics action

A

Act on the CNS to
Suppress pain impulses
Suppress respirations and coughing
Activating MEU receptors, effects resp and cough areas in the brain, suppressing respirations and cough

282
Q

All opioids are controlled substances bc likelihood of abuse, dependence, respiratory depression, worried about physical and psychological dependents of the medication.

A

Opioid Analgesics

283
Q

Can cause euphoria which leads to development of tolerance.

A

Opioid Analgesics

284
Q

Decreased analgesic effect and decreased euphoria-tolerance

A

Opioid Analgesics

284
Q

Opioid Analgesics Contraindications

A

Head injury- decreased respirations therefore causes CO2 to increase then causing intercranial pressure increase. And increased sedation. Assessing mental status.
Hypotension – use with caution

284
Q

Off label uses- coughs (codeine), over use of opioids (constipation)- antidiarrheal effect

A

Opioid Analgesics

285
Q

Opioid Analgesics Drug Interactions

A

St. John’s Wort- cause decreased effectiveness or morphine
Kava kava- for sleeping/decreased anxiety. Worried about oversedation (overdosing)
Valerian
All Causes increased sedation

286
Q

Morphine: side effects/adverse reactions

A

Drowsiness, dizziness, euphoria
Confusion, depression, miosis, blurred vision
GI distress, flatulence, constipation
Orthostatic hypotension, weakness
Urinary retention, pruritis(common) but does not indicating allergy to it
Psychological dependence
Respiratory depression

287
Q

Monitor for respiratory depression. 12-20

288
Q

Antidote- Narcan (Naloxone)

A

Morphine (opioids)

289
Q

Morphine Assessment-

A

assessing vital signs frequently and closely monitoring them(low BP and RR). If post op and BP is 90/60 no morphine for pain. Assessing vital signs related to pain- is effective.

290
Q

Morphine Nursing Interventions-

A

Older adult population- extremely high pain tolerances, watching vital signs. assessing bowel sounds and bowel movements (obstruction, constipation)- prophylactic tx- stool softener, fluids movement. pupils, urine output-S/E of urinary retention. Administer pain meds before peak pain level. Naloxone/Narcan available when pt on opioids should have standing order. Always double IV doses and prescriber orders related to morphine, hydromorphone and fentyl must give in small doses. Use safety precautions bc risk for falls (dizziness, drowsiness)- remind to call for help

291
Q

Morphine Education-

A

taking at home to avoid other cns depressants- alcohol can cause increase in sedation d rsp dep. Possibility of requiring substance use disorder. Identify symptoms early to relay to provider. Orthostatic hypotension- let feel touch the floor before getting out of bed. Increase fiber and fluids to decrease constipation

291
Q

Meperidine (Demerol) Uses

A

Primarily effective for GI procedures and pain
Generally, not given for more than 2-3 days
Preferred to morphine during pregnancy/Labor&Delivery

292
Q

Meperidine (Demerol) S/E/Adverse effects

A

Less constipation and urinary retention than morphine
Can cause neurotoxicity, especially in older adults- more sensitive. Looking at nervousness, agitation, irritability, tremors, and seizures- indicative of neurotoxicity.

293
Q

Less respiratory depression occurrence in newborns

A

Meperidine (Demerol)

294
Q

Hydromorphone (Dilaudid) Use

A

Analgesic effect is approximately 6 times more potent than morphine

295
Q

Hydromorphone (Dilaudid) Side effects/adverse effects

A

Drowsiness, dizziness, confusion, orthostatic hypotension, weakness
Constipation, but causes less GI distress than morphine
Urinary retention
Tolerance, dependence can easily occur
Miosis, respiratory depression(cardinal signs of toxicity)

296
Q

More potent than morphine
Fast onset and short duration
Do not give to pt w hypotension

A

Hydromorphone (Dilaudid)

297
Q

Fast onset and short duration

A

Hydromorphone (Dilaudid)

298
Q

Do not give to pt w hypotension

A

Hydromorphone (Dilaudid)

299
Q

Patient-Controlled Analgesia (PCA)- Medications used

A

Morphine most often used
Also – fentanyl, hydromorphone, & meperidine

300
Q

Loading dose-

A

basal dose, nurse set PRN limits

301
Q

Predetermined safety limits by providers orders

A

Patient-Controlled Analgesia (PCA)

302
Q

Lockout mechanism- once maximum limit is reaches it locks out

A

Patient-Controlled Analgesia (PCA)

303
Q

Help provide Near-constant analgesic level- therapeutic level

A

Patient-Controlled Analgesia (PCA)

304
Q

IV analgesics set up with a pump with a time set system

A

Patient-Controlled Analgesia (PCA)

305
Q

Only the pt must push the button to administer self not significant other pushing just bc they think

A

they are in pain

306
Q

Pediatric pt the parent should not activate the pump while the child is sleeping. If the pt is pediatric they can help administer that with

A

proper education.

307
Q

Most common- fentynol, hydromorphone, and merperidine
On the pump it shows how many times they press, how much given. Controlled substance log.

A

Patient-Controlled Analgesia (PCA)

308
Q

Helpful for chronic pain

A

Transdermal Opioid Analgesics

309
Q

Provide continuous pain control

A

Transdermal Opioid Analgesics

310
Q

Fentanyl is most commonly used (Use gloves)

A

Transdermal Opioid Analgesics

310
Q

More potent than morphine
Available in various strengths

310
Q

Not good for acute or post operative pain

A

Transdermal Opioid Analgesics

311
Q

Can be used for cancer pain, chronic back pain, and developed tolerance to other opioid meds orally

A

Transdermal Opioid Analgesics

311
Q

Can be used for breakthrough pain management, may already have a patch and need additional PRN meds.

A

Transdermal Opioid Analgesics

312
Q

Has different way of communication.
Crying, holding, guarding- different pain scales and document what pain scale used.

A

Analgesics in Children

313
Q

Older adults- decreased hepatic and renal function so decrease doses of analgesics.

A

Analgesics in older adults

314
Q

Polypharmacy- causes increased risk for adverse reactions.

A

Analgesics in older adults

314
Q

Pain is under reported.

A

Analgesics in older adults

314
Q

Observe for pain closelt-facial grimincing, guarding, refusing to do something.

A

Analgesics in older adults

315
Q

dementia, hearing loss, vision loss-can’t understand and report effectively.

A

Analgesics in Cognitively impaired individuals

316
Q

Oriented or not oriented.

A

Analgesics in Cognitively impaired individuals

317
Q

Watch for physical signs of pain-faces scale.

A

Analgesics in Cognitively impaired individuals

318
Q

Caregivers w/ them may know normal (ask questions).

A

Analgesics in Cognitively impaired individuals

319
Q

dosages may need to be adjusted until the pain is controlled or risk vs benefit side effects become worse than the pain.

A

Analgesics in Oncology patients

320
Q

High dosages.

A

Analgesics in Oncology patients

321
Q

Less concerned about addiction and dependence as long as managing pain.

A

Analgesics in Oncology patients

321
Q

Thorough pain assessment.

A

Analgesics in Individuals with substance abuse history

321
Q

Address pain issue but can still get opioids. .

A

Analgesics in Individuals with substance abuse history

322
Q

May need higher dose.

A

Analgesics in Individuals with substance abuse history

323
Q

Use different than fentanyl if they used it before

A

Analgesics in Individuals with substance abuse history

324
Q

Ask about past drugs used

A

Analgesics in Individuals with substance abuse history

325
Q

Adjuvant Analgesics

A

Anticonvulsants
Antidepressants- TCAs
Corticosteroids
Antidysrhythmics
Local anesthetics

326
Q

Gabapentin-neropathy pain (decreases excitability of the nerve stimulant, blocking nerve transmission, decreasing neuropathic pain.
Prevents migraine headaches.

A

Anticonvulsants

327
Q

Amitriptyline- Helps with peripheral neuropathy used in lower dosages than in depression. Lots of side effects. Thorough med and drug history. Inhibiting reuptake of serotonin and norepinephrine.

A

Antidepressants- TCAs

328
Q

Reducing nociceptor stimuli. Inflammation

A

Corticosteroids

329
Q
  • Mexiletine, blocks sodium channels to reduce pain
A

Antidysrhythmics

330
Q

Lidocaine- patches are used to provide analgesic effect by interrupting the transmission of pain signals to the brain. Numbs surface placed on.

A

Local anesthetics

331
Q

Developed for other purpose than pain relief

A

Adjuvant Therapies

332
Q

May potentiate action of pain meds and can be used along side of them to allow for decreased use of opioid dosages. Less dosages of both drugs

A

Adjuvant Therapies

333
Q

Opioid Agonist-Antagonists Examples

A

Nalbuphine (Nubain), Buprenorphine, & Butorphanol

334
Q

Most often use for pts w hx of opioid abuse bc of lower potential for abuse bc causes less receptor activation than full agonists.- less intense analgesic effects.

A

Buprenorphine

335
Q

Opioid Agonist-Antagonists Uses

A

Moderate to severe pain
Decrease likelihood of substance abuse disorder

336
Q

Opioid Agonist-Antagonists Action

A

Agonists at kappa pain receptors
Antagonists at mu pain receptors

337
Q

Opioid Agonist-Antagonists Side effects/adverse effects

A

Constipation, urinary retention
Less Respiratory depression than regular opioids
Hallucinations or unusual dreams

337
Q

Psychiatric concerns- avoid this med

A

Opioid Agonist-Antagonists

338
Q

Nalbuphine hydrochloride- Assessment

A

Assess vital sings, pain. Watch for changes significant o vital signs, bowel sounds, urinary output.

339
Q

Nalbuphine hydrochloride- Nsg interventions

A

Administering IV undiluted.

340
Q

Nalbuphine hydrochloride- Education

A

avoid alcohol and other CNS depressant to decrease risk of adverse reaction or S/E

341
Q

Opioid Antagonists example

A

Naloxone (Narcan)- most commonly used OA

342
Q

Opioid Antagonists action

A

Blocks receptors and displaces opioids

343
Q

Opioid Antagonists Reverses effects of opioids

344
Q

Opioid Antagonists uses

A

Antidote for opioid toxicity and overdose

345
Q

Opioid Antagonists Side effects/Adverse effects

A

Sweating, flushing, agitation, dyspnea
Hypo/hypertension, tachycardia- extreme pain, (vital signs)
Nausea, vomiting
Elevated PTT, bleeding
Reversal of analgesia

346
Q

Monitor vital signs and bleeding

A

Opioid Antagonists

347
Q

Figure out if the med is effective when everything is reversed- figureout alternative method to reduce rebound pain

A

Opioid Antagonists

348
Q

Migraine Headaches Characteristics

A

Unilateral throbbing pain
Nausea, vomiting
Photophobia
Last hours to days
Occurs more in women
Can be preceded by an aura

349
Q

Migraine Headaches Triggers

A

Cheese, chocolate, red wine, aspartame, MSG
Fatigue, stress, missed meals
Odors, light
Hormonal changes
Drugs, weather
Too much or too little sleep

350
Q

Migraine Headaches Pathophysiology Theory

A

Due to neurovascular events in cerebral cortex

351
Q

Reason for analgesics

A

Migraine Headaches

352
Q

Due to neurovascular events in cerebrovascular

A

Migraine Headaches

353
Q

Keep notebook/log to list symptoms and diet for day/experienced

A

Migraine Headaches

354
Q

Cluster Headaches Characteristics

A

Severe unilateral non-throbbing pain
Usually located around eye
Occur in a series of cluster attacks
One or more attacks every day for several weeks
Not associated with an aura
Do not cause nausea and vomiting
More common in males

355
Q

Migraine and Cluster Headaches Prevention

A

Avoid triggers
Prevent by Beta-adrenergic blockers
Anticonvulsants
Tricyclic antidepressants

356
Q

Propranolol
Atenolol (risk Nonselective, asthma)

A

Prevent by Beta-adrenergic blockers

357
Q

Valproic acid
Gabapentin

A

Anticonvulsants

358
Q

Keep log for diet/symptoms

A

Migraine and Cluster Headaches

359
Q

Amitriptyline
Imipramine

A

Tricyclic antidepressants

360
Q

Avoid triggers to those attacks

A

Migraine and Cluster Headaches

361
Q

Migraine and Cluster Headaches management

A

Analgesics
Opioid analgesics
Ergot alkaloids
Selective serotonin1 receptor agonists

362
Q

Aspirin with caffeine, acetaminophen (Excedrin)
NSAIDs: ibuprofen, naproxen

A

Analgesics

363
Q

Meperidine, butorphanol nasal spray-opioid agonist antagonist

A

Opioid analgesics

364
Q

Dihydroergotamine mesylate (Migranal)- tx migranes and cluster headaches

A

Ergot alkaloids

364
Q

constricting the blood vessels to the brain. Prevents inflammation and blocks sensation

A

Selective serotonin1 receptor agonists

364
Q

Sumatriptan (Imitrex)-prodotype for migrances and clusterheadaches, zolmitriptan

A

Selective serotonin1 receptor agonists

364
Q

Most migraine combo Meds-

365
Q

Sumatriptan (Imitrex) use

A

Treats migraine and cluster headaches

366
Q

Sumatriptan (Imitrex) action

A

Causes vasoconstriction of cranial arteries

367
Q

Sumatriptan (Imitrex) Side effects/adverse effects

A

Dizziness, drowsiness, flushing, fatigue
Dysgeusia- altered taste, nausea, vomiting
Paresthesia, seizures
Hypertension, dysrhythmias, thromboembolism, MI, stroke
Suicidal ideation

368
Q

Sumatriptan (Imitrex) Drug Interactions

A

Dihydroergotamine or other ergot alkaloids- can cause vasoconstriction to bp to be dangerously high level. Wait full 24 hours before taking it

369
Q

Sumatriptan (Imitrex) med class

370
Q

Contraindication, Hypertension- can cause stroke

A

Sumatriptan (Imitrex)

371
Q

Monitoring BP and educate monitory bp at home

A

Sumatriptan (Imitrex)

372
Q

Causes increase risk of blood clots

A

Sumatriptan (Imitrex)

373
Q

For the patient taking acetaminophen regularly, what should the nurse do? (Select all that apply)

A

Monitor routine liver enzyme tests
Encourage the patient to check packaging labels of other OTC meds
Report side effects immediately; toxicity can cause severe hepatic damage

374
Q

A patient’s pain medication is changed from morphine sulfate to hydromorphone. Which statement regarding hydromorphone does the nurse identify as being true?

A

Hydromorphone is more potent than morphine.

375
Q

The nurse assesses a patient receiving morphine via a PCA pump. The patient has a respiratory rate of 6 breaths/min. The nurse anticipates administration of which of the following drugs?

376
Q

The nurse identifies which of the following as a common side effect/adverse effect of morphine therapy?

377
Q

A patient received morphine sulfate for severe pain. The nurse assesses the patient 20 minutes later. What is the best indication that the medication has been effective?

A

Patient verbalizes pain relief.

NSG (13 decks)

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