Pharm Exam 1

Question 1

Opioid

Answer 1

general term used for the opium- derived or synthetic analgesics used to treat moderate to severe pain
(schedule II under Controlled Substances Act)

Question 2

What do Opioids do?

Answer 2

1. do not change tissues where pain originates
2. change client’s perception of pain
3. treat pain centrally in the brain

Question 3

Natural Opioids

Answer 3

1. morphine sulfate (gold standard), 2. codeine, 3. opium alkaloids, 4. tincture of opium

Question 4

Synthetic Opioids

Answer 4

1. methadone, 2. levorphanol, 3. remifentanil, 4. meperidine

Question 5

Opioids Actions on Receptors

Answer 5

mu: morphine-like supraspinal analgesia, respiratory and physical depression, miosis, reduced GI motility
delta: dysphoria, pscyhotomimetic effects, respiratory and vasomotor stimulations caused by drugs with antagonist activity
kappa: sedation and miosis

Question 6

Agonist

Answer 6

drugs that bind well to a receptor

Question 7

Partial agonist

Answer 7

drugs that bind to a receptor, but response is limited

Question 8

Agonist-antagonist

Answer 8

drugs that have properties of both the agonist and antagonist

Question 9

Opioid Agonist Uses

Answer 9

moderate to severe acute and chronic pain, opiate dependence, decrease anxiety, adjunct to anesthesia, labor/delivery process analgesia, epidurally/intrathecally relieve pain for extended time, MI pain, severe diarrhea, persistent cough

Question 10

Opioid Agonist Adverse Reactions

Answer 10

CNS: weakness, euphoria, headache, dizziness, miosis, insomnia, agitation, tremor, increased intracranial pressure ( impairment of mental and physical tasks)
cough suppression*

Respiratory: depression of rate and depth of breathing**

Gastrointestinal: N/V, dry mouth, biliary tract spasms CONSTIPATION*, anorexia

Cardiovascular: facial flushing, tachycardia, bradycardia, palpitations, peripheral circulatory collapse *orthostatic hypotenstion

Genitourinary: retention* or hesitancy, spasms of ureters and bladder sphincter

Allergic Rxs/Other: sweating, urticaria, pruitus, pain at injection site, local tissue irritation, rash

Question 11

GI Motility and Opioids

Answer 11

GI system NEVER adapts for secondary effects of opioids, slow GI motility and constipation are always a problem
Ensure increase of fiber/fluid, physical activity, and laxative/stool softener

Question 12

Opioid Contraindications

Answer 12

allergy, acute bronchial asthma, emphysema, (respiratory depression), head injury/increased intracranial pressure, convulsive disorders, severe renal/hepatic dysfunction, acute ulcerative colitis

Question 13

Opioid Precautions

Answer 13

older adults (start with lower dose), opioid naiive, biliary surgery, pregnancy category B and C, extreme obesity (prolonged adverse rxns), abdominal pain, BPH, supraventricular tachycardia

Question 14

Opioid Interactions

Answer 14

alclohol, antihistamines, antidepressants, sedatives, phenothiazines (CNS depression)
opioid agonist-antagonist (opioid withdrawal)
Barbiturates (respiratory depression)

Question 15

Opioid Special Considerations

Answer 15

obtain BP, HR, RR, pain
pain can be taken 5-10 minutes after IV med, 20-30 after IM med, 30 after oral med
notify primary health care provider if analgesic is not effective
Opioid- naiive: respiratory depression risk
antidiarrheal: note bowel movements or blood in stool

Question 16

Opioid- Transdermal

Answer 16

only one patch at a time, only clean with water before applying patch, date/time patch, fold sticky sides together for disposal, remove old patch after 72 hours, press for 10-20 sections upon application **heat can increase the absorption of drug

Question 17

Opioid- Epidural

Answer 17

small amount of opioid analgesic is injected into epidural space by bolus or continuous infusion pump, fewer systemic adverse reactions, lower dose administered, greater client comfort
Uses: post- op pain, labor pain, intractable chronic pain
Monitor** respiratory depression, sedation, nausea, confusion, urinary retention, have resuscitation equipment nearby

Question 18

Opioids- Acute Pain

Answer 18

PCA: client can self-administer, nurses set the ordered time interval (or lockout interval) between doses
opioid and non-opioid combination
Severe acute pain: sufentanil
Severe pain that is acute or chronic: hydrocodone

Question 19

Opioids-Chronic Pain

Answer 19

Morphine sulfate most widely used
available PO, nasally, IM, IV, rectally, SQ
Given around the clock not PRN (8-12 hours)
Do not chew, crush, break oral is preferred if pt. can swallow
When on long-acting, fast- acting can be given for breakthrough pain
Transdermal (fentanyl) route effective with cancer pain
Use cautiously in elderly, not be used in opioid naiives, adverse rxns

Question 20

Opioid Agonist- Antagonists

Answer 20

Prototypes: butorphanol and buprenorphine
acts as antagonist on either mu or kappa opioid receptor and as an agonist on the other opioid receptor
Special considerations: lower potential for abuse, causes little euphoria, less respiratory depression, less analgesic effect
Therapeutic Uses: relief of moderate to severe pain, treatment of opioid dependence (buprenorphine), adjunct to anesthesia, relief of labor pain

Question 21

Tolerance vs. Dependence

Answer 21

Tolerance: client takes opioid analgesic over time and body physically adapts to drug; greater amounts are needed to achieve same effects

Dependence: client experiences adverse effects if medication is stopped

*respiratory depression not usually a concern for long-term opioid therapy but monitor GI system and have bowel program

Question 22

Opioid Antagonists

Answer 22

Antagonist: greater affinity for opiate receptor than the opioid drug (agonist), competes for receptor
Prevents or reverses all effects; pain will return almost immediately
If no opioid in system, antagonist has no drug effect

Question 23

Opioid Antagonist Uses

Answer 23

Naloxone, post- op acute respiratory depression, opioid adverse effects, suspected acute opioid overdosage, others can be used to treat clients addicted to opiates

Question 24

Opioid Antagonist Contraindicatons, Precautions, Interactions

Answer 24

Contraindicated: allergy
Precaution: pregnancy (B), infants of opioid-dependent mothers, clients with opioid dependency or cardiovascular disease
Interacts with Opioids: may produce withdrawal symptoms in clients physically dependent on drug
may prevent action or intended use of opioid antidiarrheals, antitussives, and analgesics

Question 25

Opioid Antagonist Special Considerations

Answer 25

document and assess HR, BP, RR
monitor vital signs every 5-15 minutes after client is responsive, look for ventricular tachycardia
continue monitoring for up to. 2 hours
a repeat dose of naloxone may be ordered if opioid seems to have longer effect (half-life can exceed naloxones)

Question 26

withdrawal

Answer 26

physiological manifestations that occur when the concentration of the substance declines in bloodstream

Question 27

Abstinence Syndrome

Answer 27

occurs when client abruptly withdrawals from a substance to which they are physically dependent

Question 28

Common substances abused

Answer 28

alcohol, caffeine, opioids, cannabis, hallucinogens, inhalants, sedative/hypnotics, stimulants, tobacco

Question 29

Withdrawal/ abstinence from opioids

Answer 29

symptoms can occur within 1 hour to several days after last intake
symptoms: agitation, insomnia, flu-like manifestations, rhinorrhea, yawning, sweating, piloerection, abdominal cramping, diarrhea
suicidal ideation can occur

Question 30

Opioid Withdrawal Treatment

Answer 30

Methadone substitution: opioid agonist, replaces opioid client is dependent on, must be administered at approved center

Clonidine: Assists with withdrawal effects like diarrhea, N/V, can cause dry mouth, does not reduce craving

Buprenorphine: agonist-antagonist, considered safer than methadone ( decreased risk of resp. depression)

Question 31

Alcohol Withdrawal

Answer 31

symptoms last 4-12 hours after last intake and can continue 5-7 days

Manifestations: N/V, tremors, restlessness, tachycardia, seizures

Delirium can occur 2-3 days after last intake, medical emergency (psychotic manifestations, severe hypertension, cardiac dysrhythmias)

Question 32

Alcohol Withdrawal Tx

Answer 32

Benzodiazepines: (diazepam, lorazepam/Ativan)
benzo. antidote: flumazenil
Adjunct Meds: carbamazepine, decreased seizure risk,
Clonidine: decrease BP, decrease HR
Propanolol, atenolol: decrease BP, decrease HR, decrease craving

Question 33

Alcohol Abstinence Maintenance

Answer 33

Disulfiram (Antabuse): causes individual to become sick from upsurge of acetaldehyde which is toxic (blocks conversion of acetaldehyde to acetic acid)

**Acetaldehyde syndrome when used with alcohol
can lead to respiratory depression, cardiovascular supression, seizures, and death

Avoid any product with alocohol including mouthwash

Medication effects persist for TWO weeks following discontinuation

Question 34

Alcohol Abstinence Maintenance

Answer 34

Naltrexone: opioid antagonist that suppresses craving and pleasurable effects of alcohol
must abstain from alcohol prior to starting med
no opioid dependency
take w/ meals
Can be given orally daily or monthly IM (VIVITROL)

Question 35

Nicotine Withdrawal/Abstinence

Answer 35

Abstinence syndrome evidenced by irritability, nervousness, restlessness, insomnia, and difficulty concentrating

Bupropion (Wellbutrin): decreases cravings, increased risk for seizures, can cause dry mouth and insomnia

Nicotine Replacement Therapy: lozanges, gum, patches, nasal spray, inhalers
avoid while pregnant and breastfeeding