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Pharm II (Exam1) (48, 49, 50) > Pharm II (Exam 1) (48, 49, 50) > Flashcards

Pharm II (Exam 1) (48, 49, 50) Flashcards

1
Q

What is the name of the system in the CNS that relieves pain by suppressing the transmission of pain signals from the peripheral nerves?

A

The endogenous analgesia system.

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2
Q

What is the action of pure opioid agonists?

A

Relieves pain by binding to receptors in the brain, spinal cord, and peripheral tissues.
Blocks and reduces pain transmission.

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3
Q

What do pure opioid agonists treat?

A 
Prevent or relieve acute or chronic pain 
Acute mycardial infarction 
Biliary colic 
Renal colic 
Burns 
Traumatic injuries 
Postoperative states 
Cancer
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4
Q

What are some side effects of pure opioid agonists?

A

N/V
Constipation
Decreased respiratory function
Pupil constriction

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5
Q

Contraindications of pure opioid agonists?

A 
Pregnancy
Respiratory depression
Liver/Kidney disease
Prostatic hypertrophy 
Increased cranial pressure 
Head injury 
Seizure disorders
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6
Q

Nursing interventions for pure opioid agonists?

A

Pain management
Preventing Drug-drug interactions
Assessing for Adverse effects
Respiratory status

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7
Q

Patient education for pure opioid agonists?

A 
No alcohol
No smoking
No driving
Only take as perscribed 
Sit or lie down at least 30 - 60 minutes after receiving an opioid by injection
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8
Q

Examples of pure opioid agonists?

A 
Morphine Sulfate (MS Contin, Roxanol)
Codeine
Fentanyl
Tramadol (ultram) 
Hydromorphone (Dilaudid) 
Meperdine (Demerol) 
Methodone (Dolophine) 
Oxycodone (Oxycontin, Roxicodone)
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9
Q

What is the action of Opioid Antagonists?

A

Reverses the analgesia and the CNS and respiratory depression caused by agonists. (antidote)
Prevents agonists from binding to sites, competes with opioids.

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10
Q

What are opioid antagonists used for?

A

Used for the treatment of respiratory depression caused by an overdose of opioids.

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11
Q

What are the side effects of opioid antagonists?

A 
HTN 
Tremors
Sweating 
Decreased respiratory function 
N/V
Drowsiness
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12
Q

Contraindications of opioid antagonists?

A

Narcotic abusers
Pregnancy
Respiratory depression

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13
Q

Nursing interventions for opioid antagonists?

A

Monitor pulse and respiration’s

Assess the patient for a therapeutic response

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14
Q

What are some examples of opioid antagonists?

A

Naloxone (Narcan)

Naltrexone (Depade, Revia)

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15
Q

Patient education for opioid antagonists?

A

May cause drowsiness

Inform patient that after taking this medication for a period of time, that it may cause withdraw.

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16
Q

What is the action of opioid agonists/antagonists?

A

Sedative effect
1/3 the potency of morphine
Weakly antagonizes the analgesic effect of morphone and meperidine.
Causes respiratory, cardiac, and behavioral depression.

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17
Q

What are opioid agonists/antagonists used for?

A

Pain management

Used during all phases of surgery

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18
Q

What are some side effects of opioid agonists/antagonists?

A

Risk of dependency

Respiratory depression

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19
Q

Contraindications of opioid agonists/antagonists?

A

Pregnancy/breastfeeding

Patients with or having problems associated with hypothyroidism, bowel issues, and hypertrophied prostate

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20
Q

Nursing interventions for opioid agnoists/antagonists?

A

No alcohol
Frequent vital checks (B/P & RR)
Assess pain levels

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21
Q

Patient education for opioid agonists/antagonists?

A

Do not stop taking the medication abruptly
No driving
May cause drowsiness/dizziness
Notify health care provider if pain is getting worse

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22
Q

Examples of opioid agonists/antagonists?

A

Butorphanol (stadol)

Nalbuphine (nubain)

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23
Q

What is the action of amides?

A

Diminishes pain by blocking nerve conduction
Decreases neuronal membrane permeability to Na+
Depolarization inhibitor
Inhibits the depolarization and blocks nerve conduction

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24
Q

What are amides used for ?

A

Relieving pain
Used as a local anesthesia
Numbs the area

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25
Q

What are some side effects of amides?

A 
Analgesia 
Numbness 
Metallic taste 
Tinnitus 
Agitation
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26
Q

Contraindications of amides?

A 
Hypersensitivity 
Trauma
Sepsis 
Blood dyscrasias  
Cardiac abnormalities
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27
Q

Nursing interventions for amides?

A

Monitor for signs and symptoms of any adverse side effects
Apply to affected area topically
Use nebulizer following dilution in NS/sterile H2O

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28
Q

Patient education for amides?

A

Report any adverse side effects
Remove pain patch before applying a new one
Do not eat or drink after oral intake of lidocaine for at least 60 minutes.

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29
Q

Examples of amides?

A

“canie” drugs

Lidocaine (anestacon, dilocaine, L-caine, lidoderm, Lidoject-1, LidoPen, Xylocaine)

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30
Q

What is the action of esters?

A

Decreases the influx of sodium into the nerve cell and depresses depolarization to prevent conduction of the nerve impulse.

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31
Q

What are esters used for?

A

Early onset anesthetic (2-5 mins; lasts about an hour)

Pain reliever

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32
Q

What does LAST stand for?

A

Local anesthetic systemic toxicity

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33
Q

When does LAST occur?

A

Occurs when the local anesthetic is absorbed systemically, resulting in extreme CNS excitation followed by cardiovascular excitation and cardiovascular collapse.

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34
Q

What are some side effects of esters?

A 
LAST
Analgesia 
Circumoral numbness
 Metallic taste
Tinnitus
Agitation
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35
Q

Contraindications of esters?

A 
Hypersensitivity 
Inflammation 
Sepsis 
Meningitis 
Abdominal pressure 
Impaired cardiac function
36
Q

Nursing interventions for esters?

A

Assess the patient for a therapeutic response

Assess the skin for any redness, itching, hives or rash

37
Q

Patient education for esters?

A

Do not eat or drink anything until the numbness disappears
Report any signs of a rash, hives, redness or feelings of anxiety to health care provider
Do not walk/ambulate without assistance

38
Q

Examples of esters?

A

Procaine hydrochloride (Novacaine)

39
Q

What is the action of neuromuscular blocking agents?

A

Suspends nerve impulses at the neuromuscular junction

Can be titrated to produce weakness through complete paralysis

40
Q

What are neuromuscular blocking agents used for?

A

Used to help relax skeletal muscles

Used along-side other inhalation IV agents

41
Q

What are some side effetcs of neuromuscular blocking agents?

A

Anaphylaxis

Mild dermatological issues (urticaria & erythema)

42
Q

Contraindications of neuromuscular blocking agents?

A

Hypersensitivity

Allergy to vecuronium or non-depolarizing neuromuscular blocking agents

43
Q

Nursing interventions for neuromuscular blocking agents?

A

Maintenance of patients airway and respiratory function

ABC’s!

44
Q

Patient education for neuromuscular blocking agents?

A

No smoking
No alcohol
No supplements 2 weeks prior to surgery

45
Q

What are some examples of neuromuscular blocking agents?

A

“ium” drugs
Vecuronium (Norcuron)
Attacurium (Tracrium)
Cisatacurim (Nimbex)

46
Q

What is the action of inhalation anesthetics?

A

Blocks the perception of pain

The exact mechanism of action has not yet been established

47
Q

What are inhalation anesthetics used for ?

A

General anesthesia

Can be used in combination with other agents to produce a balanced anesthesia

48
Q

What are some side effects of inhalation anesthetics?

A

Respiratory depression
Circulatory depression
Airway irritation
Bronchospasm

49
Q

Contraindications for inhalation anesthetics?

A

FH of malignant hyperthermia

A disease process associated with a serious disease

50
Q

What is TIVA?

A

Total intravenous anesthesia

51
Q

TIVA replaces:

A

The inhalation agent with a less emetic and nonmalignant hyperthermia triggering IV anesthetic for the induction and maintenance of anesthesia.

52
Q

Nursing interventions for inhalation anesthetics?

A

Check B/P post-op
Check/monitor vitals frequently
Monitor O2 stat
Provide comfort for the patient (warm blanket)

53
Q

Patient education for inhalation anesthetics?

A

No smoking
No alcohol
No supplements 2 weeks prior to surgery

54
Q

Examples of inhalation anesthetics?

A 
"flurane" drugs 
Isoflurane (Forane) 
Desflurane (Suprane) 
Enflurance (Ethrane) 
Sevoflurane (Ultane)
55
Q

What is the action of IV anesthetics?

A

Produces amnesia, euphoria, and hypnosis

Blocks pain perception

56
Q

What are IV anesthetics used for?

A

General anesthesia
Used for asthma patients (bronchodilator)
Is also used for patients with COPD and pulmonary disease

57
Q

What are some side effects of IV anesthetics?

A

Pain, burning, stinging sensation at the site (emulsion formula)
Hiccups
Myoclonic movements

58
Q

Contraindications for IV anesthetics?

A

Lipid metabolism
Pancreatitis
Allergy to sulfates
Allergic to soybean, soy products, eggs, or egg products

59
Q

Nursing interventions for IV anesthetics?

A

Prevent drug-drug interactions
Assess for adverse side effects
Monitor VS and O2 stat

60
Q

Patient education for IV anesthetics?

A

Explain the recovery phase
May have burning, stinging, or pain sensation at site
No smoking

61
Q

Examples of IV anesthetics?

A 
Propofol (Diprivan) 
Ketamine (Ketalar) 
Fospropofol (Lusedra) 
Etomidate (Amidate) 
Methohexital (Brevital)
62
Q

What is the benzodiazepine antagonist?

A

Flumazenil (Romazicon)

63
Q

What is the action of benzodiazepines?

A

Enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.

64
Q

Why has the FDA issued a black box warning for Midazolam (Versed)

A

Because of the profound respiratory depression that may result in hypoxia, brain damage, or death.

65
Q

What are benzodiazepines used for?

A

Short term sedation
Temporary CNS depression
Regional anesthetic

66
Q

What are some side effects associated with benzodiazepines?

A

Respiratory depression
Apnea
At increased doses –> hypnosis

67
Q

Contraindications for benzodiazepines?

A

Pregnancy –> increases the risk of cogential defects and CNS depression in the baby
Pulmonary disease

68
Q

Nursing interventions for benzodiazepines?

A

Monitor vitals
Assess LOC frequently during sedation
Assess LOC 2-6 hours post-sedation

69
Q

Patient education for benzodiazepines?

A

No alcohol
Know your limits
Educate patient regarding dependency of benzos

70
Q

Example of a benzodiazepine?

A

Midazolam (Versed)

71
Q

Adjuvant medications used in general anesthesia?

A

Midazolam (Versed)

Fentanyl (Sublimaze)

72
Q

What is acute pain?

A

Results from injury trauma, spasm, disease processes, and treatment or diagnostic procedures that damage body tissues.
(Sharp or cutting)

73
Q

What is somatic pain?

A

Results from stimulation of nociceptiors in the skin, bone, muscle, and soft tissue.
(Sharp, burning, gnawing, throbbing, or cramping)

74
Q

What is an example of chronic somatic pain?

A

The bone and joint pain of arthritis

75
Q

What is an example of acute somatic pain?

A

A sprain or other traumatic injury

76
Q

What is visceral pain?

A

Results when nociceptors are stimulated in abdominal or thoracic organs and their surrounding tissues.
(Deep, dull, aching, or cramping)

77
Q

What are some examples of visceral associated pain?

A

Cholecystitis, panceratitis, uterine disorders, and liver disease.

78
Q

What is neuropathic pain?

A

Caused by lesions or physiologic changes that injure peripheral pain receptors, nerves, or the CNS; it is the excessive excitability in the damaged area or surrounding normal tissues, so that nerve cells discharge more easily.
(Severe, shooting, burning, or stabbing)

79
Q

What are some examples of neuropathic associated pain?

A

Diabetes mellitus (diabetic neuropathy)
Herpes zoster infections (postherpetic neuralgia)
Traumatic nerve injuries
Cancer or some cancer treatments

80
Q

Monoamine oxidase inhibitors (MAO) should not be taken with Morphine Sulfate, why?

A

Increases the risk of HTN, respiratory depression, or coma; should not be taken within 14 days or each other

81
Q

What are the 4 elements associated with general anesthesia?

A

Amnesia
Analgesia
Hyposis
Muscle relaxation

82
Q

What are the 3 phases of general anesthesia?

A

Induction–> rendering the patient unconscious
Maintenance –> administering a continuous level of anesthetic
Emergence –> stopping anesthetic to allow patient to wake up

83
Q

Local anesthetic agents may be _______, _______, or ________.

A

Topical, spinal, or epidural

84
Q

Lidocaine is classified as a ______ _______ ________?

A

Local amide anesthetic

85
Q

Procain is classified as a _______ _______ ________?

A

Ester local anesthetic

Pharm II (Exam1) (48, 49, 50) (1 decks)

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