Pharm quiz 1 - 2

Question 1

acute pain is how long?

Answer 1

up to 6 months

Question 2

Nociceptive pain is caused by

Answer 2

stimulation of peripheral nerve fibers that respond only to
stimuli approaching or exceeding harmful
intensity (nociceptors) and may be classified
according to the mode of noxious stimulation; (chili peppers, etc)

Question 3

neuropathic pain results from

Answer 3

any nerve that is NOT functioning. lesions or diseases affecting the somatosensory system or a nerve

Question 4

 Common Causes of Neuropathic Pain

Answer 4

🞑 HIV
🞑 Diabetes
🞑 Alcoholism
🞑 Chemotherapy
🞑 Multiple Sclerosis
🞑 Shingles
🞑 Amputation

Question 5

visceral pain, Like somatic pain, nociceptors

Answer 5

send signals to the spinal cord and brain when damage is detected. Unlike somatic pain, however, visceral pain is harder to pinpoint

Question 6

Sometimes described as

Answer 6

generalized aching or squeezing. It is caused by compression in & around the organs, or by stretching of the
abdominal cavity

Question 7

visceral pain examples

Answer 7

🞑 Endometriosis
🞑 Irritable bowel syndrome
🞑 Bladder pain (cystitis)
🞑 Prostate pain
🞑 Fibroids

Question 8

pain assessment (ABCDE)

Answer 8

 Ask about pain- “What bought you to the Hospital?”
 Believe the patient and family
 Choose appropriate options for management
 Deliver timely and coordinated interventions
 Empower patients to control options

Question 9

who pain scale

Answer 9

 Pain Description
 “Mild pain” - 1 to 3
 “Moderate pain” - 4 to 6
 “Severe pain” 7 to 10

Question 10

 Opioid

Answer 10

• Inclusive term– means “opiate like”, includes endogenous opioid-peptides, synthetic or semi-synthetic which have actions similar to those of morphine

Question 11

morphine

Answer 11

Action
🞑 OpioidAgonist Analgesic
🞑 Mimics endogenous opioid peptides producing analgesia, euphoria& sedation
🞑 Binds to the same receptor sites as opioid peptides (natural enkephalins & endorphins)
🞑 Modulates pain perception in the brain and spinal cord
 Use
🞑 Analgesia, pain relief
🞑 Anxiety reduction
🞑 Sedation, drowsiness
🞑 Sense of well being (*unlabeled use: MI pain relief)
**(Morphine Sulfate Extended release)

Question 12

morphine precautions and adverse effects

Answer 12

🞑 Respiratory suppression ***** ABC
 Monitor in COPD, Asthma, obesity and sleep apnea
🞑 Pregnancy or labor
 Decreased uterine contraction, fetal depression
🞑 Head Injury
 Elevates ICP (intercranial)
 Adverse Effects
🞑 Opioid induced constipation (OIC)
🞑 Orthostatic hypotension
🞑 Urinary retention
🞑 Cough suppression (post-oppneumonia risk)

Question 13

morphine nursing considerations

Answer 13

🞑 In pill / capsule form (ER/SR) do not crush, chew
before administering
🞑 Make sure that a patient is observed for at least 24
hours in fully equipped and staffed environment
if morphine is given by epidural or intrathecal
route
🞑 IV Push:Have pt lie down, dilute & push slowly to
minimize effects
🞑 Reassure pt’s that they are unlikely to become addicted
when using opiates for medical purposes

Question 14

morphine precautions and interactions

Answer 14

🞑 Biliary Colic ? (spasms of the common bile duct)
🞑 Nausea and Vomiting
🞑 Miosis–pupil excessive constriction
🞑 Neurotoxicity (agitation, delirium, hallucinations, increased pain)
 Drug Interactions
🞑 CNS depressants will intensify adverse effects
 Alcohol, barbiturates, benzodiazepines
🞑 Antihypertensives exaggerate orthostatic hypotension
🞑 MAOI’s (tx Depression) may cause seizures and death
 Antidote – naloxone – (Narcan®)

Question 15

Meperidine (Demerol®) - think Sz

Answer 15

Meperidine (Demerol®) - think Sz
 Actions
🞑 Opioid Analgesic
🞑 May provide local anesthetic effects
 Use
🞑 Drug induced rigors
🞑 Post anesthesia shivering
🞑 Alternative to other opioid

Question 16

demerol precautions and adverse effects

Answer 16

Precautions
🞑 Vistaril (antihistamine) combowill intensify effect of Demerol®
🞑 Short ½ life
🞑 Normeperidine metabolite is toxic
🞑 NTE> 600mg / 24 hours for over 2 days
 Adverse Effects
🞑 Toxic seizures
🞑 Blockade of Serotonin reuptake (mood hormone neurotransmitter)

Question 17

demerol interactions and nursing considerations

Answer 17

Drug Interactions
🞑 Others: MAOI combo can cause excessive activationof
serotonin receptors causing excitation, delirium,
hyperthermia, seizures, coma & death
 Nursing Considerations
🞑 Less respiratory depression, constipation and vomiting
as compared to morphine
 Pregnancy Category B

Question 18

difference btwen merperidine and morphinea

Answer 18

Meperidine is less apt to release histamine or to
increase biliary tract pressure
 Meperidine has a shorter duration of action
 Meperidine has poor oral bioavailability
 Meperidine is metabolized in the liver to
normeperidine, a CNS neurotoxin, that is especially
dangerous to children and older adults

Question 19

naloxone precautions and adverse effects

Answer 19

Precautions!
🞑 Give IV, IM, Sub-Q (PO has rapid first pass effect)
However, PO form is used in addiction
treatment at 50 mg/day
🞑 Administered in the absence of opioids has no effect
🞑 Given prior to opioids will block opioid action
🞑 Administered during opioid use will reverse effects
🞑 Given to physically dependent opioid patients will cause an immediate acute withdrawal effect
 Adverse Effects
🞑 Pain, loss of analgesia
🞑 Increased respiratory rate
🞑 Restlessness, anxiety

Question 20

naloxone drug interactions and nursing considerations

Answer 20

Drug Interactions
◦ Cannabinoids:may cause enhancedcannabinoid effect(mechanism
unknown)
◦ All opiate combo’s(Vicodin®, Percocet®, etc.)
◦ Yohimbe:May result inadditive therapeutic or adverse effects (additive
effect)
⦁ Nursing Considerations
◦ Monitor the patient continuously after useof naloxone, repeat dosesmaybe
needed
◦ Maintainan open airway and be prepared to provide artificial ventilation
and cardiac supportif needed to counteractthe opioid overdose
 Pregnancy Category: C

Question 21

vicodin actions and use

Answer 21

Actions
🞑 Opioid combo
 Use
🞑 Produces analgesia and antipyretic effects, hydrocodone binds to various opioid receptors producing analgesia and sedation

Question 22

vicodin precautions and adverse effects

Answer 22

Precautions
🞑 Cr at baseline for renal disease,
adjust as needed (Bun 7-20, Cr 0.84-1.21)
🞑 LFT’s if severe hepatic disease(ALT 7-55u/L, AST 8-33u/L)
 Adverse Effects
🞑 Respiratory depression
🞑 Hepatotoxicity
🞑 Dependency, Abuse

Question 23

vicodin drug interactions and nursing considerations

Answer 23

🞑 Inhibitors: Amiodarone (cardiovascular drug)
🞑 Inducers: barbiturates, tegretol
 Nursing Considerations
🞑 Avoid abrupt cessation to prevent withdrawal sx
🞑 Name confusion: Hycodan®, Percodan®,
Hydro/ codone combos etc.
 Pregnancy Category: C

Question 24

methadone actions and use

Answer 24

Actions
🞑 Opioid Analgesic
🞑 Action similar to morphine
 Use
🞑 Relieve severe or chronic pain
🞑 Methadone Maintenance
 Treat opioid addicts, substitute methadone for the opioid
 Withdrawal is accomplished by administering methadone
gradually in smaller doses

Question 25

methadone use and precautions

Answer 25

🞑 Methadone suppression: Prevents opioid induced
euphoria, by giving addicts larger doses of methadone
(>100 mg/day) pt will develop tolerance to other
opioids. Taking street drugs will not produce same
euphoric effects.
 Precautions
🞑 Severe dysrhythmias, prolongs the QT interval, V-fib
🞑 Respiratory suppression

Question 26

methadone adverse effects and pregnancy

Answer 26

Adverse Effects
🞑 Severe dysrhythmias, prolongs QT interval, V-Fib
 DrugInteractions
🞑 Inhibitors: sertraline, rifampin
🞑 Inducers: tegretol, phenobarb, phenytoin, barbiturate anesthetics
🞑 Caution with many HIV ARV’s ( antiretroviral )
 NursingConsiderations
🞑 ChestPain-> EKG
🞑 Patient should be in a medication program*
 Pregnancy Category: C

Question 27

issues affecting pain management

Answer 27

 Tolerance
🞑 A larger dose of medication is required to produce the
same effect previously elicited by a smaller dose
🞑 CrossTolerance
 Refers to a person tolerant of one drug being tolerant of
another dug in the same class(codeine, heroin, methadone,
oxycodone)
 Will not be tolerant to other CNS depressants like alcohol,
barbiturates, benzodiazepines, general anesthetics

Question 28

issues affecting pain management - physical dependence

Answer 28

Physical Dependence
🞑 Withdrawal syndrome
will occur if the drug is abruptly discontinued
🞑 Adaptive cellular changes occurdue to continuousdrug
exposure
🞑 Body will require continued presence of drug to function normally

Question 29

Abuse

Answer 29

Abuse
🞑 Intentional misuseof drugs inconsistentwith medical or
social norms

Question 30

Myths:
🞑 Pain should be

Answer 30

treated, not prevented

Question 31

Selected Nursing Diagnoses
Related to Opioid Therapy

Answer 31

Selected Nursing Diagnoses
Related to Opioid Therapy
 Ineffective airway clearance related to cough reflex
suppression
 Ineffective breathing pattern: hypoventilation related to
CNSdepressant effects of drug
 Risk for deficient fluid volume related to nausea and/or
vomiting
 Constipation
 Urinary retention
 Risk for injury related to sensory/perceptual alterations

Question 32

Use of Opioids in Children

Answer 32

⦁ Children are left untreated or are inadequately treated for
pain
⦁ Pain assessment in children is more difficult
⦁ Consider giving children medications for pain in same
circumstances as an adult
⦁ Approach to child should be individualized
⦁ Growth and developmental characteristics of various
ages of children should be understood
⦁ Assessment tools that meet developmental age of child
(pain faces, stick figures, thermometer diagram) should be
used
⦁ Listen to parents, family members, and guardians about
child’s behavior when he or she is in pain

Question 33

Use of Opioids in the Older Adult

Answer 33

⦁ Dosage and dosing intervals are required
⦁ Observe for enhanced medication responses
⦁ Older adults have multiple medical problems and
take numerous medications
⦁ Multiple assessment skills should be used
⦁ Height, weight, and body surface area are not
accurate measurements for analgesic dosing in the
older adult
⦁ Communicate, remembering cultural, physiologic,
and psychological differences
⦁ Assessments should be adapted to meet the needs of
the older adult
⦁ Some analgesics are inappropriate for the older adult

Question 34

Frequently abused substances
and Street Drugs

Answer 34

 Alcohol
🞑 Action:
 Central Nervous system depressant
 Enhances serotonin – mediated release of dopamine
 Binds with GABA receptors-
🞑 Uses:
 Prolonged life (moderate usage)
 Dementia risk reduction (moderate usage)
 MI risk reduction (moderate usage)
 IncreasesHDL
 Suppresses inflammatory component of atherosclerosis
 Dilates cutaneous blood vessels

Question 35

Frequently abused substances
and Street Drugs
 Alcohol
🞑 Precautions:

Answer 35

 Tolerance (needing more to achieve effect)
 Dose dependent (Thiamine Deficiency)
 Wernicke’s encephalopathy (confusion, nystagmus)
 Korsakoff’s psychosis (memory gaps, polyneuropathy)
🞑 Adverse effects
 Damage to myocardium, HTN(dose dependent)
 Respiratory depression
 Liver damage, cirrhosis, cancer
 Erosive gastritis, varices

Question 36

Frequently abused substances
and Street Drugs
 Alcohol
🞑 Adverse effects

Answer 36

Frequently abused substances
and Street Drugs
 Alcohol
🞑 Adverse effects
 Breast and colorectal cancer
🞑 Drug Interactions
 Inhibitors: Coffee, Milk (myths!)
 Inducers: CNS depressants (barbiturates, benzodiazepines)
 Interactions: NSAIDS = injury to gastric mucosa Tylenol® =
liver damage with only 2-4 drinks per day (limit should not
exceed 2 grams per day)
🞑 PregnancyCategory:
(moderate use?,No know safe alcohol level)

Question 37

Frequently abused substances
and Street Drugs
 Abuse Management of alcohol
 “CAGE”

Answer 37

Frequently abused substances
and Street Drugs
 Abuse Management of alcohol
 “CAGE”
🞑 Cut down – have you ever thought about cutting down
on your drinking?
🞑 Annoyed – Have people annoyed you by criticizing
your drinking?
🞑 Guilty – have you ever felt guilty about your drinking?
🞑 Eye opener – Have you ever had a drink the first thing
in the morning to steady your nerves or get rid of a
hangover?

Question 38

Frequently abused substances
and Street Drugs
 Alcohol Withdrawal

Answer 38

🞑 A set of symptoms that occur due to physiologic
response to alcohol dependence
🞑 Low dependence:
 12 – 24 hours:Anxiety, disturbed sleep, nausea, mild
tremors and weakness
🞑 High dependence
 12-72 hours: Cramps, nausea, vomiting, intense tremors,
tachycardia, hypertension, fever
🞑 Severe dependence
 Delirium Tremens(DT’s)occur in less than 1%
 Hallucinations, Disorientation,Tremors,Seizures

Question 39

Frequently abused substances
and Street Drugs
 Alcohol Withdrawal Management

Answer 39

 Alcohol Withdrawal Management
🞑 Benzodiazepines: (Librium®,Valium®, Ativan®)
 Decrease the w/d symptoms and stabilize vital signs.
Prevent seizures
🞑 Beta-adrenergic blockers (Inderal®, TenORmin®)
 Improve vital signs, decrease autonomic component of
withdrawal
🞑 Alpha-adrenergic blockers (CataPRES®)
 Improve vital signs, decrease autonomic component of
withdrawal

Question 40

Chlor-DI-ze-POX-ide (Librium®)

Answer 40

Chlor-DI-ze-POX-ide (Librium®)
 Action:
🞑 Potentiates the actions of GABA, especially in the limbic
system, reticular formation
 Uses:
🞑 Short-term management of anxiety, acute alcohol
withdrawal, preoperatively for relaxation

Question 41

Chlordizepoxide
 Precautions:

Answer 41

Chlordizepoxide
 Precautions:
🞑 CNS: Dizziness, drowsiness, confusion, headache,
anxiety, tremors, stimulation, fatigue, depression,
insomnia, hallucinations
🞑 CV: Orthostatic hypotension, edema, ECG changes,
tachycardia, hypotension
 Adverse effects:
🞑 Decrease: effect—cowslip, kava, Queen Anne’s lace, St.
John’s wort, valerian

Question 42

Chlordizepoxide
 NURSING CONSIDERATIONS

Answer 42

Chlordizepoxide
 NURSING CONSIDERATIONS
🞑 Assess: B/ P(lying, standing), pulse; if systolicB/ P
drops 20 mm Hg, hold product, notify prescriber
🞑 Assistancewith ambulation during beginning therapy,
sincedrowsiness/dizziness occurs • Checkto see PO
medication hasbeen swallowed if patient isdepressed,
suicidal

Question 43

⦁ Stages of Sleep

Answer 43

⦁ Stages of Sleep
◦ Non–rapid eye movement (non-REM) sleep
 Stage 1: 2% to 5%
 Stage 2: 50%
 Stage 3: 5%
 Stage 4: 10% to 15%
◦ REM sleep: 25-33%

Question 44

Physiologic Functions
During Non-REM Sleep

Answer 44

 Blood pressure falls
 Pulse rate is slowed
 Metabolic rate is decreased
 Gastrointestinal tract activity is slowed
 Urine formation slows
 Oxygen consumptionand carbon dioxide production
are reduced
 Body temperature decreases slightly
 Respirations are slower and shallower
 Body movement is minimal

Question 45

Drug therapy in the treatment of
anxiety or insomnia

Answer 45

Drug therapy in the treatment of
anxiety orinsomnia
What is the role of drug therapy in the treatment of
anxiety orinsomnia?
⦁ After nondrug interventions are attempted first a drug
therapy plan ischosen based onthe level of CNS
suppression desired
⦁ Antianxiety / Anxiolytic
⦁ Sedatives
⦁ Hypnotics

Question 46

Lorazepam (Ativan®)

Answer 46

Precautions
🞑 Children <12 yr, geriatric patients, debilitated,
renal/hepatic disease, addiction, suicidal ideation,
abrupt discontinuation
 Adverse Effects
🞑 Dizziness, drowsiness, Orthostatic hypotension, ECG
changes, tachycardia, hypotension; apnea, cardiac
arrest (IV, rapid)

Question 47

lorazepam nursing considerations

Answer 47

 Nursing Considerations:
🞑 That product may be taken with food
🞑 Not to use product for everyday stress or longer than 4
mos. unless directed by prescriber
🞑 May be habit forming
🞑 Toavoid OTC preparations (cough, cold, hay fever)
unless approved by prescriber
🞑 Toavoid driving, activities that require alertness, since
drowsiness may occur
🞑 To rise slowly

Question 48

Common Antianxiety and
Anxiolytic Agents

Answer 48

Benzodiazepines
(typically end with “-zepam” or “-zolam”)
● Examples include alprazolam, oxazepam, midazolam, triazolam

Question 49

Drug Therapy

Answer 49

 Sedatives reduce nervousness, excitability, or
irritability by producing a calming or soothing
effect
 Hypnotics are used to induce sleep with greater
CNS depression than sedatives
🞑 Other than benzodiazepines, may include chloral
hydrate

Question 50

alprazolam (xanax)

Answer 50

Actions
🞑 Depresses subcortical levels of CNS, including limbic
system, reticular formation
 Uses
🞑 Anxiety, panic disorders with or without agoraphobia,
anxiety with depressive symptoms
🞑 (Unlabeled use) Premenstrual dysphoric disorders

Question 51

xanax - adverse effects

Answer 51

Adverse Effects
🞑 Dizziness, drowsiness,orthostatic hypotension, blurred
vision,
 Precautions
🞑 Geriatric patients, debilitated, hepatic disease, obesity,
severe pulmonary disease
 Contraindicated:
🞑 Pregnancy (D), breastfeeding, hypersensitivity to
benzodiazepines, closed-angle glaucoma, psychosis,
addiction

Question 52

xanax nursing considerations

Answer 52

🞑 Assess:• Mental status: anxiety, mood, sensorium,
orientation, affect, sleeping pattern, drowsiness, dizziness,
especially in geriatric patients prior to, and during
treatment
🞑 B/ Plying, standing; pulse; if systolicB/ Pdrops 20 mm Hg,
hold product, notify prescribe

Question 53

diazapam (valium)

Answer 53

Action
🞑 Benzodiazepine
🞑 Potentiates gamma-aminobutyric acid
🞑 Depress neuronal function at multiple sites in the CNS
 Uses
🞑 IV forms used to treat status epilepticus
🞑 Anxiety and Panic Disorders
🞑 Insomnia
🞑 Muscle Spasm
🞑 ETOH withdrawal - #1

Question 54

diazapam precautions

Answer 54

Precautions
🞑 Pregnancy Category D
🞑 Tolerance and Physical Dependence
🞑 Inject slowly into a large vein (5mg/min)flush pre/post
with NSS
 Adverse effects
🞑 CNS depression
🞑 Anterograde amnesia unable to make new memories after amnesia induced events
🞑 Paradoxical effects
🞑 Abuse

Question 55

diazapam nursing considerations

Answer 55

Nursing Considerations: Assess
🞑 For alcohol withdrawal symptoms, including hallucinations
(visual, auditory), delirium, irritability, agitation, fine to
coarse tremors
🞑 For seizure control and type, duration, intensity of seizures
🞑 For muscle spasms; pain relief

Question 56

benzo utility

Answer 56

What are the advantages of benzodiazepines over
other agents?
⦁ Low fatality rates
⦁ Low Abuse Potential
⦁ More favorable adverse effect profiles
⦁ Fewer seriousdrug interactions
⦁ What are the indications for benzodiazepines?
🞑Anxiety Disorders
🞑Alcohol Withdrawal
🞑 Preoperativemeds,Insomnia,Seizuresand NeuromuscularDisease

Question 57

benzo interactions

Answer 57

Do the benzodiazepines interact significantly with
other drugs?
🞑 Nursing attention to other CNS depressants and
benzodiazepine usage
🞑 Check for alcohol use
🞑 Combined with zidovudine(HIV antiviral) may increase
toxic levels as the drug isnot metabolized as well

Question 58

alternatives to benzos?

Answer 58

Benzodiazepine-like Drugs
zolpidem tartrate
ZAL-e-plon
eszo-PIC-lone
 Serotonergic Anxiolytics
buspirone
 Antihistamine Anxiolytics
hydroxyzine

Question 59

Use of Antianxiety, Sedative,
HypnoticAgents in Children

Answer 59

Limited
● May cause paradoxical reactions
● May be used in carefully selected situations (severe
anxiety with asthma, pre-anesthesia, during
seizures)
● Requires close monitoring by health care team

Question 60

Use of Antianxiety, Sedative,
HypnoticAgents in Older Adults

Answer 60

May also cause paradoxic reactions
● Requires careful dosage titration
● Requires careful monitoring by health care team

Question 61

Role of Drug Therapy in
Treatment of Anxiety or Insomnia

Answer 61

Antianxiety or anxiolytic agents reduce feelings
of excessive anxiety (apprehension, fear,
nervousness, worry, or panic); used when
nondrug interventions are not effective or are
inappropriate for the degree of symptoms present

Question 62

Significant Drug Interactions With
Benzodiazepines

Answer 62

(Enhanced CNS Depressant Effects)
 Can occur when used with:
 Alcohol
 CNS depressants
 Opioid analgesics
 Anesthetics
 Tricyclic antidepressants
 Close monitoring is necessary because the dosage
of one or both drugs may need to be adjusted

Question 63

nonceceptors respond to what types of pain?

Answer 63

🞑 “thermal” (heat or cold),
🞑 “mechanical”(crushing, tearing, etc.) and
🞑 “chemical”(iodine in a cut, chili powder in the eyes).

Question 64

alprazolam

Answer 64

xanax