Quiz 2 Flashcards
What analgesics activate the mu receptors and exert a weak activation of kappa receptors:
Opioids: morphine/codeine; controlled substances
Activation of what receptor will lead to respiratory depression, euphoria, sedation, analgesia:
mu receptors
Activation of what receptor leads to sedation and analgesia:
Kappa receptors
What are the two isomers that opioids have:
levo and dextro
what isomer has an analgesia effect
levo
What isomer has an antitussive effect:
levo and dextro
Which isomer causes physical dependence:
levo
What are the characteristics of opioid isomers:
3 A: analgesia, antitussive (medulla), antidiarrheal; suppressed RR (medulla)
What is given to treat moderate/severe acute/chronic pain; pre-op; or dyspnea d/t ventricular failure and PE:
opioids (indications)
Would you give opioids to pts w/head injuries:
No
Would you give opioids to asthmatic pts:
No
Would you give opioids to pts w/hypotension:
No
Would you give opioids to pts in labor or delivery of pre-mis:
No
Would you give opioids to renal or hepatic impairment pts:
No
What are the side effects d/t opioids:
orthostatic hypotension; N/V/constipation; Drowsiness/sedation/confusion; and urinary retention
What is a S/S of opioids toxicity:
pupillary constriction
What are the ADVERSE effects d/t opioids:
RR depression (<10); hypotension, P. constriction; tolerance/physical dependance; withdrawal syndrome
What drugs can increase the effect of opioids:
EtOH; sedative-hypnotics; antipsychotic; muscle relaxants
What are the nemonics for common opioids:
Drugs ending w/ONE (phone/done), MFM: morphine, fentanyl, meperidine
What is the onset of morphine sulfate when given parenterally:
Rapid especially if it’s IV
What is the duration of morphine sulfate:
3-5 hrs
What is the duration of morphine sulfate controlled release:
8-12 hr
If a pt has severe pain, how is morphine sulfate given:
IV
What are the pharmocokinetics of morphine sulfate:
liver metabolizes; sm amount crosses BBB; 90% is excreted = short half-life; crosses placenta/breast milk
If you were giving morphine sulfate PO, what is the normal dose:
10-30 mg q 4 hr
If you were giving morphine sulfate SQ/IM, what would the dose be:
5-15 mg q 4 hr
If you were giving Morphine sulfate IV, what would the dose be:
4-10 mg q 4 hrs
Would you give an higher dose of morphine sulfate/opioids PO or parenterally:
PO (d/t 90 being excreted)
What is the assessment process when giving opioids:
RR (asthma), PMH (liver), drug hx, VS/RR, I &Os; pain amount
Incase of a Morphine sulfate overdose, what med is giving to counteract it:
Narcan (Naloxone)
What are nsg interventions after giving Morphine sulfate:
administer before pain reaches peak; check urine uotput/VS; bowel sounds; pupil changes; LOC
What are some important morphine sulfate pt teachings:
No EtOH/CNS depressants; teach addiciton; have pt report dyspnea/dizziness
What are two important morphine sulfate nsg dx:
Acute pain r/t surgical tissue injury; ineffective breathing pattern r/t excess morphine dosage
You give a pt 4-10 mg of morphine SQ. You notice a half hour later that the pt has respiratory depression, constriction of the pupils, and hypotension. These S/S are d/t:
opioid overdose; Naloxone (Narcan) should be given
What are the s/s of opioid overdose:
RR depression; hypotension; constriction of the pupils; and drowsiness
What are the S/S of opioid withdrawal:
N/D; abd cramps; watery eyes/runny nose/diaphoresis; muscle twitching; increased BP/P; restlessness/irritability
What is given to tx opioid withdrawal symptoms:
Methadone is substituted in place of opioids
Why is methadone given once a day and not q 4 hours:
HAlf life of methadone is longer than most opioids
What are the two types of methadone txs:
Weaning program; maintenance program
The MD Rx methadone for a pt 40 mg/day x2 days, and then decreases amount to 5-10 mg/day. You understand that this pt is under what type of methadone tx:
Weaning program
The MD Rx methadone for a pt 20 mg daily. You understand that the pt is under what type of methadone tx:
Maintenance program (dose remains consistent)
What would a MD Rx a pt for rapid opiate detoxification agent:
Clondine
What drug manages opioid withdrawal, is dosed up to 17 mcg/kg/day; decreases sympathetic outflow from CNS caused by opioids; used as a rapid opiate detox agent:
Clondine
Agonist or antagonist: A drug that binds (Morphine)
agonists binds to promote an action
Agonist or antagonist: A drug that oppose/blocks Naloxone (narcan)
antagonists block/opposes an action
Your pt is in labor and has a severe pain. your pt asks for pain relief. You can’t give Morphine as it crosses the placenta and may decrease urge to push. What do you give instead:
Nubain (newborn) (nalbuphine hydrochloride)
An example of an opioid agonist-antagonist is (an opioid agonist added to an opioid antagonist in hopes to decrease opioid abuse):
Nubain (nalbuphine hydrochloride)
Is Nubain (nalbuphine hydrochloride) given to CA pts:
NO
What is the onset for Nubain (nalbuphine HCL):
rapid; peak occurs w/in 30 min via IV; duration is the same for all routes; increases pain threshold
What drug blocks receptors to displace any opioids=inhibiting opioid action; is given for post-op opioid depression or opioid overdose; increase PTT (bleeding):
Antagonist drug called Narcan (naloxone)
A type of sedation that utilizes administration of CNS depressants/analgesics to provide analgesia, relieve anxiety; provide amnesia; where the consciousness is depressed, pt may fall asleep, but is not unresponsive; so that the protective airway reflexes maintained is defined as:
procedural sedation/conscious sedation used for surgical, Dx, or interventional procedures
To prevent or reduce anxiety is defined as:
anxiolysis
What are the goals of conscious sedation:
To provide analgesia, amnesia, and anxiolysis
What are the common drugs used for conscious sedation:
Fentanyl (sublimaze) and Versed (Midazolam)
What are the effects of Fentanyl (sublimaze) and Versed (Midazolam):
sedation and relaxation
What are the nsg responsibility to the pt when conscious sedation (Fentanyl (Sublimaze)/Versed (Midazolam):
discuss need for sedation; check informed consent; may feel burning sensation upon administering; inform about side effects; monitor S/S of over sedation/adverse reactions; monitor VS/EKG/Pulse Ox
An alternative route for opioid administration for self administered pain relief is defined as:
PCA (pt controlled analgesia)
What are the common PCA drugs:
FHM: Fentanyl (Sublimaze), Hydromorphone (Dilaudid), Morphine
What is the loading dose of PCA meds:
2-10 mg
How does the lockout mechanism work when using PCA meds:
keeps the pt from overdosing; the button is timed=if the pt presses once, then they can’t immediately press it again.
What does the nurse do to the PCA meds dose:
titrates/adjusts dose
What is the goal of PCA meds:
to avoid episodes of severe pain and over sedation
Can a pt’s family push he PCA button for the pt:
NO
Are On-Q meds opioids:
NO. They are anesthetic
An MD has put in the shoulder of a pt an elastomeric pump that’s connected to an antimicrobial cath that consist of a local anesthetic to provide continuous infusion post-op. You know this to be a:
On-Q pain buffer system pump
What are the NSG responsibilities for On-q pump
Make certain clamps are open/no kinks in tubing; no tape over filter; check dressing over catheter; make certain medication label is attached to pump
What are some On-Q pump side effects:
increase pain; redness/swelling/discharge at cath site; ringing/buzzing in ears/ metal taste in mouth; numbness/tingling to mouth/finger/toes
What population is at risk for opiate addiction:
illegal drug users/medical setting (pts/health care professional)
Impaired performance as a result of drug use is defined as:
chemical impairment
What is the percentage of nurses with substance abuse:
10-20%
What are the types of characteristics of impaired performance:
personality/behavioral changes; job attendance; poor judgement/errors/illogical documentation; discrepancies in controlled-drug handling/records
What are the cardinal S/S of inflammation:
redness, edema, heat, pain, loss of function
What are the two phases of inflammation:
vascular phase and delayed phase
This chemical mediator is a potent vasodilator=relaxed sm muscles=increased cap permeability; also sensitizes nerve cells to feel pain:
prostaglandins
What enzymes are responsible for creating prostaglandins:
COX converts arachidonic acid into prostaglandins
Which COX protects the stomach lining and regulates platelets:
COX-1
What COX triggers inflammation and pain:
COX-2
What are the actions of prostaglandin inhibitors:
4 As: analgesia, antipyretic; anti0inflammatory; anticoagulant
What are the first generation NSAIDs and what COX enzymes do they block:
Non-selective=COX-1 and COX-2; ASA, ibuprofen; naproxen
What are the second generation NSAIDS nd what COX do they block:
Tylenol (acetaminophen); selective to COX-2
This NSAID is an antipyretic and analgesic; inhibits synthesis of PGs; has no antiinflammatory effect; no GI toxicity:
Acetaminophen (tylenol)
What is the safe dose of acetaminophen and what is the therapeutic range:
2000 mg/day; 5-20 mcg/mL
What NSAIDs can cause hepatoxicity which could cause death in 1-4 days from hepatic necrosis:
Acetaminophen
What are the early S/S of hepatic damage; and what labs should you check for:
N/V/D, abd pain: liver labs (AST, ALT, ALP)
Your pt is showing early symptoms of acetaminophen overdose. What do you give the pt:
Acetylcysteine (mucomyst)
The MD Rx a pt mucomyst (acetylcysteine) PO. Why is the MD giving mucomyst therapy to the pt PO:
antidote for acetaminophen overdose to prevent liver/kidney damage
The MD rx the pt mucomyst (acetylcysteine) as an inhaler. Why is the MD giving mucomyst therapy to the pt as an inhaler:
to break up mucous (mucolytic)
This type of NSAID is an antipyretic, antiinflammatory, anticoagulant, analgesic; inhibits PGs production; inhibits heat regulator center; decreases platelet aggregation:
ASA (first generation NSAIDs)
What is the dose of ASA you would give for pain:
325-650 mg q 4h
What is the dose of ASA for thromboembolic:
325-650 BID
What is the dose of ASA for anti-inflammatory:
3.6-5.4 g/day divided
Would you give ASA to a pt w/gout:
NO
What is the onset of ASA:
onset is 30 min; crosses placenta; 50% is excreted in the urine (watch kidneys=uric acid=gout)
What drugs interact with ASA and shouldn’t be given together:
anticoagulants (can cause bleeding); oral hypoglycemic; GLUCOCORTICOIDS (increases uric acid)
What labs are affected when taking ASA:
decrease cholesterol/K/THYROID GLANDS (T3-T4); increase PTT/uric acid
What are the side effects of ASA:
abd pain, GI DISTRESS; heart burn; dizziness/ N/V/D
What are the adverse effects of ASA:
Tinnitus (ringing of ear); ulcers; bleeding; bronchospasm
What are the common NSAIDS given to elderly pts to block COX-2 as GI distress is very common in the elderly:
Celebrex (celecoxib)
When giving NSAIDS to the elderly pts, what labs are most important to monitor:
renal function
What can occur if you give a child pt ASA when they are sick (with flu, cold, viral infections):
Reye Syndrome
What are the S/S of reye syndrome:
acute encephalopathy; fatty infiltration of the liver/heart/pancreas/kidneys/spleen/lymph nodes
What are the two types of corticosteroids that controls inflammation by suppressing or preventing response at the injured site or autoimmune disorders and the dosage IS TAPERED over 5-10 days:
prednisone and dexamethasone
An inflammation condition that attacks the joints, tendons, and other tissues; characterized by increased amounts of uric acid d/t ineffective clearance of uric acid from the kidneys is defined as:
Gout (commonly seen on the big toe) DONT GIVE ASA
What are the three types of Gout medications:
CPA: Colchicine (acute S/S), Probenecid (Benemid for chronic gout), Allopurinol (Zyloprim for late-stage renal impairment)
This antiinflammatory gout med is given to inhibit leukocytes, alleviates acute symptoms, does not inhibit/promote uric acid synthesis; should NOT be given to renal pts:
Colchicine
This antiinflammatory Gout med is given to increase the rate of uric acid excretion for chronic gout:
proBENecid (benemid) a type of uricosuric (pee uric acid)
This antiinflammatory gout med is given to renal pts, inhibits synthesis of uric acid; prophylactic to gout attacks:
AlloPurinol (zyloprim) Remember A to Z; a type of uric acid inhibitor
What are the nsg teaching concerning uric acid inhibito Allopurinol (zyloprim)
Yearly eye exam d/t damaging the eye; NO lrg doses of vitamin C d/t stroke; avoide foods high in purine; don’t take w/EtOH/caffeine/HTCZ diuretics
How many stages are there in REM:
1: increased eye movement;BP;RR;temp
How many stages in NREM:
4: HR slows; body repairs; BP/temp decreases; REM occurs after 90 min
What do sedatives diminish w/o affecting consciousness:
physical and mental responses
What can occur if you increase the sedative/hypnotic dose:
hypnotic effect occurs=natural sleep
What type of “acting” hypnotics are effective for achieving sleep:
short-acting hypnotics
What type of “acting” hypnotics are effective for sustaining sleep:
Intermediate-acting hypnotic
What are the side effects of sedatives/hypnotics;
rebound REM (nightmares); dependence; depression; RR depression; hangover
What are the four types of sedative/hypnotics:
2 pines and 2 ates: Benzodiazepines/nonbenzodiazepines and barbiturates/chloralhydrate
What barbiturate would you give for SZ, epilepsy:
Long acting phenobarbital
What barbiturate would you give for maintaining sleep, insomnia, anxiety:
intermediate acting butisol
What barbiturate would you give for inducing sleep who have difficulty falling asleep (not insomnia)
short acting nembutal
What barbiturate would you give as a general anesthetic:
pentothal
What are the two types of Benzodiazepines are given for insomnia (inducing and sustaining), increases GABBA; decreases nervous excitation:
Restoril and valium (restore valium)
What is used as a short term tx of insomnia=less than 10 days:
Nonbenzodiazepines medication is Ambien
What sedative/hypnotic is given to induce sleep and decrease NOCTURNAL AWAKENINGS, less S/S of hangover/RR depression/Tolerance; does not repress REM; given to elderly:
chloralhydrate
What are some considerations of sedative/hypnotic use in the elderly:
use non-pharmacological methods first; No EtOH/antidepressants/antipsychotics/narcotics; should be GRADUALLY WITHDRAWN
