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Pharmocolgy > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

What analgesics activate the mu receptors and exert a weak activation of kappa receptors:

A

Opioids: morphine/codeine; controlled substances

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2
Q

Activation of what receptor will lead to respiratory depression, euphoria, sedation, analgesia:

A

mu receptors

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3
Q

Activation of what receptor leads to sedation and analgesia:

A

Kappa receptors

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4
Q

What are the two isomers that opioids have:

A

levo and dextro

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5
Q

what isomer has an analgesia effect

A

levo

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6
Q

What isomer has an antitussive effect:

A

levo and dextro

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7
Q

Which isomer causes physical dependence:

A

levo

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8
Q

What are the characteristics of opioid isomers:

A

3 A: analgesia, antitussive (medulla), antidiarrheal; suppressed RR (medulla)

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9
Q

What is given to treat moderate/severe acute/chronic pain; pre-op; or dyspnea d/t ventricular failure and PE:

A

opioids (indications)

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10
Q

Would you give opioids to pts w/head injuries:

A

No

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11
Q

Would you give opioids to asthmatic pts:

A

No

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12
Q

Would you give opioids to pts w/hypotension:

A

No

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13
Q

Would you give opioids to pts in labor or delivery of pre-mis:

A

No

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14
Q

Would you give opioids to renal or hepatic impairment pts:

A

No

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15
Q

What are the side effects d/t opioids:

A

orthostatic hypotension; N/V/constipation; Drowsiness/sedation/confusion; and urinary retention

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16
Q

What is a S/S of opioids toxicity:

A

pupillary constriction

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17
Q

What are the ADVERSE effects d/t opioids:

A

RR depression (<10); hypotension, P. constriction; tolerance/physical dependance; withdrawal syndrome

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18
Q

What drugs can increase the effect of opioids:

A

EtOH; sedative-hypnotics; antipsychotic; muscle relaxants

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19
Q

What are the nemonics for common opioids:

A

Drugs ending w/ONE (phone/done), MFM: morphine, fentanyl, meperidine

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20
Q

What is the onset of morphine sulfate when given parenterally:

A

Rapid especially if it’s IV

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21
Q

What is the duration of morphine sulfate:

A

3-5 hrs

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22
Q

What is the duration of morphine sulfate controlled release:

A

8-12 hr

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23
Q

If a pt has severe pain, how is morphine sulfate given:

A

IV

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24
Q

What are the pharmocokinetics of morphine sulfate:

A

liver metabolizes; sm amount crosses BBB; 90% is excreted = short half-life; crosses placenta/breast milk

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25
Q

If you were giving morphine sulfate PO, what is the normal dose:

A

10-30 mg q 4 hr

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26
Q

If you were giving morphine sulfate SQ/IM, what would the dose be:

A

5-15 mg q 4 hr

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27
Q

If you were giving Morphine sulfate IV, what would the dose be:

A

4-10 mg q 4 hrs

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28
Q

Would you give an higher dose of morphine sulfate/opioids PO or parenterally:

A

PO (d/t 90 being excreted)

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29
Q

What is the assessment process when giving opioids:

A

RR (asthma), PMH (liver), drug hx, VS/RR, I &Os; pain amount

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30
Q

Incase of a Morphine sulfate overdose, what med is giving to counteract it:

A

Narcan (Naloxone)

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31
Q

What are nsg interventions after giving Morphine sulfate:

A

administer before pain reaches peak; check urine uotput/VS; bowel sounds; pupil changes; LOC

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32
Q

What are some important morphine sulfate pt teachings:

A

No EtOH/CNS depressants; teach addiciton; have pt report dyspnea/dizziness

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33
Q

What are two important morphine sulfate nsg dx:

A

Acute pain r/t surgical tissue injury; ineffective breathing pattern r/t excess morphine dosage

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34
Q

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:

A

opioid overdose; Naloxone (Narcan) should be given

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35
Q

What are the s/s of opioid overdose:

A

RR depression; hypotension; constriction of the pupils; and drowsiness

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36
Q

What are the S/S of opioid withdrawal:

A

N/D; abd cramps; watery eyes/runny nose/diaphoresis; muscle twitching; increased BP/P; restlessness/irritability

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37
Q

What is given to tx opioid withdrawal symptoms:

A

Methadone is substituted in place of opioids

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38
Q

Why is methadone given once a day and not q 4 hours:

A

HAlf life of methadone is longer than most opioids

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39
Q

What are the two types of methadone txs:

A

Weaning program; maintenance program

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40
Q

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:

A

Weaning program

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41
Q

The MD Rx methadone for a pt 20 mg daily. You understand that the pt is under what type of methadone tx:

A

Maintenance program (dose remains consistent)

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42
Q

What would a MD Rx a pt for rapid opiate detoxification agent:

A

Clondine

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43
Q

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:

A

Clondine

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44
Q

Agonist or antagonist: A drug that binds (Morphine)

A

agonists binds to promote an action

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45
Q

Agonist or antagonist: A drug that oppose/blocks Naloxone (narcan)

A

antagonists block/opposes an action

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46
Q

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:

A

Nubain (newborn) (nalbuphine hydrochloride)

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47
Q

An example of an opioid agonist-antagonist is (an opioid agonist added to an opioid antagonist in hopes to decrease opioid abuse):

A

Nubain (nalbuphine hydrochloride)

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48
Q

Is Nubain (nalbuphine hydrochloride) given to CA pts:

A

NO

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49
Q

What is the onset for Nubain (nalbuphine HCL):

A

rapid; peak occurs w/in 30 min via IV; duration is the same for all routes; increases pain threshold

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50
Q

What drug blocks receptors to displace any opioids=inhibiting opioid action; is given for post-op opioid depression or opioid overdose; increase PTT (bleeding):

A

Antagonist drug called Narcan (naloxone)

51
Q

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:

A

procedural sedation/conscious sedation used for surgical, Dx, or interventional procedures

52
Q

To prevent or reduce anxiety is defined as:

A

anxiolysis

53
Q

What are the goals of conscious sedation:

A

To provide analgesia, amnesia, and anxiolysis

54
Q

What are the common drugs used for conscious sedation:

A

Fentanyl (sublimaze) and Versed (Midazolam)

55
Q

What are the effects of Fentanyl (sublimaze) and Versed (Midazolam):

A

sedation and relaxation

56
Q

What are the nsg responsibility to the pt when conscious sedation (Fentanyl (Sublimaze)/Versed (Midazolam):

A

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

57
Q

An alternative route for opioid administration for self administered pain relief is defined as:

A

PCA (pt controlled analgesia)

58
Q

What are the common PCA drugs:

A

FHM: Fentanyl (Sublimaze), Hydromorphone (Dilaudid), Morphine

59
Q

What is the loading dose of PCA meds:

A

2-10 mg

60
Q

How does the lockout mechanism work when using PCA meds:

A

keeps the pt from overdosing; the button is timed=if the pt presses once, then they can’t immediately press it again.

61
Q

What does the nurse do to the PCA meds dose:

A

titrates/adjusts dose

62
Q

What is the goal of PCA meds:

A

to avoid episodes of severe pain and over sedation

63
Q

Can a pt’s family push he PCA button for the pt:

A

NO

64
Q

Are On-Q meds opioids:

A

NO. They are anesthetic

65
Q

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:

A

On-Q pain buffer system pump

66
Q

What are the NSG responsibilities for On-q pump

A

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

67
Q

What are some On-Q pump side effects:

A

increase pain; redness/swelling/discharge at cath site; ringing/buzzing in ears/ metal taste in mouth; numbness/tingling to mouth/finger/toes

68
Q

What population is at risk for opiate addiction:

A

illegal drug users/medical setting (pts/health care professional)

69
Q

Impaired performance as a result of drug use is defined as:

A

chemical impairment

70
Q

What is the percentage of nurses with substance abuse:

A

10-20%

71
Q

What are the types of characteristics of impaired performance:

A

personality/behavioral changes; job attendance; poor judgement/errors/illogical documentation; discrepancies in controlled-drug handling/records

72
Q

What are the cardinal S/S of inflammation:

A

redness, edema, heat, pain, loss of function

73
Q

What are the two phases of inflammation:

A

vascular phase and delayed phase

74
Q

This chemical mediator is a potent vasodilator=relaxed sm muscles=increased cap permeability; also sensitizes nerve cells to feel pain:

A

prostaglandins

75
Q

What enzymes are responsible for creating prostaglandins:

A

COX converts arachidonic acid into prostaglandins

76
Q

Which COX protects the stomach lining and regulates platelets:

A

COX-1

77
Q

What COX triggers inflammation and pain:

A

COX-2

78
Q

What are the actions of prostaglandin inhibitors:

A

4 As: analgesia, antipyretic; anti0inflammatory; anticoagulant

79
Q

What are the first generation NSAIDs and what COX enzymes do they block:

A

Non-selective=COX-1 and COX-2; ASA, ibuprofen; naproxen

80
Q

What are the second generation NSAIDS nd what COX do they block:

A

Tylenol (acetaminophen); selective to COX-2

81
Q

This NSAID is an antipyretic and analgesic; inhibits synthesis of PGs; has no antiinflammatory effect; no GI toxicity:

A

Acetaminophen (tylenol)

82
Q

What is the safe dose of acetaminophen and what is the therapeutic range:

A

2000 mg/day; 5-20 mcg/mL

83
Q

What NSAIDs can cause hepatoxicity which could cause death in 1-4 days from hepatic necrosis:

A

Acetaminophen

84
Q

What are the early S/S of hepatic damage; and what labs should you check for:

A

N/V/D, abd pain: liver labs (AST, ALT, ALP)

85
Q

Your pt is showing early symptoms of acetaminophen overdose. What do you give the pt:

A

Acetylcysteine (mucomyst)

86
Q

The MD Rx a pt mucomyst (acetylcysteine) PO. Why is the MD giving mucomyst therapy to the pt PO:

A

antidote for acetaminophen overdose to prevent liver/kidney damage

87
Q

The MD rx the pt mucomyst (acetylcysteine) as an inhaler. Why is the MD giving mucomyst therapy to the pt as an inhaler:

A

to break up mucous (mucolytic)

88
Q

This type of NSAID is an antipyretic, antiinflammatory, anticoagulant, analgesic; inhibits PGs production; inhibits heat regulator center; decreases platelet aggregation:

A

ASA (first generation NSAIDs)

89
Q

What is the dose of ASA you would give for pain:

A

325-650 mg q 4h

90
Q

What is the dose of ASA for thromboembolic:

A

325-650 BID

91
Q

What is the dose of ASA for anti-inflammatory:

A

3.6-5.4 g/day divided

92
Q

Would you give ASA to a pt w/gout:

A

NO

93
Q

What is the onset of ASA:

A

onset is 30 min; crosses placenta; 50% is excreted in the urine (watch kidneys=uric acid=gout)

94
Q

What drugs interact with ASA and shouldn’t be given together:

A

anticoagulants (can cause bleeding); oral hypoglycemic; GLUCOCORTICOIDS (increases uric acid)

95
Q

What labs are affected when taking ASA:

A

decrease cholesterol/K/THYROID GLANDS (T3-T4); increase PTT/uric acid

96
Q

What are the side effects of ASA:

A

abd pain, GI DISTRESS; heart burn; dizziness/ N/V/D

97
Q

What are the adverse effects of ASA:

A

Tinnitus (ringing of ear); ulcers; bleeding; bronchospasm

98
Q

What are the common NSAIDS given to elderly pts to block COX-2 as GI distress is very common in the elderly:

A

Celebrex (celecoxib)

99
Q

When giving NSAIDS to the elderly pts, what labs are most important to monitor:

A

renal function

100
Q

What can occur if you give a child pt ASA when they are sick (with flu, cold, viral infections):

A

Reye Syndrome

101
Q

What are the S/S of reye syndrome:

A

acute encephalopathy; fatty infiltration of the liver/heart/pancreas/kidneys/spleen/lymph nodes

102
Q

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:

A

prednisone and dexamethasone

103
Q

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:

A

Gout (commonly seen on the big toe) DONT GIVE ASA

104
Q

What are the three types of Gout medications:

A

CPA: Colchicine (acute S/S), Probenecid (Benemid for chronic gout), Allopurinol (Zyloprim for late-stage renal impairment)

105
Q

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:

A

Colchicine

106
Q

This antiinflammatory Gout med is given to increase the rate of uric acid excretion for chronic gout:

A

proBENecid (benemid) a type of uricosuric (pee uric acid)

107
Q

This antiinflammatory gout med is given to renal pts, inhibits synthesis of uric acid; prophylactic to gout attacks:

A

AlloPurinol (zyloprim) Remember A to Z; a type of uric acid inhibitor

108
Q

What are the nsg teaching concerning uric acid inhibito Allopurinol (zyloprim)

A

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

109
Q

How many stages are there in REM:

A

1: increased eye movement;BP;RR;temp

110
Q

How many stages in NREM:

A

4: HR slows; body repairs; BP/temp decreases; REM occurs after 90 min

111
Q

What do sedatives diminish w/o affecting consciousness:

A

physical and mental responses

112
Q

What can occur if you increase the sedative/hypnotic dose:

A

hypnotic effect occurs=natural sleep

113
Q

What type of “acting” hypnotics are effective for achieving sleep:

A

short-acting hypnotics

114
Q

What type of “acting” hypnotics are effective for sustaining sleep:

A

Intermediate-acting hypnotic

115
Q

What are the side effects of sedatives/hypnotics;

A

rebound REM (nightmares); dependence; depression; RR depression; hangover

116
Q

What are the four types of sedative/hypnotics:

A

2 pines and 2 ates: Benzodiazepines/nonbenzodiazepines and barbiturates/chloralhydrate

117
Q

What barbiturate would you give for SZ, epilepsy:

A

Long acting phenobarbital

118
Q

What barbiturate would you give for maintaining sleep, insomnia, anxiety:

A

intermediate acting butisol

119
Q

What barbiturate would you give for inducing sleep who have difficulty falling asleep (not insomnia)

A

short acting nembutal

120
Q

What barbiturate would you give as a general anesthetic:

A

pentothal

121
Q

What are the two types of Benzodiazepines are given for insomnia (inducing and sustaining), increases GABBA; decreases nervous excitation:

A

Restoril and valium (restore valium)

122
Q

What is used as a short term tx of insomnia=less than 10 days:

A

Nonbenzodiazepines medication is Ambien

123
Q

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:

A

chloralhydrate

124
Q

What are some considerations of sedative/hypnotic use in the elderly:

A

use non-pharmacological methods first; No EtOH/antidepressants/antipsychotics/narcotics; should be GRADUALLY WITHDRAWN

Pharmocolgy (6 decks)

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