Analgesics Flashcards
(169 cards)
1
Q
Salycilates properties
A
Antipyretic, analgesic, anti-inflammatory
2
Q
Salicylate MOA
A
antipyretic: Decrease body temperature by dilating peripheral blood vessels, analgesic: inhibit prostaglandins,
3
Q
Salicylate indications
A
Prolong bleeding time, mild-moderate pain, maintain pregnancy, rheumatoid arthritis, osteoarthritis, rheumatic fever, reducing elevated body temperature
4
Q
Salicylate ex
A
Aspirin, magnesium salicylate, sodium salicylate
5
Q
Aspirin interactions
A
Valproic acid, beta blockers, ACE inhibitors, diuretics, anticoagulants
6
Q
Acetaminophen classification
A
Nonsalicylate
7
Q
Acetaminophen side effects
A
Leading cause of acute liver failure, potentially hepatoxic, skin eruptions, urticaria, hemolytic anemia, hypoglycemia, pancytopenia, jaundice
8
Q
Acetaminophen considerations
A
Often found in other medications, preferred for elderly, may alter blood glucose test results
9
Q
NSAIDs classification
A
Nonsalicylates
10
Q
NSAIDs interactions
A
Decreased effectiveness of diuretics, anticoagulants increase risk of bleeding, increased effectiveness of lithium and possible lithium toxicity, increased effectiveness of cyclosporine, increase effectiveness of hydantoins, decreased effectiveness of antihypertensive drugs, increased risk of renal impairment with long term acetaminophen use
11
Q
NSAIDs aren’t for people with
A
Impaired renal function, heart failure, increased risk of cardiovascular disease, relieve postoperative pain from a coronary artery bypass graft (CABG), 3rd trimester of pregnancy, lactation,
12
Q
NSAIDs side effects
A
Dyspepsia (mild digestion disorder), nausea, heartburn, epigastric pain (upper, central, abdomen)
13
Q
Topical analgesics indications
A
Strains and sprains
14
Q
Topical analgesics ex
A
Camphor, menthol, methyl salicylate, methyl nicotinate, trolamine sacilylate, capsacin
15
Q
Topical analgesics aren’t for people with
A
Anticoagulation therapy
16
Q
Topical analgesics considerations
A
Don’t put tight bandages on area, don’t use with heating devices
17
Q
NSAIDs MOA
A
Block COX enzymes, inhibit prostaglandin synthesis
18
Q
NSAIDs indications
A
Mild-moderate pain, headaches, migraines, osteoarthritis, rheumatoid arthritis, sprains and strains, toothache, primary dysmenorrhea, fever
19
Q
COX-1 primary side effects
A
GI- related
20
Q
COX-2 primary side effects
A
Cardiovascular related
21
Q
NSAIDs- COX-1 ex
A
Flurbiprofen, ketorolac (more GI side effects), ketoprofen, tolmetin, aspirin
22
Q
Non-selective NSAIDs ex
A
Ibuprofen, naproxen
23
Q
COX-2 selective NSAIDs ex
A
Indomethacin (more GI side effects), sulindac, piroxicam, mefenamic acid, meloxicam, diclofenac (more heart related side effects), celecoxib (more heart related side effects), etodolac
24
Q
NSAIDs restrictions
A
Don’t use before or after heart surgery, most aren’t for kids under 18 (except ibuprofen), elderly more likely to have life threatening side effects
25
NSAIDs side effects
Can increase risk of heart attack or stroke, edema, hyperkalemia, high blood pressure, palpitations, heart failure, asthma, decreased neutrophil, hives, vertigo, seizures
26
Opioids MOA
Bind to mu, delta, or kappa receptors in CNS (change how patients perceived pain in the brain)
27
Opioid classes
Phenanthrenes, phenylheptylamines, phenylpiperdines
28
Opioids adminsitration
Well absorbed through subcutaneous, IM, oral, or transdermal patch, undergo 1st pass metabolism, excreted by kidneys
29
When to give opioids for analgesic purposes
Sever constant pain with terminal illnesses or cancer
30
What opioid for acute pulmonary edema
IV morphine
31
What opioid for diarrhea
Phenylpiperdines or synthetic opiates because of selective GI effects
32
Opioids for cough- adminstration and what drugs
Use of opioids for cough had decreased, but can use codeine, or dextrometorphan
33
When to give opioids for anesthesia
Most common use, used as adjunctive therapy, epidural, or in high risk surgeries to decrease cardiovascular depression
34
Opioids side effects general
Respiratory depression, decreased GI motility, miosis, pruritus, rash, urticaria, sweating, pain at injection site, and local tissue irritation
35
Opioids main concern
Tolerance and dependency
36
Strong opioid Agonists ex
Phenanthrenes: morphine, hydromorphone; phenylheptylamines: methadone; phenylpiperdines: fentanyl, meperidine
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Mild to moderate opioid Agonists ex
Phenanthrenes: codeine, oxycodone, hydrocodone; phenylheptylamines: propoxyphene; phenylpiperdines: diphenoxylate, loperamide
38
Opioid mixed receptor actions
Nalpuphine, butorphanol, pentazocine
39
Opioid antagonists ex
Naloxone, naltrexone
40
Opioid antagonists MOA
Block effects of opioids by competitive binding (reverses all effects, not just a specific side effect)
41
Anesthesia considerations
Stop taking herbal supplements 2-3 weeks before surgery, discontinue aspirin and blood thinners before surgery
42
Cyclooxygenase
Enzyme responsible for prostaglandin synthesis, and contributes to integrity of stomach lining, pain and inflammation
43
Dysmenorrhea
Painful cramping during menstruation
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Dysuria
Painful or difficult urination
45
Ecchymosis
Bruise like subcutaneous hemorrhage
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5th vital sign
Inclusion of pain inquiry when temperature, pulse, respirations, and blood pressure readings are taken
47
Referred pain
Pain felt in an area remote from the site of origin, possibly along the same dermatome
48
Oliguria
Reduced urine output
49
Phenylketonuria (PKU)
A genetic birth defect causing the amino acid phenylalanine to build up toxic levels in the body
50
Polyuria
Increased urination
51
Purpura
Excessive skin hemorrhage causing red-purple patches under the skin
52
Somnolence
Excessive drowsiness or sleepiness
53
Stomatitis
Inflammation of a cavity opening, such as the oral cavity
54
Transient ischemic attack (TIA)
Temporary interference with blood supply to the brain causing symptoms related to the portion of the brain affected (ie temporary blindness, aphasia, dizziness, numbness, difficulty swallowing, or paresthesias), they may last a few moments to several hours, after which no neurological damage is evident
55
3 types of pain intensity scales
Simple descriptive pain intensity scale, 0-10 numeric pain intensity scale, visual analog scale (VAS)
56
Celecoxib risks
Increased risk of serious cardiovascular thrombosis, myocardial infection, and stroke
57
Which NSAIDS aren’t used for rheumatoid arthritis or osteoarthritis
Ketorolac, mefenamic, and meloxicam
58
Celecoxib contraindications
Allergy to sulfonamides, and history of cardiac disease or stroke
59
Ibuprofen contraindications
Hypertension, peptic ulceration, GI bleeding
60
Arthrotec combined what 2 drugs
Diclofenac and misoprostol
61
Arthrotec contraindications
Pregnancy
62
NSAIDs precautions
Pregnancy (cat B), elderly , bleeding disorders, renal disease, cardiovascular disease, and hepatic impairment
63
Migraine headache meds ex
Prophylactic treatment includes drugs from the following categories: beta blockers, CCBs, antidepressants, or anti epileptics, drugs include sumatriptan (most end in Triptan)
64
Maigraine headache meds actions
Activation of the 5-HT receptors causes vasoconstriction and reduces neurotransmission
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Migraine headache meds adverse reactions
Dizziness, nausea, fatigue, pain, dry mouth, flushing, coronary artery vasospasm, cardiac arrhythmia, tachycardia, and myocardial infarction
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Migraine headache meds contraindications
Allergy to selective serotonin Agonists
67
5-HT Agonists contraindications
Ischemic heart disease (ex: angina or myocardial infarction), TIAs, uncontrolled hypertension, people taking MAOIs
68
Migraine headache meds precautions
Hepatic or renal function impairment, elderly, patients requiring dialysis, pregnancy (cat C), lactating
69
Ergot derivatives NSAIDs contraindications
HIV patients taking protease inhibitors, people taking macrolides
70
5-HT Agonists interactions
Cimetidine and oral contraceptives increase effectiveness of 5-HT agonist
71
Migraine headache sufferers with PKU should avoid
Rizatriptan and zolmitriptan
72
Conduction block
Type of regional anesthesia produced by injection of a local anesthetic drug into or near a nerve trunk, (ex: epidural, transsacral, and brachial)
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General anesthesia
Sensation free state of entire body
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Local anesthesia
Provision of a pain free state in a specific body area
75
Neuroleptanalgesia
Altered state of consciousness or sensation
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Preanesthetic drug
Pertaining to status before administration of an anesthetic drug
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Regional anesthesia
Injection of a local anesthetic around nerves to block sensation
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Spinal anesthesia process
Type of regional anesthesia produced by injection of a local anesthetic drug into the subarachnoid space of the spinal cord, results in a loss of feeling and movement in lower extremities, lower abdomen, and perenium
79
Topical anesthesia use
Surface of the skin, open area or mucous membrane, may be used to desensitize the skin or mucous membrane to the injection of a deeper local anesthetic
80
Topical anesthesia administration
Can use a cotton swab or spray directly on area, can also be dispensed transdermally for chronic pain relief
81
Local infiltration anesthesia uses
It’s the injection of a local anesthetic drug into tissues. Common in dental procedures, suturing of small wounds, or making an incision in a small area
82
Local infiltration anesthesia administration
In palliative care, can be given subcutaneously through a pump
83
Spinal anesthesia use
Surgeries for lower limbs, such as a total knee replacement or hip surgery
84
Epidural
Injection of local anesthetic in space surrounding the dura of the spinal cord
85
Transsacral block (aka caudal block)
Injection of a local anesthetic into the epidural space at the level of the sacrococcygeal notch
86
Brachial plexus block
Injection of a local anesthetic into the brachial plexus
87
Epidural use
Obstetrics
88
Transsacral block use
Obstetrics
89
Brachial plexus block use
Surgery of arm or hand
90
Preparing patient for local anesthesia
Explain process, ask allergy history, clean area with antiseptic, shave area, possible require patient to fast
91
Anesthetics can be mixed with what to provide local vasoconstriction
Epinephrine
92
Combined epinephrine and anesthetic contraindication
When local anesthetic is used on an extremity
93
Local anesthetics ex
articaine, bupivacaine, chloroprocaine, lidocaine, mepivacaine, prilocaine, ropivacaine
94
Preanesthetic drug ex
Opioid or anti anxiety, cholinergic blocking, antiemetic
95
Opioid or anti anxiety drug use as a preanesthetic
To decrease anxiety and apprehension immediately before surgery
96
Cholinergic blocking drug as a preanesthetic use
Decrease secretions of the upper respiratory tract
97
Antiemetic drugs as a preanesthetic use
Decrease incidence of nausea and vomiting during the immediate postoperative recovery period
98
Preanesthetic Drugs aren’t for
Elderly
99
Preanesthetic opioids ex
Fentanyl, meperidine, morphine
100
Preanesthetic barbiturates ex
Secobarbital
101
Preanesthetic cholinergic blocking drugs ex
Atropine, glycopyrrolate, scopolamine
102
Anti anxiety drugs with antiemetic properties preanesthetics ex
Hydroxyzine
103
Anti anxiety drugs preanesthetics ex
Diazepam, lorazepam, midazolam, chlordiazepoxide
104
Sedative Drugs preanesthetic ex
Droperidol
105
How is general anesthesia most commonly achieved
With anesthetic vapors of volatile liquids, which are inhaled a vapors or by nitrous oxide
106
Stage 1 of general surgical anesthesia
Analgesia (induction): begins with administration and lasts until consciousness is lost
107
Stage 2 of general surgical anesthesia
Delirium : patient may move and mumble incoherently, muscles are rigid, patient is unconscious and can’t feel pain, and noises are exaggerated
108
Stage 3 of general surgical anesthesia
Surgical analgesia : divided into 4 planes. Plane 1 is light and plane 4 is deep, at plane 2 or 3, the patient is ready for the procedure
109
Stage 4 of general surgical anesthesia
Respiratory paralysis : rare and dangerous stage of anesthesia, respiratory arrest and cessation of all vital signs may occur
110
General anesthesia drugs ex
Barbiturates (methohexital),etomidate, propofol, benzodiazepines (midazolam), ketamine, nitrous oxide (gas), sevoflurane (volatile liquid), isoflurane (volatile liquid), desflurane (volatile liquid), fentanyl, droperidol, remifentanil
111
General anesthesia muscle relaxants ex
Cisatracurium,pancuronium, succinylcholine
112
Which drugs are used together to accomplish neuroleptanalgesia
Fentanyl and droperidol
113
Aggregation
Clumping if blood elements
113
Jaundice
Yellow discoloration of the skin because of liver disease
114
Pancytopenia
Reduction in all cellular elements of the blood
115
Prostaglandins
Fatty acid derivative found in almost every tissue and fluid of the body that affects the uterus and other smooth muscles, also thought to increase the sensitivity of peripheral pain receptors to painful stimuli
116
Reye syndrome
Acute and potentially fatal disease of childhood, associated with a previous viral infection
117
Salicylism
Adverse reaction to a salicylate characterized by dizziness, impaired hearing, nausea, vomiting, flushing, sweating, rapid and deep breathing, tachycardia, mental confusion, lassitude, drowsiness, respiratory depression, coma
118
Acute pain
Brief, and lasts less than 3-6 months, usually subsides when the injury heals
119
Chronic pain
Lasts more than 6 months and is often associated with specific diseases (cancer, sickle cell anemia, etc)
120
How can the sensation of pain be modified
At the site (peripherally) when the cause is treated, or by modifying the signal in the brain (centrally)
121
Aspirin MOA
Prolong bleeding time by inhibiting aggregation of platelets, more potently inhibits prostaglandin synthesis
122
Aspirin uses
Decrease risk of myocardial infarction in those with unstable angina or previous myocardial infarction, reduce risk of transient ischemia of the brain because of fibrin platelet emboli, help maintain pregnancy in special at risk populations (low dose only)
123
Salicylate side effects
Gastric upset, heartburn, nausea, vomiting, anorexia, GI bleeding (significant blood loss over time)
124
Allergy to salicylates signs
Hives, rash, angioedema, bronchospasm with asthma like symptoms
125
Salicylates contraindications
Allergy to NSAIDs, bleeding disorders or tendencies (GI bleeding, blood dyscrasias, anticoagulants, antineoplastic Drugs), pregnancy (cat C) and lactation
126
Aspirin pregnancy cat
D
127
Aspirin contraindications
Children or teens with influenza or chickenpox because it can be associated with reye syndrome
128
Salicylates precautions
Lactation, hepatic or renal disease, pre existing hypothrombinemia, vitamin K deficiency, GI irritation (peptic ulcers), mild diabetes, gout
129
Aspirin overdose results in
Salicylism
130
Salicylates interactions
Anticoagulants increase risk of bleeding, increased serum level of NSAIDs, activated charcoal decrease absorption of salicylates, antacids decrease effects of salicylates, carbonic anhydride inhibitors increase risk for salicylism
131
Differences between aspirin and acetaminophen
Aspirin is a salicylate, and possesses anti inflammatory and anticoagulant properties that acetaminophen doesn’t have
132
Acetaminophen uses
Mild to moderate pain, reduce fever, managing pain and discomfort with arthritic disorders, aspirin allergy and works with people who have bleeding disorders (bleeding ulcer, hemophilia), people on anticoagulants or who have recently had minor surgery
133
Acetaminophen overdose signs
Nausea, vomiting, confusion, liver tenderness, hypotension, cardiac arrhythmias, jaundice, and acute hepatic and renal failure
134
Acetaminophen pregnancy cat
B
135
Acetaminophen precautions
Severe or recurrent pain, or high and continued fever
136
Acetaminophen interactions
Barbiturates, hydantoins, isoniazid, and rifampin increase risk of toxicity and decrease effect of acetaminophen, decreased effectiveness of loop diuretics, alcohol
137
Agonist-antagonist
Drug with birth agonist and antagonist properties
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Cachectic
Malnourished, in poor health, physically wasted
139
Compounding medications
Made under the super ion of a licensed pharmacist, combining, mixing, or altering the ingredients of a drug to create a medication tailored to the needs of an individual patient
140
Miosis
Constriction of the pupil of the eye
141
Opioid naive
No previous use or infrequent use of opioid medications
142
Partial Agonists
Agent that binds to a receptor but produces a limited response
143
Patient controlled analgesia
Drug pump and delivery system that allows patients to administer their own analgesic medication intravenously within a preset protocol
144
Tolerance
The body's physical adaptation to a drug
145
Mu receptor effect with opioids
Supraspinal analgesia, respiratory and physical depression, miosis, reduced GI motility
146
Delta receptor opioid responses
Dysphoria, psychotomimetic effects (hallucinations), respiratory and vaso otro stimulations caused by drugs with antagonist activity
147
Kappa receptor opioid response
Sedation and miosis
148
Most widely used opioid
Morphine sulfate
149
Moderate to severe pain opioids ex
Meperidine and levorphanol
150
Moderate pain opioids ex
Hydrocodone, codeine, pentazocine
151
Opioids uses
Decrease anxiety and sedate patient before surgery, support anesthesia, promote obstetric analgesia, relieve anxiety in patients with dyspnea associated with pulmonary edema, control pain for extended periods without apparent loss of motor, sensory, or sympathetic nerve function, relieve myocardial infarction pain, manage opiate dependence, severe diarrhea and intestinal cramping, severe and persistent cough
152
Opioids CNS side effects
Euphoria,weakness, headache, lightheadedness, dizziness, sedation, miosis, insomnia, agitation, tremor, increased intracranial pressure, impairment of mental and physical tasks
153
Opioids respiratory system reactions
Depression of both rate and depth of breathing
154
GI system opioid side effects
Nausea, vomiting, dry mouth, biliary tract spasms, constipation, anorexia,
155
Cardiovascular opioid side effects
Facial flushing, tachycardia, bradycardia, palpitations, peripheral circulatory collapse
156
Opioids side effects genitourinary
Urinary retention or hesitancy, spasms of the ureters and bladder spinchter
157
Opioid side effect considerations
Respiratory system will adapt to side effects of opioids, but the GI system won’t
158
Opioids contraindications
Acute bronchial asthma, emphysema, upper airway obstruction, head injury, increased intracranial pressure, convulsive disorders, severe renal or hepatic dysfunction, acute ulcerative colitis
159
Opioids pregnancy cat
C, not recomendé use during pregnancy or labor because they may prolong labor or cause respiratory depression in the infant
160
Oxycodone pregnancy cat
B
161
Opioids precautions
Elderly, opioid naive people, biliary surgery, lactating, undiagnosed abdominal pain, supraventricular tachycardia, prostatic hypertrophy, and renal or hepatic impairment
162
Opioids interaction
Alcohol, antihistamines, antidepressants, sedatives, and phenothiazines increase risk of CNS depression, opioid Agonist-antagonists increase risk of opioid withdrawal symptoms, barbiturates can cause respiratory depression, hypotension, or sedation
163
Antagonist
Substance that counteracts the action of something else
164
Cell surface receptor
Area built into the cell membrane which binds with chemical signs and causes a response by the cell
165
Opioid antagonists uses
Postoperative acute respiratory depression, reversal of opioid adverse effects, suspected acute opioid overdosage
166
Opioid antagonists side effects
Nausea, vomiting, sweating, tachycardia, increased blood pressure, tremors
167
Opioid antagonists
Pregnancy (cat B), infants of opioid dependent mothers, patients with an opioid dependency or cardiovascular disease
168
Opioid antagonists interactions
Prevent that action of opioid antidiarrheals, antitussives, and analgesics
