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Pharmacology > Analgesics and Antiinflammatory #3 > Flashcards

Analgesics and Antiinflammatory #3 Flashcards

(58 cards)

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1
Q

What are three nursing interventions for narcotics?

A
  • Must have witness and Co-sign discarded or wasted medication
  • Ensure records and drug count matches
  • Double lock all narcotics and keys must be accounted for
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2
Q

Nursing interventions for narcotics are regulated by Federal, State, and Agency policies… These include:

A
  • Board of Nursing/ Nurse Practice Act
  • Board of Pharmacy
  • Ohio Revised Code
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3
Q

T/F Pain is an unpleasant sensory and emotional experience.

A

True

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4
Q

T/F Pain requires good assessment and knowledge of pain to treat/ control adequately

A

True

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5
Q

What can prevent health care professionals from treating pain adequately? (4)

A
  • inadequate knowledge
  • poor assessment skills
  • concern about regulation of controlled substances
  • fear of patient addiction
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6
Q

Why would a patient be reluctant to report pain/ take pain medications? (5)

A
  • culture
  • gender differences
  • inadequate description or reporting of pain
  • fear loss of control
  • side effects
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7
Q

What are problems related to the health care system that denies patients from receiving pain control? (3)

A
  • cost
  • access
  • “not being listened to”
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8
Q

What are 3 main physiological stressors of unrelieved pain?

A
  • increased respiration rate
  • increased HR
  • increased BP
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9
Q

What are 3 stress responses of unrelieved pain?

A
  • fluid retention
  • glucose intolerance
  • impaired immune response- pneumonia
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10
Q

What can result from stress responses due to unrelieved pain?

A
  • constipation
  • weakness
  • confusion
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11
Q

What is addiction?

A

psychological and physical dependence on a substance beyond normal voluntary control (usually after prolonged use of a substance)

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12
Q

What is dependence?

A

reliance of a substance, that is not present, will cause impairment of psychological or physical function (need regular use to prevent withdrawal)

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13
Q

What is tolerance?

A

requiring increased dose to maintain same effect (frequently occurs in with chronic pain, such as cancer pain)

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14
Q

Different types of pain include:

A
  • acute (pain occurs suddenly and responds to treatment)
  • chronic (pain persists for more that 6 months- difficult to treat or control)
  • somatic (pain of skeletal muscle, ligaments and joints)
  • visceral (pain from smooth muscle and organs)
  • vascular (pain from vascular or perivascular tissues—> contribute to headaches/ migraines)
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15
Q

Damaged cells release which chemical mediators?

A
  • prostaglandins (causes increased vasodilation, capillary permeability, pain, and fever)
  • bradykinins (causes increase capillary permeability)
  • serotonin (helps block the perception of pain in the brain)
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16
Q

T/F Nociceptors are in all types of tissue

A

True (from the powerpoint, but what about the brain?)

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17
Q

Non-opioid (OTC) medications include:

A
  • Acetaminophen (prototype) (which IS Tylenol)

- NSAIDs- example is Ibuprophen (prototype)

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18
Q

Opioids (narcotics, controlled substances) include:

A

-Morphine (prototype)- examples are methadone and oxycodone

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19
Q

What are adjuvants/ what do they do?

A
  • used in addition to pain meds

- may control some types of pain, depending on the source (such as inflammation or neuropathic)

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20
Q

What are some examples of adjuvants? (3)

A
  • corticosteroids
  • anitconvulsants
  • tri-cyclic antidepressants (TCA’s)
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21
Q

T/F Nonsteroidal Antiinflammatory Drugs (NSAIDs) are addictive and more potent that opiates.

A

False

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22
Q

NSAIDs are used for what type of pain?

A

mild to moderate pain

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23
Q

What are the effects of NSAIDs?

A
  • analgesic
  • antipyretic
  • antiiflammatory (except acetaminophen which have a minimal effect)
  • some have antiplatelet action
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24
Q

Which NSAID has an very minimal antiiflammatory effect?

Study These Flashcards
A

Acetaminophen (which IS Tylenol) :)

25
NSAIDs relieve pain by effects on chemical medicators by:
inhibiting cycloxygenase which results in decreased prostaglandin synthesis
26
Two types of cycloxygenase include:
COX-1- protects stomach and regulates platelets COX-2- triggers pain and inflammation (COX 2 inhibitors can help control arthritis type pain, but can cause some cardiac problems)
27
T/F ASA and many other NSAIDs inhibit both types of protaglandins.
True
28
What do two types of prostaglandin do?
- one causes increased vasodilation, capillary permeability, pain, and fever - another promotes the mucosal barrier (stomach lining) protecting the stomach from high acid food
29
What are the different types of NSAIDs?
- Salicylates- aspirin - COX-2 inhibitors- celecoxib (Celebrex) and rofecoxib (Vioxx) - Propionic acid group- ibuprofen (Motrin and Advil) - Others include naproxen (Aleve) and indomethacin (indocin)
30
Side effects/ Adverse Reactions of NSAIDs include:
- GI irritation, ulcers (due to inhibition of COX 1 and 2) - Inhibitor of platelet aggregation (increased bleeding tendencies, increase effect of anticoagulants, increase menstrual flow) - Hypersensitivities (vertigo and bronchospasm)
31
T/F Aspirin can be given to children under the age of 12 for any fever?
False (if done, risk for Reye's Syndrome)
32
T/F Chronic use of NSAIDs can cause renal impairment (especially propionic group like Ibuprofen).
True
33
T/F Acetaminophen is in 25% of all OTC meds sold (over 200 OTC preparations)
True
34
T/F Acetaminophen has NO effect on gastric lining or platelets and has a fairly wide safety margin.
True
35
What are the toxic effects of acetaminophen overdose and what increases that risk?
- acute liver failure (hepatotoxicity)/hepatic necrosis | - When taken with Alcohol, the risk is increased
36
How would you give to treat for an overdose of acetaminophen?
mucomist
37
How can an overdose of acetaminophen occur?
-If you have more than 4 mg/day or -Long term use of more than 2 mg/day
38
What are corticosteroids and what is important to note about them?
- They suppress inflammation by inhibiting of the immune process--> depress lymphocyte activity - Must be tapered off (if used more than 1-2 weeks)
39
What are some examples of corticosteroids?
- prednisone - dexamethasone - solu-cortef
40
What are side effects of corticosteroids?
- glucose intolerance - weight gain - osteoporosis - skin changes - increased risk for infection/ poor healing
41
What are some examples of DMARDs (Disease modifying antirheumatic drugs)?
- Gold- used as antirheumatic (ex. gold salts- Ridaura, Solganal) - Immunosuppressive agents- inhibit inflammatory process - Immunomodulators - Antimalarials
42
T/F Some antidepressants or anitconvulsants are used as adjunct drugs for pain (esp. neuropathic).
True | examples include: Gabapentin, Elavil, Pregabalin (Lyrica)
43
What type of pain are narcotic analgesics used for?
moderate to severe pain
44
What are some examples of narcotic analgesics?
- morphine | - codeine
45
What do narcotic analgesics do to the CNS?
- suppress pain perception - suppress respiration - suppress cough (antitussive) - suppress GI motility= constipation
46
What is important to know about morphine?
- administered IM, IV, PO - very effective in acute, severe pain (offers euphoria) - relief of respiratory distress in terminal illness near death - effective in treating chronic pain if extended release forms - effective in acute heart failure (if pulmonary edema)-reduces preload, afterload, gives euphoira
47
The synthetic narcotic, Meperidine (Demerol), has what characteristics?
- no antitussive effect - very dangerous in renal insufficieny - can be neurotoxic (tremors and seizures) - does not diminish uterine contractions (may be given during labor for pain) - less constipation and urinary retention - Use with extreme selectivity
48
T/F Tramadol (Ultram) binds to microreceptors, possibilly has no dependence, used for moderate to severe pain, and is contraindicated with alcohol and opioids.
True
49
Narcotic Side effects/ Adverse reaction include:
- respiratory depression (give narcan if resp. rate <10) - orthostatic hypotension - consitpation - N / V - Somnolence (drowsiness) - allergenic if rash/hives develop - tolerance and dependence
50
What are some of the withdrawal symptoms?
- agitation - tachycardia - HTN - GI symptoms - skin sensation of "crawling bugs"
51
What should you monitor with a patient on a narcotic?
-respiratory rate (RR any will need narcan These occur if pt is opioid naive or drug has accumulated too much during renal or hepatic disease.
52
When a patient is on narcotics, the nurse should pay special attention to:
- Safety risk (BP changes, sedation) - Constipation - Caution if patient has liver or renal disease - Caution in elderly (lower dose) - Make accurate assessments - Listen to pt (what does/doesn't work)
53
Besides Naloxone (Narcan), what is another narcotic antagonist (anitdote)?
Naltrexone HCL (ReVia)
54
What do narcotic antagonists do and how should they be given (not route)?
- They compete for opiate receptors ("knock opiate off" to stop effect) - They must be given slowly and carefully
55
What are some condraindications of Narcotic use?
-head injuries -respiratory dysfunction (can be used to control cough) -shock states (can decrease BP further) -GI motility problems (can worse anticholinergic effects).... can be used to control diarrhea in some patients Make sure to evaluate risk vs. benefit
56
T/F Combinations of narcotic agonists and antagonist result in less risk for tolerance to develop and can lower the narcotic dose needed.
True
57
Examples of Combinations of narcotic agonists and antagonists include:
- Pentazocine (Talwin)- most commonly used - Butorphanol tartrate (Stadol) - Buprenorphine (Buprenex)
58
T/F Acetaminophen is Tylenol
True :)

Pharmacology (5 decks)

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