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pharm 140 > ch 26 narcotics > Flashcards

ch 26 narcotics Flashcards

(67 cards)

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1
Q

pain

A

subjective, sensory, emotional experience

a major indicator for drug therapy

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2
Q

transduction

A

initiation of a pain signal

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3
Q

pain receptor

A

found on peripheral end plates of afferent neurons

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4
Q

afferent neuron

A

sensory neurons that carry nerve impulses from sensory stimuli TOWARDS the CNS

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5
Q

efferent neuron

A

motor neurons that carry neural impulses away from CNS and towards muscles

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6
Q

limbic system

A

produces emotional response to physical stimulus of pain

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7
Q

inhibitory substances

A

endogenous opioids, serotonin, norepinephrine, GABA

bind with receptors on afferent neurons to prevent further transmission of painful stimuli

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8
Q

opioid receptors

A

receptor sites that respond to naturally occuring peptides and endorphins

located in CNS, GI tract

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9
Q

nociceptive pain

A

caused by direct stimulus to a pain receptor in response to painful stimuli

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10
Q

neuropathic pain

A

pain resulting from nerve injury

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11
Q

acute pain

A

immediate phase of response to injury from tissue damage

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12
Q

chronic pain

A

may persist well behind actual tissue injury and healing

may interrupt ADLs

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13
Q

nonpharmacologic techniques to control pain

A 
relaxation therapy
guided imagery
biofeedback
music distraction
exercise
TENS
massage
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14
Q

treating pediatric pain

A

codeine
fentanyl (nontransdermal)
hydrocodone
morphine

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15
Q

treating adult pain

A

educate pt about requesting pain meds

pt controlled analgesia pump (PCA)

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16
Q

treating pain during pregnancy

A

morphine and meperidine

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17
Q

treating pain for older adults

A

assess thoroughly for pain
monitor for adverse effects
safety measures in place

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18
Q

narcotic analgesics indications

A

conditions, disorders or treatments that are accompanied by moderate to severe pain

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19
Q

types of narcotic analgesics

A

opiate agonists
mixed agonist-antagonists
opiate antagonists

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20
Q

narcotics are typically

A

UNDER prescribed

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21
Q

morphine indications

A

moderate to severe pain

acute or chronic

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22
Q

morphine pharmacokinetics

A

IV or PO
metabolized in liver
onset 15-30 min, duration 3-7 hrs

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23
Q

morphine pharmacodynamics

A

AGONIST

at mu, kappa, possibly delta opiate receptors

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24
Q

morphine contraindications

A

hypersensitivity
resp conditions
GI obstruction

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25
morphine cautions
head injury increased ICP hepatic/renal impairment
26
morphine black box warning
risk of overuse and death risk of death with other depressants keep out of reach of children
27
morphine adverse effects
physical dependence dizziness, headache, blurred vision, sedation, seizures euphoria, hallucinations, anxiety bradycardia, cardiac arrest, shock, hypotension, peripheral edema n/v, constipation, anorexia, ileus, urinary retention thrombocytopenia, anemia, leukopenia respiratory depression
28
morphine interactions
alcohol benzodiazepines/depressants general anesthetic/MAO inhibitors (lower dosage of morphine) serotonergic drugs (may increase risk of serotonin syndrome)
29
morphine nursing dx
ineffective breathing pattern (hypoventilation) r/t respiratory depression 2/2 drug therapy constipation r/t drug therapy urinary retention r/t anticholinergic effects of drug on urinary sphincters risk for injury r/t orthostatic hypotension or sedation 2/2 drug effects
30
morphine interventions
max therapeutic effects: assess pain prior to and during therapy using a pain assessment tool min adverse effects: conduct frequent assessment and monitor respirations, provide pain meds for breakthrough pain
31
morphine pt education
``` constipation as side effect notify provider if difficulty breathing incentive spirometry do not drive while taking drug do not crush/break/chew drug stress importance of rating pain accurately ```
32
morphine nursing considerations
``` frequent respiratory assessment thorough pain assessment monitor for s/s serotonin syndrome monitor for s/s adrenal insufficiency keep narcan on hand stool softener/stimulant lax should also be ordered ```
33
drug of choice in relieving MI pain
morphine
34
mild narcotic agents
codeine hydrocodone propoxyphene
35
codeine indications
mild to moderate pain
36
codeine pharmacokinetics
absorbed from GI tract peaks 1-2 hrs can be excreted in breastmilk
37
codeine pharmacokinetics
acts at specific opioid receptors in CNS to produce analgesia, euphoria, sedation
38
codeine contraindications
do not give with other narcotics
39
codeine adverse effects
drowsiness, sedation dry mouth n/v constipation
40
codeine interactions
``` other narcotics antihistamines phenothiazines barbituates tricyclic antidepressants cimetidine alcohol ```
41
codeine nursing dx
disturbed sensory perception r/t drowsiness, sedation risk for ineffective airway clearance r/t suppression of cough reflex constipation 2/2 drug therapy
42
codeine interventions
max therapeutic effect: ask pt to rate pain before and during therapy min adverse effect: provide for pt safety, assess resp function, do not administer to pts who must cough to clear airway
43
codeine pt teaching
drowsiness and impaired orientation may occur | do not take with other depressants
44
codeine is contraindicated in
pt with chest tubes because they will need to cough and breathe deeply to facilitate lung expansion
45
narcotic agonist-antagonists
mixed opioid effects less substance abuse potential than some agonists prototype pentazocine (Talwin)
46
pentazocine (Talwin) indications
moderate to severe pain | often used in surgery pts
47
pentazocine (Talwin) pharmacokinetics
oral, SC, IM metabolized by liver peak 1-3h, duration 3h
48
pentazocine (Talwin) pharmacodynamics
mixed agonist/antagonist stimulates kappa receptors weakly antagonizes mu receptors
49
pentazocine (Talwin) contraindications
hypersensitivity
50
pentazocine (Talwin) cautions
respiratory conditions hepatic/renal impairments cardiac issues
51
pentazocine (Talwin) adverse effects
``` n/v dizziness, lightheadedness resp depression/suppressed cough reflex urinary retention uteral spasms ```
52
pentazocine (Talwin) interactions
barbiturate gen anesthetics (phenobarbitol) may increase risk of resp depression, hypotension, coma
53
pentazocine (Talwin) pregnancy category
category C
54
pentazocine (Talwin) nursing dx
disturbed sensory perception r/t dizziness, lightheadedness imbalanced nutrition 2/2 n/v ineffective health maintenance r/t abuse of pentazocine
55
pentazocine (Talwin) interventions
max therapeutic effect: provide environmental controls to reduce sensory stimuli and aid relaxation min adverse effect: ensure safety precautions are used, keep narcan on hand
56
pentazocine (Talwin) pt education
pt will learn adverse effects and report | importance of proper medication administration
57
hepatic pts and pentazocine (Talwin)
liver disease slows metabolism of pentazocine
58
narcotic antagonists
bind to opioid receptors but do not activate | blocks effects of too much opioid/opioid overdose
59
naloxone (Narcan) indications
reverse effects of opioid agonists | opioid overdose
60
naloxone (Narcan) pharmacokinetics
absorbed systemically when given IV metabolized in liver excreted in urine
61
naloxone (Narcan) contraindications
hypersensitivity
62
naloxone (Narcan) cautions
narcotic addiction (will cause wd) pregnancy/lactation cardiovascular disease
63
naloxone (Narcan) adverse effects
``` acute narcotic withdrawal seizures, tremors pulmonary edema, tachycardia, hypotension, HTN, v-fib nasal dryness, congestion n/v diaphoresis ```
64
naloxone (Narcan) interactions
methylnaltrexone, naldemedine, naloxegel may enhance risk of opioid withdrawal
65
naloxone (Narcan) nursing considerations
monitor pts for resp depression larger doses required for buprenorphine reversal only effective for reversing respiratory depression caused by opioids
66
naloxone (Narcan) pt education
educate pt/family about s/s of opioid toxicity instruct person about proper intranasal administration naloxone may precipitate opiate withdrawal
67
gate control theory
asserts that non-painful input closes the nerve "gates" to painful input, which prevents pain sensation from traveling to the central nervous system

pharm 140 (18 decks)

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