Drugs affecting the central nervous system

Question 1

What are the definitions of acute, chronic, superficial, visceral

Answer 1

Acute=sudden; chronic=.3mo; visceral=organs, sm muscles

Question 2

Opioid analgesics/opioid agonists common facts:

Answer 2

pregnancy B/controlled substance; opium was used in 350 BC; some drugs taken from opium include morphine/codeine

Question 3

Where do opioids act on:

Answer 3

specific opoid receptors of CNS

Question 4

Opioids activate what type of receptors from the CNS:

Answer 4

MU receptors and weak activation of Kappa (K) receptors

Question 5

Activation of MU receptors do what:

Answer 5

analgesia respiratory depression, euphoria, sedation

Question 6

Activation of K receptors cause:

Answer 6

analgesia and sedation

Question 7

What isomers do opioids have:

Answer 7

Levo isomers=analgesic effect; dextro isomer=antitussive response

Question 8

Which of the isomers cause dependence:

Answer 8

levos

Question 9

What are the indications of opioids:

Answer 9

moderate/severe pain; pre-op/dyspnea and PE

Question 10

What are some contraindications of opioids:

Answer 10

head injuries; asthma; hypotension; labor; renal/hepatic impairment

Question 11

What is the dosage factors of analgesics in older adults:

Answer 11

adjust dose to low amount to decrease side effects

Question 12

What is the dosage factors of analgesics in chronological age:

Answer 12

AGE, size, weight of pt

Question 13

What is the dosage factors of analgesics in comorbidity:

Answer 13

D/t all types of other disease processes: dose should be adjusted

Question 14

What is the dosage factors of analgesics in oncology pts:

Answer 14

Use the WHO pain scale; want comfort

Question 15

What is the dosage factors of analgesics in substance abuse:

Answer 15

Still have to tx acute injury despite substance abuse; holding meds doesn’t help them w/substance abuse

Question 16

What are some side effects of opioids:

Answer 16

orthostatic hypotension, N/V/D, drowsiness, sedation, confusion, urinary retention

Question 17

WHat are some adverse effects of opioids:

Answer 17

Respiratory depression, increased ICP, hypotension, pupillary constriction (sign of toxicity), dependence/tolerance, withdrawal

Question 18

What are some drug interactions with: EtOH, hypnotic, antipsychotic drugs, muscle reaction

Answer 18

increases the effect

Question 19

What are some common opioid analgesics:

Answer 19

morphine sulfate, fentanyl, Meperidine, codeine, and some (ONE side effects)

Question 20

What is the pharmacodynamics of morphine sulfate:

Answer 20

binds with opioid receptors, paternal administration has rapid onset, duration is 3-5 hrs; controlled released tabs are 8-12 hrs

Question 21

What are the pharmacokinetics of morphine sulfate:

Answer 21

metabolized in liver, iv for severe pain, sm amount crosses the blood brain barrier, short half life, crosses through placenta and breast milk

Question 22

Common dosages of morphine sulfate in adult:

Answer 22

Adult: po=10-30mg, IV=4-10 mg;

Question 23

Why are oral dosages of oral opioids:

Answer 23

oral dosages undergoes extensive metabolism on hepatic pass through the liver prior to reaching the systemic circulation

Question 24

Incase respiratory distress would occur in a pt taking an opioid, what antagonists would we give to block effect of opioid:

Answer 24

Narcan

Question 25

What are some S/S of opioid overdose:

Answer 25

respiratory depression, hypotension, drowsiness, pupillary constrictions=use Narcan (can be given in a post-op situation d/t excessive # of opioids)

Question 26

Opioid withdrawal causes:

Answer 26

N/D, abd cramps, restlessness, irritability, watery eyes, runny nose, and diaphoresis, muscle twitching, increase BP/HR

Question 27

What drugs would we Rx for withdrawal of opioids:

Answer 27

Methadone (half life is longer than opioids so methadone is given once a day)

Question 28

What are some metadone Tx programs:

Answer 28

Weaning program (1st 2 days the dose is same amount as orig street drug, than after 2 days the drug is decreased to 5-10 mg) and maintenance program (dose remains consistance or given one dose every day)

Question 29

What drug is given for opiate detoxification:

Answer 29

Clondine or Catapress to manage the withdrawal

Question 30

What opioid agonist-antagonists combination is not given for cancer pain and is safe for using during labor:

Answer 30

Nubain

Question 31

What are some common drugs used for conscious sedation:

Answer 31

fentanyl and versed

Question 32

What are the goals of conscious sedation:

Answer 32

analgesia, amnesia, anxiolysis

Question 33

What is an alternative route for opioid administration for self-administration of pain relief:

Answer 33

PCA (pt controlled analgesia)

Question 34

What are some common PCA drugs:

Answer 34

morphine, fetanyl,dilaudid

Question 35

What are some common info to know about PCA:

Answer 35

Loading dose, lockout mechanism, nurse titrates, maintains a near-constant analgesic level, and avoids episodes of severe pain and over sedation

Question 36

What is a On-Q pain buster system:

Answer 36

not used for opioids, a continuos infusion of a local anesthetic to keep the area numb

Question 37

A physiological and physical dependence upon a substance beyond normal voluntary control, usually after a prolonged use of a substance beyond normal voluntary control, usually after a prolonged use of a substance is defined as:

Answer 37

addiction

Question 38

Controlled substance act:

Answer 38

defined opioids through 1-5

Question 39

What population is at risk for addiction:

Answer 39

those who use drugs on the streets, healthcare professionals and pts

Question 40

What are some characteristics in a nurse w/substance abuse:

Answer 40

changes in personality/behavior, job performance, and attendance, poor judgment, errors, illogical documentation, discrepancies in controlled-drug handling and records

Question 41

What program can rn’s go for substance abuse:

Answer 41

Diversion program (license may be put on hold, but not revoked)