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NURS 5590 > M4 study guide > Flashcards

M4 study guide Flashcards

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1
Q

What receptors do opioid analgesics affect?

A

MU + Kappa

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2
Q

What are the effects of of activation of MU receptors?

A

Pure agonists produce analgesia, respiratory depression, sedation, physical dependence, slowed GI motility

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3
Q

How do opioid analgesics affect receptors?

A

acts primarily by activating MU receptors, also producing a weak activation of Kappa receptors

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4
Q

Best practices r/t use of topical anesthetics

A

minimize the amount being absorbed to avoid toxicity can be done by 1. apply the smallest amt 2. avoid application to large surface areas 3. avoid applications to broken or irritated skin 4. avoid strenuous exercise, wrapping the site, heating the site-all of which can accelerate absorption through increasing skin temp

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5
Q

Name some topical anesthetics

A

Lidocaine, tetracaine, cocaine

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6
Q

What are topical anesthetics used for?

A

Used to relieve pain, itching, and soreness of various causes including; infections, thermal/sunburns, diaper rash, wounds bruises, insect bites, plant poisoning

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7
Q

Complications r/t topical anesthetics?

A

Can be absorbed and produce serious life threatening effects. Cardiac toxicity can result in bradycardia, heart block, or cardiac arrest. CNS toxicity can result in respiratory depression, seizures, coma

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8
Q

Risk for toxicity increases w/ amount absorbed, determined primarily by:

A
  1. Amount applied 2. Skin condition 3. Skin temp
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9
Q

What is the reward circuit?

A

A system that normally serves to reinforce behaviors essential for survival

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10
Q

What is the major neurotransmitter released on the reward circuit?

A

Dopamine

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11
Q

Neurotransmitter effects on the reward circuit in those with SUD

A

Drugs can activate the circuit and cause dopamine release (may be 2-10x as much as what normally is released)
When the system is activated this causes a tendency to repeat behavior, w/ repeated action over time the system under goes synaptic remodeling, thereby consolidating changes in brain function

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12
Q

What occurs if the brain is put into excessive amounts of activation of the reward circuit in someone with SUD

A

The brain will 1. produce less domapine 2. reduce the number of dopamine receptors

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13
Q

What are the effects of alcohol on the CNS

A

depression of CNS and activation of reward circuit

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14
Q

What 3 receptors/neurotransmitters are involved w/ alcohol and CNS

A

GABA-inhibitory neurotransmitter-alcohol binds to GABA causing CNS depression
Glutamate receptors-alcohol binds to glutamate receptors it blocks excitation and reduces CNS activity
5-HT3 receptors-rewarding effects of alcohol. Triggers the reward circuit

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15
Q

All 3 of these promote release of dopamine

A

GABA, 5-HT3 receptors, Glutamate receptors

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16
Q

How are migraines treated

A

Treatment is based on severity and functional improvement.
Abortive therapy + Preventative therapy

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17
Q

Mild migraine

A

NSAID e.g aspirin, naproxen

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18
Q

Moderate Migraine

A

DHE or Ergotamine (ergot alkoloid), NSAID combo products

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19
Q

Severe Migraine

A

Metoclopramide, Triptans-Imitrex (First line drug tx migraines), NSAIDS (ketoralac), Ergotamine or DHE

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20
Q

How often should you use abortive meds for migraines

A

no more than 1-2 times a week

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21
Q

Antiemetics and Migraine therapy

A

important adjuncts to help treat migraines

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22
Q

Non specific analgesics

A

Abortive therapy
NSAIDS + NSAID combos e.g aspirin
Opioid analgesics

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23
Q

Migraine specific drugs

A

Serotonin receptor agonists (triptans)
Ergots

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24
Q

Prophylaxis meds for migraines

A

Beta blockers-first line drug (propanolol used most often)
AEDs-Divalproex and Topiramate have the stongest efficacy
Tricyclic anti-depressants
Estrogens
CGRP receptor antagonists

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25
Vasoconstrictors and local anesthetics
Vasoconstrictors (epinephrine) decrease local blood flow + delays systemic absorption of an anesthetic
26
What 2 benefits does delaying absorption of local anesthetics have
Prolongs anesthesia and reduces risk of toxicity
27
Opioid agonists
Activates MU and Kappa receptors e.g. morphine, codeine, meperidine Produces analgesia, euphoria, sedation, resp depression, physical dependence, and constipation
28
Opioid antagonist
Antagonist at MU and Kappa receptors e.g. Naloxone Reversal of respiratory depression and CNS depression caused by overdose of opioid agonist
29
Methyllnatrexone
used to treat constipation induced by opioids Is a opioid antagonist
30
Migraine pain
Moderate-severe lasting up to 3 days
31
Migraine character
Throbbing, unilateral or biltaeral
32
Migraine prodrome
Aura: visual field cut, flashing lights, zig zags
33
Migraine Associated symptoms
N/V, photophobia, phonophobia
34
Migraine precipitating factors
Anxiety, stress, fatigue, menstruation, ETOH, tyramine containing foods
35
Migraine epidemiology
More severe/common in women + famillial hx
36
Migraine aggravating factors
Physical activity
37
Agonist-Antagonist
When administered alone they produce analgesia, if given to a patient taking a pure agonist, these drugs can antagonize analgesia cause by the pure agonsist
38
Pentazocine, nalbuphine, butorphenol
Agonist-antagonist drugs antagonist at MU + agonist at Kappa
39
Buprenorphine
Partial agonist Partial agonist at MU + partial agonist/ weak antagonist at Kappa
40
Tolerance
Results from regular drug use, can be defined as a state in which a particular dose elicits a smaller response that it did with initial use As tolerance increases, higher and higher doses are needed to elicit desired effects
41
Cross Tolerance
Tolerance from one drug confers tolerance to another generally develops among drugs within the same class
42
Withdrawal syndrome
constellation of s/s that occurs in physically dependent individuals when they discontinue drug use
43
Physical Dependence
Defined as a state in which an abstinence syndrome will occur if drug is discontinued Takes place as a result of prolonged drug exposure
44
Psychological dependence
An intense subjective need for a particular psychoactive drug
45
Cross-dependence
Ability of one drug to support physical dependence on another drug. Generally exists among drugs in the same pharmacologic family
46
How is SUD defined
A cluster of cognitive, behavioral, and physiological symptoms with continued use despite significant substance related problems Dependence is not required but may be present All dependent people do not have SUD SUD is not equivalent to addiction
47
Preferred therapies for patients with chronic pain
Non pharmacologic therapy and nonopioid therapy should be used to treat chronic pain before starting opioid therapy Current recommendations suggest initiating therapy with IR medications first Use of nonopioid adjuvant meds should be continued to maximize pain control
48
Naloxone when given to someone who is physically dependent on opioids
Naloxone will precipitate an immediate withdrawal reaction an excessive dose can transport a patient from a state of poisoning to a state of acute withdrawal
49
Naloxone
Opioid antagonist, used to reverse effects of opioid overdose
50
How should naloxone be administered?
Series of small doses rather than one large dose
51
Side effects/ adverse effects of opioids including morphine
Constipation Respiratory depression-can occur 90 mins after PO ingestion urinary retention-encourage pt to void Q4 tolerance and dependence-happens w/ continued use Sedation Euphoria Orthostatic hypotension Emesis-promotes n/v; pt may need antiemetics
52
Practice considerations when prescribing opioid drugs to patients with non cancer related pain
Opioids only after non opioids have failed 1 prescriber 1 pharmacy discuss benefits/risks Good documentation
53
3 principles of Treatment of headache
1. abort or prevent headache 2. patient responses vary 3. some HA drugs can cause dependence
54
Schedule 1 drugs
high potential for abuse, no approved medical use in US, therefore not prescribed e.g. cocaine, heroin
55
Schedule 2 drugs
Must be typed of filled in ink or indelible pencil and signed by the prescriber, or electonically Oral prescriptions only in emergencies, must obtain written within 72 hours cannot be refilled cant write multiple prescriptions on the same day for the same patient and the same drug
56
Schedule 3 drugs
Oral, written, or electronic prescriptions; if authorized by the prescriber these medications can be refilled up to 5 time; refills must be made within 6 months of the original order If additional meds are needed beyond the amt. provided for in original prescription a new prescription must be written
57
Schedule 4 drugs
Same as schedule 3 drugs
58
Schedule 5 drugs
Same rules as schedule 3 and 4 Can be dispensed by a pharmacist if certain criteria are met. The amt. dispensed is limited Recipient is at least 18 years old The pharmacist writes and initials a record indicating the date,name, amt. of drug, and the name and address of the recipient State and local laws do not prohibit dispensing schedule 5 drugs w/out prescription
59
What is Fentanyl
Opioid agonist, 100x more potent than morphine can be given transdermal, parenteral, transmucosal, intranasal Schedule 2 drug Adverse Rx: respiratory depression, sedation, constipation, urinary retention, nausea
60
Drug-drug interaction involving CYP system in patients receiving Fentanyl
Fentanyl is metabolized by CYP3A4, therefore fentanyl can be increased by CYP3A4 inhibitors (Ketoconazole and Ritonavir) these patients should be monitored closely for signs of respiratory depression and other signs of toxicity
61
Nicotine replacement therapy (NRT)
Nicotine gum Nicotine lozenge Nicotine patch Nicotine inhaler Nicotine nasal spray
62
Nicotine Free products
Sustained release bupropion Varenicline (Chantix)
63
Varenicline (Chantix)
taken to decrease nicotine cravings and suppress symptoms of withdrawal

NURS 5590 (12 decks)

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