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Pharmacology > MSK- Exam 1 > Flashcards

MSK- Exam 1 Flashcards

1
Q

World Health Organization Analgesic Ladder (3 Steps)

A

Step 1: Mild to moderate pain
Step 2: More Severe pain
Step 3: Severe Pain

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2
Q

Reason behind Adjuvants?

A

Used to complement the effects of opioids; not used as substitutes
Help manage concurrent symptoms that exacerbate pain

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3
Q

What do cycloxygenase inhibitors do?

A

They are NSAIDS that block COX 1 and/or COX 2 (the enzyme that converts arachidonic acid to prostaglandins)

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4
Q

Abbreviation of Aspirin

A

ASA

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5
Q

4 A’s of Aspirin usage?

A

Analgesics: Blocks prostaglandin pain messenger info
Anti-Inflammatory: Prevents vasodilation and capillary permeability
Anti-pyretic: Blocks prostaglandins from relaying message to hypothalamus (thermostat) fever prevention
Anti-Platelet: Blocks thromboxane (platelet aggregration)

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6
Q

What to be mindful of with someone taking Aspirin medication in terms of possible upcoming procedure/bleed risk?

A

Stop taking aspirin at least 7-10 days prior to surgery, because of the anti platelet effect, this will cause you to bleed very easily and platelet life span is 7-10 days. Irreversible

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7
Q

Pharmacokinetics Aspirin Distribution? Why important?

A

Extensively protein bound. Malnutrition patients will have a greater amount of the drug in system due to protein deficiency. Causing you to see exaggerated effects of drug (bleeding more easily).

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8
Q

Importance of acid excretion of aspirin?

A

Aspirin is heavily influenced by PH. Meaning if you have acidic urine, you cant just dump hydrogen ions, drug will stay in system longer.

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9
Q

Aspirin dosage, high and low

A

Low dose: 81 mg (preventative for heart attack/stroke, clot prevention in relation to platelets)
High dose: 325 mg (Headache)

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10
Q

Why do doctors prescribe aspirin post hip or knee surgery?

A

Prevention of DVT’s, 325 mg utilized as an anti platelet drug in prevention of thrombus.

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11
Q

Adverse Effects of Aspirin?

A

Reyes Syndrome: Child recovering from viral infection, takes aspirin, blood sugar drops and then the acidity and ammonia level in blood increases. Death and/or brain damage
Salicylism: Poisoning

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12
Q

Common Side Effects of Aspirin- What does Aspirin come in, in the military?

A

Brown BAG:
B- Bleeding (platelet)
A- Affects renal function (Prostaglandin blockage in afferent and efferent of kidneys, bouncer in the club is broken)
G- Gastric Upset (blocked prostaglandins)

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13
Q

1st Generation Non-NSAID

A

Ibuprofen

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14
Q

Key difference between aspirin and ibuprofen?

A

Reversibly inhibits COX 1 and COX 2, so not used to prevent MI or CVA because after 24 hours, the anti platelet effect is gone.

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15
Q

Non-Aspirin NSAID 2nd Generation

A

Celecoxib (Celebrex)

Last choice drug for long term management of pain

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16
Q

Why is Celecoxib prescribed? Key difference?

A

Blocks COX 2: Suppresses Inflammation, pain and fever, but spares COX 1 causing less gastric ulceration. Can be prescribed to those with ongoing stomach issues.

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17
Q

Two risks of Celecoxib?

A

Can actually increase the risk of CVA and MI because it does not affect platelet aggregation, and since it suppresses inflammation still- the vessels are not dilating and becoming leaky- causing higher risk of CVA and MI.

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18
Q

Allergy related to Celecoxib?

A

Sulfa Allergies will have a reaction

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19
Q

Pre-Administration Thoughts for COX inhibitors?

A

Assessment: any indications of anemia or bleeding
MAR: Anticoagulants; Glucocorticoids; EtOH; Meds that impair renal function
History: Liver issues; renal issues; < 18 yo [ASA]; pregnant; Alcohol use;
Allergies: Sulfonamide [Celebrex]

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20
Q

Administration Consideration of COX Inhibitors

A

To avoid gastric upset, encourage enteric coated, drink a full glass of water or take with food

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21
Q

Ongoing Evaluation and Interventions for COX Inhibitors

A

Assess for efficacy
Be able to identify s/s of salicylism [ASA]
Tinnitus, sweating, headache, and dizziness; Respiratory alkalosis
Can lead to poisoning (hospitalization/ slow infusion of bicarbonate)

Assess for s/s of cerebral vascular accident (CVA) or myocardial infarction (MI) [Celebrex]

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22
Q

Acetaminophen (Tylenol) Taken for What and Why

A

Pain and Fever, Only blocks prostaglandins in CNS. Zero Anti Inflammatory Effects

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23
Q

Tylenol is metabolized where?

A

Liver. Harsh on liver, cognizant of.

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24
Q

Dosing of Acetaminophen?

A

2g (Liver issues), 3g, 4g

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25
Q

Adverse Effects of Acetaminophen? Common and Serious

A

Common: Very few at normal doses
Serious: Steven Johnson Syndrome, overdose can lead to hepatotoxicity, treatment for overdose is acetylcysteine

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26
Q

Pre Administration Considerations for Acetaminophen?

A

Assessment: LFTs
MAR: Any hidden acetaminophen (tyllenol) (cold remedies; pain formulations) ;
History: Liver issues; Undernourished; Alcohol use

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27
Q

Administration Considerations of Acetaminophen?

A 
Do not exceed recommended doses 
Common routes (PO & PR)
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28
Q

Evaluation/Intervention of Acetaminophen

A

Assess for efficacy: reduction in pain and/or fever
Assess for liver toxicity. Early symptoms: Nausea and vomiting, diarrhea, sweating, abdominal pain
Educate client that if rash or blisters appears, this may be a medical emergency. Notify us immediately

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29
Q

What type of drug is Aspirin?

A

First generation NSAID, COX Inhibitor

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30
Q

What type of drug is Ibuprofen?

A

First Generation NSAID, COX Inhibitor

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31
Q

What type of drug is Celecoxib (celebrix)

A

Second Gen NSAID, COX 2 Inhibitor

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32
Q

Acetaminophen is an NSAID, True or False

A

False, Analgesic and anti pyretic

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33
Q

Glucocorticoid drugs MOA? Corticosteroids

A

Dumb down immune system by reducing inflammatory response

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34
Q

Dosing of Glucocorticoids

A

Low and Slow, also discontinue low and slow for cortisol production to come back up

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35
Q

Common adverse effects of Glucocorticoids?

A

I FEAR GLUCOSE INTOLERANCE AND PSYCH PATIENTS

Infection, fluid and electrolyte imbalances, glucose intolerance (diabetic patients), Psychologic disturbances

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36
Q

Long term effects of glucocorticoids?

A

Cushings like symptoms
osteoporosis, muscle wasting and thinning of the skin, peptic ulcer disease
Serious: Sudden adrenal insufficiency

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37
Q

Im a nurse and Im going to administer cortisone or prednisone- what am i thinking about? What am I telling the patient

A
  1. NO compromise of immune system (live virus vaccine or fungal infection)
  2. Check the route- multiple modes of administration
  3. If you discontinue fast it will be bad
  4. This revs you up so take in morning and earlier in the day the better
  5. Assess for hypokalemia because it will lower potassium levels
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38
Q

Morphine Use

A

Relief of moderate to strong pain

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39
Q

MOA of morphine

A

Mimics actions of endogenous opioid peptides, primarily at mu receptors

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40
Q

Common Side affects of morphine

A

Think anti-cholinergic. Blocks rest and digest

Constipation, urinary retention, sedation (earliest indicator of overdose), nausea, hypotension, cough suppression.

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41
Q

Serious adverse effects of morphine

A

Respiratory addiction then overdose

Respiratory depression, addictive, overdose

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42
Q

Clinical Manifestation of overdose

A

CPR

Coma, Pinpoint pupils, respiratory depression

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43
Q

Naloxone

A

Narcan
IM, IV, SQ.
No oral due to extensive 1st pass and its an emergency drug…
No adverse
Pure opioid antagonist by blocking receptor sites

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44
Q

Tramadol brand name

A

Ultram

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45
Q

Tramadol use

A

moderate to severe pain

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46
Q

Tramadol MOA

A

Blocks uptake of serotonin and norepinephrine

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47
Q

Tramadol adverse common effects

A

Think anti- cholinergic effects

Sedation, constipation, headache, dry mouth, dizziness

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48
Q

Is tramadol an opioid

A

No, its a non opioid centrally acting analgesic

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49
Q

Why do opioids cause nausea, how do we treat

A

stimulate chemoreceptor trigger zone in the medulla to cause intense nausea and vomiting. Treat with antiemetics

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50
Q

Why do opioids cause constipation

A

activation of mu receptors.

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51
Q

Why opioids cause orthostatic hypertension? how we treat

A

inhibits the baroreceptor reflex and by causing peripheral vasodilation. Assess BP before ambulation, position changes slowly, assist with ambulation

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52
Q

Opioid can cause respiratory depression why and how we treat?

A

Activation of mu receptors. Monitor frequently, sedation is earliest indicator of respiratory depression, RR less than 12 use reversal agents, practice pulmonary toileting- deep breathing coughing all that nurse stuff

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53
Q

Tramadol main things to be aware of (2)?

A

Suicide vehicle- be aware and also seizures are a serious adverse effect

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54
Q

Hard no on tramadol for pre administration?

A

If patient is prescribed MAOI thats a no. You will have two drugs as CNS depressant.
Also any other CNS depressants, SSRIs, etc.

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55
Q

Pre-Assessment of Tramadol

A

Pain assessment and RR

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56
Q

Tramadol Patient history BE AWARE

A

History of addiction, alcohol abuse, depression

57
Q

Tramadol Ongoing evaluation

A

Pain
Falls
Mental state

58
Q

Purpose of antidepressants with with Opioids for pain

A

Analgesic effect, lower need for opioids

59
Q

Purpose of analgesic antiseizure drugs

A

Reduce nerve firing

60
Q

Purpose of local anesthetics like lidocaine with Opioids

A

Blocks pain channel from transmitting at site of injury

61
Q

Signs of hypokalemia- possible glucocorticoid side effect

A

muscle weakness and/or irregular pulses

62
Q

Early signs of Opioid physical dependence?

A

Anorexia, irritability, tremor and gooseflesh (going cold turkey)

63
Q

Peak sign of physical dependence on opioids

A

violent sneezing, weakness, Nausea/vomiting, diarrhea, abdominal cramps, kicking movements (kicking the habit)

64
Q

Nursing implications Opioids pre administration assessment

A

Pain assessment, respiratory rate, mental status, BP

65
Q

Opioid pre-administration MAR

A

CNS depressants, anti-cholinergics, hypotensive agents

66
Q

Admin of Morphine in minutes

A

4-5 minutes slowly IV

67
Q

Ongoing eval and interventions for morphine

A

Pain assessment
Monitor respiration
Educate on fall risk (proactive toileting)
Increase fluid and fiber for constipation
coughing

68
Q

Opioid tolerant definition

A

Patient taking at least 60 mg of morphine or another equal opioid for a week or longer

69
Q

Opioid naive definition

A

Patients who have not had the amount listed for opioid tolerate in a week or more

70
Q

PCA is what and used for what

A

Patient controlled Analgesia, used for short term post surgical pain

71
Q

PRN used for what

A

Break through pain

72
Q

Fixed scheduled drugs used for what

A

Routine pain management approach

73
Q

DMARDS stands for

A

Disease-modifying anti-rheumatic drugs

74
Q

Purpose of taking Methotrexate and when to start taking it

A

Reduce joint destruction and slow disease progression, take within 3 months of diagnosis

75
Q

MOA of methotrexate

A

Blocks folic acid which results in suppression of DNA, RNA, and protein synthesis

76
Q

What three drugs do we take for treatment of RA

A

NSAIDS
Glucocorticoids
DMARDS

77
Q

Methotrexate is non-biologic or biologic

A

Nonbiologic

78
Q

Methotrexate reduces activity of what lymphocytes, further acting as an immunosuppressant

A

B and T lymphocytes

79
Q

Adverse effects of methotrexate

A
  1. Liver damage (hepatic toxicity)
  2. bone marrow suppression (tired/pale/sob) low platelets so possible bleeds, infection due to decrease in WBCs
  3. GI ulceration
  4. Pneumonitis- inflammation of lung tissue
  5. Cap it all off with reduced life expectancy
80
Q

Uses of Methotrexate besides RA

A

Abortion pill, Cancer, Crohns, Psioriasis

81
Q

Dosing of methotrexate routes

A

PO, IM, SUBq (for treatment of RA)

82
Q

Hard no with Methotrexate (1)

A

Pregnancy

83
Q

Pre admin for nurse of methotrexate

A

Routine blood work, CBC, testing liver and kidney function

84
Q

Etanercept (Enbrel) “intercept”

A

MOA: Suppresses inflammation by neutralizing (intercepting) tumor necrosis factor
Route: Sub Q
Common Adverse effect/patient teaching: Injection site reactions
Serious adverse: Infections especially TB, increased risk for lymphoma, liver injury

85
Q

5 Hard nos for Enbrel

A
  1. HPV or TB
  2. Demyelinating disorders
  3. Infections
  4. Live vaccines
  5. Severe HF patients
86
Q

What is acute Ghout (attacks per year) Vs Chronic gout

A

Acute- fewer than 3 times per year

Chronic- Greater than 3 times a year

87
Q

Acute gout drug

A

Colchicine (Colcrys)

88
Q

Use of Colchicine

A

Acute gouty arthritis

89
Q

Colchicine is metabolized by what

A

Liver

90
Q

Colchicine testing pre admin

A

CBC, renal, and hepatic function testing

91
Q

Colchicine can cause suppression of this and 1 more thing

A

Bone marrow suppression and Rhabdo

92
Q

DO not drink this with colchicine

A

Grapefruit juice (CYP3A4)

93
Q

Colchicine can cause rhabdo so dont take with this drug that also causes rhabdo

A

Statins

94
Q

Chronic gout management drugs

A

Allopurinol and Probenecid

95
Q

Allopurinol Use, MOA, Adverse effect(s)

A

Use- Drug of choice for chronic gout, can reverse existing tophi
also for cancer with hyperuricemia

96
Q

Long term adverse affect of Allopurinol

A

Cataracts

97
Q

Probenecid Use, MOA

A

Use: Urate lowering drug, prevents and decreases tophi
MOA: promotes renal uric acid excretion through inhibition of tubular reabsorption of uric acid

98
Q

Serious adverse effect of Probenecid

A

Renal injury

99
Q

Trifecta pre admin of any bone related drug like Allopurinol or Probenecid

A

CBC, renal and hepatic function test

100
Q

DO not take aspirin with Allopurinol or probenecid

A

Probenecid- possible kidney damage

101
Q

Which Chronic gout drug can i take during active flare up?

A

Allopurinol but not probenecid

102
Q

How do i take Probenecid or Allopurinol

A

PO

103
Q

Education for each drug Allopurinol and Probenecid

A

P- Fluids while taking this med and and do not start during acute episode
A- If rash then stop taking
A and P- Acute gout flare up may occur

104
Q

Calcitonin Use, MOA, and Dosing routes

A

Use: Osteoporosis treatment not prevention
MOA: Mimics calcitonin by inhibiting osteoclast activity and promoting renal excretion of calcium
Dosing- Intranasal, IM, or SUB q

105
Q

Alendronate (Fosamax) is what type of drug

A

Bisphosphonate

106
Q

What is Alendronate (Fosamax) used for

A

Prevention and treatment of osteoporosis in both men and women, as well as bone cancer and pagets disease

107
Q

MOA of Alendronate

A

Suppresses bone reabsorption decreasing osteoclast activity

108
Q

2 big nos for fosamax

A

Pregnancy and any issues swallowing

109
Q

Instructing someone taking fosamax

A

Take intact tablet in the am on an empty stomach, remain upright for 30 minutes

110
Q

Serious effects of of fosamaxx

A 
Esophagitis
Atypical femoral fractures
Renal 
Pre admin- look for NSAId use
**Only bone drug not required to do CBC, Liver, and kidney tho**
111
Q

SERM

A

Selective Estrogen Receptor Modulator

112
Q

Raloxifene or Evista USE

A

Osteoporosis, preserves bone density and breast cancer

113
Q

MOA of Evista

A

Structurally similar to estrogen, binds to estrogen receptors- can behave as antagonist and agonist

114
Q

Things to be aware of for Evista and patient-

A

May increase hot flashes and leg cramps along with thromboembolic events

115
Q

Before I give Evista I want to look at patients

A

Bone Mineral density

116
Q

2 Hard nos to Evista

A

Pregnancy and history of VTE

117
Q

Ongoing eval and intervention for Evista

A
  1. If client will experience prolonged immobility, discontinue this med 3 days prior
  2. Minimize periods of inactivity, do not want clot to form
  3. Assess client for signs of any clot that either traveled up to pulmonary or they have any signs of dvt (swelling, weakness on one side, pain, warmth, cant breathe)
118
Q

Teriparatide (Forteo)

A
  • First and only drug used for osteoporosis that increases bone formation
  • It is synthetic PTH essentially
  • Drawback- increases risk for bone cancer
119
Q

Denosumab (Prolia)

A

RANKL inhibitor

  • post menopausal osteoporosis
  • Side effects include: hypocalcemia, infections, skin reactions, osteonecrosis of the jaw
120
Q

Baclofen Use/MOA/Peak/Administration

A
  • Used for spasticity r/t MS or spinal cord injuries
  • Suppresses hyperactivity/structural analog of GABA
  • Peaks 1 hour post PO
  • PO administration or Intrathecal
121
Q

Serious side effects of Baclofen

A

Withdrawal- Seizures or hallucinations- especially with intrathecal admin

122
Q

Baclofen is a CAMRS

A

Centrally Acting muscle relaxer for Spasticity

123
Q

Adverse affects of Baclofen

A

Anti cholinergic symptoms (headache, N/V, constipation) also is a CNS depressant- Urinary retention

124
Q

Baclofen meds you should be aware of in the patients MAR

A

Opioids, benzos, anticholinergics (double whammys)

125
Q

History of any of these in patients history for Baclofen

A

Outpatient alcohol use, BPH (related to urinary retention), schizophrenia

126
Q

How is Baclofen administred

A

PO

127
Q

Ongoing eval and interventions for Baclofen

A

Monitor for improvement in ROM
Educate on falls
Do not stop medication suddenly (seizures and hallucinations)

128
Q

Dantrolene

A

Acts directly on skeletal muscle by suppressing release of calcium from Sarcoplasmic reticulum

129
Q

Dantrolene is commonly used for

A

Spasticity
Malignant hyperthermia
Rigidity (emergency reduction in rigors)

130
Q

Is dantrolene toxic on liver

A

YEs

131
Q

Monitor what test for dantrolene

A

LFTs and avoid with anyone that has liver impairment

132
Q

Common adverse effect of dantrolene

A

flushing when taken IV, muscle weakness, drowsiness, diarrhea

133
Q

Cyclobenzaprine (Flexerel) Use

A

Relief of muscle spasms

134
Q

Dantrolene is a DAMR

A

Direct acting muscle relaxer for localized muscle

135
Q

Flexeril adverse effects

A

CNS depressant and anticholinergic effects

136
Q

Pre admin/Administrate how/Ongoing eval and interventions Flexeril

A

Assess ROM and dexterity, Orally, Assess improvement of ROM, possible anticholinergic effects (urinary retention and constipation) assess and educate on falls, chew gum to relieve dry mouth

137
Q

Flexeril Peaks when and what is it metabolized by

A

4 hours and liver

138
Q

Flexerel can have adverse reactions when taken with

A

CNS depressants, antidepressants, other anticholinergic drugs

139
Q

Be aware of patient that has history of ____ and ____ for administering Flexeril

A

Alcohol outpatient use and BPH (due to urinary retention)

Pharmacology (6 decks)

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