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Pharmacology > Nurs 605 Module 4 > Flashcards

Nurs 605 Module 4 Flashcards

(57 cards)

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1
Q

What is acute pain?

A

Acute pain: most common experience by patients, short term and temporary, lasting minutes or weeks

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2
Q

What is chronic pain?

A

Chronic pain: pain that lasts beyond tissue healing time or pain that lasts > than 3 months

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3
Q

What is nociceptive pain?

A

pain of the muscles, can be divided into somatic and visceral pain
somatic is localized where visceral is deep organ pain

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4
Q

What is neuropathic pain?

A

pain described by a compression of the nerves

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5
Q

What is the mechanism of action of acetaminophen and what is the maximum adult dose? what is the max dose for chronic pain?

A 
anti-pyretic
analgesic
no anti-inflammatory effects
max dose in adults 4000mg/day
max dose with chronic pain 3200mg/day
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6
Q

What is the mechanism of NSAIDS?

A

antipyretic
analgesic
anti-inflammatory affects
inhibits prostaglandins, causes GI side effects
equally potent to opioids
inihibits COX pathways that decreases pain

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7
Q

What are some classes of NSAIDS and what are the common NSAIDs/

A 
salicylates-ASA
COX 2 inhibitors-celecoxib
proprionic-ibuprofen, naproxen
indoles-indomethacin
others-ketoralac, diclenofonac
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8
Q

Describe COX 1 and why is it important? How do NSAIDS work on COX 1?

A 
COX 1- inhibits prostaglandins; decreased platelet aggregation = increased GI side effects and thinning of blood 
most adverse effects are from COX 1
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9
Q

What is COX 2?

A

another production of prostaglandin

increased platelet aggregation-better GI symptoms buit increased cardiovascular risk

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10
Q

What are some adverse effects of NSAIDs?

A

CNS: tinnitus, headache
Renal: renal insufficiency
GI: abdo pain, nausea/vomiting, ulcers

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11
Q

How would you manage the GI side effects of NSAIDs?

A 
stop the drug if needed
misoprostol-decreases risk of GI ulcers
PPIs
antacids
rantidine
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12
Q

Why can you not take lithium with NSAIDs?

A

medication interaction, lithium levels can increase in the serum levels with use of NSAIDs

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13
Q

Opioid vs. opiate

A

opiate- natural derivative of the opium poppy

opioid- synthetic creation of opiates such as hydromorphone

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14
Q

How is codeine made?

A

derived from morphine in the opium poppy

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15
Q

Describe the mechanism of action of opioids

A

works on the Mu receptor in the brain

gives the morphine like effects: sedation, analgesia, respriatory depression, bradycardia, euphoria

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16
Q

What dosage would you start on someone who is opoioid naive?

A

morphine2.5mg-10mg PO q 4 hours

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17
Q

What is incident pain?

A

predictable pain that may worsen with activity or movement

short in duration, acute and severe

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18
Q

What can you provide prior to incident pain?

A

fentanyl or sufentanil transmucosal

very potent, very quick acting

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19
Q

What can you provide prior to incident pain? What is the suggested dose?

A

fentanyl or sufentanil transmucosal
fentanyl 25-50mcg SL
sufentanil 12.5mcg SL
very potent, very quick acting

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20
Q

A patient is not responding to pain, what may be some factors contributing to this?

A 
pain is greater than estimated
not adherent
genetics-low levels of CYP 2D6 which cannot activate codeine into morphine=no levels of analgesic
interactions
intolerative
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21
Q

What are some adverse effects with opioids?

A 
resp depression
pruritis
constipation
nausea/vomiting
sedation
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22
Q

Describe how to manage respiratory depression in a patient taking opioids?

A

could be opiate naive
could be increasing in metabolites because of decreased renal clearance
excessive doses

stop offending drug, nalaxone if needed

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23
Q

Why does nausea and vomiting occur in individuals taking opiiods?

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A

decreased gastric motility
tolerance develops in 3-4 days
can take antiemetics

24
Q

Describe neurotoxicity and How would you manage neurotoxicities?

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A

increased metabolites in the system
causes CNS changes-confusoin, hallucinations
incresaing pain despite increasing opioid

discontinue or lower the opiod dose

25
Why does constipation happen with opioids and how would you manage it?
opioids causes decreased peristalsis and increased water absorption not a tolerance needs to give laxatives such as senna or lactulose with opioids
26
Which opioid most commonly causes pruritis and how woul dyou manage it?
morphine | can take hydroxyxine or diphenhydramine for relief
27
Opiods cause sedation, why does this happen?
may be a successful analgesic dose persistent sedation may indicate another concern tolerance builids in 3-4 days
28
Describe some adjuvant analgesics
adjuvant analegesics used alongside the opioid for pain
29
What would you use in bone pain as an adjuvant analgesic?
NSAIDs just as good as opioids, may be able to decrease the opioud dose use lower risk medications such as ibuprofen, naproxen
30
When would you use trycylcic analgesics as an adjuvant analgesic?
neuropathic pain | amytriptyline, nortryptyline
31
What are some tools used to manage opioid use?
UDS, questionnaires limited prescribing using a contract, goal setting with patient
32
Describe the process in an opioid trial?
opiiouds should only be prescribed short term assess for benefit-will be noticed early in 2-6 weeks risks of addiction
33
How would you evaulate an opioid trial?
Trial success? benefits noticed, improvements in function, decreased pain, safety maintained, little to no side effects Failed: signs of misuse, harm or diversion, no reduction in pain, no increase in function, intolerance to opioids
34
What are some factors to consider prior to prescribing opioids?
``` patient safety efficacy of the drug goal setting drug interactions prepare to stop or change if not helping ```
35
Describe some considerations of codeine
weak Mu agonist CYP 2D6 inhibitor and/or inducer 1-10% of population either rapid or slow metabolizers slow metabolizers don't get analgesic effect, cant conver to morphine; can lead to toxicity rapid metabolizers - cant also get opioid toxicity as rapid metabolism
36
Descrive some considerations of oxycodone/oxycontin
mu, delta, kappa receptor CYP 2D6/3A4 inhibitor or inducer (messy metabolism) not tamperproof, addictive considerations when taking-gels when gets wet, don't lick take with full glass of water contraindicted in those who can't swallow
37
Describe considerations of fentanyl
very potent do not use in opoiod naive patients as can be difficult to convert patches can have residual medication on them, handlw e with care clean with water only, no alcohols or soaps as this can add to residual effect renal and heptatotoxic-contraindicated and cautioned in elderly and renal/hepatotixc concerns serotonin toxicity
38
How long does it take for fentanyl patchesto reach steady state?
6 days
39
What are some risks when prescribing buprenorphine patches?
can precipitate opiate withdrawl morphine equivalen to <30mg if switching qT prolongation naloxone not effective to reverse overdose increased drug interactions-can't use if using MAOi's in 14 days
40
Is tramadol an opioid? what are the adverse effects of tramadol?
yes! different prescribing rules many mechanisms of action nalaxone in OD may cause seizures serotonin toxicity
41
What is serotonin toxicity and what drugs can cause this?
SCAN can be caused by increase of opioids plus other serotonin reuptake drugs fentanyl, tramadol, bupenorphine serotonin toxicity consciousness- anxiety, agitation, delirium, hallucinations autonomic- hypertension, nausea, vomiting, diaphoresis neuromuscular-rigidity, tremors, jerks
42
What are the benefits of suboxone?
any NP can prescribe as long as they take a course=greater access decreased risk of drug interactions quicker to get to therapeutic dose decreased risk of respiratory depression
43
Describe the mechanism of action of suboxone
split into bupenorphine and naloxone bupenorphine: partial opioid agonist; ceiling effect; higher affinity to receptors; binds to the mu receptors to prevent withdrawl but also maintain comfort naloxone: specially as a deterrant for aberrant behaviours; injection can cause full withdrawl; opooid antagonist
44
What is the route of administration of suboxone and why?
SL route only, needs to activate through the mucousal membrane cannot inject as nalaxone is in it as a deterrent oral route of this drug means no therapeutic effect
45
What are the indications for use of suboxone
opooid use disorder only
46
What assessment is required for suboxone initiation?
``` health and medical assessment UDS substance use history drugs labs ```
47
What are the contraindications for use of suboxone?
respiratory depression liver dysfunction ETOH use delirium tremens
48
What are the drug interactions when using suboxone?
ETOH benzos, CNS depressants MAOIs esp within 14 days herbal, st johns wort
49
What are the doses of suboxone available in Canada?
subxone 2mg/0.5mg 8mg/2mg 12mg/3mg 16mg/4mg
50
You want to start a suboxone induction on a patient; why do patients have to be in moderate withdrawl prior to starting suboxone?
must be in withdrawl 12-24 hours | can be put into precipitated withdrawl if lots of opioids are still in their system
51
What tool do you use in clinic to start suboxone on a patient?
COWs scale | measures their state of withdrawl
52
What score on a COWs scale warrants a suboxone start? what dose would you give them? What if their score is greater than 24?
>12 can start suboxone start with 2mg/0.5mg or 4mg/1mg (if at risk of precipitated withdrawl, start with 2mg) >24 give 6mg/1.5mg dose
53
What is the maximum amount of suboxone you can give on day 1 of induction? day 2? day 3?
day 1: 12mg/3mg day 2: 16mg/4mg day 3: 24 mg/6mg
54
Your patient has taken their maximum dose of suboxone on day 1 but is still having withdrawl symptoms; what would be your next step?
can't give anymore attempt to give medications to make them more comfortable until next day clonidine, antiemetics, antidiarrheals, analgesics etc
55
What is the dosage of suboxone used to titrate patients up?
2mg/0.5 or 4mg/1mg
56
You and a patient agree to do a home induction of suboxone; what score must the patient be at for their SOWs prior to starting suboxone?
>17 | start with 2mg/0.5mg
57
What dose of suboxone will you give your patient if they missed their 16mg/4mg suboxone 4 days ago?
same dose if 5 days or less | if greater than 7 days cut by half or consult

Pharmacology (13 decks)

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