Quiz 2 Flashcards
1
Q
What analgesics activate the mu receptors and exert a weak activation of kappa receptors:
A
Opioids: morphine/codeine; controlled substances
2
Q
Activation of what receptor will lead to respiratory depression, euphoria, sedation, analgesia:
A
mu receptors
3
Q
Activation of what receptor leads to sedation and analgesia:
A
Kappa receptors
4
Q
What are the two isomers that opioids have:
A
levo and dextro
5
Q
what isomer has an analgesia effect
A
levo
6
Q
What isomer has an antitussive effect:
A
levo and dextro
7
Q
Which isomer causes physical dependence:
A
levo
8
Q
What are the characteristics of opioid isomers:
A
3 A: analgesia, antitussive (medulla), antidiarrheal; suppressed RR (medulla)
9
Q
What is given to treat moderate/severe acute/chronic pain; pre-op; or dyspnea d/t ventricular failure and PE:
A
opioids (indications)
10
Q
Would you give opioids to pts w/head injuries:
A
No
11
Q
Would you give opioids to asthmatic pts:
A
No
12
Q
Would you give opioids to pts w/hypotension:
A
No
13
Q
Would you give opioids to pts in labor or delivery of pre-mis:
A
No
14
Q
Would you give opioids to renal or hepatic impairment pts:
A
No
15
Q
What are the side effects d/t opioids:
A
orthostatic hypotension; N/V/constipation; Drowsiness/sedation/confusion; and urinary retention
16
Q
What is a S/S of opioids toxicity:
A
pupillary constriction
17
Q
What are the ADVERSE effects d/t opioids:
A
RR depression (<10); hypotension, P. constriction; tolerance/physical dependance; withdrawal syndrome
18
Q
What drugs can increase the effect of opioids:
A
EtOH; sedative-hypnotics; antipsychotic; muscle relaxants
19
Q
What are the nemonics for common opioids:
A
Drugs ending w/ONE (phone/done), MFM: morphine, fentanyl, meperidine
20
Q
What is the onset of morphine sulfate when given parenterally:
A
Rapid especially if it’s IV
21
Q
What is the duration of morphine sulfate:
A
3-5 hrs
22
Q
What is the duration of morphine sulfate controlled release:
A
8-12 hr
23
Q
If a pt has severe pain, how is morphine sulfate given:
A
IV
24
Q
What are the pharmocokinetics of morphine sulfate:
A
liver metabolizes; sm amount crosses BBB; 90% is excreted = short half-life; crosses placenta/breast milk
25
If you were giving morphine sulfate PO, what is the normal dose:
10-30 mg q 4 hr
26
If you were giving morphine sulfate SQ/IM, what would the dose be:
5-15 mg q 4 hr
27
If you were giving Morphine sulfate IV, what would the dose be:
4-10 mg q 4 hrs
28
Would you give an higher dose of morphine sulfate/opioids PO or parenterally:
PO (d/t 90 being excreted)
29
What is the assessment process when giving opioids:
RR (asthma), PMH (liver), drug hx, VS/RR, I &Os; pain amount
30
Incase of a Morphine sulfate overdose, what med is giving to counteract it:
Narcan (Naloxone)
31
What are nsg interventions after giving Morphine sulfate:
administer before pain reaches peak; check urine uotput/VS; bowel sounds; pupil changes; LOC
32
What are some important morphine sulfate pt teachings:
No EtOH/CNS depressants; teach addiciton; have pt report dyspnea/dizziness
33
What are two important morphine sulfate nsg dx:
Acute pain r/t surgical tissue injury; ineffective breathing pattern r/t excess morphine dosage
34
You give a pt 4-10 mg of morphine SQ. You notice a half hour later that the pt has respiratory depression, constriction of the pupils, and hypotension. These S/S are d/t:
opioid overdose; Naloxone (Narcan) should be given
35
What are the s/s of opioid overdose:
RR depression; hypotension; constriction of the pupils; and drowsiness
36
What are the S/S of opioid withdrawal:
N/D; abd cramps; watery eyes/runny nose/diaphoresis; muscle twitching; increased BP/P; restlessness/irritability
37
What is given to tx opioid withdrawal symptoms:
Methadone is substituted in place of opioids
38
Why is methadone given once a day and not q 4 hours:
HAlf life of methadone is longer than most opioids
39
What are the two types of methadone txs:
Weaning program; maintenance program
40
The MD Rx methadone for a pt 40 mg/day x2 days, and then decreases amount to 5-10 mg/day. You understand that this pt is under what type of methadone tx:
Weaning program
41
The MD Rx methadone for a pt 20 mg daily. You understand that the pt is under what type of methadone tx:
Maintenance program (dose remains consistent)
42
What would a MD Rx a pt for rapid opiate detoxification agent:
Clondine
43
What drug manages opioid withdrawal, is dosed up to 17 mcg/kg/day; decreases sympathetic outflow from CNS caused by opioids; used as a rapid opiate detox agent:
Clondine
44
Agonist or antagonist: A drug that binds (Morphine)
agonists binds to promote an action
45
Agonist or antagonist: A drug that oppose/blocks Naloxone (narcan)
antagonists block/opposes an action
46
Your pt is in labor and has a severe pain. your pt asks for pain relief. You can't give Morphine as it crosses the placenta and may decrease urge to push. What do you give instead:
Nubain (newborn) (nalbuphine hydrochloride)
47
An example of an opioid agonist-antagonist is (an opioid agonist added to an opioid antagonist in hopes to decrease opioid abuse):
Nubain (nalbuphine hydrochloride)
48
Is Nubain (nalbuphine hydrochloride) given to CA pts:
NO
49
What is the onset for Nubain (nalbuphine HCL):
rapid; peak occurs w/in 30 min via IV; duration is the same for all routes; increases pain threshold
50
What drug blocks receptors to displace any opioids=inhibiting opioid action; is given for post-op opioid depression or opioid overdose; increase PTT (bleeding):
Antagonist drug called Narcan (naloxone)
51
A type of sedation that utilizes administration of CNS depressants/analgesics to provide analgesia, relieve anxiety; provide amnesia; where the consciousness is depressed, pt may fall asleep, but is not unresponsive; so that the protective airway reflexes maintained is defined as:
procedural sedation/conscious sedation used for surgical, Dx, or interventional procedures
52
To prevent or reduce anxiety is defined as:
anxiolysis
53
What are the goals of conscious sedation:
To provide analgesia, amnesia, and anxiolysis
54
What are the common drugs used for conscious sedation:
Fentanyl (sublimaze) and Versed (Midazolam)
55
What are the effects of Fentanyl (sublimaze) and Versed (Midazolam):
sedation and relaxation
56
What are the nsg responsibility to the pt when conscious sedation (Fentanyl (Sublimaze)/Versed (Midazolam):
discuss need for sedation; check informed consent; may feel burning sensation upon administering; inform about side effects; monitor S/S of over sedation/adverse reactions; monitor VS/EKG/Pulse Ox
57
An alternative route for opioid administration for self administered pain relief is defined as:
PCA (pt controlled analgesia)
58
What are the common PCA drugs:
FHM: Fentanyl (Sublimaze), Hydromorphone (Dilaudid), Morphine
59
What is the loading dose of PCA meds:
2-10 mg
60
How does the lockout mechanism work when using PCA meds:
keeps the pt from overdosing; the button is timed=if the pt presses once, then they can't immediately press it again.
61
What does the nurse do to the PCA meds dose:
titrates/adjusts dose
62
What is the goal of PCA meds:
to avoid episodes of severe pain and over sedation
63
Can a pt's family push he PCA button for the pt:
NO
64
Are On-Q meds opioids:
NO. They are anesthetic
65
An MD has put in the shoulder of a pt an elastomeric pump that's connected to an antimicrobial cath that consist of a local anesthetic to provide continuous infusion post-op. You know this to be a:
On-Q pain buffer system pump
66
What are the NSG responsibilities for On-q pump
Make certain clamps are open/no kinks in tubing; no tape over filter; check dressing over catheter; make certain medication label is attached to pump
67
What are some On-Q pump side effects:
increase pain; redness/swelling/discharge at cath site; ringing/buzzing in ears/ metal taste in mouth; numbness/tingling to mouth/finger/toes
68
What population is at risk for opiate addiction:
illegal drug users/medical setting (pts/health care professional)
69
Impaired performance as a result of drug use is defined as:
chemical impairment
70
What is the percentage of nurses with substance abuse:
10-20%
71
What are the types of characteristics of impaired performance:
personality/behavioral changes; job attendance; poor judgement/errors/illogical documentation; discrepancies in controlled-drug handling/records
72
What are the cardinal S/S of inflammation:
redness, edema, heat, pain, loss of function
73
What are the two phases of inflammation:
vascular phase and delayed phase
74
This chemical mediator is a potent vasodilator=relaxed sm muscles=increased cap permeability; also sensitizes nerve cells to feel pain:
prostaglandins
75
What enzymes are responsible for creating prostaglandins:
COX converts arachidonic acid into prostaglandins
76
Which COX protects the stomach lining and regulates platelets:
COX-1
77
What COX triggers inflammation and pain:
COX-2
78
What are the actions of prostaglandin inhibitors:
4 As: analgesia, antipyretic; anti0inflammatory; anticoagulant
79
What are the first generation NSAIDs and what COX enzymes do they block:
Non-selective=COX-1 and COX-2; ASA, ibuprofen; naproxen
80
What are the second generation NSAIDS nd what COX do they block:
Tylenol (acetaminophen); selective to COX-2
81
This NSAID is an antipyretic and analgesic; inhibits synthesis of PGs; has no antiinflammatory effect; no GI toxicity:
Acetaminophen (tylenol)
82
What is the safe dose of acetaminophen and what is the therapeutic range:
2000 mg/day; 5-20 mcg/mL
83
What NSAIDs can cause hepatoxicity which could cause death in 1-4 days from hepatic necrosis:
Acetaminophen
84
What are the early S/S of hepatic damage; and what labs should you check for:
N/V/D, abd pain: liver labs (AST, ALT, ALP)
85
Your pt is showing early symptoms of acetaminophen overdose. What do you give the pt:
Acetylcysteine (mucomyst)
86
The MD Rx a pt mucomyst (acetylcysteine) PO. Why is the MD giving mucomyst therapy to the pt PO:
antidote for acetaminophen overdose to prevent liver/kidney damage
87
The MD rx the pt mucomyst (acetylcysteine) as an inhaler. Why is the MD giving mucomyst therapy to the pt as an inhaler:
to break up mucous (mucolytic)
88
This type of NSAID is an antipyretic, antiinflammatory, anticoagulant, analgesic; inhibits PGs production; inhibits heat regulator center; decreases platelet aggregation:
ASA (first generation NSAIDs)
89
What is the dose of ASA you would give for pain:
325-650 mg q 4h
90
What is the dose of ASA for thromboembolic:
325-650 BID
91
What is the dose of ASA for anti-inflammatory:
3.6-5.4 g/day divided
92
Would you give ASA to a pt w/gout:
NO
93
What is the onset of ASA:
onset is 30 min; crosses placenta; 50% is excreted in the urine (watch kidneys=uric acid=gout)
94
What drugs interact with ASA and shouldn't be given together:
anticoagulants (can cause bleeding); oral hypoglycemic; GLUCOCORTICOIDS (increases uric acid)
95
What labs are affected when taking ASA:
decrease cholesterol/K/THYROID GLANDS (T3-T4); increase PTT/uric acid
96
What are the side effects of ASA:
abd pain, GI DISTRESS; heart burn; dizziness/ N/V/D
97
What are the adverse effects of ASA:
Tinnitus (ringing of ear); ulcers; bleeding; bronchospasm
98
What are the common NSAIDS given to elderly pts to block COX-2 as GI distress is very common in the elderly:
Celebrex (celecoxib)
99
When giving NSAIDS to the elderly pts, what labs are most important to monitor:
renal function
100
What can occur if you give a child pt ASA when they are sick (with flu, cold, viral infections):
Reye Syndrome
101
What are the S/S of reye syndrome:
acute encephalopathy; fatty infiltration of the liver/heart/pancreas/kidneys/spleen/lymph nodes
102
What are the two types of corticosteroids that controls inflammation by suppressing or preventing response at the injured site or autoimmune disorders and the dosage IS TAPERED over 5-10 days:
prednisone and dexamethasone
103
An inflammation condition that attacks the joints, tendons, and other tissues; characterized by increased amounts of uric acid d/t ineffective clearance of uric acid from the kidneys is defined as:
Gout (commonly seen on the big toe) DONT GIVE ASA
104
What are the three types of Gout medications:
CPA: Colchicine (acute S/S), Probenecid (Benemid for chronic gout), Allopurinol (Zyloprim for late-stage renal impairment)
105
This antiinflammatory gout med is given to inhibit leukocytes, alleviates acute symptoms, does not inhibit/promote uric acid synthesis; should NOT be given to renal pts:
Colchicine
106
This antiinflammatory Gout med is given to increase the rate of uric acid excretion for chronic gout:
proBENecid (benemid) a type of uricosuric (pee uric acid)
107
This antiinflammatory gout med is given to renal pts, inhibits synthesis of uric acid; prophylactic to gout attacks:
AlloPurinol (zyloprim) Remember A to Z; a type of uric acid inhibitor
108
What are the nsg teaching concerning uric acid inhibito Allopurinol (zyloprim)
Yearly eye exam d/t damaging the eye; NO lrg doses of vitamin C d/t stroke; avoide foods high in purine; don't take w/EtOH/caffeine/HTCZ diuretics
109
How many stages are there in REM:
1: increased eye movement;BP;RR;temp
110
How many stages in NREM:
4: HR slows; body repairs; BP/temp decreases; REM occurs after 90 min
111
What do sedatives diminish w/o affecting consciousness:
physical and mental responses
112
What can occur if you increase the sedative/hypnotic dose:
hypnotic effect occurs=natural sleep
113
What type of "acting" hypnotics are effective for achieving sleep:
short-acting hypnotics
114
What type of "acting" hypnotics are effective for sustaining sleep:
Intermediate-acting hypnotic
115
What are the side effects of sedatives/hypnotics;
rebound REM (nightmares); dependence; depression; RR depression; hangover
116
What are the four types of sedative/hypnotics:
2 pines and 2 ates: Benzodiazepines/nonbenzodiazepines and barbiturates/chloralhydrate
117
What barbiturate would you give for SZ, epilepsy:
Long acting phenobarbital
118
What barbiturate would you give for maintaining sleep, insomnia, anxiety:
intermediate acting butisol
119
What barbiturate would you give for inducing sleep who have difficulty falling asleep (not insomnia)
short acting nembutal
120
What barbiturate would you give as a general anesthetic:
pentothal
121
What are the two types of Benzodiazepines are given for insomnia (inducing and sustaining), increases GABBA; decreases nervous excitation:
Restoril and valium (restore valium)
122
What is used as a short term tx of insomnia=less than 10 days:
Nonbenzodiazepines medication is Ambien
123
What sedative/hypnotic is given to induce sleep and decrease NOCTURNAL AWAKENINGS, less S/S of hangover/RR depression/Tolerance; does not repress REM; given to elderly:
chloralhydrate
124
What are some considerations of sedative/hypnotic use in the elderly:
use non-pharmacological methods first; No EtOH/antidepressants/antipsychotics/narcotics; should be GRADUALLY WITHDRAWN
