Flashcards in Wk 9. Opiods & Analgesics Deck (30):
1. Define opioid.
Any drug that has actions similar to those of morphine.
2. Define opiate.
Applies only to compounds present in opium.
3. Explain the WHO three-step analgesic ladder.
Start with a nonopioid. If no pain relief, give an opioid for mild-moderate pain. If severe pain, give an opioid for moderate-severe pain. May use nonopioids and adjuvants with opioids to provide more pain relief.
4. An equianalgesic dose of a pain medication is equivalent to how much morphine IM?
10 mg morphine IM
5. Which receptors are stimulated by opioid analgesics?
Mu and kappa
6. Stimulation of which receptors can result in severe respiratory depression and physical dependence?
7. Morphine works best for what type of pain?
Constant, dull pain
8. Morphine binds to receptors which are located where?
Brain and spinal cord
9. What is the toxic metabolite of meperidine (Demerol)? What effects may it have?
Normeperidine. Agitation, irritability, tremors, seizures.
10. Meperidine (Demerol) may interact with a variety of antidepressants because it increases what neurotransmitter?
11. Most mixed agonists/antagonists are agonists at what receptor? Antagonists at what receptor?
Agonist – Kappa
Antagonist – Mu
12. Administering a mixed agonist/antagonist with an opioid may lead to what?
Pain or withdrawal
13. Name a commonly-used opioid antagonist.
14. To which side effects of opioids do patients NOT develop a tolerance? What interventions are warranted?
Constipation, miosis (pinpoint pupils). Stress safe environment and nightlights, as well as the use of laxatives and stool softeners.
15. Cross tolerance exists between morphine and what other drugs?
16. Define physical dependence.
Physical dependence is an abstinence syndrome which will occur if the drug is stopped abruptly.
17. Define addiction.
A behavioral pattern characterized by using a psychoactive substance despite physical, psychological, or social harm.
18. What is a common cause of death from opioids? Opioids should be withheld if the respiratory rate drops to ___ or below.
Respiratory depression. 12.
19. What 6 interventions can be used to prevent constipation with opioid use?
Exercise, fiber, fluid, stool softener, stimulant laxative, methylnaltrexone
20. Sedation commonly occurs with opioid administration. What can be expected with prolonged administration?
21. Nausea and vomiting may be avoided with opioid use by what two interventions?
Pretreatment with an antiemetic, lying still
22. What three interventions should a nurse teach a patient about the risk of orthostatic hypotension from opioids?
Lie down or sit if dizzy or lightheaded, change positions slowly, use ambulatory assistance
23. Itching from opioids is mediated by what chemical?
24. How do opioids affect vision?
Causes miosis which impairs vision.
25. How can opioids increase intracranial pressure (ICP)?
Opioids can decrease respirations which increase the amount of CO2 in the bloodstream. Elevated CO2 causes vasodilation which increases ICP.
26. How do opioids affect the mother and fetus/neonate?
Opioids may suppress uterine contractions and cause respiratory depression of the neonate. The fetus may develop a physical dependence with prolonged use by the mother.
27. Why is the administration of opioids done with precaution in inflammatory bowel disease?
Opioids can cause toxic mega colon or a paralytic ileus.
28. What are the three symptoms in the classic triad of opioid toxicity?
Coma, respiratory depression, miosis (pinpoint pupils)
29. What fraction of the total daily dose of opioids is usually given as a supplemental dose for breakthrough pain?
1/6 of the total daily dose