EXAM 1- W/O Prototypes

TYPES OF PAIN

• Acute pain

• Chronic pain

• Neuropathic pain

• Nociceptive pain

• Radicular pain

Opioid agonists:

• Morphine, fentanyl, meperidine, hydromorphone, and methadone

Opioid agonistsantagonists:

Butorphanol

DUAL-MECHANISM ANALGESIC AGENTS Ex

Tramadol

DUAL-MECHANISM ANALGESIC AGENTS MOA

•Binds with low affinity to mu receptors in the CNS

•Prevents the reuptake of norepinephrine and serotonin

DUAL-MECHANISM ANALGESIC AGENTS CI

•Manage moderate to moderately severe pain, both acute and chronic

DUAL-MECHANISM ANALGESIC AGENTS SE

•Sedation, dizziness, headache, nausea, and constipation

DUAL-MECHANISM ANALGESIC AGENTS ADR

•Seizures, urinary retention, serotonin syndrome, mania (w/SSRIs), respiratory depression, addiction, and toxicity

DUAL-MECHANISM ANALGESIC AGENTS Ed

•Basics

•Constipation – increase their fluid and fiber intake, as well as activity and exercise

•Monitor respiratory rate

•Avoid abrupt cessation (serotonin effect)

OPIOID ANTAGONISTS Ex

Naloxone

OPIOID ANTAGONISTS MOA

• Competitively binds to the opioid receptors in the central and peripheral nervous systems

• Prevent opioid agonists from exerting their effects

OPIOID ANTAGONISTS CI

• Reverses opioid toxicity (very short acting/redose q20 mins)

• Prevention of EtOH/opioid relapse

• Opioid induced constipation

OPIOID ANTAGONISTS SE

• Acute withdrawal (nausea, vomiting, diarrhea, abdominal pain, anxiety, aggression, and runny nose)

OPIOID ANTAGONISTS ADR

• V-tach

• Pulmonary edema

OPIOID ANTAGONISTS Ed

• Basics

• Watch for withdrawal manifestations

NONOPIOID ANALGESICS Ex Acetaminophen

Acetaminophen

NONOPIOID ANALGESICS MOA Acetaminophen

• Interferes with COX mechanism in the CNS w/o effective peripheral tissues

• Interrupts PG production in the CNS while stimulating serotonin pathway

NONOPIOID ANALGESICS CI Acetaminophen

• Reduces mild to moderate pain and fever

NONOPIOID ANALGESICS SE Acetaminophen

• GI upset and itching may occur

NONOPIOID ANALGESICS ADR Acetaminophen

• Liver damage

• Nephrotoxicity, acute generalized exanthematous pustulosis, necrolysis, and Stevens-Johnson syndrome

NONOPIOID ANALGESICS Ed Acetaminophen

• Basics

• Avoid EtOH consumption before, during or after taking acetaminophen

NONOPIOID ANALGESICS Ex Asprin/Ibuprofen

Asprin/Ibuprofen

NONOPIOID ANALGESICS MOA Asprin/Ibuprofen

•Blocks COX1 & COX2

NONOPIOID ANALGESICS CI Asprin/Ibuprofen

• Reduces inflammation, pain and fever

NONOPIOID ANALGESICS SE Asprin/Ibuprofen

•Ibuprofen:

•Common side effects are heartburn, dyspepsia, nausea, and vomiting. Long-term use at high doses can significantly increase the risk of developing stomach ulcers.

•Aspirin:

•Common side effects include nausea, epigastric upset, and dyspepsia.

NONOPIOID ANALGESICS ADR Asprin/Ibuprofen

•GI bleeding, kidney problems, increased blood pressure, allergic reactions, tinnitus, and dermatological reactions

NONOPIOID ANALGESICS Ed Asprin/Ibuprofen

•Basics

•Instruct clients to tell the provider about a history of allergies to NSAIDs, GI bleeding or ulcerations, kidney problems, asthma, heart failure, heart attack, and pregnancy or possible pregnancy.

•Instruct clients to report manifestations of an allergic reaction, bleeding, increase in blood pressure, difficulty breathing, decreased urine output, swelling, or weight gain.

NONOPIOID ANALGESICS Ex Lidocaine

Lidocaine

NONOPIOID ANALGESICS MOA Lidocaine

• Inhibits nerve impulses by blocking sodium ion transport across the neuronal membrane

NONOPIOID ANALGESICS CI Lidocaine

• Local anesthesia (and dysrhythmia)

NONOPIOID ANALGESICS SE Lidocaine

• Redness, irritation, itching, or rash

NONOPIOID ANALGESICS ADR Lidocaine

• Systemic toxicity

NONOPIOID ANALGESICS Ed Lidocaine

• Basics

• After upper extremity regional blockage, extremity must be secured (tied down)

ADJUVANT ANALGESICS Ex ANTIDEPRESSANT

venlafaxine (SNRI)

ADJUVANT ANALGESICS MOA ANTIDEPRESSANT

• Slows the reuptake of serotonin and norepinephrine in the CNS

• Increases serotonergic activity in the spinal pathway that signals pain

ADJUVANT ANALGESICS CI ANTIDEPRESSANT

• Fibromyalgia, chronic musculoskeletal pain, and neuropathic pain (DM, chemo)

ADJUVANT ANALGESICS SE ANTIDEPRESSANT

• Increased perspiration, decreased appetite, constipation, painful urination, drowsiness, fatigue, and insomnia

ADJUVANT ANALGESICS ADR ANTIDEPRESSANT

• Suicidal ideation (BBW), serotonin syndrome, neuroleptic malignant syndrome, seizures, bleeding, pancreatitis, hepatotoxicity, erythema multiforme, and StevensJohnson syndrome

ADJUVANT ANALGESICS Ed ANTIDEPRESSANT

• Basics

• Advise clients to report new or unexpected behaviors or thoughts, including thoughts of suicide.

• Caution clients not to stop taking this medication abruptly.

ADJUVANT ANALGESICS Ex ANTICONVULSANT

Anticonvulsant- gabapentin

ADJUVANT ANALGESICS MOA ANTICONVULSANT

•Inhibits calcium channels in the brain allowing the release of neurotransmitters

ADJUVANT ANALGESICS CI ANTICONVULSANT

•Nerve pain (neuralgia, neuropathic, and fibromyalgia)

ADJUVANT ANALGESICS SE ANTICONVULSANT

•LOTS: Impaired coordination, weakness, dizziness, vertigo, drowsiness, altered reflexes, and weakness

ADJUVANT ANALGESICS ADR ANTICONVULSANT

•Hypersensitivity reactions, suicidal ideation, Stevens-Johnson syndrome, and rhabdomyolysis

ADJUVANT ANALGESICS Ed ANTICONVULSANT

•Basics

•Caution clients not to stop taking this medication abruptly.

•Advise clients to talk to the provider before taking any new medication and to tell the provider about all over-the-counter medications

COMPLEMENTARY AND ALTERNATIVE MEDICINE Ex

Weed

COMPLEMENTARY AND ALTERNATIVE MEDICINE MOA

•CB1 receptors in the brain regulate the neurotransmitters norepinephrine, serotonin, dopamine, and GABA.

•CB2 receptors are located in peripheral tissues and play a role in immune and reduction of inflammatory responses.

COMPLEMENTARY AND ALTERNATIVE MEDICINE CI

•Reduce chronic pain, neuropathic pain, and the spasms of multiple sclerosis when other conventional treatments are insufficient or have undesirable side effects.

COMPLEMENTARY AND ALTERNATIVE MEDICINE SE

COMPLEMENTARY AND ALTERNATIVE MEDICINE

•Dry mouth, nausea (CHS), dizziness, disorientation, euphoria, confusion, sedation, tachycardia, and difficulty breathing

COMPLEMENTARY AND ALTERNATIVE MEDICINE ADR

•Reversible, acute psychosis, panic attack, and cannabis hyperemesis syndrome

COMPLEMENTARY AND ALTERNATIVE MEDICINE Ed

•Basics

•Advise clients to start with a low dose and increase incrementally until the relief they are seeking is achieved.

•Teach clients to purchase cannabis products from a reputable retail outlet and ask for the quality and purity lab test results.

SEDATIVE-HYPNOTICS Ex

PROPOFOL, ETOMIDATE, AND KETAMINE

SEDATIVE-HYPNOTICS MOA

•Activates the GABA complex in the brain, keeping the GABA channel open longer, allowing greater amounts of chloride to cross the cell membrane

SEDATIVE-HYPNOTICS CI

•Anesthesia induction

•Sedation

SEDATIVE-HYPNOTICS SE

•Sedation, amnesia, respiratory depression, and, potentially, apnea

SEDATIVE-HYPNOTICS ADR

•Hypotension

SEDATIVE-HYPNOTICS Ed

•Inform clients that a nurse will continuously monitor their vital signs and level of consciousness until both have returned to baseline.

•Provide verbal and written instructions as to when they can return to activities such as driving

SYNTHETIC OPIOIDS Ex

FENTANYL

SYNTHETIC OPIOIDS MOA

• Synthetic opioids act on mu receptors in the brain to relieve pain and increase anesthetic depth

SYNTHETIC OPIOIDS CI

• Reducing pain during or after surgical procedures

• Blunting the sympathetic response to intubation

• Suppressing airway reflexes

• Prevent coughing and bronchospasm for laryngoscopy/intubation

SYNTHETIC OPIOIDS SE

• Sedation, dry mouth, headache, and respiratory depression

SYNTHETIC OPIOIDS ADR

• Skeletal muscle (chest wall) rigidity, difficulty breathing, opioid-induced hyperalgesia, allodynia, cardiovascular depression, hypotension that requires intervention, respiratory depression, and adrenal insufficiency

SYNTHETIC OPIOIDS Ed

• No driving for at least 24 hours after the procedure

• Monitoring required before, during, and after procedure

BENZODIAZEPINES Ex

LORAZEPAM

BENZODIAZEPINES MOA

• Increase GABA in the body causing inhibitory effect resulting in CNS depression

BENZODIAZEPINES CI

• Anxiolytic

• Sedation

• “Balanced” anesthesia

BENZODIAZEPINES SE

• NV

• Apnea

BENZODIAZEPINES ADR

Respiratory depression, sedation, coma, and death (w/opioids)

BENZODIAZEPINES Ed

• Monitoring required before, during, after procedure

• Not to take benzodiazepines with other medications that cause CNS depression

BARBITURATES Ex

METHOHEXITAL

BARBITURATES MOA

• Increase GABA in the body causing inhibitory effect resulting in CNS depression

BARBITURATES CI

• Anxiolytic

• Sedation

• “Balanced” anesthesia

BARBITURATES SE

• NV

• Apnea

BARBITURATES ADR

• Respiratory depression, sedation, coma, and death (w/opioids)

BARBITURATES Ed

• Monitoring required before, during, after procedure

• Not to take benzodiazepines with other medications that cause CNS depression

NEUROMUSCULAR BLOCKING AGENTS Ex

SUCCINYLCHOLINE

NEUROMUSCULAR BLOCKING AGENTS MOA

• Mimics acetylcholine, binding to nicotinic receptors and causing continuous depolarization

NEUROMUSCULAR BLOCKING AGENTS CI

• Rapid sequence intubation and short procedures requiring quick onset

NEUROMUSCULAR BLOCKING AGENTS SE

• Hyperkalemia

• Malignant hyperthermia

• Prolonged paralysis

NEUROMUSCULAR BLOCKING AGENTS ADR

• See side effects

• Which patients would not be good candidates for succinylcholine induction?

NEUROMUSCULAR BLOCKING AGENTS Ed

• Emphasize the importance of disclosing any personal or family history of reactions to anesthesia or neuromuscular disorders

NONDEPOLARIZING Ex

ROCURONIUM

NONDEPOLARIZING MOA

• Blocks acetylcholine from binding to its receptors, preventing depolarization and muscle contraction

NONDEPOLARIZING CI

• Suitable for longer surgeries requiring sustained muscle relaxation

NONDEPOLARIZING SE/ADR

• Hypotension

• Bradycardia

NONDEPOLARIZING Ed

• Emphasize the importance of disclosing any personal or family history of reactions to anesthesia or neuromuscular disorders

LIDOCAINE MOA

• Binds to voltage-gated sodium channels to prevent nerves from achieving action potentials

LIDOCAINE CI

• Local anesthesia

• Epidural anesthesia

• Regional anesthesia

• Spinal anesthesia

• Topical anesthesia

LIDOCAINE SE

• Tingling, numbness, and loss of temperature and pressure sensations

LIDOCAINE ADR

• LAST [Local Anesthetic Systemic Toxicity] -> localized nerve damage that can cause temporary or permanent neuropathic pain, numbness, or weakness

LIDOCAINE Ed

• Inform clients of the expected duration of action of the local anesthetic they receive

Types of headaches

• Tension-type headaches

• Migraine headaches

• Cluster headaches

• Sinus headaches

CLASSES OF MEDICATIONS

• Antihistamines

• Beta-blockers

• Calcium channel blockers

Decongestants

Neuromuscular blocking agents

Serotonin receptor agonists:

• Serotonin 5-HT1B/5-HT1D receptor agonists (triptans)

• Serotonin 5-HT1F receptor agonist (ditans)

Live-Attenuated Vaccines:

MMR, varicella

Inactivated Vaccines:

Haemophilus influenzae b, hepatitis A, inactivated poliovirus

mRNA Vaccines:

SARS-CoV2, rotavirus

Indications and contradictions for vaccines

• • Travel Immunization

• • School Immunization Requirements

• • Special Considerations:

  • • Allergies

  • • Pregnancy

  • • Clients who are immunocompromised

What is innate immunity?

The body’s natural, present-at-birth defense that responds immediately to pathogens. Includes barriers, inflammation, phagocytes, and natural killer cells.