pharm- upper year flashcards (copy)

Basic Concepts in Pain

multidimensional, pain is multifactorial and affects the whole person, pain can be acute., chronic or both, different types of pain require different treatments, clients should be asked whether they have. pain, if. client reposts pain a pair. assessment. should eb done, the clients self. report of pain is gold standard

Neuroanatomy of Pain

afferent pathways, interpretive centres, efferent pathways

•Afferent pathways

•Begin in the PNS, travel to the spinal gate in the dorsal horn and then ascend to higher centers in the CNS

•Interpretive centers

•Located in the brainstem, midbrain, thalamus and cerebral cortex

•Efferent pathways

•Descend from the CNS back to the dorsal horn of the spinal cord

endogenous analgesic system

pain control system descending from brainstem to the spinal cord that may explain why a runner who twists his leg during a competition may finish the run before he really feels the pain

Pain can be modulated;

that means the amount of injury is not necessarily correlated to the amount of pain perception

What is pain modulation?

physiologic process of suppressing or facilitating pain

•Endogenous Opioids

•Family of morphine like neuropeptides that inhibit transmission of pain impulses in the periphery, spinal cord and brain by binding with mu, kappa and delta receptors

opioid receptors are responsible for:

are widely distributed throughout the body and are responsible for general well-being and modulation of respiratory and cardiac functions, stress and immune responses, GI function, reproduction and neuroendocrine control

•Three main classes of opioid receptors

mu, kappa, delta

mu receptors

•Analgesia, respiratory depression, euphoria, sedation, and physical dependence

Kappa receptors:

•Analgesia and sedation; kappa activation may underlie psychotomimetic effects seen with certain opioids

what typed of opioid drugs is there 1

pure opioid agonist, agonist-antagonist opioids, pure opioid antagonist

Pure opioid agonists

•(morphine; codeine; activate mu and kappa)

Agonist-antagonist opioids

•pentazocine; nalbuphine; do not give with a pure agonist)

Pure opioid antagonists

naloxone; methylnaltrexone; block mu and kappa)

source of morphine

Seedpod of the poppy plant

Morphine Overview of pharmacologic actions

pain relief, drowsiness, mental clouding, anxiety reduction, sense of well-being

what to look out for giving opioids

respriratory depression, constipation, urinary retention, mitosis, tolerance and physical dependence , slows everything down

Morphine therapeutic use

relief of pain by mimicking the actions the endogenous opioid peptides primarlyata the mu receptors

Define endogenous

Substances produced inside the body

define tolerance

increased dose required to obtain the same. response to a drug

define physical dependence

about 10 hours after last dose, symptoms include nausea basically withdraw, last 7-10 days, unpleasant but not lethal.

pharmacokinetics of morphine

does not cross blood-brain barrier easily, only a small fraction of each dose reaches site of analgesic action

define NSAIDs

Nonsteroidal anti-inflammatory drugs

NSAID mechanism of action

blocking. the chemical activity the enzyme COX

define analgesic NSAIDs mechanism of action

treatment of headaches, mild to moderate pain and inflammation. block chemical. activity of. either. COX, PG. pathway and LT pathway

define antipyretic NSAIDs mechanism of action

to reduce fever, inhibits prostangland E within area of the brain that. controls temperature

define salicylates NSAIDs mechanism of action

have antiplatlet activity, inhibit platelet aggregation

NSAIDS adverse effects.

gastrointestinal- dyspepsia, heartburn, nausea, GI bleeding and mucosal lesions

renal- reductions in creatinine clearance, acute tubular necrosis with renal failure

cardiovascular- noncardiogenic pulmonary edema

what can be used to reduce averse effects of NSAIDS

misoprostol (apo-misoprostol)

NSAID salicylates aspirin

analgesic (pain)

antipyretic (fever)

anti-inflammatory

antithrombotic (reduce blood clots)

antiarthritic

NSAID salicylates aspirin actions

prevent thrombotic events, treat pain, headaches, neuralgia, myalgia, arthralgia, inflammation, arthritis, pleurisy, pericarditis, systemic lupus.

how to take aspirin (salicylate)

with food, milk or an antacid to avoid irritation due to it causing GI distress

5 aspirin(salicylate)toxicity signs and symptoms

1. Hyperventilation because it directly stimulates the respiratory center---lead to metabolic acidosis (compensating for the hyperventilation) 2. Damages glucose metabolism 3. Cerebral and pulmonary edema due to increased membrane permeability 4. Tinnitus and hearing loss 5. Hyperthermia

aspirin(salicylate)toxicity acute

ingesting 150mg/kg

aspirin (salicylate) toxicity treatment

no specific antidote. may need mechanical ventilation, dextrose iv, sodium bicarbonate to keep out of CNS do not drop blood ph below 7.4, fluid 10-20ml/kg check lungs, effects arise when serum levels exceed 2.89 to 4.3 mmol/l

NSAIDS warning from health canada

all NSAIDS except aspirin, can cause increase risk of adverse cardiovascular thrombotic events including fatal MI and stroke, increase risk of. GI Adverse events and older adults are at greater risk

A patient is taking ibuprofen 800 mg three times a day by mouth as treatment of OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?

A. Increased bleeding tendencies

B. Increased chance for GI bleeding

C. Increased nephrotoxic effects

D. Reduced anti-inflammatory effects of the NSAID

Correct answer: B

Rationale: NSAIDs taken with alcohol may result in an increased risk of GI bleeding.

acetaminophen (Tylenol)

analgesic (pain) and antipyretic (fever) properties, does not suppress platelet aggregation, does not effect renal blood flow or renal impairment.

acetaminophen Tylenol overdose

sever liver injury, hepatic necrosis can lead two coma and death.

acetaminophen Tylenol overdose symptoms

nausea, vomiting, diarrhea, sweating, adnominal pain

treatment for acetaminophen (Tylenol) overdose

acetylcysteine (mucomyst) must be. given within 8-10 hours of overdose to prevent severe. liver injury. substitutes the depleted glutathione that. converts toxic metabolites to nontoxic ones

acetaminophen adverse effects

rare at therapeutic level. associated with. development of Steven Johnson syndrome. increases bleeding in people taking warfarin, increase risk of liver injury with regular alcohol consumption

The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily, and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands that the indication for the 325 mg of aspirin once daily is:

A. Pain management

B. Fever reduction

C. Treatment of osteoarthritis

D. Thromboprevention

Correct answer: D

Rationale: "Low-dose" aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for pain, fever, or arthritis are much higher usually.

A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this?

A.The patient's pain should subside by that time.

B.There are concerns about addiction to the drug.

C.The medication can cause severe kidney and GI effects.

D.The medication loses its effectiveness over time.

Correct answer: C

Rationale: The main adverse effects of ketorolac include kidney impairment, edema, GI pain, dyspepsia, and nausea. It is important to note that the medication can be used for only 5 to 7 days because of its potential adverse effects on the kidneys and on the GI tract.

infections

bacteria, viruses, fungi and protozoans

antibiotics bacteriostatic

inhibit. the growth of bacteria. but dont kill it.

antibiotic. bactericidal

directly. kill the bacteria

how do most antibiotics work

inhibiting bacterial cell wall synthesis in some way. but, bacteria can mutate to survive an attack by the antibiotic. The production of β-lactamases is one way in which bacteria can fend off the effects of antibiotics.

define empiric therapy

It is used when antimicrobials are given to a person before the specific bacterium or fungus causing an infection is known. used in dire situations

define. definitive therapy

specimen is obtained and studied, antibiotic is tailored to treat identified specimen.

what contributes. to antibiotic resistance

overuse of broad-spectrum antibiotics

define prophylactic antibiotic therapy

used when high risk if. infection. used. to. prevent an infection

define. superinfection

antibiotics reduce or completely eliminate. normal bacterial. flora. when these are killed, other bacteria and fungi takeover. and cause infection

define host-specific factors

pertain specifically to a given patient and can affect the success or failure of. antibiotic therapy. such as age, history. of. allergy, organ functions

classes of antibiotics

sulfonamides, penicillins, cephalosporins, macrocodes, quinolone, ahminoglycosides and tetracyclines

action of sulfonamides

inhibit growth of bacteria, known as bacteriostatic antiobiotic

what does sulphonamides have effect on

broad spectrum of antibacterial activity, against gram- positive and gram- negative organisms.

why is sulfamethoxazole used to treat UTIs

achieve high concentrations in the kidneys through which they are eliminated

sulpha allergy

relations frequently begin with fever followed by a rash

B-lactam antibiotics include

penicillins, cephalosporins, carbapenems and monobactams

penicillins actions

kill variety of gram-positive and some negative. some bacteria can actually kill penicillin using B lactamases

4 subgroups of penicillins

-natural penicillins

-penicillinase resistant penicillins

-aminopenicillins

-extended-spectrum penicillins

most common bacteria penicillin is used for

infection caused by gram positive bacteria. streptococcus spp. enterococcus Spp. and staphylococcus

adverse effects of penicillin

urticaria, pruritus and angioedema.

cephalosporins (antibiotic)

semisynthetic antibiotics that are structurally and pharmacologically related to penicillins

first generation cephalosporins effect

active against gram positive bacteria

second generation cephalosporins effect

activity against gram positive organisms but enhanced agains gram negative

carbapenems (antibiotic)

broadest antibacterial action. bactericidal and inhibit cell wall synthesis. used on people with acutely ill patients. effect can be drug induced seizure activity. must be infused over 60 minutes

what is the only monobactams

aztreonam (Clayton)

what is a monobactams antibiotic

it is a synthetic B-lactam antibiotic that is primary active against aerobic gram-negative bacteria,

what is aztreonam (monobactams) used for

it is a bactericidal used for moderate to severe systemic infections and UTIs

examples of Macrolides

erythromycin, clarithromycin, azithromycin,

Fidaxomicin (Dificid)

Antibiotic, Macrolide, commonly used for bacteria associated with diarrhea. common side effects are nausea, vomiting, and GI bleeding.