Chapter 26 - Opioid Agonists, Opioid Antagonists, and Antimigraine Agents

Pharmacology; Exam 4

A client is to receive an opioid cough syrup. The nurse would expect this preparation to contain:

• meperidine.

• codeine.

• hydromorphone.

• fentanyl

codeine

What examples of common adverse effects shoould the nurse discuss with a client prescribed an opioid? Select all that apply.

• miosis

• constipation

• respiratory depression

• surpressed cough reflex

• confusion

• Miosis

• Constipation

• Respiratory depression

• Suppressed cough reflex

• Confusion

The nurse works in a long-term care facility. When administering opioids to clients, the nurse must monitor for which side effect?

• Bleeding

• Sleep deprivation

• Constipation

• Diarrhea

Constipation

The health care provider has ordered 0.2 mg naloxone to be administered intramuscularly stat. The pharmacy has available naloxone 0.4 mg/mL. How many mL will the nurse administer to the client?

0.5 mL

A client diagnosed with migraines expresses interest in taking an over-the-counter acetaminophen, aspirin, and caffeine combination drug. Which information presented in the client’s history should prompt the nurse to discourage the client from taking the drug?

• The client has a chronic venous ulcer on the lower leg.

• The client has not adhered to previous treatment regimens.

• The client has a diagnosis of liver cirrhosis.

• The client is a smoker.

• The client has a diagnosis of liver cirrhosis.

When describing the actions of various drugs, a nursing instructor defines the drug as a substance that counteracts the action of something else. The instructor is describing which action?

• agonist

• antagonist

• anti-inflammatory

• analgesic

antagonist

A client has been administered an opioid. For what effect should the nurse regularly assess?

• Tachycardia

• Oliguria

• Level of consciousness (LOC)

• Edema

• Level of consciousness (LOC)

Naloxone will reverse the effects of which drugs? Select all that apply.

• fentanyl

• valproic acid

• warfarin

• lorazepam

• codeine

fentanyl

codeine

A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?

• Oral

• Subcutaneous

• Sublingual

• Transdermal patch

Oral

A client, 4 days' postoperative, is being weaned off an opioid analgesic. The client reports no relief from pain. The nurse suspects the client:

• has developed a cross-hypersensitive reaction.

• has developed a withdrawal syndrome.

• has become addicted to the analgesic.

• needs a higher dose of analgesic.

has developed a withdrawal syndrome

The nurse is caring for a client who is suffering from postoperative pain. The health care provider orders 2.5 mg of morphine IV q2h. Morphine is supplied in 10 mg/mL vials. How many mL will the nurse administer in each dose?

• 1 mL

• 2.5 mL

• 0.5 mL

• 0.25 mL

0.25 mL

The nurse is caring for a postoperative client with a history of opioid misuse who has been ordered to receive a dose of an opioid antagonist medication. Which issues should the nurse be prepared to address?

• Multiple doses may be needed to be therapeutic.

• During pain assessment, the client may report less pain..

• Double the standard dosage of the medication may be needed.

• The client may begin to demonstrate symptoms of withdrawal.

• Multiple doses may be needed to be therapeutic.

The nurse is reviewing the discharge instructions with the client going home on an opioido for pain management. What would the nurse include in the instructions? Select all that apply.

• Limit fluid intake.

• Eat frequent small meals

• Take a laxative/stool softener.

• Rise slowly from a sitting or lying position.

• Avoid driving

• Eat frequent small meals

• Take a laxative/stool softener

• Rise slowly from a sitting or lying position

• Avoid driving

Which should be included when assessing pain? (Select all that apply.)

• What medications client usually takes to relieve the pain

• Location of the pain

• Intensity of pain

• What factors cause the pain to improve or worsen

• What medications client usually takes to relieve the pain

• Location of the pain

• Intensity of pain

• What factors cause the pain to improve or worsen

The nurse suspects opioid overdose in a client after surgery. What interventions must the nurse initiate for this client? (Select all that apply.)

• Administer naloxone

• Prepare for endotracheal intubation

• Insert a Foley catheter

• Notify the health care provider

• Decrease the client’s IV fluids

• Administer naloxone

• Prepare for endotracheal intubation

• Notify the health care provider

The client has had a myocardial infarction. The nurse is administering morphine sulfate for the pain. What vital sign would the nurse monitor that directly relates to the use of this opioid?

• Pulse

• Heart rate

• Temperature

• Respiratory rate

Respiratory rate

Prior to administering morphine, the nurse checks the client’s medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication?

• Antibiotic

• NSAID

• Monoamine oxidase (MAO) inhibitor

• Antihypertensive

• Monoamine oxidase (MAO) inhibitor

A client is to receive an opioid that will be applied transdermally. The nurse identifies this as which agent?

• Morphine

• Hydromorphone

• Codeine

• Fentanyl

Fentanyl

When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.)

• Client maintains adequate nutritional status.

• An adequate breathing pattern is maintained.

• Client reports decreased urinary output.

• Therapeutic response is achieved and discomfort is reduced.

• Client reports decreased bowel movements.

• Client maintains adequate nutritional status

• An adequate breathing pattern is maintained

• Therapeutic response is achieved and discomfort is reduced

A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication?

• Glasgow coma scale

• Vital signs

• Pain scale

• Subjective assessment

Pain scale

What is the gate control theory of pain, and how is this related to blocking pain for a patient?

Gate control theory states that the transmission of a nerve impulse can be

modulated at various points along its path by descending fibers from the

brain that close the “gate” and block transmission of pain information and by

A fibers that are able to block transmission in the dorsal horn by closing the

gate for transmission for the A-delta and C fibers. The blocking of these

gates blocks pain impulses.

What are the key lifespan considerations for an older adult when administering opioids?

Older patients should be specifically asked whether they require pain

medication.

Older patients are more likely to experience the adverse effects

associated with these drugs, including central nervous system,

gastrointestinal, and cardiovascular effects.

Older patients often have renal or hepatic impairment; they are also more

likely to have toxic levels of the drug related to changes in metabolism

and excretion.

The older patient should have safety measures in effect—side rails, call

light, assistance to ambulate—when receiving one of these drugs in the

hospital setting.

What are the key nursing intervention considerations for a patient receiving an opioid antagonist?

Maintain open airway and provide artificial ventilation and cardiac

massage as needed to support the patient. Administer vasopressors as

needed to manage narcotic overdose.

Provide continuous monitoring of the patient, adjusting the dosage as

needed, during treatment of acute overdose.

Provide comfort and safety measures to help the patient cope with the

withdrawal syndrome.

Ensure that patients receiving naltrexone have been narcotic-free for 7 to

10 days to prevent severe withdrawal syndrome. Check urine opioid levels

if there is any question.

If the patient is receiving naltrexone as part of a comprehensive narcotic

or alcohol withdrawal program, advise the patient to wear or carry a

MedicAlert warning so that medical personnel know how to treat the

patient in an emergency.

Institute comfort and safety measures, such as side rails and assistance

with ambulation, to ensure patient safety; institute bowel program as

needed for treatment of constipation; use environmental controls to

decrease stimulation; and provide small frequent meals to relieve GI

irritation if GI upset is severe.

Offer support and encouragement to help the patient cope with the effects

of the drug regimen.

Provide thorough patient teaching, including drug name and prescribed

dosage; measures to avoid adverse effects; warning signs to report

immediately that may indicate possible problems; safety measures such

as avoiding driving, avoiding making important decisions, and having a

responsible person available for assistance; and the importance of

continued monitoring and evaluation to enhance patient knowledge about

drug therapy and to promote adherence.

What are the key lifespan considerations for an adult when administering antimigraine medication?

Adults requesting treatment for migraine headaches should be carefully

evaluated before one of the antimigraine drugs is used to ensure that the

headache being treated is of the type that can benefit from these drugs.

The ergots and the triptans are contraindicated during pregnancy because

of the potential for adverse effects in the mother and fetus.

People who can become pregnant should be advised to use contraception

while they are taking these drugs.

People who are breast or chestfeeding should be encouraged to find

another method of feeding the baby because of the potential for adverse

drug effects on the baby.

A fibers

medium and large-diameter nerve fibers that are typically myelinated and carry peripheral impulses associated with vibration, stretch, and pressure to the spinal cord; they are further divided into alpha, beta, gamma, and delta type

A-delta fibers

medium-diameter myelinated nerve fibers that carry peripheral impulses associated with pain to the spinal cord

C fibers

unmyelinated, small, slow-conducting fibers that carry peripheral impulses associated with pain to the spinal cord

ergot derivative

drug that causes a vascular constriction in the brain and the periphery; relieves or prevents migraine headaches but is associated with many adverse effects

gate control theory

theory that states the transmission of a nerve impulse can be modulated at various points along its path by the activation of larger sensory fibers transmitting tactile information to the brain, closing the “gate” and blocking transmission of pain information being communicated by the smaller A-delta and C fibers

migraine headache

headache characterized by severe, unilateral, pulsating head pain associated with systemic effects, including gastrointestinal (GI) upset and sensitization to light and sound; related to a hyperperfusion of the brain from arterial dilation

nociception

transmission of unpleasant stimuli from the point of initial injury to the brain via specialized nerve fibers

opioid agonists

drugs designed to react with specific opioid receptors throughout the body to stimulate the effects of the receptors

opioid agonists–antagonists

drugs that react at some opioid receptor sites to stimulate their activity and at other opioid receptor sites to block activity

opioid antagonists

drugs that block the opioid receptor sites; used to counteract the effects of opioids or to treat an overdose

opioid receptors

receptor sites on nerves that react with endorphins and enkephalins, which are receptive to opioid drugs

pain

a sensory and emotional experience associated with actual or potential tissue damage

spinothalamic tracts

nerve pathways from the spine to the thalamus along which pain impulses are carried to the brain

triptan

selective serotonin receptor blocker that causes a vascular constriction of cranial vessels; used to treat acute migraine attacks

Pain

by definition, is a sensory and emotional experience associated with actual or potential tissue damage

The transmission of unpleasant stimuli from the point of initial injury to the brain via specialized nerve fibers is labeled

nociception

The ? are medium, myelinated fibers that respond quickly to acute pain.

A-delta fibers

The ? are small, unmyelinated, and slow conducting

C fibers

These larger ? do not transmit pain impulses; instead, they transmit sensations associated with pressure, stretch, and vibration

A fibers

Spinothalamic tracts

run from the spinal cord into the thalamus, where they form synapses with various nerve cells that transmit the information to the cerebral cortex

According to the ?, the transmission of these impulses can be modulated or adjusted all along these tracts.

gate control theory

Opioid receptors

are receptor sites that respond to naturally occurring peptides, the endorphins and the enkephalins

One major method of pain management involves the use of

opioid agonists

Migraine headaches

are also due to the activation of the trigeminal nerve that causes inflammation within the meningeal blood vessels

Which of the following is correct about pain according to the gate control theory?

It is caused by gates in the CNS.

It can be blocked or intensified by gates in the CNS.

It is caused by gates in peripheral nerve sensors.

It cannot be affected by learned experiences.

It can be blocked or intensified by gates in the CNS.

Opioid receptors are found throughout the body

only in people who have become addicted to opiates.

in increasing numbers with chronic pain conditions.

to incorporate pain perception and blocking.

to initiate the release of endorphins.

to incorporate pain perception and blocking.

Opioid agonists are controlled substances because they

are very expensive.

can cause respiratory depression.

can cause physical dependency and addiction.

can be used only in a hospital setting.

can cause physical dependency and addiction

Injecting an opioid into an area of the body that is chilled can be dangerous because

an abscess will form.

the injection will be very painful.

an excessive amount may be absorbed all at once.

narcotics are inactivated in cold temperatures.

an excessive amount may be absorbed all at once

Proper administration of an ordered opioid

will frequently lead to addiction.

should be done promptly to prevent increased pain and the need for larger doses.

would include holding the drug as long as possible until the patient really needs it.

should rely on the patient’s request for medication.

should be done promptly to prevent increased pain and the need for larger doses

Migraine headaches

occur during sleep and involve sweating and eye pain.

occur with stress and feel like a dull band around the entire head.

often occur when drinking coffee.

are throbbing headaches on one side of the head.

are throbbing headaches on one side of the head.

The triptans are a class of drugs that bind to serotonin receptor sites and cause

cranial vascular dilation.

cranial vascular constriction.

clinical depression.

nausea and vomiting.

cranial vascular constriction

The only triptan that has been approved for use in treating cluster headaches as well as migraines is

naratriptan.

rizatriptan.

sumatriptan.

zolmitriptan.

sumatriptan

Opioid agonists are drugs that react with opioid receptors throughout the body. Which conditions would the nurse expect to find when assessing a patient who was taking an opioid agonist?

Hypnosis

Sedation

Analgesia

Euphoria

Orthostatic hypotension

Increased salivation

Analgesia
Sedation
Euphoria

Orthostatic hypotension

The nurse would expect to administer an opioid agonist as the analgesic of choice for which patients?

A patient with severe postoperative pain

A patient with severe chronic obstructive pulmonary disease and difficulty in breathing

A patient with severe, chronic pain

A patient with ulcerative colitis

A patient with recent biliary surgery

A patient with cancer and severe bone pain

A patient with severe postoperative pain
A patient with severe, chronic pain
A patient with cancer and severe bone pain