NR293 Pharm Exam 2 Chamberlain Questions and answers + rationales

what are analgesics?

medications that relieve pain without loss of consciousness

What is nociception?

perception of pain

what is a pain threshold?

stimuli needed to produce the sensation of pain

what is a pain tolerance?

different for everyone, amount of pain a person can endure without interfering with normal functioning

somatic pain

originates from skeletal muscle, ligaments, and joints

referred pain

pain that is felt in a location other than where the pain originates

visceral pain

originates from organs and smooth muscle

central pain

marked by chronic pain stemming from damage to CNS

bradykinin

causes vasodilation

What are adjuvant drugs?

assist primary drugs in relieving pain

what are opioid drugs?

synthetic drugs that bind to the opiate receptors to relieve pain

mild agonist opioid drugs

codeine and hydrocodone

strong agonists

morphine, hydromorphone, oxycodone, meperidine, fentanyl, and methadone

Can a nurse dilute opioid drugs in an iv?

No, not unless the pharmacy specifically says to and opioids should not be given through a normal saline device

what is the opioid ceiling effect?

drug reaches a maximum analgesic effect

If you take 5 mg of a medication for pain, that 5 mg will go to receptor sites to block pain signals but let's say you take 10 mg, What will happen?

. Even if you increase the dose, it will have the same effect no matter how much you take, can have more of an adverse effect (why the pt may take more and more of something and then take more and then they begin to overdose.

what do opioid agonists do?

bind to an opioid pain receptor site to block pain

what do opioid agonists-antagonists do?

bind to a pain receptor but causes a mixed response, weaker than full agonist

what do opioid antagonists do?

blocks or takes out the agonist effects

ex: narcan reverses opioid overdose

what is Equianalgesia?

ability to provide equivalent pain relief by calculating dosages that provide comparable analgesia.

opioid analgesics contraindications

known drug allergy, severe asthma, COPD/respiratory insufficiency, pregnancy

opioid analgesics indications

moderate to severe pain (7+), cough center suppression, diarrhea, balanced anesthesia

A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern?

A.Pulse

B.Blood pressure

C.Temperature

D. Respirations

D. respirations

opioid analgesics adverse effects

CNS depression, GI upset, urinary retention (check bladder distention), diaphoresis/flushing, pupil constriction, constipation, itching

what is a common opioid medication given for overdose?

Naloxone (Narcan)

what do opioid analgesics interact with?

alcohol, antihistamines, barbiturates, benzos

codeine sulfate

less effective, more commonly used as an antitussive

fentanyl

narrow therapeutic window; injection, patch, lozenges

Methadone Hydrochloride (Dolophine)

synthetic opioid analgesic, choice for detoxification for opioid addicts, prolonged QT interval and causes cardiac dysrhythmias

morphine sulfate

opioid analgesic, prototype; used for severe pain

Naxolone (Narcan)

opioid antagonist; for complete or partial reversal of opioid induced respiratory depression

Acetaminophen (tylenol)

non-opioid analgesic; can alter liver function, antipyretic and analgesic effects

Acetaminophen MOA

blocks pain impulses peripherally by inhibiting prostaglandin synthesis

Acetaminophen indications

mild to moderate pain (3-5), fever, alternative to aspirin

Acetaminophen max dosage

<3000 mg/day

<2000 mg/day for older adults

Acetaminophen Contraindications

drug allergy, liver dysfunction, liver failure

A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be

A.1000 mg.

B.2000 mg.

C.3000 mg.

4000 mg.

B. 2000 mg

Implications for Analgesics

-obtain thorough health history, medications, including herbals

-monitor I and O

-monitor liver enzymes

-monitor pain

-oral taken with food

-monitor vitals, hold meds if abnormal

WATCH RR

what are sedatives?

CNS depressant drugs that have an inhibitory effect on the CNS; reduce:

nervousness

excitability

irritability

what do hypnotic sedatives do?

cause sleep; these are dose dependent

what are benzodiazepines?

CNS depressant drugs commonly prescribed for sedation or sleep

benzodiazepines sedative hypnotic types (3)

long acting, intermediate acting, short acting

what are the long acting benzodiazepines?

Clonazepam (Klonopin) and Diazepam (Valium)

what are the short acting benzodiazepines?

Midazolam (Versed), Eszopiclone (Lunesta)

what are the intermediate acting benzodiazepines?

Alprazolam (Xanax), lorazepam (Ativa)

when is clonazepam used?

for alcohol withdrawal or extreme anxiety

when is xanax used?

reduce anxiety

when is ativan used?

clinical setting, sleep

when is Versed used?

clinical setting, outpatient procedures, puts patient to sleep for 20-30 minutes

Benzodiazepines MOA

depresses CNS activity

Benzodiazepines: Drug Effects

calming on CNS, not a direct muscle relaxant

Benzodiazepines: Indications

sedation, skeletal muscle relaxation, anxiety relief, acute seizure disorders, agitation

Benzodiazepines adverse effects

headache, drowsiness, dizziness, "hangover effect or daytime sleepiness

When providing education to the patient on the use of a benzodiazepine medication, the nurse will include which information?

A.These medications have little effect on the normal sleep cycle.

B.Using this medication may cause drowsiness the next day.

C.It is safe to drive while taking this medication.

D.These drugs are safe to use with alcohol.

B

which is more common with Benzodiazepines- overdose or respiratory depression?

overdose

what is the antidote for Ativan ?

Flumazenil (Romazicon)

Benzodiazepines interactions

can heighten effects of other suppressants , grapefruit juice, other CNS depressants

when is diazepam (valium) used?

anxiety or alcohol withdrawal

When is Eszopiclone (Lunesta) used?

hypnotic effect, keeps you asleep, provide full 8 hour

when is Zolpidem (Ambien) used?

short acting hypnotic, low incidence of daytime sleepiness but can sleepwalk

not given to older adults

Kava should not be taken with which Benzodiazepines?

Ambien, Lunesta, and Sonata

Barbiturates MOA

Increase the DURATION of GABA-mediated chloride ion channels

Barbiturates Drug effects

sedative or hypnotic effects, narrow therapeutic window; lowers resp rate

Barbiturates indications

sedation, chronic seizures, anesthesia for surgery

Barbiturates adverse effects

GI upset, hypotension, vasodilation, respiratory suppression, SJS, reduced REM

An older adult patient taking multiple medications has a barbiturate added to his medication regimen. When administering a barbiturate to an older adult, the nurse should expect

A.a decrease in dosages of the other medications.

B.the patient will experience increased amounts of REM sleep.

C.to administer half of the usual dose of the barbiturate.

D.total relief of anxiety.

C

What is the antidote for barbiturates?

THERE ISN'T ONE, in event of overdose all we can do is provide airway support by maintaining an adequate airway and assisting with ventilation or oxygen therapy

barbiturates drug interactions

alcohol, benzodiazepines

Pentobarbital (Nembutal)

long acting, clinical use, prevent tonic-clonic seizures

Barbiturates have a low therapeutic index. This means

A.low doses are not therapeutic.

B.the toxic range is narrow.

C.they are habit forming.

the effective, safe dosage range is narrow.

D

common barbiturates

Phenobarbital and Pentobarbital

what are the 2 types of muscle relaxants?

direct and indirect

indications of muscle relaxants

painful musculoskeletal conditions, back spasms, cerebral palsy

muscle relaxants adverse effects

dizziness, drowsiness, fatigue,

common muscle relaxants

Cyclobenzaprine (Flexaril) and Dantrolene (Dantrium)

Which statement regarding muscle relaxants does the nurse identify as being accurate?

A.Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.

B.Cyclobenzaprine (Flexeril) produces little sedation.

C.Patients taking muscle relaxants are at high risk of developing hypertension.

D.Patients taking muscle relaxants should be told to stop taking the medication if they feel sleepy.

A

what are CNS stimulants?

drugs that stimulate a specific area of the brain or spinal cord

CNS stimulant MOA

stimulate areas of the brain associated with mental alertness

what conditions are CNS stimulants used for?

ADHD, Narcolepsy, migraines, neonatal apnea

what are the drug effects of CNS suppressants?

relaxation of bronchial smooth muscle, increased respiration, dilation of pulmonary arteries

adverse effects of CNS suppressants

tachycardia, palpitations, angina, anxiety, urinary frequency, nausea, vomiting, dry mouth, insomnia

What is an amphetamine used to treat?

ADHD and narcolepsy -go to is amphetamine aspartate (Adderall)

What is atomexetine? What is it used for?

It is an amphetamine CNS depressant used to treat Adderall -has a black box warning for suicidal thoughts

A teenage boy will be receiving atomoxetine (Strattera) as part of treatment for ADHD. Which statement about this drug therapy is accurate?

A.Strattera is highly addictive.

B.Psychotherapy is rarely helpful in cases of ADHD.

C.The patient should be monitored for possible suicidal thoughts and behavior

D.Strattera is used to treat narcolepsy as well as ADHD.

C

What is methylphenidate? what is it used for?

Ritalin, CNS suppressant, first drug of choice for treating ADHD ; can cause insomnia- give at least 6 hrs before bed, baseline height and weight

what is Modafinil (Provigil) and what is it used for?

CNS suppressant used for narcolepsy/ excessive daytime sleepiness, less abuse potential, promotes wakefulness

what suffix should you look for for Antimigraine drugs?

7 triptans

Before administering a serotonin agonist, it is most important for the nurse to assess the patient for a history of

A.hypertension.

B.allergy to penicillin.

C.chronic bronchitis.

D.cataracts.

A

Triptans MOA

cause vasoconstriction in cerebral arteries

Triptans adverse effects

vasoconstriction, irritation at injection site, tingling, flushing

What is Sumatriptan (Imitrex)?

It is a antimigraine medication used for headaches.

what are analeptics?

used for neonatal apnea ; caffeine; used for bronchodilation

Analeptics-Caffeine (what does it do)

increases HR and can cause palpitations

what are adverse effects of Analeptics?

muscle tension and tremors

nursing implications for analeptics

assess for euphoria

what is a seizure

brief episode of abnormal electrical activity in nerve cells of the brain

what is a convulsion

involuntary spasms of voluntary muscles-skeletal, facial, and ocular

what is epilepsy?

chronic, recurrent pattern of seizures

what does idiopathic mean?

no know cause

what is secondary epilepsy?

underlying cause (ex-trauma, infection)