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200 Cards in this Set
- Front
- Back
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A patient is taking acetaminophen. The nurse should warn the patient that ____ is the maximum dose per day. With alcoholics, the dose is ____.
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4g or 4000mg
2g or 2000mg |
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Which liquid should the patient be instructed to avoid when taking acetaminophen
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alcohol
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The patient who is taking phenytoin concurrently with acetaminophen is in danger of:
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hepatotoxicity
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The nurse warns the patient taking acetaminophen that adverse effects of this medication include a
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headache
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the nurse know that the antidote for acetaminophen overdose is:
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acetylcysteine
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Which opiate is responsible for producing toxic metabolites:
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Meperidine(Demerol)
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Which adverse effect of opiates is the most serious:
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respiratory depression
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The patient is receiving IV morphine following severe chest pain. The nurse know the IV morphine should be diluted to prevent:
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tachycardia
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A patient is receiving nalbuphine(Nubain). 48 hours after drug discontinuation, the nurse should monitor for:
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abdominal cramps
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The patient is given a dose of naloxone(Narcan), The nurse knows that:
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the pts. vital signs and respiratory status must be monitored.
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Which of the following migraine preparations has increased GI absorption:
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Ergotamine tartrate with caffeine
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Which adverse effects are the most common with ergot derivatives:
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Nausea
cold fingers and toes |
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The onset of action for intranasal dihydroergotamin occurs within
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5 minutes
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A patient is taking ergotamine tartrate. The nurse knows that concurrent use of ___ may lead to ergot toxicity.
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erythromycin
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Avoid concurrent alcohol when taking more than __ to ___ doses of acetaminophen per day
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one to two
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Reversal of opiate antagonists is too rapid what occurs:
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tachycardia
fainting |
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what may happen after the duration of action of naloxone decreases
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vital signs and respiratory status may change
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Naloxone is given ___ not ___
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IV
IM |
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what is given to reverse opiate overdose
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naloxone(narcan)
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abdominal cramps are opioid ______ effects
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withdrawal
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The most serious adverse effect of opiates is
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respiratory depression
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other adverse effects of opiates are
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dilated pupils
seizures orthostatic hypotension |
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codeine, fentanyl and oxycodone produce no ____ ____
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toxic metabolites
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Meperidine(Demerol) is responsible for producing the toxic metabolite _____ which may lead to ___
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Normeperidine
neurotoxicity |
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Morphine ___ vessels and may lead to ______,_____,_____
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dilates
hypotension,respiratory depression, skeletal muscle relaxation and flaccidity |
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More than ___ dose of ___ may be needed to reverse opiate toxicity
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one
Naloxone(Narcan) |
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The risk of hepatotoxicity is increased with concurrent administration of ____ with acetaminophen
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phenytoin
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The most common adverse effects of ergot derivatives are:
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nausea
peripheral ischemia |
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peripheral ischemia is evident of:
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cold fingers or toes
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Concurrent erythromycin and ergotamine may lead to:
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ergot toxicity
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pain that is sudden and usually subsides when treated
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Acute pain
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Persistent or recurring pain that is often difficult to treat
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Chronic pain
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Pain that originates from the skeletal muscles,ligaments, or joints
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Somatic pain
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Pain that originates from the organs or smooth muscles
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visceral pain
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Pain that originates from the skin or mucous membranes
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superficial pain
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Pain that is thought to account for most migraine headaches
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Vascular pain
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Pain that results from injury or damage to the peripheral nerve fibers
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Neuropathic pain
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Pain that is due to psychologic factors,not physical conditions or disorders
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Psychogenic pain
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Pain that occurs with tumors, trauma or inflammation of the brain
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Central pain
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Pain that relates to a body part that has been removed
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Phantom pain
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During a marathon , a runner had to drop out after 16 miles because of severe muscle spasms. This type of pain is:
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Somatic
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A young man has been taken to the ER because of a suspected overdose of morphine tablets. which drug may be used to treat the overdose?
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NaloxoneHCL(Narcan)
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An anticonvulsant drug has been ordered as part of a patient's pain mgmt. program. The purpose of the anticonvulsant in this case is to
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relieve neuropathic pain
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What should be included in an assessment before giving an opioid analgesic
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The level of pain on a scale
prior analgesic use allergies |
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Any drug that binds to a receptor and causes a response has ____ properties
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agonist
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Mrs. G. is experiencing pain and itching due to a severe case of poison ivy on the skin. she is experiencing ___ pain.
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superficial
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Mr. Y. has become physical dependent on opioid analgesics yet he has stopped taking it, he is suffering withdrawal which is also called
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opioid abstinence syndrome
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Psychologic dependence on a substance, usually resulting from habitual use, that is beyond normal voluntary control
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Addiction(psychologic dependence)
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Drugs that are added as a second drug for combined therapy with a primary drug and may have additive or independent analgesic properties
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Adjuvnat analgesic drugs
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A substance that binds to a receptor and causes a response
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Agonist
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A substance that binds to a receptor and causes a partiall response that is not as strong as that caused by an agonist
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Agonist-Antagonist
(partial agonist) |
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What occurs when a given pain drug no longer effectively controls a patient's pain despite the administration of the highest safe dosages
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Analgesic ceiling effect
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Medications that relieve pain without causing loss of consciousness
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Analgesics
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A drug that binds to a receptor and prevents(blocks) a response
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Antagonist
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Pain resulting from any of a variety of causes related to cancer and/or the metastasis of cancer
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Cancer pain
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The most common and well-described theory of pain transmission and pain relief. It uses a gate model to explain how impulses from damaged tissues are sensed in the brain.
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Gate theory
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Analgesics that are not classified as opioids
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nonopiod analgesics
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A large, chemically diverse group of drugs that are analgesics and also possess antiinflammatory and antipyretic activity but are not steroids
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Nonsteroidal antiinflammatory drugs(NSAIDS)
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Natural narcotic drug containing or derived from opium that binds to opiate receptor in the brain to relieve pain
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opiate analgesic
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Describes pts. who are receiving opioid analgesics for the first time and who therefore are not accustomed to their effects
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opioid-naive
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A normal physiologic condition that results from long-term opioid use in which larger doses of opioids are required to maintain the same level of analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms
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opioid-tolerant
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Pain is a subjective and individual experience; IT CAN BE WHATEVER THE PERSON SAYS IT IS
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Pain
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The level of a stimulus that results in the perception of pain
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Pain threshold
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A drug that binds to a receptor and causes an activation response that is less than that caused by a full agonist
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partial agonist
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Pain occurring in an area away from the organ of origin
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Referred pain
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Name the nonpharmacological methods of pain mgmt are:
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massage
imagery acupuncture therapeutic touch relaxation techniques spirituality |
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an unpleasant sensory and emotional experience associated with either actual or potential tissue damage
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Pain
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Tissue injury causes the release of:
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Bradykinin
Histamine Prostaglandins Potassium Serotonin |
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peptide that causes blood vessels to enlarge (dilate), and therefore causes blood pressure to lower. A class of drugs called ACE inhibitors, which are used to lower blood pressure, increase bradykinin further lowering blood pressure. Bradykinin works on blood vessels through the release of prostacyclin, nitric oxide, and endothelial-derived hyperpolarizing factor.
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Bradykinin
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Histamine is a biogenic amine involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter.[1] It is found in virtually all animal body cells. New evidence also indicates that histamine plays an important role in chemotaxis of white blood cells
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Histamine
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*cause constriction or dilation in vascular smooth muscle cells
*cause aggregation or disaggregation of platelets *sensitize spinal neurons to pain *decrease intraocular pressure *regulate inflammatory mediation *regulate calcium movement *control hormone regulation *control cell growth |
Prostaglandins
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a peripheral signal mediator
the major storage site is platelets, which collect serotonin for use in mediating post-injury vasoconstriction |
Serotonin
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A fibers sense what type of pain
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sharp and well localized
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C fibers sense what type of pain
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Dull and nonlocalized
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What type of fibers travel up the spinal cord and meet at the dorsal horn
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A and C nerve fibers
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The so called gate is located in the
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dorsal horn
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The closing of the gatre seems to be affected by the activation of ____ fibers
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A fibers
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Opeing of the gate is affected by the stimulation of ___ fibers
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C fibers
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The body is equipped with certain endogenous neurotransmitters known as
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Enkephalins
endorphins |
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What pathway is used by the opioid analgesics to alleviate pain
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small sensory"C" nerve fibers are triggered by A fibers.
A fibers close the gate and pain is relieved |
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An enkephalin is a pentapeptide involved in regulating pain and nociception in the body. The enkephalins are termed endogenous ligands, or specifically endorphins, as they are internally derived and bind to the body's opioid receptors
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Enkephalins
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a morphine like substance originating from within the body
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endo rphins
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endogenous opioid polypeptide compounds. They are produced by the pituitary gland and the hypothalamus in vertebrates during strenuous exercise,excitement, and orgasm, and they resemble the opiates in their abilities to produce analgesia and a sense of well-being.
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endorphins
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When a nerve impulse reaches the spinal cord, _______ are released which prevent nerve cells from releasing more pain signals.
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endorphins
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_____ allow someone to immediately after injury feel a sense of power and control over themselves which allows them to persist with activity for an extended time.
Runner's high |
endorphins
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Large-diameter Aβ fibers are nonnociceptive (do not transmit pain stimuli) and inhibit the effects
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Gate theory
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To judge if the mental and respiratory depression are associated to the opioid the nurse should:
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hold one or two doses
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What is used to relieve pruritus
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Diphenhydramine(Benadryl)
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Adverse Effects of Opioids:
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Dry mouth
urinary retention pruritus myoclonus dysphoria euphoria sleep disturbances sexual dysfunction(males) ADH secretion |
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Itch is an unpleasant sensation that evokes the desire or reflex to scratch.
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pruritus
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involuntary twitching of a muscle or a group of muscles
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myoclonus
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an unpleasant or uncomfortable mood, such as sadness (depressed mood), anxiety, irritability, or restlessness
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dysphoria
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a state of very intense happiness and feelings of well-being
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euphoria
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If titrated in small amounts the ___ ____ may be reversed without analgesia reversal
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respiratory depression
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Phenothiazines or metoclopramide are ____ and manage ___/___
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antiemetics
Nausea and Vomiting |
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Fentanyl,sufentanil and alfentanil are commonly used in combination with anesthetics to maintain a ___ ___ of anesthesia
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balanced state
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OxyContin is a sustained-release form of _____
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oxycodone
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Contin means
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continuous-release
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Sometimes a patient receiving doses of a long-acting dosage form every 12 hours will have what is known as:
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breakthrough pain
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Opioids suppress the ____ __ ___, which results in ___ ___
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medullary cough center
cough suppression |
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The most commonly used opioid to control coughing is
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codeine
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Dextromethorphan a nonopioid cough suppressant is usually given because doesnt cause
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sedation
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Opioids are related to their anticholinergic effects which can cause:
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constipation
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Paregoric and diphenoxylate/atropine are used to control
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diarrhea
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Adjuvant drug therapy may include:
and opioids can be given in smaller dosages |
NSAIDS
antidepressants anticonvulsants corticosteroids |
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codeine and acetaminophen is considered:
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Adjuvant drug therapy
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Contraindication of opioid analgesics include:
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drug allergy
severe asthma elevated intracranial pressure head injury morbid obesity sleep apnea myasthenia gravis paralytic ileus |
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Obesity contradicted with opioid because:
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The opioid excretion is prolonged due to the affinity to fat and could lead to toxicity
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High doses of opioids adverse effects are
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respiratory depression
urinary retention |
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Addiction is characterized by behaviors that include one or more of the following:
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impaired control over drug use
compulsive use continued use despite harm craving |
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Withdrawal symptoms include:
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rebound pain
mental agitation tachycardia elevated blood pressure seizures |
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Opioid-naive patients should be given:
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lower dosages
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All opioids cause some ___ release
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histamine
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Histamine release is related to which adverse effects of opioids:
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pruritus
rash flushing orthostatic hypotension |
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synthetic opioids elicit the least ____ release
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histamine
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naturally occuring opioids elicit the _____ histamine release
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highest
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The effects of naloxone are short lived and usually last about ____ _____
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one hour
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Increased bladder tone from opioids causes:
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urinary retention
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Cautions with administration of Narcan are
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raised or lower BP
dysrhythmias pulmonary edema withdrawal |
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Name opioid antagonist(reversal drugs)
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nalmefene(IV)
Naloxone(IV) naltrexone(PO) |
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intravenously
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IV
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by mouth
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PO
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Urinary retention is prevent by
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giving low dosages of an opioid agonist-antagonist or an opioid antagonist
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Indications of methadone(dolophine) are:
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Opioid analgesic
relief of chronic pain opioid detoxification opioid addiction maintenance |
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Meperidine(Demerol,Pethidine)
indications are: |
Obstetric analgesia
preoperative sedation |
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Fentanyl citrate(duragesic,oralet,actiq) indications are:
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Procedural sedation
adjunct to general anesthesia |
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Opioids can cause an abnormal increase in these lab values:
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AST and ALT
creatinine |
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Opioids can decrease ____ levels
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glucose
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Morphine sulfate is a schedule ____ controlled substance.
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two
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Opioids such as ___ and ___ would be safer to use with pts. with renal impairment.
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hydromorphone(Dilaudid)
Fentanyl |
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codeine is widely used as an:
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antitussive
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antitussive is a:
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cough suppressor
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Fentanyl lollipop is called:
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Actiq
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Fentanyl(duragesic patch) takes __ to ___ hours to reach a steady state then can be changed every ___ days.
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6 to 12
three |
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Fentanyl was initially used for the control of ___ pain
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cancer
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Some insurance companies refused to pay for this expensive drug due to the misuse except for cancer
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fentanyl
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Meperidine(Demerol,Pethidine) use is cautioned in
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elderly
long term analgesic kidney dysfunction |
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Meperidine(Demerol,Pethidine) use is cautioned in
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elderly
long term analgesic kidney dysfunction |
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A metabolite, normeperidine can accumulate and lead to:
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seizures
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After 48 hours this drug can be toxic
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meperidine(Demerol,Pethidine)
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Concurrent use of ____ with Demerol can lead to deep coma and death
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MAOI's
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This drug is elimated through the liver and a safer choice for renally impaired patients
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methadone
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Pentazocine or Methadone is used for:
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heroin-addicted patients
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This drug is used for neuropathic and cancer related pain
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methadone
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this drug is combined such drugs percocet and percodan
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oxycodone hydrochloride
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oxycodone+aspirin is:
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percodan
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oxycodone+acetaminophen is:
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percocet
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Hydrocodone+acetaminophen combined drugs are:
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Vicodin
Lorcet Lortab |
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competitive agonists exert:
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no action
|
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Buprenorphine(Buprenex) is a:
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Partial agonist
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Butorphanol(Staldol) is a:
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Partial agonist
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Nalbuphine(Nubain) is a:
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Partial agonist
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Pentazocine(Talwin) is a:
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Partial agonist
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All but butorphanol are alos available in combination with the opioid antagonist ___ to enchance their opioid antoagonistic effects
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Naloxone(Narcan)
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Naloxone hydrochloride is a:
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pure opioid antagonist
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A opioid antagonist Naltrexone hydrochloride trade names are:
|
ReVia
Trexan |
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What are adverse effects of Naloxone:
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Nausea
Tachycardia |
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This antagonist drug is used for the treatment of alcoholism:
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Naloxone
|
|
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cyclooxygenase-2 inhibitors also called:
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COX-2
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Name the cyclooxygenase-2 inhibitor:
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Celebrex
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Acetaminophen blocks peripheral pain impulses by:
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inhibition of prostaglandin synthesis
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Naltrexone is contraindicated in pts. with:
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hepatitis
liver dysfunction/failure hypersensitivity to it |
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Heat is dissipated through resulting ___ and ___
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vasodilation
increased peripheral blood flow |
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NSAID's are not used for the treatment of:
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arthritic inflammation
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acetaminophen are not associated with:
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cardiovascular effects(edema)
Platelet effects(bleeding) |
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antipyretic
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antifever
|
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Acetaminophen is used for febrile children due to the brainwastin condition known as:
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Reye's syndrome
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contraindications to acetaminophen include:
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hypersensitivity to it
liver disease genetic disease(G6PD) |
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G6PD is called:
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glucose-6-phosphate dehydrogenase deficiency
|
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The most severe adverse effect of acetaminophen is:
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blood dyscrasias(anemias)
nephotoxicities |
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An overdose of acetaminophen can lead to:
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hepatic necrosis
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doses of acetaminophen greater than ___ mg/kg may result in hepatic toxicity
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150
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The maximum daily adult dose of acetaminophen is:
|
4000mg
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This antagonist works by preventing the hepatotoxic metabolites of acetaminophen from forming
|
acetylcysteine
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The most lethal drug interaction of acetaminophen and ______
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alcohol
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other drugs that potentiallly can ineract with acetaminophen include
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phenytoin
barbiturates isoniazid refampin beta-blockers anticholinergics |
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tartrazine(yellow dye no.5) is contraindication with the use of what drug:
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acetaminophen
|
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Tramadol(Ultram) inhibits the reuptake of both:
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norepinephrine
serotonin |
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Tramadol(Ultram) is contraindicated in:
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alcohol
hypnotics centrally acting analgesics opioids psychotropic drugs |
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Tramadol(Ultram) has similar effects like:
|
opioids
|
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What adverse effect has been reported with the use of Tramadol and tricyclic antidepressants,SSRI,MAOI,neuroleptics:
|
seizures
|
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Selective Serotonin reuptake inhibitor
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SSRI
|
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Psychological factors of pain aree:
|
insomnia
depression withdrawal anxiety mood changes changes in lifestyle |
|
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What should the nurse also assess with pain mgmt:
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Level of orientation
status of bowel sounds urinary retention |
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symptoms of chronic acetaminophen poisoning:
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rapid weak pulse
dyspnea cold,clammy extremities |
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Adults who ingest more that 2.6g within a 24 hour period of acetaminophen are at risk for:
|
loss of appetite
jaundice N/V |
|
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nausea and vomiting
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N/V
|
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Decrease renal function can lead to:____ and what labs should be assessed.
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toxicity
BUN and creatinine |
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Flumazenil is indicated to:
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*reverse conscious sedation or general anesthesia
*manage benzodiazepine overdose |
|
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IV fluids should be administered during muscle relaxant overdose to avoid:
|
crystalluria
|
|
|
Propoxyphene
orphenadrine can resulted in additive CNS effects with: |
muscle relaxants
|
|
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Additive CNS effects of muscle relaxants include:
|
Mental confusion
anxiety tremors *hypoglycemia |
|
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metaxalone may produce _____-____ results in glucose determinations.Ex: Benedict's solution,Fehling's solution.
|
false-positive
|
|
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Baclofen
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(Lioresal)
|
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Chlorphenesin
|
Maolate
|
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Chlorzoxazone
|
Paraflex
|
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Cyclobenzaprine
|
flexeril
|
|
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metaxalone
|
skelaxin
|
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Dantrolene
|
Dantrium
|
|
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If blood pressure or vital signs are below normal what should be done:
|
with hold the medication
|
