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41 Cards in this Set
- Front
- Back
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The immediate phase of response to an insult or injury: |
Acute pain |
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Compulsive use of a drug for a secondary gain: |
Addiction |
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Drugs used in the management of pain that have another primary pharmacotherapeutic action: |
Adjunct analgesics |
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Drugs used to treat pain: |
Analgesics |
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Transitory flare-ups of pain over baseline: |
Breakthrough pain |
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Pain that persists well beyond actual tissue injury: |
Chronic pain |
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Characterized by a withdrawal syndrome upon cessation of the drug: |
Dependence |
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Drugs used to treat pain that work on the perception of pain by the brain: |
Narcotics |
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Results from injury to the peripheral receptors, afferent fibers, or CNS: |
Neuropathic pain |
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Caused by the activation of delta and C nociceptors in response to painful stimuli: |
Nociceptic pain |
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Another name for a narcotic drug derived from opium: |
Opioid |
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An unpleasant sensory and emotional experience: |
Pain |
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A dose of medication added to the standing doses for pain management: |
Tolerance |
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Equianalgesic dosages are compared with? |
morphine (Roxanol) R: the standard measure of pain relief |
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Morphine has many actions, including: |
inhibiting the release of substance P R: decreasing substance P modulates pain perception |
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Morphine administration is contraindicated in which of the following disorders: a. Head injury b. Hepatic insufficiency c. Renal impairment d. All of the above |
a. Head injury R: Morphine causes sedation which would mask changes in the LOC. Which is the most sensitive indicator of neurologic compromise. |
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The most hazardous adverse effects to the use of morphine occur to the: |
Respiratory system |
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In addition to pain relief, codeine is also frequently used as a: |
Cough suppressant R: Codeine acts directly on the medullary cough center to depress the cough reflex |
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Codeine is used cautiously in patients with respiratory disorders because it may: a. cause bronchoconstriction b. cause bronchodilation c. decrease respiratory secretions d. lead to accumulation of secretions and a loss of respiratory reserve |
d. Lead to accumulation of secretions and a loss of respiratory reserve R: Codeine does not affect the diameter of the bronchioles, nor does it decrease respiratory secretions |
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In addtion to CNS depressants, codeine may have drug-drug interactions with: a. antibiotics b. antiulcer medications c. bronchodilators d. anticoagulants |
b. antiulcer medications R: When codeine is co-administered with H2 antagonists, the narcotic actions are enhanced, resulting in potential toxicity and an increased risk for respiratory depression |
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Which of the following statements about pentazocine (Talwin) is correct? a. Its a narcotic agonist b. Its a narcotic antagonist c. Its both a narcotic agonist and an antagonist d. Its none of the above |
c. Its both a narcotic agonist and antagonist |
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Because of its pharmacodynamics, IV pentazocin (Talwin): a. increases the workload of the heart b. decreases the workload of the heart c. increases the workload of the lungs d. decreases the workload of the lungs |
a. increases the workload of the heart |
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The most common adverse effects to pentazocin (Talwin) include: a. respiratory depression b. soft tissue induration, nodules, and cutaneous depression c. nausea, vomiting, dizziness, and euphoria d. excitement, tinnitus, disorientation, and confusion |
c. nausea, vomiting, dizziness, and euphoria R: all of these adverse effects are possible, but these are the ones that're most likely to occur. |
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Which of the following would be an adverse effect from morphine? a. Tachycardia b. Biliary colic c. Diarrhea d. Decreased intracranial pressure |
b. Biliary colic |
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Which of the following patients would be a poor candidate to receive morphine? a. Paul, a premature infant b. Rex, 15 years old post car accident c. Bethany 50 years old post surgery to correct a fractured wrist d. Laura, 60 years old with an acute MI |
a. Paul, a premature infant |
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Which of the following statements is true about fentanyl? (Mark all that apply) a. It is more effect than morphine b. It is more potent than morphine c. Topical preparations are used to treat chronic pain d. IV administration may be to treat acute pain or as anesthesia |
b. It is more potent than morphine c. Topical preparations are used to treat chronic pain d. IV administration may be to treat acute pain or as anesthesia |
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Your patient has been given morphine 2mg IV. She now has an increase in her BP and resting pulse and states that she feels very anxious. You suspect: a. an idiosyncratic reaction b. an additive effect c. a synergistic effect d. an agonist response |
a. an idiosyncratic reaction R: these symptoms are the exact opposite of what you expect in a patient receiving morphine. |
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Your 77 year old patient has just had surgery for a fractured ankle. The patient is in severe pain and has morphine sulfate ordered to control pain. With your knowledge of morphine, you would expect the dosage of morphine to: a. be equal to the dose for a young adult b. be higher than the dose for a young adult c. be lower than the dose for a young adult |
c. be lower than the dose for a young adult R: In the elderly, the blood-brian barrier is less efficient, so CNS-depressant drugs cross the blood-brain barrier more freely. |
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Your 55 year old patient has a fractured rib. She is being released from the emergency room with a prescription for a narcotic analgesic. Before discharging this patient, you assess the patient's lifestyle, diet, and habits. Which of the following questions should be included in this assessment? a. "Are you able to drink 3 L of water a day?" b. "Do you drink alcoholic beverages?" c. "Do you take other medications?" d. "Do you have stairs in your home?" |
b. "Do you drink alcoholic beverages?" R: alcohol is a CNS depressant that interacts with all opioids |
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Your patient is taking tylenol with codeine No. 3 to control the pain from a fractured arm. Five days later, the patient calls the clinic and states, "I'm having problems having a bowel movement since I started this drug." Which of the following is the most appropriate response? a. "This is an expected adverse effect to the use of codeine. Increase your fluid intake and take a bulk laxative such as Metamucil." b. "This is an additive effect of codeine. Stop taking this medication." c. "This is an expected adverse effect to the use of codeine. Double the dose, and it will clear out your bowel." d. "You are probably allergic to the codeine. Stop taking the medication." |
a. "This is an expected adverse effect to the use of codeine. Increase your fluid intake and take a bulk laxative such as Metamucil." R: All opioids cause constipation. Bulk laxatives are the type of laxatives that mimic the body's action to expel feces |
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Your patient is being discharged with a prescription for tylenol with codeine. Which of these areas of assessment needs special attention? a. Health status and environment b. Culture and lifestyle, diet and habits c. Health status, lifestyle, diet and habits, and environment d. Health status and culture |
c. Health status, lifestyle, diet and habits, and environment |
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Your patient was admitted for observation after a suicide attempt. Upon discharge the patient is prescribed a narcotic analgesic for an injury sustained during the suicide attempt. Which of the following narcotics would be contraindicated for this patient? a. Propoxyphene (Darvon) b. Hydrocodone (Vicodin) c. Codeine d. None of the above |
a. Propoxyphene (Darvon) |
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During a psychiatric intake interview with your patient, she states, "My mom put me here. She is concerned because of my use of 'T's and 'blues.'" With your knowledge of these drug combination, you carefully assess: a. the heart and lungs b. the lungs and CNS c. kidney and liver function d. the CNS and skin |
b. the lungs and CNS R: The most serious complications of "T's and Blues" are pulmonary disease and neurologic events. |
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Which of the following adverse effects is specifically related to tramadol (Ultram)? a. seizure activity b. respiratory depression c. constipation d. vomiting |
a. seizure activity R: Morphine and other opioids cause respiratory depression, constipation, and nausea and vomiting. In addition, tramadol may induce seizure activity. |
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Your surgical patient's pain has been well controlled with the fentanyl iontophoretic transdermal system (Ionsys). The patient states, "I am so afraid of going home because I just know I am going to have a lot of pain." Prior to discharge the nurse should: a. teach the patient how to clean the iontophoretic system b. discontinue the iontophoretic system c. fill the system with fentanyl to avoid opioid withdrawal d. contact the home health department to ensure the home health nurse will monitor the system at the patients home |
b. discontinue the iontophoretic system R: The Ionsys is a transdermal route for patient-controlled analgesia (PCA) for hospitalized patients. It's used to treat acute post-op pain in adults but not intended for home use. |
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Your patient in the emergency department arrived non-responsive. The friend of the patient states, "I think he took an overdose of methadone, but I'm not sure." You administer IV naloxone and the patient awakes. What is the most essential nursing action for this patient? a. contact psychiatry services for an admit consult b. Administer sodium bicarbonate to keep the patients blood pH normal c. draw blood for a methadone level d. frequently monitor the patinet's level of consciousness |
d. frequently monitor the patient's level of consciousness R: Naloxone has a very short half-life. Careful monitoring of the patient beyond initial response is warranted because the duration of action of the methadone may be longer than the duration of naloxone. |
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The efficacy of other opioids is measured against _________. |
morphine |
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What is the most serious adverse effect from morphine? |
Respiratory depression |
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How is excessive respiratory depression treated? |
Naloxone, the antidote to narcotic overdose |
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Patients treated for pain should also have a prescribed _______ _____ to manage any breakthrough pain. |
Rescue dose |
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What is codeine and synthetic forms of codeine (hydrocodone), often combined with for increased pain control? |
Non-steroidal anti-inflammatory agents |
