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40 Cards in this Set

  • Front
  • Back
Name 2 groups of opioid analgesics?
opioid agonists/antagonists
opioid agonists
Name 3 opioid agonists/
antagonists?
buprenorphine
butorphanol
pentazocine
Name 13 opioid agonists?
codeine
fentanyl (oral transmucosal)
fentanyl (parenteral)
fentanyl (transdermal)
hydrocodone
hydromorphone
meperidine
methadone
morphine
nalbuphine
oxycodone
oxymorphone
propoxyphene
Opioid analgesics are used in the management of?
moderate to severe pain
__________ is used as a general anesthetic adjunct.
Fentanyl
Opioids bind to opiate receptors in the CNS, where they act as ______ of endogenously occurring opioid peptides (eukephalins and endorphins). The result is alteration to the perception of and response to pain.
agonists
Contraindications?
hypersensitivity
Precautions?
Use cautiously in patients with undiagnosed abdominal pain, head trauma or pathology, liver disease, or history of addiction to opioids.
okay
Precautions?
Use ______ doses initially in elderly and those with respiratory diseases.
smaller
Prolonged use may result in ______ and the need for larger doses to relieve pain. Psychological or physical dependence may occur.
tolerance
Interactions?
Increases the ____ depressant properties of other drugs, including alcohol, antihistamines, antidepressants, sedative/hypnotics, phenothiazines, and MAO inhibitors.
CNS
Use of partial-antagonist opioid analgesics:
buprenorphine
butorphanol
nalbuphine
pentazocine
may precipitate opioid _____ in physically dependent patients.
withdrawal
Interactions?
Use with MAO inhibitors or procarbazine may rsult in severe _______ reactions (esp with meperidine).
paradoxical
Nalbuphine or pentazocine may (increase, decrease) the analgesic effects of other concurrently administered opioid analgesics.
decrease
ASSESSMENT:
What 3 characteristics of pain should be assessed prior to and at the peak following administration?
location
intensity
type
When titrating opioid doses, increases of ___-___% should be administered until there is either a ___% reduction in the patient's pain rating on a numerical or visual analogue scale or the patient reports satisfactory pain relief.
25-50%

50%
A repeat opioid dose can be safely administered at the time of the peak if previous dose is _____ and side effects are _____.
ineffective
minimal
Patients requiring higher doses of opioid agonist-antagonists should be converted to an opioid ____.
agonist
Opioid agonist-antagonists are not recommended for 1______ use or as first-line therapy for acute or
2____ pain.
1 prolonged
2 cancer
An _____ chart should be used when changing routes or when changing from one opioid to another.
equianalgesic
Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is less than ____/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant ______. Dose may need to be decreased by ___ - ____%. Initial drowsiness will diminish with continued use.
10
h;ypoventilation
25-50%
Assess prior analgesic history. Antagonistic properties of agonist-antagonists may induce withdrawal symptoms in patients physically dependent on opioids. What are symptoms of withdrawal?
abdominal cramps
increased blood pressure
temperature
vomiting
Prolonged use may lead to physical and psychological dependence and tolerance. This should not prevent patient from receiving adequate analgesia. Most patients who receive opioid analgesics for pain do not develop psychological dependence. Progressively higher doses may be required to relieve pain with chronic therapy.
okay
Assess _____ function routinely. Prevention of ____ should be instituted with increased intake of fluids and bulk, stool softeners, and laxatives to minimize constipating effects. Stimulant laxatives should be administered routinely if opioid use exceeds ___-___ days, unless contraindicated.
bowel
constipation
2-3 days
Monitor intake and output ratios. If significant discrepancies occur, assess for urinary _____ and inform physician or other hcp.
retention
Toxicity and Overdose:
If an opioid antagonist is required to reverse respiratory depression or coma, _____ (trade name) is the antidote.
naloxone (Narcan)
Dilute the 0.4-mg ampule of naloxone in 10 ml of 0.9% NaCl and administer how?
0.5 ml (0.02 mg) by direct IV push every 2 min.
For children and patients weighing less than 40 kg, dilute 0.1 mg of naloxone in 10 ml of 0.9% NaCl for a concentration of 10 mcg/ml and administer how?
0.5 mcg/kg every 1-2 min. Titrate dose to avoid withdrawal, seizures, and severe pain.
List 4 potential nursing diagnoses?
1 Pain, acute
2 Sensory perception,
disturbed (auditory,
visual) (side effects)
3 Injury, risk for (s.e.)
4 Knowledge, deficient,
related to disease
processes and medication
regimen
IMPLEMENTATION:
Do not confuse morphine with
_____ or _____; errors have resulted in fatalities
hydromorphone
meperidine
Explain therapeutic value of medication before administration to enhance the analgesic effect.
okay
Regularly administered doses may be more effective than _____ administration. Analgesic is more effective if given _____ pain becomes severe.
prn
before
Coadministration with ______ analgesics may have additive analgesic effects and may permit lower doses.
nonopioid
Medication should be discontinued _____ after long-term use to prevent withdrawal symptoms.
gradually
Instruct the patient on how and when to ask for pain medication.
okay
Medication may cause drowsiness or dizziness. Caution patient to call for assistance when _____ or smoking and to avoid driving or other activities requiring alertness until response to medication is known.
ambulating
Advise patient to make position changes slowly to minimize ____ ____.
orthostatic hypotension
Caution patient to avoid concurrent use of alcohol or other ____ depressants with this medication.
CNS
Encourage patient to ____, ____, and ____ deeply every 2 hours to prevent atelectasis.
turn
cough
breathe
EVALUATION:
Effectiveness of therapy can be demonstrated by:
Decreased severity of pain without significant alteration in level of ______ or ________ status.
consciousness
respiratory