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83 Cards in this Set
- Front
- Back
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Pain threshold
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the level of stimulus needed to produce a painful sensation
(How much pain it takes for us to yell) |
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Pain tolerance
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the amount of pain a person can tolerate without it interfering with normal function
(How much can we take without it affecting out lives) |
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Tachyphlaxis
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the rapid progressive decrease in response to a drug after repetitive administration
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What are the symptoms of benzodiazepine overdose?
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confusion and decreased reflexes
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What type of barbiturate is used to prevent convulsions?
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long acting
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Barbiturates are contraindicated for the use in patient who have:
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liver disease
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Benzodiazepines are contraindicated in persons with:
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narrow-angle glaucoma
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the muscle relaxant given for malignant hyperthermia is:
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dantrolene
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Somatic pain
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originates from skeletal muscles, ligaments, and joints
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Superficial pain
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originates from skin and mucous membranes
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Visceral pain
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originates from organs and smooth muscles
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Vascular pain
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originates from vascular or perivascular tissues (headaches)
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Neuropathic pain
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injury or damage to peripheral tissue of the CNS
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Psychogenic pain
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pain that originates from the head
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Considering the gate theory of pain, what is the purpose of medications?
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to close the gate
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A-fibers
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larger in diameter fibers which conduct sharp and well localized pain impluses
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C-fibers
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small diameter fibers which slowly conduct dull and non-localized pain impulses
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What are the neurotransmitters that alter pain experience?
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endorphins and enkephalins
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What is the ultimate goal when addressing pain with your patient?
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pain control
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What is the key to adequately treating your patient's pain?
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assessment
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What are examples of opiate agonists?
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Codeine, Demerol, Fentanyl, Morphine, Ocycodone
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What are some patches that can control pain?
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fentanyl or duragesic
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What type of medications do you want to use for breakthrough pain?
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shorter acting narcotic
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What do you use for a narcotic overdose?
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Narcan (naloxone)
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Who shouldn't use opiates?
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those who are allergic, sever asthmatics, sleep apnea, paralytic ileus, severe head injury, pregnancy
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What are some withdrawal symptoms of opoids?
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n/v/diarrhea, chills, mental agitation, tachycardia, increased B/P, diaphoresis, runny nose, cramps, delirium tremors
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What are the side effects of opiates?
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CNS depression --> respiratory depression, n/v constipation urinary retention (elderly)
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What labs should you check for a pt on opiates?
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ALT, AST, Alkaline phosphase
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What is the max daily dosage for acetaminophen?
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4 grams
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How do you treat a tylenol overdose?
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stomach pump and a medication called acetylcyseine (Mucomyst)
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How should you offer acetylcysteine (Mucomyst) acetaminophen OD treatment.
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series of 17 treatments
smells like rotten eggs try mixing it with juice and offering it with a straw |
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What is the difference between sedatives and hypnotics?
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Sedatives: used to reduce nervousness, excitability, and irritability without causing sleep. May be a hypnotic in larger amounts
Hypnotics: cause sleep |
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What was the first type of drugs introduced for insomnia?
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barbiturates
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What are the side effects of barbiturates?
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drowsiness, lethargy, dizziness, hangover effect, interferences with sleep cycle
deprive patients of REM sleep |
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What is a barbiturate rebound phenomenon?
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when the drug is stopped and the REM portion of sleep increases. Frequently leads to nightmares
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What do you do for a barbiturate overdose?
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supportive
there are no antidotes or drug antagonists activated charcoal may be used in removing barbiturates from stomach and circulation |
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What benzodiazepines are commonly used for sedative-hypnotic indications
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estazolam (ProSom)
flurazepam (Dalmane) quazepam (Doral) temazepam (Restoril) triazolam (Halcion) |
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What are benzodiazepines commonly used for?
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sedation, sleep induction, skeletal muscle relaxation, anxiety relief, ETOH withdrawal, agitation, depression
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Sleep hygiene
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routine sleep patterns, avoiding heavy exercise prior to bedtime, avoiding heavy meals late in the evening, eating turkey, avoiding caffeine, trying warm milk prior to bed
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What are the side effects of benzo?
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headache, hang-over effect, habit forming
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What is the antidote for benzo toxicity?
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flumazenil (Romazicon)
but only in extreme cases |
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What are some adverse reactions of muscle relaxers
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sedation, drowsiness, fatigue, dizziness
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Flexeril (cyclobenzaprine)
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highly sedating muscle relaxant, watch for altered sensorium and prevent injury especially in geriatric patients, high fall risk, hangover
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Baclofen (Lioresal)
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muscle relaxant given to relieve extremity spasms in paraplegia and quadriplegia
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Dantrium (dantrolene)
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muscle relaxant used for malignant hyperthermia, can cause liver problems, works directly on skeletal muscles
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Chloral hydrate
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oldest sedative-hypnotics which does not effect REM sleep, very prone to tachyphylaxis
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Seizure
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A brief episode of abnormal electrical activity in the nerve cells of the brain
(What happens in the brain) |
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convulsions
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involuntary spasmodic contractions of any or all voluntary muscles throughout the body
(What we actually see) |
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Epilepsy
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The name for the disease where chronic and recurrent seizure activity occurs
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What is the difference between primary and secondary epilepsy?
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Primary: Don't know what causes it
Secondary: Do know what causes it |
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What is the primary cause of secondary epilepsy in infants and children?
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developmental defects, metabolic disease, or injury at birth
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What is the primary cause of secondary epilepsy in adults?
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acquired brain disorder (head injury, disease, or infection of brain/spinal cord, stroke or brain tumors)
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Partial seizure
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Short alterations in consciousness, repetitive unusual movements, psychological changes and confusion
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What seizures are typed as partial seizures?
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simple and complex seizures
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Simple seizures
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patient usually stays conscious, they have an aura, have movement on one side of the body
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Complex seizures
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looses consciousness 1-3 minutes, automotizisms
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Generalized seizures
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most often seen in children, characterized by temporary lapses in consciousness lasting a few seconds. Staring off into space, inattentive look, rhythmic movements of the eyes, head and hands, but no convulsions
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tonic clonic seizure
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grand mal seizures, 2-5 minutes of unconsciousness
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Absence seizure
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petty mal seizure, day dreaming occurs more in children than adults, brief loc (few seconds) don't remember event
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Myoclonic seizures
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just in one side
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Post ictal state
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the time after a seizure when a pt is super tired
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Status epilepticus
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Life threatening emergency characterized by generalized tonic-clonic seizures which occurs in succession
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What is the drug of choice to treat status epilepticus?
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Valium (diazepam)
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What type of seizures are classified as generalized seizures?
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tonic clonic, absence, and myoclonic seizures
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What is the goal of AED therapy?
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Prevent the spread of excessive electrical impulses from abnormally functioning cells and protect surrounding normal cells
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Do AED's have narrow or large therapeutic windows?
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narrow therapeutic windows
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What is the gold standard for epilepsy?
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Dilantin (Phenytoin)
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What is the therapeutic drug level for Dilantin (Phenytoin)?
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10-20
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How do you give Dilantin IV?
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only with normal saline, infused slowly
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what are teh common side effects of Dilantin?
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lethargy, abnormal movements, mental confusion, and cognitive changes
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What labs are important for Dilantin?
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liver function, CBC,
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What should the nurse enforce for a patient on Dilantin?
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Calcium supplement with Vit D because it causes osteoporosis
Daily brushing and flossing and routine dental visits because it causes gingival hyperplasia take it at the same time each day |
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What is gingival hyperplasia?
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overgrowth of the gums
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What is dilantin facies?
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long term use causes a change in apperarance: acne, hirsutism, gingival hyperplasia, hypertrophy of SQ tissue
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Depakote (Valproic acid) is an AED, what is the therapeutic level?
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50-100
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Depakote (Valproic acid) is an AED, what is the fatal side effects?
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hepatotoxicity and pancreatitis
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Depakote (Valproic acid) is an AED, what type of effect does it have on warfarin and phenytoin?
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it also increases the blood levels of warfarin and phenytoin by displacing them from blood proteins that they bind to
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What classification is Tegretol (Carbamezepine), and what is it's therapeutic level?
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Antiseziure med
4-12 |
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What AEDs are used for diabetic neuropathy, fibromyalgia, and chronic pain conditions?
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neuronin (Gabapentin)
Lyrica (Pregabalin) |
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Parkinson's disease
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chronic progressive, debilitating disorder, affecting the deficiency of dopamine producing neurons in the brain
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Dyskinesia
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rigid and tense muscles
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Chorea
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Type of dyskinesia associated with PD
irregular, spasmodic, involuntary moments of limbs and facial muscles |
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Dystonia
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type of dyskinesia
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