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83 Cards in this Set

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