Pharm Test 2 (Headaches And Analgesics)

Front 1

stimulation of MU receptors causes:

Back 1

analgesics (drugs that relieve pain)

constipation (from decrease GI motility)

respiration depression *test* when the receptor is stimulated, it causes the body ot naturally slow down it's RR.

euphoria - state of well being that comes from the endorphin transmitter being stimulated

(physical dependence and decreastion GI motility- leading to constipation)

Front 2

stimulation of Kappa causes:

Back 2

sedation
analgesia- relieves pain
duiresis- increased urination
dysphoria (anxiety, restlessness)

(Decreased GI motility)

Front 3

when Mu and Kappa are both stimulated, we're sedating the patient but the MU is stimulated it uniquely results in

Back 3

euphoria and respiratory distress

Front 4

pure opioid agonists activate:

Back 4

mu and kappa

mu-agonist
kappa- agonist

Front 5

opioid agonist - antagonists

what do they have

blocking occurs in the ____, why?

Back 5

have both mu and kappa properties for helping and blocking.

Mu -antagonist
Kappa- agonist

blocking occurs in the MU receptors and the blockage occurs so we don't get respiratory depression and it reduces sedation.

Front 6

pure opioid antagonist
-when would you give these?

Back 6

only when someone OD on drugs. u need to block the receptor so it doesn't keep responding to the drug so you improve their RR and sedation

Front 7

what is an analgesic?

Back 7

a med to help pain

Front 8

what is an opioid antagonist?

Back 8

it blocks the opiod receptor and they can't respond to drugs

Front 9

Morphine sulfate (MS)

what receptors does it work on?

by binding to these receptors, the drug occupies the receptor space and this enhances

Back 9

mu and kappa
(mu is the agonist and kappa is the agonist)

the analgesic effect and euphoria

Front 10

Morphine sulfate (MS)

the higher the dose, the

Back 10

greater the receptor stimulation

Front 11

Morphine sulfate (MS)

what 3 spots does it act on?

Back 11

site of injury
CNS ganglion
brain stem

Front 12

Morphine sulfate (MS)

Dosages
-Orally..what is unique about this?

Back 12

it is significantly inactivated by the 1st pass metabolism in the liver
-you need to increase the oral doses to equal IV IM and SC effects

Front 13

Morphine sulfate (MS)

Adverse effects

what is specifically linked to the nurse?

Back 13

Nausea and vomitting (when morphine is given IV push)

this is a medication you have to push slowly (over 1 minute) if you push this medication too fast, within 10-15 minutes you pt will be throwing up

Front 14

Morphine sulfate (MS)

Adverse effects
-what are the other effects?

Back 14

1. nasuea and vomitting
2. hypotension
3. sedation
4. constipation
5. respiratory depression (can start in 7 minutes)

Front 15

before giving narcotics IV push, what must the nurse do?

Back 15

you need to have a RR and BP

Front 16

Morphine sulfate (MS)

Contraindicated in people who have:

Back 16

Gallbladder disease: Can cause spasm of the sphincter of Oddi


Head Injury: Can cause increased ICP from respiratory depression (increase CO2 in the blood = dilation of vasculature = increse ICP) if u r not breathing, CO2 builds up in your brain causing ICP pressure. Avoid morphine. Any narc can cause resp.depression


Labor: Can cause fetal respiratory depression at birth drug can get into the baby

GI: Used cautiously in patients with ulcerative colitis 2° to the potential to develop mega-colon slows down peristalsis and cause a mega colon (colon that just blows up)

Front 17

Morphine sulfate (MS)

Treatment/Uses (2)

Back 17

Post-operative pain

MI: (heart attack) Drug of choice (one of the top 3), decreases cardiac work, decreases O2 demands, decreases blood pressure

Front 18

Morphine sulfate (MS)

Abuse Potential

Abuse Liability (why do people want to abuse the drug and what is it about the drug that makes them want to take it when they don’t need it anymore)

Back 18

Schedule II

Occurs secondary to euphoria, sedation and as the drug builds in the body, it gives for perineal orgasmic sensations

Front 19

Morphine Sulfate MS

Toxicity: about patient symptoms –how do you know if the pt has gotten to much:

Back 19

RR < 12
SAO2 < 94%
B/P systolic < 90
Difficult to arouse
Hypotensive
pupils constricted

Front 20

Morphine Sulfate MS

Treatment for OD / Toxicity

Back 20

we give narcan. Narcan is the antagonist.

Front 21

Depodur
-what is it?

Back 21

This medication is a suspension of fat-soluble particles containing morphine. For epidural injections only. (highly lipophilic)

Front 22

Depodur
-Uses:

what does the nurse have to know when giving this drug

Back 22

This medication is approved only for single epidural use.

It can be given before surgery or after clamping the umbilical cord during a cesarean section delivery.

Giving it by any other routes may lead to serious breathing problems (e.g., very slow and shallow breathing).

Front 23

Depodur
Dosage
-who is it determined by:
-what side affects does this cause?

Back 23

is determined by the anesthesiologist and the type of surgery to be performed.

Does cause sedation and activates MU & Kappa

Front 24

Depodur

Severe Interactions:

Back 24

Blood levels of midazolam or triazolam(both for anxiety) may increase and cause more drowsiness or difficulty breathing

Front 25

Meperidine (Demerol)
-administration?

-IV needs to be .......

Back 25

PO IM IV and SC

diluted and not administered faster than 25mg/1 min

SOOOOOOOOOOOO if you are giving 100 mg dose, it’s going to take about ___ minutes to push)



4 minutes

Front 26

Meperidine (Demerol)

what is the action?
(3)

Back 26

MU and kappa receptor binding
CNS depression
short acting half life (3-4 hours)

Front 27

Meperidine (Demerol)

Drug response: 6

Back 27

Pain relief
Sedation, significant
Respiratory depression, decreased RR
Hypotension
Nausea / vomiting
Dizziness

Front 28

Meperidine (Demerol)

Contraindications

Back 28

Patients taking antidepressants

MAO Inhibitors

Front 29

Meperidine (Demerol)

Adverse Reactions:

Back 29

-Higher incidence of toxicity..

HOW?????


When Demerol has been given, it has active metabolites that can cause:


-Dysphoria, tremors
(dysphoria in an older client can come out as confusion so its important to understand the baseline of your client)

Front 30

Methadone

Action: (3)

Back 30

-Depresses impulse at your receptors but it’s not supposed to be addicting
-Long acting at Mu and Kappas (don’t get euphoria but you get the pain response)
-Binds to opioid receptor

Front 31

Methadone

treatment:

Back 31

Used to treat opioid addictions

Front 32

Methadone

Response:
Exacerbated effect of receptor sites with:

Back 32

with alcohol use

Front 33

Fentanyl
is also called:

Back 33

Sublimaze and Duragesic(the patch)

Front 34

Fentanyl is ____ more potent than Morphine Sulfate (test)

Back 34

100x

Front 35

Morphine is
-Fentanyl is in

Back 35

morphine-- milligrams

micrograms

Front 36

Fentanyl
-what kind of pain is this used for?

-what makes this medication absorb?

Back 36

chronic pain only..


.The patch gets activated by the heat of the human body. In the center of the patch is the drug. The membranes has thousands of little holes. The heat of the human body makes the membrane permeable and the drug is absorbed into the subcutaneous tissue of the area where the patch is laying. From the subQ tissue it enters the capillary system and then the main circulation. Knowing that, anything above 98.6 is going to cause the drug to be absorbed quicker (if they go in hot tub, fever, if they sleep on a water bed all increase body temperature and can cause an increase absorption of the drug)

Front 37

Fentanyl

-why does death result from?

Back 37

-they can cause death from resp. depression (100 times more powerful than morphine) and pts apply them at home on their own.

Front 38

Fentanyl

how long does the patch last?
what parts of the body can you put it on?

Back 38

These patches last 3 days
- Placed on specific areas on body------arm, thigh, upper back, buttocks - NEVER PUT ON BACK OF NECK (you have no fat on your

Front 39

Dilaudid: Hydromorphone

whats the ratio of morphine to dilaudid?

Back 39

8mg of morphine, I give 1mg dilaudid (8:1 ratio)

Front 40

Hydromorphone is approximately ___ times more potent on a milligram basis than morphine.

Back 40

8

Front 41

Dilaudid: Hydromorphone

used to treat:

what pregnancy category is this?

Back 41

Used to treat severe pain (kidney stones)


Pregnancy Cat C

Front 42

Dilaudid Uses

Back 42

-Biliary colic (pain caused by an obstruction in the gallbladder or bile duct)
-Burns
-Cancer (one of the drugs of choice)
-Heart attack
Injury (soft tissue and bone)
-Renal colic (sharp lower back and groin pain usually caused by the passage of a stone through the ureter)
-Surgery

Front 43

Codeine
--a lot of upset stomach comes from this)
____ of each dose is converted to morphine in the liver


--- Schedule (depends on route of admin) ____

-this is combined with ASA, Tylenol or NSAID

Back 43

a lot of upset stomach comes from this)
10% of each dose is converted to morphine in the liver


3

Front 44

Codeine

T3

Back 44

Tylenol 300mg & codeine 30mg

Front 45

Codeine

T4

Back 45

Tylenol 300mg & codeine 60mg

Front 46

Empirin is also known as:

Empirin 3

Back 46

aspirin

ASA 325mg & codeine 30 mg

Front 47

Empirin 4

Back 47

ASA 325mg & codeine 60 mg

Front 48

Oxycodone --Think of oxycodone as synthetic morphine. What is unique about this?

Back 48

NOT CONTROLLED RELEASE

Front 49

Oxycodone-
Oxycontin -

what is a controlled release? Which one isn't?

Back 49

Oxycontin -( controlled release)

Front 50

What are the ingredients
Percodan

Percocet

Back 50

Oxycodone & ASA (aspirin)
Oxycodone & Acetaminophen

Front 51

“cet” tells you its

Back 51

acetaminophen

Front 52

Pt education for all narcotics

Constipation management- when does it start?
-what do we tell them to do?

Back 52

-Constipation management starts 3 days after they start medication. they will have bricks and it hurts.

Push fluids increase fiber, veggies, yogurt, oatmeal, -Metamucil—we want soft mushy stools

Front 53

Pt education for all narcotics

Monitoring for orthostatic hypotension
-what is it?

Back 53

Monitoring for orthostatic hypotension (when the pt goes to lying position to a sitting heart rate goes up and BP goes down)
Monitoring for urinary retention

Front 54

Opioid overdose triad:

what is the first thing we notice??
-what 2 other s&s do we notice?
-what can we do to reverse the problem?

Back 54

Resp depression, pinpoint pupils, ALOC (first thing u notice)

---administer narcan to reverse problem

Front 55

Drug interactions and narcs

Back 55

Other CNS depressants: increases depressive state of brain

Antihistamines (Benadryl is very sedating) and tricyclic antidepressants
--Narcotics enhance the anticholinergic effects and increase problems with constipation and urinary retention

Front 56

BP and narcs

Back 56

Cautiously with B/P meds: increase potential for decrease B/P

Front 57

Opioid Agonist - Antagonist (type of drug given when..)


what receptors do they have?

Typically used

Back 57

to a patient in labor)

Have both mu & kappa properties for helping and blocking
(Mu- antagonists)

in labor 2° their lower incidence of respiratory depression. Safe to administer with breast feeding

Front 58

-what type?
Nalbuphine (Nubain):

Back 58

Opioid Agonist - Antagonist



Agonist kappa Antagonists mu

Stimulates kappa but blocks mu (blocks MU –euphoria, sedation, respiratory depression)

Front 59

-what type?
Butorphanol (Stadol):

Back 59

Opioid Agonist - Antagonist


agonist kappa Antagonists mu
-Nasal spray
-Going after Kappa and block mu

Front 60

PCA Patient Controlled Analgesia

-Patient receives a constant IV dose of a opioid

what is the basal dose??

Back 60

Typically basal dose is 1-2 mg/hr of that narc every hour weather they push a button or not, they are constantly getting meds

Front 61

PCA Patient Controlled Analgesia

why do we do a PCA?

Back 61

We do PCA because we want the patient up and moving (the sooner they move the sooner we can get them out of the hospital and go home)

Front 62

_____ is the key to the success of using a PCA pump

Back 62

patient education

Front 63

CA pain management

Back 63

A: Ask and assess
B: Believe
C: Choose appropriate control talking about giving the pt control to control their lives because they can’t control anything else
D: Deliver interventions in a timely manor
E: Empower and Enable patients to control their treatment and their lives. They can’t control their cancer, it’s controlling them from the inside and out

Front 64

Opioid overdose triad:

what is the first thing we notice??
-what 2 other s&s do we notice?
-what can we do to reverse the problem?

Back 64

Resp depression, pinpoint pupils, ALOC (first thing u notice)

---administer narcan to reverse problem

Front 65

Drug interactions and narcs

Back 65

Other CNS depressants: increases depressive state of brain

Antihistamines (Benadryl is very sedating) and tricyclic antidepressants
--Narcotics enhance the anticholinergic effects and increase problems with constipation and urinary retention

Front 66

BP and narcs

Back 66

Cautiously with B/P meds: increase potential for decrease B/P

Front 67

Opioid Agonist - Antagonist (type of drug given when..)


what receptors do they have?

Typically used

Back 67

to a patient in labor)

Have both mu & kappa properties for helping and blocking


in labor 2° their lower incidence of respiratory depression. Safe to administer with breast feeding

Front 68

Opioid Agonist - Antagonist

Nalbuphine (Nubain):

Back 68

Agonist kappa Antagonists mu

Stimulates kappa but blocks mu (blocks MU –euphoria, sedation, respiratory depression)

Front 69

Opioid Agonist - Antagonist

Butorphanol (Stadol):

Back 69

Agonist kappa Antagonists mu
-Nasal spray
-Going after Kappa and block mu

Front 70

PCA Patient Controlled Analgesia

-Patient receives a constant IV dose of a opioid

what is the basal dose??

Back 70

Typically basal dose is 1-2 mg/hr of that narc every hour weather they push a button or not, they are constantly getting meds

Front 71

PCA Patient Controlled Analgesia

why do we do a PCA?

Back 71

We do PCA because we want the patient up and moving (the sooner they move the sooner we can get them out of the hospital and go home)

Front 72

_____ is the key to the success of using a PCA pump

Back 72

patient education

Front 73

CA pain management

Back 73

A: Ask and assess
B: Believe
C: Choose appropriate control talking about giving the pt control to control their lives because they can’t control anything else
D: Deliver interventions in a timely manor
E: Empower and Enable patients to control their treatment and their lives. They can’t control their cancer, it’s controlling them from the inside and out

Front 74

Migraine headaches:


Symptoms:

Back 74

unilateral pain with photophobia- sensitivity to light

visual changes

hyperacousis- sensitvity to sound

N/V

Front 75

Migraine headaches:

caused by

Back 75

Neurovascular disorder with vascular dilation and 2° inflammation causing a pain response


Dilatory – dilated blood vessel

OR

Constricted headaches

Front 76

Headaches

prevention
-what is #1

Back 76

-Learn triggers teach client what triggers HA if that fails then we start with the medication
-Beta blockers: Propanolol
-Ca+ Channel blockers: -Verapamil
-Anti-depressants: Depakote, Elavil
-Anti-inflammatories: Ibuprofen, Acetaminophen & caffeine
-Estrogen supplement: use of the BCP, low dose estrogen patch
-Vitamin B2 (Riboflavin) 400mg qd

Front 77

Relieving Migraine Headaches
--Assist your patient to understand to start treatment at the onset of symptoms and not wait


Medications used

Back 77

Anti-Inflammatories: PO, Acetaminophen & caffeine, Ibuprofen caffeine constricts so you give it to someone with a dilatory headache that we want to constrict blood vessels

Front 78

Narcotics and headaches

Back 78

Try not to give, not the drug of choice they do nothing for the headache. It doesn’t go after dilation or constriction. It’s a “band aid” it is not treatment

Front 79

Migraine Headaches - Meds continued

what is the main med given for migraine headaches?

Back 79

Ergots: PO, SL, Supp, action site not clearly understood. Ergots typically given just for migraine headaches

Front 80

Ergots:
-what do they do?

-what else are they used to treat?
-what side affect can it cause (2)

tell me about pregnancy

Back 80

-Block (antagonists) inflammation associated with the trigeminal vascular system (help inflammation that occurs within the vessels)

-Ergotamine (for inflammation) & caffeine (for constriction) (Cafergot), Migranal (ergot alkaloid) nasal spray

-Also used to TX cluster HA’s
-Can cause nausea
-Can develop physical dependence
-Ergots Cannot take during pregnancy category X

Front 81

triptans work on:

Back 81

These drugs work on dilatory headaches and they cause constriction


Serotonin is a chemical in the brain –we have receptors in the brain that respond to serotonin, its selective.The selective serotonin agonists are called triptan, when u see the word triptan think migraine head ache treatment. There are specific receptors for serotonin.

Front 82

Selective Serotonin agonists (triptans):

Can cause

Back 82

vasoconstriction of the cerebral/cardio vascular system and produce an anti-inflammatory effect (test)

Front 83

Selective Serotonin agonists (triptans):

What pregnancy category?

Prior to administration the patient should have been evaluated for

Back 83

C



any coronary or cerebral risk factors by their primary health care provider (coronary and stroke risk factors-------test and NCLEX)

cornory risk factors =men over 40, smokers, patients with hypertension, post menopausal women, hypercholesterolemia, obesity, diabetes, family history of CAD.

Front 84

Selective Serotonin agonists (triptans):

Adverse Effects:

Back 84

Coronary vasospasm, leading to angina, leading to hypertension

Front 85

Cluster Headaches Headache
-where do they begin?

-how long do they last?

Back 85

begins over 1 eye above the eye brow. It’s a deep throbbing pain that’s intense.

Typically occurs in a series lasting 10-15 minutes to two or more hours.

Front 86

cluster headaches
--Symptoms are different:


usually mistaken for a sinus headache, why?

Back 86

Throbbing pain over one eye, nasal congestion, may occur 1-2x’s a day.


-Usually mistaken for a sinus headache y? cuz there can be nasal congestion nthat goes along with it and the pain can be in ur maxillary sinuses

Front 87

cluster headaches
-treatment?

Back 87

Treatment – don’t know what causes them. It’s trial and error
-Oxygen: via mask x10-15 minutes – treatment of choice
-Anti-inflammatories
-Prednisone
-Selective serotonin agonists: Imitrex SL, do not combine with others
-Ergots: Block (antagonists) PO, SL, Supp, action site not clearly understood.
Ergotamine & caffeine (Cafergot), Migranal (ergot alkaloid) nasal spray

Front 88

Tension Headaches – what is it?

Back 88

constriction of muscles in the neck that could lead to a migraine headache

Front 89

Tension Headaches - symptoms

what does it feel like?
-what are some factors that could cause this?

Back 89

-Usually a band type feeling around the head, tight feeling, pressure “inside” feeling.
-Look at precipitating factors
-Stress, fatigue, depression, insomnia, prolonged position, neck tension from sitting, ergonomics of a work area, computer work, vision problems, head aches

Front 90

Tension Headaches

-treatment:

Back 90

-Preventative
-Anti-inflammatories,
-Antianxiolytics for people with depression and that is the problem and they don’t really have any true pathology to cause a headaches we use these
-Antidepressants for people with depression and that is the problem and they don’t really have any true pathology to cause a headaches we use these