Pharm Test 3 Pain Management

Front 1

Drugs used to relieve pain w/o producing LOC or reflex activity

Back 1

ANALGESICS

Front 2

What term was once used to refer to drugs derived from opium, such as heroin & morphine

Back 2

OPIATE

Front 3

Relieves severe pain w/o LOC?

Back 3

OPIATE AGONIST (creates a response)

Front 4

What are the opiate receptors?

Back 4

Delta
Mu
kappa
Epsilon
sigma

Front 5

What v/s has to be checked before admin of opiates?

Back 5

Respirations (don't give if < 12)

Front 6

What are 3 Opiate contraindications?

Back 6

1.head injury (if given an opiate, nurse will not be able to assess LOC affectively)
2. Pregnancy- 1st trimester, birth defects)
3. Lactation (breast feeding)

Front 7

What are the uses of Opiates?

Back 7

-relieve acute or chronic (> than a 3 mth period), moderate to severe pain
-pre-op sedation
-balanced anesthesia

Front 8

What are 4 side effects of OPIOID AGONIST that will effect the pt's safety?

Back 8

1. sedation
2. light-headedness, dizziness
3. confusion, disorientation(keep reorientating pt, see often in older adults)
4. orthostatic HYPOtension

Front 9

What are 3 other side effects of opioid AGONIST?

Back 9

1. N/V
2. sweating
3. constipation (increase fluids/fiber & take a stool softner daily)

Front 10

What are 3 side effects to REPORT w/ opioid AGONIST?

Back 10

1. Respiratory depression (if < 12 hold med & call md)
2. Urinary Retention (occurs b/c of bladder spasms
-monitor urinary output
-check for bladder distension
3. Excessive use or abuse
-opioid w/drawal or opioid abstinence syndrome

Front 11

What are the early signs of withdrawal w/ opiate addiction?

Back 11

-restlessness -perspiration
-lacrimation -mydriasis
-runny nose -goose flesh(bumps)

(over the next 24 hours these signs will intensify)

Front 12

What w/drawal sx develop over the next 24 hours w/ Opiate addiction?

Back 12

-muscle & abdominal cramps
-hot/cold flashes -diarrhea
-n/v -sneezing -elevated v/s
-severe aches in the legs, back abdomen -increase in body temp/ R, B/P, P

Front 13

When does the w/drawal sx of opiate addiction reach a peak?

Back 13

36-72 hours after d/c of med

Front 14

When does the w/drawal sx of opiate addiction disappear

Back 14

over the next 5 to 14 days

Front 15

What are the drug interactions w/ opiate AGONISTS?

Back 15

1. CNS depressants (general anesthetics, sedative-hypnotics, alcohol, antihistamines)
-usually decrease dose of opiates

Front 16

What are the 3 groups that Opiate AGONISTS are subdivided into?

Back 16

1. Morphine-like derivatives
2. meperidine-like derivatives(demerol)
3. Methadone- like derivates

Front 17

What drugs are MORPHINE-like derivatives?

Back 17

1.MS contin(for chronic pain)
2. codeine
-antitussive effect, now use dextromethorphan(robitussin like),
combo products: Emprin #3: codeine 30mg/ASA 325mg, Empirn #4 60mg/ASA 325mg
Tylenol #2 #3, #4 (codeine 15, 30, 60/ APAP 300mg)
3. Fiorinal, Firorinal #3 #4
4. Dilaudid 5. Numorphan
6. Oxycodone 7. Oxycontin 8. Percodan 9. Percocet
10. Vicodan 11. Vicodin ES 12. Lorcet 13. Lortab

Front 18

What's in Fiorinal?

Back 18

-ASA 325
-caffeine 40 mg
-butalbital 50 mg
(used for migraine HA

Front 19

What is the generic for Dilaudid?

Back 19

-hydromorphone

Front 20

What is the generic for Numorphan?

Back 20

-oxymorphone

Front 21

What are the 4 strengths for Percocet (APAP)?

Back 21

2.5mg/325'
5mg/325
7.5/500
10mg/650

Front 22

Dilaudid is used for _____ pain?

Back 22

chronic pain
PCA pump: acute or chronic pain

Front 23

*What's in Vicodin ES?

Back 23

HC 7.5mg/APAP 750mg

Front 24

*What's in Lorcet?

Back 24

HC 10mg/ APAP 650mg

Front 25

*What's in Lortab 10/500mg

Back 25

HC 10mg/ APAP 500mg

Front 26

Name the Meperidine-like derivatives Drugs?

Back 26

1. Sublimaze (fentanyl): has a short life if given parenteral
2. Demerol (meperidine)

Front 27

Name the METHADONE-like derivatives Drugs?

Back 27

1. Dolophine (methodone):Long acting,1 day
2. Orlaam (levomethadyl acetate): last up to 3 days:long acting

Front 28

What is Sublimaze used for?

Back 28

generic: fentanyl
- used in balanced anesthesia
-transdermal patch known as duragesic (2 types: apply q 3 days, apply q 7 days)

Front 29

What is the generic for Sublimaze?

Back 29

fentanyl

Front 30

What is the generic for Demerol?

Back 30

-meperidine (

Front 31

*What is the opioid of choice for the Detoxification tx of opioid addicts?

Back 31

*Dolophine (methodone)
-used w/ drug addicts
-long acting
-reduces the severity of w/drawls (sx w/ herion)

Front 32

What is the generic for Orlaam?

Back 32

-levomethadyl acetate (methadone like)

Front 33

What is the generic for Darvon?

Back 33

-propoxyphene HCL

Front 34

What's in Darvon Compound?

Back 34

-ASA
-caffeine
-propoxyphene

Front 35

What's in Darvocet?

Back 35

-propoxphene napsylate
-APAP

Front 36

What type of pain is Opiate Partial-Agonist-Antagonist used to treat?

Back 36

-Moderate to severe pain assoc. w/ cancer, burns, renal colic, preoperative/obstetric/ surgical analgesia
-short term (up to 3 wks)
-

Front 37

Define Ceiling Effect?

Back 37

-increasing the dosage does not significantly increase the analgesia but increase the sides effects
-contrary to the action of the opiate agonists, a larger dose does Not produce a higher analgesic effect

Front 38

What drug class will have a ceiling effect?

Back 38

-Opiate Partial Agonist-Antagonist

Front 39

When will Opiate Partial Agonist-Antagonist be effective analgesics?

Back 39

-when used w/o prior admin of opiate agonists
-the pharmacologic action depends on whether an opiate agonist has been admin previously & the extent to which physical dependence has developed to that opiate agonists

Front 40

**Name 4 Opiate Partial Agonist-Antagonist Drugs?

Back 40

1. Buprenex (buprenorphine)
2. Stadol (butorphanol)
3. Nubain (nalbuphine)
4. Talwin (pentazocine
-good to use these drugs if pt has not previously used opiate agonist (will not be effective if pt has taken opiate agonist)
-will not give an analgesic effect, instead it will increase side effects

Front 41

What drug is used as an analgesic for obstetrics?

Back 41

nalbuphine (not a controlled substances)
-has a ceiling effect for analgesia & R depression

Front 42

What is the generic name for
1. Buprenex
2. Stadal C-IV
3. Nubain
4. Talwin C-IV

Back 42

1. buprenorphine
2. butorphanol
3. nalbuphine
4. pentazocine

Front 43

What are the Side Effects to expect w/ Opiate Partial Agonist-Antagonist?

Back 43

-clamminess -dizziness
-sedation -N/V
-dry mouth -sweating
-constipation

Front 44

What are the Side Effects to report w/ Opiate Partial Agonist-Antagonist?

Back 44

-confusion, disorientation, hallucination
-respiratory depression
-excessive use or abuse

Front 45

What are 2 drug interactions w/ Opiate Partial Agonist-Antagonist?

Back 45

1. CNS depressants
2. other opiates

Front 46

Name 3 Opiate Antagonist drugs.

Back 46

1. Narcan (naloxone)
2. Revex (nalmefene)
3. ReVia/ Traxan (naltrexone

Front 47

What are the therapeutic uses for Opiate Antagonist?

Back 47

-tx for opioid overdose
-reversal of effects of opioids(ie. respiratory depression)
-reversal of respiratory depression in an infant

Front 48

What is Narcan used for ?

Back 48

-pure opiate antagonist
-reverses the depressant effects: opiate agonist (only), Opiate partial agonist (only), propoxyphene (Darvon), only
-NOT effective against CNS depression of sedatives-hypnotics(ie. baritbuates)

Front 49

What is the generic name for Revex and its uses?

Back 49

-Nalmefene
-longer duration than Narcan

Front 50

What is the generic name for ReVia/ Traxan and it's uses?

Back 50

-Naltrexone
-used in drug abuse tx programs
-adjunct tx of alcoholoism

Front 51

What is the generic name and uses for Ultram?

Back 51

-tramadol hydrochloride
-centrally acting analgesic
-rapidly absorbed orally & not affected by food

Front 52

What are the adverse effects w/ Ultram?

Back 52

-drowsiness -dizziness
-HA -nausea
-constipation -seizures

Front 53

What are Adjuvant Meds used for ?

Back 53

-enhances the effect of opiods
-allows for lower dosages of opioids
-help alleviate other sx that aggravate pain (depression,seizues, dysrhythmias)
-tx of neuropathic pain
-used in cancer-related conditions(ie. increased intracranial pressure, spinal cord compression, bone pain

Front 54

What are the uses and actions for Tylenol?

Back 54

-nonopiate analgesic
-analgesic
-mild to moderate pain
-cause pain impulses to be blocked peripherally
-inhibits prostaglandin synthesis (what causes pain at injury site)

Front 55

What are PROSTAGLANDINS?

Back 55

-chemical mediator
-present in most tissue
-stored & released by MAST cells
-increase capillary permeability
-attaracts WBCs to site of inflammation
-causes Pain

Front 56

What drug has no anti-inflammatory effect & no effect on platelets?

Back 56

-acetaminophen
-has

Front 57

What is acetaminophen used to treat?

Back 57

-fever (anti-pyretic): acts on the hypothalmus to lower body temp
-muscle pain
-joint pain

Front 58

What are the side effects w/ acetaminophen?

Back 58

-rash, nausea, vomiting
*Hepatotoxicity

Front 59

What is the max dose/day for acetaminophen?

Back 59

-4g/day

Front 60

What is the antidote used for hepatotoxicity caused by acetaminophen?

Back 60

-Mucomyst (acetylcysteine): decreases mucus in the respiratory tract

Front 61

What are 3 uses of Salicylates?

Back 61

1. analgesic: mild to moderate pain
2. Antipyretic
3. Antiinflammatory

Action: r/t inhibition of prostaglandin synthesis

Front 62

Why does the nurse not give ASA to kids w/ flu like sx?

Back 62

-Rye Syndrome

Front 63

*Inhibition of platelet aggregation (thins blood)?

Back 63

Salicylates (ASA)
-plt loses its ability to aggregate & form clots for the duration of its lifetime (7-10 days)
-inhibition of the synthesis of thromboxane A2, inducer of plt aggregation

Front 64

Inducer of plt aggregation?

Back 64

-thromboxane A2

Front 65

What are the contraindications w/ Salicylates?

Back 65

-hypersensitivity
-GI bleed (alcoholics, peptic ulcers, GERD)
-Vit K deficiency (increase in bleeding precaution)
-child & young adults w/ flu-like sx (b/c of Rye Syndrome)
-pregnancy

Front 66

What is Rye Syndrome?

Back 66

-encephalapathy(increase swellin in brain
-increase fatty deposits
-liver failure

Front 67

*What are the side effects to expect w/ Salicylates?

Back 67

-Gastric irritation (give w/ food, H2O, milk, or use enteric coated ASA)

Front 68

*What are the side effects to Report w/ Salicylates?

Back 68

-GI bleeding: black tarry stool, coffee ground vomiting
-Salicylism: salicylate toxicity= ringing in ears, hearing loss, visual problems N/V, dizziness

Front 69

What are the Drug Interactions w/ Salicylates?

Back 69

-do not take at same time as other NSAIDS
-inhibits the excretion of uric acid by ANTIGOUT meds (alluopurinol)
-enhances the ANTICOAGULANT effects of Coumadin
-enhances the effect of ORAL HYPOGLYCEMIC (only oral)
-may cause methotrexate toxicity (given to caner pt or rheumotoid arthritis
-increase GI ulceration if taken w/ corticosteriods
-Do NOt take w/ alcohol

Front 70

What is the action for NSAIDS?

Back 70

1. prostaglandin inhibitor
2. acts by blocking cyclo-oxygenase (excreted to help w/ inflammation)
-2 enzymes (cox 1 & cox 2)
-slow the synthesis of both thromboxane & prostaglandin mediators of inflammation
3. Cox-1 are the 1st generation NSAIDS
-celebrex- cox-2 ibuprofen=cox1 -torodal=cox-1

Front 71

*What are the uses for NSAIDS?

Back 71

-analgesic -anti-gout
-antiinflammatory -antipyretic
-vascular HA -platelet inhibitor

Front 72

What are the side effects to expect w/ NSAIDS?

Back 72

-gastric irritation
-constipation
-dizziness
-drowiness

Front 73

What are the Side effects to Report w/ NSAIDS?

Back 73

-GI bleeding -confusion
-hives, pruitus, rash
nephrotoxicity hepatotoxicity
blood dyscrasias (RBC, WBC)

Front 74

What are 7 drug interactions w/ NSAIDS?

Back 74

1. enhance anticoagulants
2. increases effects of oral hypoglycemic
3.inhibits effects of diuretics (lasix, thiazide diuretics)
4. induce Lithium toxicity
5. may inhibit the plt-inhibiting effect of asa
6. probenecid inhibitis the excretion of NSAIDS
7. may cause Dilantin (phenytoin) toxicity

Front 75

What are 9 Nursing Considerations w/ NSAIDS?

Back 75

1. oral admin 2. surgery
3.monitor V/S
4 signs of GI bld
5. Monitor for hepatic toxicity, 6. hypersensitivity, 7. urinary output & edema, 8. sensory changes
9. Asses for character, duration, location & intensity of pain and the presence of inflammation

Front 76

What drug helps to prevent GI bleed?

Back 76

Cytotec (misoprostol)