Scc Pharmacology Exam 3 - Opioid Analgesics

Front 1

Define analgesic

Back 1

drugs that relieve pain without causing loss of consciousness

Front 2

Define opioid

Back 2

any drug, natural or synthetic, that has actions similar to those of morphine

Front 3

Define the term opiate.

Back 3

more specific & only applies to compounds present in opium (morphine, codeine)

Front 4

List a few various interpretations of the term narcotic.

Back 4

- Analgesic, a CNS depressant & any drug capable of causing physical dependence
- In a legal context to despignate not only the opioids but also such diverse drugs as cocaine, marijuana, LSD

Front 5

Name three families of endogenous opioid peptides.

Back 5

- Enkephalins, endorphins, dynorphins
- Serve as neurotransmitters, nuerohormones & nueromodulators

Front 6

Name 4 responses to activation of Mu opioid receptors.

Back 6

Analgesia, respiratory depression, euphoria & sedation

Front 7

Identify the three major groups of drugs that bind to opioid receptors.

Back 7

o Pure opioid agonists
o Agonist-antagonist opioids
o Pure opioid antagonists

Front 8

Because the pure opioid agonists activate mu receptors and kappa receptors, what 6 effects can be produced?

Back 8

Produce analgesia, euphoria, sedation, respiratory depression, physical dependence, constipation & other effects

Front 9

When given alone, what effect do agonist-antagonist opioids, such as pentazocine or butorphanol have?

Back 9

Analgesia

Front 10

When given to a patient taking a pure opioid agonist, what effect do agonist-antagonist opioids, such as pentazocine have?

Back 10

Can antagonize analgesia caused by the pure agonist

Front 11

What is the principal use of pure opioid antagonists?

Back 11

Reversal of other effects caused by opioid agonists

Front 12

Name 6 pharmacologic effects of morphine.

Back 12

Analgesia, sedation, euphoria, respiratory depression, cough suppression & suppression of bowel motility

Front 13

Name the 3 medicinal compounds contained in opium. Where does opium come from?

Back 13

- Morphine, codeine & papaverine
- Opium comes from the seedpod of a the poppy plant, the dried juice of the poppy seedpod

Front 14

In addition to relieving pain, name 4 pharmacologic actions of morphine

Back 14

Causes drowsiness, mental clouding ,anxiety reduction, and a sense of well-being

Front 15

Through actions on the CNS and periphery, name eight adverse effects that morphine can cause?

Back 15

Respiratory depression, constipation, urinary retention, orthostatic hypotension, emesis, miosis, cough suppression & biliary colic

Front 16

What is the principal indication for morphine?

Back 16

Relief of moderate to severe pain

Front 17

Name 4 effects that morphine is able to cause that contribute to the relief pain

Back 17

Relieve postoperative pain, chronic pain of cancer, labor & delivery pain, relive pain of MI and dyspnea associated w/ left ventricular failure

Front 18

How soon might respiratory depressant effects occur after an opioid …
IV?
IM?
Subcutaneous injection?

Back 18

IV injection? 7 minutes
IM injection? 30 minutes
Subcutaneous injection? 90 minutes

Front 19

With all three routes how long may respiratory depression persist?

Back 19

4 - 5 hours

Front 20

During opioid administration what action should be taken if the respiratory rate falls below 12 breaths per minute?

Back 20

Opioid should be withheld and the prescriber notified

Front 21

Name 4 ways that opioids promote constipation.

Back 21

Suppress propulsive intestinal contractions, intensify nonpropulsive contractions, increase the tone of the anal sphincter & inhibit secretion of fluids into the intestinal lumen

Front 22

Name 2 nonpharmacologic measures that can reduce opioid-induced constipation.

Back 22

Physical activity & increased intake of fiber & fluids

Front 23

Because of their effect on the intestine, what can opioids effectively treat?

Back 23

diarrhea

Front 24

What effect do opioids have on BP …
when standing?

Back 24

When standing up? Lowers BP, person becomes dizzy or lightheaded

Front 25

How does morphine cause urinary hesitation and urinary retention? How else can morphine interfere with voiding?

Back 25

- By increasing tone in the urinary sphincter, increasing tone in the detrusoer muscle, the drug can elevate pressure w/in the bladder causing urinary urgency
- Interfere w/ voiding by suppressing awareness of bladder stimuli
- Also can decrease urine production by partly promoting release of antidiuretic hormone

Front 26

How is the patient assessed for urinary retention? How often?

Back 26

Palpating the lower abdomen every 4 – 6 hours for bladder distention, intake & output

Front 27

Because opioids suppress the cough reflex, what adverse respiratory effects may result?

Back 27

Accumulation of secretions in the airway

Front 28

Compare the incidence of nausea and vomiting in the patient receiving morphine who is lying still or ambulating.

Back 28

Uncommon in the recumbent patient but occur in 15% to 40% of ambulatory patients

Front 29

Euphoria

Back 29

exaggerated sense of well-being

Front 30

Disphoria

Back 30

a sense of anxiety & unease

Front 31

How does morphine and other opioids impair vision?

Back 31

Cause papillary constriction (miosis), may constrict to “pinpoint” size

Front 32

Name 6 different routes used to administer morphine.

Back 32

Oral, IM, IV, subQ, epidural, intrathecal

Front 33

Due to much of the drug being inactivated during the first pass through the liver, how are oral doses affected?

Back 33

Oral doses need to be larger than parenteral doses to produce equivalent analgesic effect

Front 34

tolerance

Back 34

a state in which a larger dose is required to produce the same response that could formerly be elicited by a smaller dose.

Front 35

physical dependence

Back 35

state in which an abstinence syndrome will occur if drug use is abruptly stopped.

Front 36

Describe four early symptoms of opioid abstinence syndrome occurring about 10 hours after the last dose.

Back 36

Yawning, rhinorrhea, sweating
Followed by: anorexia, irritability, tremor & “gooseflesh”

Front 37

At the peak of abstinence syndrome, what symptoms may occur?

Back 37

Violent sneezing, weakness, nausea, vomiting, diarrhea, abdominal cramps, bone & muscle pain, muscle spasm & kicking movements

Front 38

How likely is physical dependence when opioids are taken acutely to treat pain?

Back 38

rarely

Front 39

According to the Controlled Substance Act how are morphine and other strong opioids classified? What does this mean?

Back 39

Schedule II – a moderate to high abuse liability

Front 40

Describe the classic triad of signs produced with opioid overdose.

Back 40

Coma (profound & pt can’t be aroused), respiratory depression (2-4 breathers/min) & pinpoint pupils ( may dilate as hypoxia sets in which can cause BP to fall)

Front 41

What should be determined before an opioid is administered?

Back 41

Respiratory rate, BP, & pulse rate

Front 42

Why are opioids sometimes administered on a "fixed schedule?"

Back 42

Medication is given before intense pain returns, pt is spared less discomfort

Front 43

When morphine is injected into IV tubing, how long should the nurse take to give it?

Back 43

Slowly over 4 -5 minutes

Front 44

When IV injections are made what two things should be available?

Back 44

Opioid antagonist and facilities for respiratory support should be available

Front 45

What is the duration of morphine administered by the epidural route?

Back 45

up to 24 hours

Front 46

What opioid with pharmacologic properties similar to morphine was considered a first line drug of choice in the past but has now declined in use?

Back 46

Meperidine
- Short half-life & dosing must be repeated at short time intervals
- Interacts adversely w/ a number of drugs
- With continuous use, there is a risk of harm owing to accumulation of a toxic metabolite

Front 47

What is the usual dosage range for hydromorphone (Dilaudid) given IM or subcutaneous? How does this compare to the usual IM or subcutaneous dose of morphine?

Back 47

Dosages range from 1 – 4 mg every 4 – 6 hours
Morphine: 5 – 1 mg every 4 hours

Front 48

What is the indication for codeine? How is it usually administered?

Back 48

o For mild to moderate pain
o Usually administered PO

Front 49

Why is the degree of pain relief that can be achieved with codeine quite low?

Back 49

Because it is achieved safely

Front 50

What 2 non-opioid analgesics are frequently combined with codeine to produce greater pain relief than either agent alone?

Back 50

Aspirin or acetaminophen

Front 51

Besides pain, for what other action is codeine widely used?

Back 51

Cough suppressant

Front 52

What is a brand name for a combination of oxycodone and aspirin?

Back 52

Percodan

Front 53

What is unique about OxyContin?

Back 53

Long acting analgesic designed to relieve moderate to severe pain around the clock for an extended time.

Front 54

What may be done if a patient taking OxyContin has break through pain?

Back 54

Supplemental dosing w/ short-acting analgesic is indicated

Front 55

To prevent a potentially fatal dose of OxyContin, how should the extended release tablets be taken?

Back 55

Swallowed whole without breaking, crushing or chewing

Front 56

What are two brand names for propoxyphene?

Back 56

Darvon

Front 57

What additional drug is in Darvocet?

Back 57

Acetaminophen

Front 58

How do agonist-antagonists compare to pure opioid agonists related to abuse potential, side effects and pain relief?

Back 58

Have a low potential for abuse, produce less respiratory depression & have less powerful analgesic effects

Front 59

What are agonist-antagonists opioids such as pentazocine (Talwin) indicated for? How does pentazocine (Talwin) compare to morphine in the treatment of severe pain?

Back 59

o Mild to moderate pain
o It is much less effective than morphine against severe pain

Front 60

If pentazocine (Talwin) is given to a patient who is physically dependent on a pure opioid what can happen?

Back 60

Can precipitate withdrawal

Front 61

Why are agonist-antagonists such as pentazocine (Talwin) and butorphanol (Stadol) contraindicated in patients with a myocardial infarction?

Back 61

It increases cardiac work, a pure agonist is preferred for relieving MI pain

Front 62

When should pain status be evaluated when a patient is being treated with opioids?

Back 62

Prior to opioid administration & about 1 hour after

Front 63

Ultimately what must pain assessment be based on?

Back 63

The patients description of his/her experience

Front 64

Name four characteristics of pain that should be part of pain assessment.

Back 64

Where pain is located, type of pain (dull, sharp), how the pain changes w/ time, what makes the pain better or worse

Front 65

Give three reasons a patient might under-report pain.

Back 65

Fear of addiction, fear of needles, and a need to be stoic & bear the pain

Front 66

Summarize the benefits of administering opioids on a fixed schedule rather than PRN.

Back 66

Each dose is given before pain returns, sparing the pt needless comfort

Front 67

How might a nurse's overconcern about the ability of opioids to cause physical dependence and addiction effect nursing decisions?

Back 67

Administer less of prescribed medication, unable to make a rational decision, supposed to be a patient advocate

Front 68

What is Patient-Controlled Analgesia?

Back 68

A method of drug delivery that permits the patient to self-administer parenteral opioids on an “as needed” basis

Front 69

For what patients has PCA been primarily used? Name five other patient conditions where PCA is used.

Back 69

Postoperative patients, pain caused by cancer, trauma, MI, vaso-occlusive sick cell crisis & labor

Front 70

What is an essential component of all PCA devices? What does it control?

Back 70

A timing control, it limits the total dose that can be administered each hour, minimizing the risk of overdose

Front 71

What opioid is used most extensively for PCA?

Back 71

morphine

Front 72

Prior to starting PCA what is the postoperative patient given?

Back 72

An opioid loading dose

Front 73

What are the principal uses for opioid antagonists?

Back 73

Opioid overdose, relief of opioid-induced constipation, reversal of postoperative opioid effects & management of opioid addiction

Front 74

Identify the pharmacologic effect of naloxone under the following circumstances…
1. When administered in the absence of opioids
2. If administered prior to an opioid
3. If given to a patient already receiving an opioid
4. If administered to a patient physically dependent on opioids

Back 74

1. No significant effects
2. Will block opioid actions
3. Reverse analgesia, sedation, euphoria & respiratory depression
4.Precipitate an immediate withdrawal reaction

Front 75

After administration of naloxone how soon will effects begin?

Back 75

IV – begins immediately and persist an 1 hour

IM or Subcutaneous – 2 to 5 minutes and persist several hours

Front 76

Following surgery how should naloxone be administered in order to reverse excessive respiratory and CNS depression without unmasking pain?

Back 76

Dosage should be titrated with care, the objective is to achieve adequate ventilation & alertness without reversing opioid actions to the point of unmasking pain