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82 Cards in this Set
- Front
- Back
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What is pain and where does it affect? |
tissue damage activating nociceptors of peripheral nerves -nociceptors are located in arterial walls, joints, muscle fascia, perisoteum, skin and soft tissue |
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Examples of nonopiods |
nsaids, analepetics, antidepressants, corticosteroids, local anestetic |
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Classes of Analgestic-Antipyretic-Anti-inflammatory medications and action |
-also knows as NSIADS -Aspirin (prototype), acetaminophen, ibuprofen, selective COX-2 inhibitor -Inhibit prostaglandins in inflamed tissue, preventing pain and edema -Anti-inflammatory, antipyretic or antiplatelet efffect |
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Asprin (ASA) |
Class: NSIAD Action: Non selective Cox inhibitor (COX 1 & 2) and antiplatelet Use: mild to mod pain, fever, INF, decreases risk of thrombus. prevent MI, angina, stroke. prevent thromboembolism in surgery pts. Adverse: Salicyism, tinnitus. COX 1 causes stomach irritation, ulceration, bleeding Nurse imp: pts avoid OTC with ASA in them, don't take 2 wk b/a surgery, don't give to children due to Rye's syndrome |
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What are COX enzymes required for? |
prostaglandin formation |
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acetaminophen |
Class: NSAID Action: antipyretic (aka no adverse bleeding :) Use: pain, fever, sleep, cold Adverse: Hepatic failure and nephrotoxicity with overdose Nurse imp: can be used with pt with GI problems b/c its easy on stomach. no more than 4 g/day so alternate between acetaminophen and ibuprofen. Drug of choice for febrile, with other symptom, for children, elderly, pregnant, those with impaired renal function. |
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what is another name for fever? |
Febrile |
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Acute liver is on the rise do to what OTC drug? |
acetaminophen |
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Ofirmev |
Class: NSAID Type: Acetaminophen Use: given IV post op to decrease need of opioids |
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Mycomyst |
-given PO in the case of a acetaminophen overdose causing hepatic failure or nephrotoxicity |
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ibuprofen |
Class: NSAID Use: pain, fever, INF, arthritis, menstrual cramps Adverse and nurse imp: same as ASA
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Indocin |
Class: NSAID Type: ibuprofen Use: INF Adverse: higher risk for side effects Nurse imp: strong anti-INF effect, has to RX |
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Aleve (naproxen) |
Class: NSIAD Type: ibuprofen Nurse imp: OTC anti-INF |
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Toradol |
Class: NSAID Type: ibuprofen Use: given IV for severe pain Nurse imp: 5 days max, can cause bleeding after that |
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Celebrex |
Class: NSIAD Type: Selective COX-2 inhibitor Action: blocks prostaglandins associated with pain and INF w/out GI upset or bleeding Use: arthritis Adverse: has black box warning due to increased risk of cardiovascular problems, GI bleeding with long term use |
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What is Gout and what are the Sx&S? |
-Body's inability to metabolize uric acid -severe pain, uric acid build up in ears and toes (look lumpy), hyperuricemia (>6 mg/dL), INF, edema in musculoskeletal system |
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Name the (3) types of anti-gout agents ? |
Zylomprim, Colchicine, Lyrica |
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Zylomprim |
Type: Anti-gout agent Action: prevents uric acid formation Nurse imp: monitor uric acid levels, give with food, increase fluids to 3000ml/day, rest and immobilize area, no ETOH, Low purine diet - AVOID: anchovies, sardines, game meats, organ meats, yeast |
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Colchincine |
Type: Anti-gout agent Action: NSAID that prevents attacks from occuring Nurse imp: same as zylomprim |
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Lyrica |
Type: anti-gout agent Action: decreases amount of pain signals sent out by damaged nerves Use: neuropathic pain (diabetic pain), fibromyalgia, adjunct treatment for seizures Adverse: tiredness, dizziness, N/V |
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Classes, Actions, Effects and Uses of Opioid Analgesics |
Classes: Morphine, OxyCotin (most are sch. II) Action: stimulate opiate receptors and bind to CNS receptors causing inhibition of ascending nerve pathways (Mu, Kappa and Delta receptors) Effects: analgesia, CNS depression, sedation Use: severe to mod acute pain, terminal cancer, MI, burns, trauma, postop, well absorbed orally, large first pass so give much more orally vs IV. |
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Contradictions, Adverse effects and Nurse implications for Opioid Analgesics |
Contra: allergy, increased ICP, resp problems Adverse: Sedation, resp depression, postural hypotension, flushing, N/V, constipation, urinary retention post op, pupil constriction -these can be worse if "opioid naive" Nurse imp: insure patient doesn't have history of sleep apnea, use in chronic pain only when other methods fail (aka like terminal cancer patients) |
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Morphine (prototype) |
Class: opioid analgesic Nurse imp: PO (SI or IR), IM, IV, SQ, IT, epidural -IM not used much due to pain -IV takes between 15-20 mins, PO 60 mins -SQ for terminally ill
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Roxanol |
Class: opioid analgesic Type: Morphine Nurse imp: given PO |
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Fentanyl |
Class: opioid analgesic Type: morphine Nurse imp: anesthesia, eipideral, IT, lollipop for kids |
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Duragesic |
Class: Opioid analgesic Type: morphine Nurse imp: patch for chronically/terminally ill patient. really long half life of 12-72 hrs. Keeps working up to 24 hrs after its removed. |
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OxyCotin |
Class: Opioid analgesic Adverse: constipation most common Nurse imp: monitor for sedation (can cause CO2 buildup in body and patient to stop breathing), alternate with non-narcs, No ETOH (synergistic effect), don't drive, don't smoke, explain IR vs SR, may be used in PCA pump, unlikely to cause addiction w/ acute pain NOTE: VERY POPULAR ABUSED DRUG
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Percodan |
Class: opioid analgesic Type: oxyCotin w/ ASA Use: acute pain, hydrocodone used more now |
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Percocett and Darvon |
Class: opioid analgesic Type: OxyCotin with acetaminophen Use: acute pain, hydrocodone used more now |
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Dilaudid |
Class: opioid analgesic Type: OxyCotin Use: post-op Nurse imp: 10x more potent than morphine so be careful when administering to not OD patient |
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Darvocet |
Class: opioid analgesic Type: OxyCotin w/ acetaminophen Nurse imp: removed from market due to heart electrical problems |
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Codeine |
Class: opioid analgesic Type: OxyCotin w/ acetaminophen Use: not used often anymore |
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Hydrocodeine |
Class: opioid analgesic Type: OxyCotin with acetaminophen -Vicodin - lots of acetaminophen -Narco - used more due to less acetaminophen |
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Demorol |
Class: opioid analgesic Type: OxyCotin Nurse imp: synthetic, not used often due to toxicity causing tremors, hallucinations and seizures |
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Ultram |
Class: opioid analgesic Type: OxyCotin Nurse: synthetic, low potential for tolerance so used for people with chronic pain |
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Narcan |
Class: Opioid Antagonist Action: compete with opioids for receptor sites in brain Use: reverse/block anesthesia, CNS and resp depression from narcotics Adverse: increase HR, BP, respiration, pain Nurse imp: produces withdrawal symptoms, repeated injection may be needed, usually used in emergency. can be used in small dose to subside adverse effects of opioids |
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Types of Opioid agnoists/antagonist |
Stadol, Nubain, Methadone |
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Stadol and Nubain |
Class: opioid agonist/antagonist Action: agonist activity at some receptors, antagonist activity at other receptors Use: pain with reduced potential for abuse Adverse: withdrawal symptoms Nurse imp: never give to someone who has received opioid analgesics due to antagonist action |
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Methadone |
Class: opioid agonist/antagonist Use: opioid addiction, cancer pain Nurse imp: longer 1/2 life than morpine so dosed in 24 hrs, high potential for abuse, needs to be weaned, |
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The 3 hypothalmic/anterior pituitary hormone drugs |
1. Sandostatin 2. Cortrosyn 3. Humatrope |
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Sandostatin |
Type: hypothalmic/anterior pituitary hormone Action: inhibits growth hormone release Use: acromegaly from non-cancerous tumor of pituitary gland, carcinoid tumors, anti-diarrheal Given: before surgery or when surgery isnt possible |
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Acromegaly |
hormonal disorder causing the release of too much growth hormone. Causes body tissue to enlarge. -Usually seen in bones of face, jaw, hands and feet |
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Cortrosyn |
Type: hypothalmic/anterior pituitary hormones Action: stimulates secretion of cortisol Use: test for adrenal insufficiency in Addison's disease - addison's will be diagnosed if cortisol levels don't rise while taking |
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Hymatrope |
Type: hypothalmic/anterior pituitary hormone Use: promote growth in children Given: 3x/week IM Nurse imp: can be used inappropriately for athletic performance, used as anti-aging, has been linked to tumor growth, monitor height growth |
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The 2 posterior pituitary drugs |
1. Pitressin 2. Pitocin |
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Pitressin |
Type: Posterior Pituitary Action: synthetic antidiuretic hormone Use: severe hypotension, shock, diabetes insipidus (common after head injury) Nurse imp: watch for water intoxication, chest pain, MI, hypertension, abdominal cramps |
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Diabetes insipidus |
low levels of antidiuretic hormone leading to patient becoming very dehydrated - common after head injury |
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Pitocin |
Type: Posterior Pituitary Action: promotes uterine contractions, stimulates milk ejection Use: induce labor, control postpartum bleeding Adverse: uterine rupture Nurse imp: only given after 40 weeks so less risk to mom/baby |
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The adrenal cortex releases what kind of hormone, what are the 3 types of drugs, how are they given and what is their use? |
-corticosteroids 1. Solu-Medrol - IV 2. Deltasone - PO 3. Decadron - PO and IV -not cures, just treat symptoms for short term Use: anti-inflammatory, immunosupprisive, anti-allergy, anti-stress |
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The corticosteroids drug adverse effects and nurse implications |
Adverse: moon face, obese trunk/thin limbs, hyperglycemia, psychosis, osteoporosis, thin skin, slow healing. these get worse the longer ptn takes Nurse imp: many drug interactions, mointor blood sugar, may need to take insulin, taper dose over several weeks, abrupt stop can lead to adrenocortical insufficiency (can be deadly), body image, take Ca+ and Vit D, take with food, risk of infection |
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Synthroid and Cytomel |
Type: Thyroid agents Given: PO or IV Action: stimulate metabolism & cardiac function Use: Hypothryoidism, myxedema coma Adverse: none unless given wrong doses Nurse imp: caution in elderly, monitor pulse and don't give if HR>100bpm, take in morning, moitor weight, lifelong replacement, don't take with iron or Ca+, don't switch between brands, monitor thyroid function |
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mysedema coma |
deadly hypothyroidism |
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The 3 types of Antithyroid drugs and what is their action? |
1. PTU 2. Radioactive iodine 3. Iodine solutions (Lugols and SSKI)
-suppress thyroid hormone and prevent conversion of T4 to T3 |
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PTU |
Type: antithyroid drug Use: hyperthyroidism, thyroid crisis Action: blocks thyroid synthesis Adverse: hypothyroidism, agranulocytosis Nurse imp: can take 3-12 weeks to work, optimum levels at 6-12 months
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Radioactive Iodine |
Type: antithyroid drug Action: radioactive isotope that emits betta and gamma rays that destroy thryroid tissue Use: hyperthyroidism, thyroid crisis Adverse: causes hyprothroidism so ptn will be on lifelong thyroid replacement, iodine toxicity Nurse imp: needs to be mixed in full glass, drank with straw to prevent teeth staining, metallic taste |
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Iodine solutions - Lugols and SSKI |
Type: Antithyroid drugs Action: inhibit release of thyroid hormones (nonradioactive) Use: hyperthryroidism, thryoid crisis Adverse: PTU or radioactive iodine can't be used after using these because they can cause the release of stored thyroid hormone, iodine toxicity Nurse imp: mixed in full glass, drank out of straw, metallic taste |
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The 5 types of Calcium drugs, what are they for and what does Vit D do? |
1. Os-cal (PO) 2. Calcium gluconate (IV) 3. Fosamax 4. Evista 5. Calcitonin (synthetic IM or nasal spray) Use: hypocalcemia that can lead to osteoporosis (Parathyroid stimulated by low Ca+ levels) Vit D: helps in the absorption of Ca+ (take ptn levels) |
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Fosamax |
Type: Biphosphate Calcium Drug Adverse: irritating to esophagus (possible link to esophageal cancer) Nurse imp: take in morning and sit up for 30 mins, watch for swallowing problems **** Reduces hip fracture by 51% and spinal fracture by 47%****** |
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Evista |
Type: Selective estrogen receptor modulator Calcium drug Action: stimulates estrogen receptors on the bone and increases bone density Nurse imp: black box warning due to risk for pulmonary embolism, stroke, those with cardiac history will not be RX'd this drug |
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Phosphate salt |
Use: hypercalcemia Action: inhibits intestinal absorption of Ca+ and increases deposition of Ca+ in bones Nurse imp: used for patients with renal failure |
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The 4 types of Insulin (pancreatic hormone) drugs and who are they for? |
1. Humalog 2. Humulin 3. NPH 4. Lantus/Levimer
-type I and some type II diabetics
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When is the patient most at risk for hypoglycemia? |
During the peak onset of insulin |
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What is the most common dosage for insulin and how is it given? |
-U-100 (there is also U-500) -IV, SubQ, nasal spray |
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Humalog |
Type: fast acting insulin Take: 15 mins before meal Onset: 15 mins Peak: 30-90 mins Duration: 6-8 hours Adverse: hypoglycemia
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Humulin |
Type: short acting (regular) insulin Take: 30 mins before meal Onset: 30 mins Peak: 2-3 hours Duration: 5-7 hours Nurse imp: continuous infusions given to DKA patients and ICU patients (better mortality rates for patients whose glucose levels kept normal) Adverse: hypoglycemia |
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NPH |
Type: intermediate acting (clouding) insulin Take: 30-45 mins before meal Onset: 60-90 mins Peak: 8-12 hours Duration: 18-25 hours Nurse imp: given with breakfast, not for acutely ill patient, insure patient is eating consistently, at home medication Adverse: hypoglycemia |
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Lantus/Levimer |
Type: long acting insulin Action: mimics liver stores of insulin giving patient constant healthy level of insulin Nurse imp: no glucose swings so no risk for hypoglycemia, given at bedtime (1 hr onset, no peak, lasts 24 hrs) *** Can't be taken with other type of insulin |
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Nurse implications with mixed combination insulin drugs |
Nurse imp: monitor blood sugar 4x/day, monitor hemoglobin A1C (want 6% or less, average less than 126 every 6 months-1 year). Teach ptn: administration, timing with food, have emergency simple sugars, s/s of hypo/hyperglycemia, "sick day" plan - don't stop taking insulin just because meals aren't normal |
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Humulin 70/30 |
Type: mixed combination insulin NPH 70%, Humulin 30% |
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Humalog 75/25 |
Type: mixed combination insulin NPH 75%, Humalog 25% |
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Weight based insulin administration |
-check patient glucose 4x/day -use chart using glucose level and weight to determine how much insulin to give |
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Sliding Scale insulin administration |
-check patient glucose 4x/day -use chart using just glucose level to determine how much insulin to give -not used commonly due to weight being a huge factor to insulin |
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Carbohydrate counting |
amount of carbs consumed determines amount of insulin given -patient also needs to check glucose levels because this is determined by food and glucose stored in liver. |
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Insulin pump |
left in skin and gives continuous basal rate of insulin -mimicks the liver -patient also needs to check glucose levels 4x/day |
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Glucophage (first line treatment) |
Type: Biguanides - oral agent Use: type II, reduce weight Action: dec. hepatic glucose production and dec. intestinal absorption of glucose Adverse: GI bloating, N/V Contra: renal disease Nurse imp: take w/ meals, stop taking 48 hrs before and after diagnostic tests (can cause renal failure/lactic acidosis if taken in combo with radiologic contrasts) |
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Glucotrol (2nd line treatment) |
Type: Sulfonylureas Use: type II - (must have some insulin production) Action: increase insulin excretion from pancreas Adverse: hypoglycemia Contra: renal disease Nurse imp: advanced diabetic patient can't use
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Prandin |
Type: Meglitinides Use: type II Action: facilitate pancrease to produce more insulin after meal Adverse: hypoglycemia, weight gain, GI upset Nurse imp: never give with sulfonylureas, 15-30 mins before meal, no meal = no dose |
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Glycet and Precose |
Type: Alpha Glucosidase inhibitors Use: Type II Action: inhibit enzymes in GI tract delaing digestion of complex carbs Adverse: GI upset, bloating Nurse imp: must take with meal |
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Byetta |
Type: Incretin mimetics Use: type II Action: slows gastric emptying and increase satiety, helps with wight loss Adverse: GI upset, Nausea, hypoglycemia Nurse imp: used in combo with other type II med, given SubQ 2x/day within 60 mins of meal |
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Junuvia |
Type: DDP-4 inhibtor Action: stimulate insulin release in response to meal Use: Type II Adverse: respiratory tract infection Contra: patients with renal failure Nurse imp: PO 1x/day, usually used with other type II drug |
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Avandia |
Use: type II Action: increase effectiveness of circulating insulin Adverse: fluid retention, edema, worsening of heart failure and heart attack Nurse imp: very limited use because of black box warning, NO NEW PATIENTS being Rx'd this drug |
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Symlin |
Use: type II Action: slows gastric empting Adverse: hypoglycemia Nurse imp: used with insulin, sulfonylureas or metformin, given SubQ |
