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Pharmacology Exam 2- Weeks 5-7- pain management
Terms in this set (87)
describe gate control theory
-close gate to pain(physical manipulation)
-able to modify entry of pain stimuli into spinal cord and brain
-built into normal pain pathways in body
if the gate in the gate control theory is open, what occurs?
if the gate in the gate control theory is closed, what occurs?
-reduces pain impulses
in the gate control theory, when does the closed portion of it occur?
stimulus is already using same pathway->massage, ice
what are some methods of managing pain?
1. remove cause of pain
2. analgesic meds
treatment recommendations for visceral pain
treatment recommendations for neuropathic pain
what is an example of an anticonvulsant
what kind of drugs quiet the brain?
treatment recommendations for somatic pain
analgesia recommendations of mild pain
analgesia recommendations ofr moderate pain
mild pain range
moderate pain range
severe pain range
what drug is oxycodone and acetaminophen combined
what drug is hydrocodone and acetaminophen combined?
analgesia recommendations for severe pain
what is the most popular drug people in ER ask for?
what are medications that relieve pain without causing loss of consciousness?
what type of opioid binds to receptors?
medication that is not primarily designed to control pain but can be used for this purpose. Some examples of adjuvant drugs are medications like antidepressants and anticonvulsants.
-synthetic drugs that bind to opiate receptors to relieve pain and originate from opium
-very strong pain relievers
mechanism of action of agonist opioids
-bind to opioid pain receptor in brain
-cause analgesic response-reduction of pain sensation
mechanism of action of partial agonist(antagonist-agonist) opioids
-bind to pain receptor
-lower dependency potential than agonist
partial agonist dugs treat what?
what is the important thing to remember about detox treatment and chronic neuropathic pain
24 hour dosing
with oxycodone(Percocet), watch for allergies to what?
with hydrocodone(Vicodin or Norco), watch for allergies to what?
what are examples of extended release forms?
duration of action for extended release
immediate release is available in what 3 forms
with transdermal patches, why should you rotate sights?
decrease irritation and enhance drug effects
what is important to remember about fentanyl transdermal patches?
do not apply heat over them because absorption will increase and cause an overdose
do fentanyl transdermal patches bring pain right away?
4 mechanisms of actions of opioids
main use of opioids
alleviate moderate to severe pain
3 mild agonists
5 strong agonists
opioids are often given with what kind of analgesic drugs to assist primary drugs with pain relief?
opioids are often used for what 3 things?
1. cough center suppression
2. treatment of diarrhea
3. balanced anesthesia
1. drug allergy
2. severe asthma
what three areas should you caution giving opioids to?
2. morbid obesity and sleep apnea
3. respiratory insufficiency
is nausea an allergy?
is itching an allergy with morphine?
adverse effects of opioids
1. CNS depression-respiratory depression
4. pupil constriction
6. itching from histamine release
since constipation is an adverse effect of opioids, what may a doctor prescribe?
interactions with opioids
3. barbiturates(sleeping pills)
result of opioid tolerance
larger dose required to maintain same level of analgesia
common physiologic result of chronic opioid treatment
physiologic adaptation of body to presence of opioid
are opioid tolerance and physical dependence expected with long term opioid treatment?
a pattern of compulsive drug use characterized by continued craving for opioid and need to use opioid for effects other than pain relief
patient teaching with opioids
1. avoid alcohol
2. report dizziness, dyspnea(difficulty breathing), excessive sedation, confusion, nausea, vomiting
3. force fluids, fiber, increase activity to avoid constipation
4. explain tolerance so patient understands why pain may return
5. no driving or operating heavy machinery
6. explain physical dependence isn't same as psychological dependence
nursing implications of opioids
1. no judgement
2. adequate pain assessments usually yield why pain medication may not be effective
3. be patient advocates
Partial agonist: -what drug works great for migraines and pregnancy the first time but the 3rd time not as great?
Partial agonist: two agonists in nalbuphine(nubaine)
Partial agonist: with nalbuphine(nubaine), there are fewer ___ adverse effects
Partial agonist: with nalbuphine(nubaine), there's milder __________ effects
Partial agonist: contraindications of opioids
dependence and addiction(never give opioids to someone with opioid withdrawal or addiction)
Partial agonist: is nalbuphine(Nubain) a partial agonist or opioid antagonist
opioid antagonist: is naloxone(Narcan) an opioid antagonist or partial agonist
opioid antagonist: when a patient experiences severe respiratory depression, what should be given?
opioid antagonist: prepare to administer Narcan(antagonist) if respiratory rate is less than ___ per minute
opioid antagonist: adverse effects of naloxone(Narcan)
3. increased respiratory rate
5. return of pain
opioid antagonist:symptoms of opioid withdrawal
4. hot flashes
5. joint pain
6. lacrimation(flow of tears)
7. rhinorrhea(nasal cavity filled with fluid)
11. abdominal cramps
non opioid analgesic drugs: does acetaminophen have anti-inflammatory effects?
non opioid analgesic drugs: which drug has analgesic and antipyretic(reduce fever) effects
brand name for acetaminophen
how does non opioid analgesic drugs acetaminophen(Tylenol) block pain impulses peripherally
inhibit prostaglandin synthesis
maximum daily dose for healthy adults for acetaminophen
maximum daily dose for elderly, liver disease, chronic heavy alcohol abusers for acetaminophen
what is an acetaminophen(Tylenol) overdose treated with?
brand name for acetylcysteine
what are three areas acetaminophen shouldn't be taken with?
1. liver dysfunction
3. drug allergy
what function tests should be monitored with someone taking acetaminophen
children with flu like symptoms or chicken pox should take which drug for fever and achiness
aspirin causes what?
-treats moderate to severe pain
-centrally acting non opioid
-not classified as controlled substance
-rare adverse effects: dizziness, sedation, N/V, constipation
-serotonin syndrome- rigid muscles, seizures
brand name for tramadol hydrochloride
which drug has serotonin syndrome when taking with SSRIs.
which two things should be taken into consideration to assess effectiveness?
1. time of onset
2. peak effect
in evaluation, what are some ways you can monitor for therapeutic effect
1. decreased complaint of pain
2. decreased severity of pain
3. increased periods of comfort
4. improved activities of daily living, appetite, sense of well being
5. decreased fever
what are the nine opioid agonists?
what is the one opioid part agonist?
what is the opioid antagonist?
what are four non opioids?
4. Acetylsalicylic Acid(aspirin)
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