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Pain Medications
Narcotics and NSAIDs
| Question | Answer |
|---|---|
| In the brain, the __________ is a relay station for incoming sensory stimuli, including pain. | thalamus |
| The ___________ nerve transmits pain signals to the ______ ____, and then to the ________. | peripheral, dorsal horn, thalamus |
| Seizure meds are very effective at treating ___________ pain. | neuropathic |
| ______ analgesics are used to treat moderate to severe pain. | Opioid |
| _________ analgesics are used to treat acute and chronic pain, and neuropathic or bone (somatic) pain. | Nonopioid |
| Opioid analgesics relieve moderate to severe pain by __________ pain signal transmission from periphery to brain. | inhibiting |
| Opioid analgesics are metabolized in the _____, and secreted in _____. | liver, urine |
| Opioid analgesics are well absorbed __, __, and _____. | PO, IM, SubQ |
| Opioids with highest potential for abuse, and risk of fatal overdose because of respiratory depression. | fentanyl, hydromorphone, methadone, oxycodone, morphine |
| Morphine is most commonly given | PO and IV (IVP, gtt, PCA) |
| Maximum analgesia with morphine occurs within _____ min. after IV, ___ min., after IM, __ min. after PO, _____ min. after SubQ. | 10-20, 30, 60, 60-90 |
| Impaired kidney or liver function may produce _________ ________. | prolonged sedation |
| Codeine | pro-drug (must be metabolized to be effective), weaker than morphine, PO route, up to 10% of ppl have problems with metabolizing. |
| Fentanyl | 100x as potent as morphine, quick acting, transdermal patches for chronic/severe pain, |
| Hydrocodone (Vicodin, Lortab) | combined with Tylenol (acetaminophen)-do not exceed dose limit!!! (4g), moderately potent |
| Hydromorphone (Dilaudid) | 7-10x as potent as morphine, no active metabolites, |
| Meperidine (Demerol) | problems with toxic metabolites-CNS stimulation, preferred in L&D for lowered effect on NB's respiratory system |
| Methadone | longest duration of action (24h 1/2 life, used for severe pain and addiction treatment, prolonged QT syndrome |
| Oxycodone | used for moderately-severe pain, can be combined with Tylenol (Percocet), short-acting (Percocet, OxyIR), long-acting (OxyContin) |
| Tramadol | lowest potential for abuse (doesn't cross blood-brain barrier well – no euphoria, effective for fibromyalgia |
| half-life Morphine | 2-3.5h |
| half-life Hydromorphone (Dilaudid) | 2-3h |
| half-life Fentanyl | 3-4h |
| half-life Oxycodone | 2-3h |
| half-life Codeine | 3h |
| half-life Methadone | 24h |
| half-life Naloxone (Narcan) | 2h |
| Equianalgesic Morphine to Hydromorphone (Dilaudid) | 10mg to 1.5mg parenteral |
| Equianalgesic Morphine to Fentanyl | 10mg to 0.1mg parenteral |
| Equianalgesic Morphine to Codeine | 10mg to 130mg parenteral |
| Equianalgesic Morphine to Hydrocodone (Vicodin, Lortab) | 30mg to 20mg oral |
| Equianalgesic Morphine to Oxycodone | 30mg to 20mg oral |
| A patient is being switched from morphine 2-4mg IV to hydromorphone. What dosage do you anticipate the provider to prescribe? | 0.3-0.6mg IV |
| Anti-prostaglandin drugs: NSAIDs | Aspirin, Ibuprofen, Ketorolac, Indomethacin, Celecoxib |
| Prostaglandins are chemical mediators found in the body tissues, and exert all of the following: | increased platelet aggregation, gastroprotection, increased body temperature, increased pain sensitivity |
| COX-1 inhibition: | gastric erosion, platelet inhibition, renal toxicity |
| COX-2 inhibition: | decreased inflammation, decreased pain, reduction of fever, protection against colorectal cancer, RENAL IMPAIRMENT, INCREASED RISK FOR CVA/MI, CONTRAINDICATED WITH SULFA ALLERGY |
| NSAIDs specific indications: | inflammatory disorders (DJD, OA, RA), mild to moderate pain, fever, suppress platelet aggregation |
| NSAIDs contrainsications: | peptic ulcer disease, GI or other bleeding disorders, impaired renal function, hypersensitivity to ASA, children, Pregnancy (ASA use with extreme caution, NEVER use Toradol) |
| NSAIDs adverse effects: | GI: bleeding, n/v, ulceration, tinnitus (especially with ASA), nephrotoxicity, rash/itching, non-aspirin NSAIDs–increased risk of CVA/MI |
| NSAIDs nursing considerations: | assess for allergies, assess for adverse effects: (bleeding [stool]) renal function), give with food to decrease GI irritation, ensure adequate fluid intake |
| NSAIDs Interactions: | Decrease the effect of: antihypertensive drugs including diuretics, ACE inhibitors, Beta blockers; Increase the effect of anticoagulants; Garlic, Ginko, Ginseng increase risk of bleeding; Ibuprofen may limit cardioprotective effect of ASA |
| Platelet inhibition effect of aspirin lasts... | 1 week |
| Acetaminophen :( | no anti-inflammatory properties, metabolized in liver & small amount remains in body as toxic metabolite, dose limit: 4gm/24hrs DO NOT EXCEED!! Further dose limits for liver impairment or hx of ETOH abuse. |
| Acetaminophen toxicity may occur with: | single large dose, chronic excessive doses, therapeutic doses in those who abuse alcohol |
| Acetaminophen toxicity: | s/s are nonspecific, 24-48 hrs. after OD ALT & AST begin to increase, later manifistations: jaundice, vomiting, CNS, stimulation with excitement and delirium followed by coma and death. |
| Acetaminophen toxicity cont.: | Gastric lavage & activated charcoal w/in 4 hrs, Acetylcystine (Mucomyst) w/in 10 hrs. may be helpful w/in 36 hrs., WILL NOT REVERSE DAMAGE ALREADY SUSTAINED |
Created by:
aek
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