154 exam 2
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| analgesics | medications that relieve pain without causing loss of consciousness
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| pain | whatever the patient says it is and occurs whenever they say it does
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| pain threshold | the level of stimulus needed to produce a painful sensation
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| pain tolerance | the patient's ability to tolerate or stand the pain; influenced by age, diseases, culture, previous experience
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| acute pain | sudden onset, usually localized with limited duration; increased hemodynamics, sweating, pallor
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| chronic pain | persistent or recurring pain lasting longer than 6 weeks; much more difficult to treat
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| somatic pain | originate from skeletal muscles, ligaments and joints; responds best to NSAIDs or nonopiates
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| superficial pain | originates from skin and mucous membranes; skinned knee, dental pain
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| visceral pain | originates from organs or smooth muscles; appendicitis, MI, gallbladder attack
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| vascular pain | originates from vascular or perivascular tissues; migraines
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| referred pain | pain is experienced in a place other than the point of origin; heart attack -> pain in left arm
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| Gate Theory | When gates are open, pain impulses are allowed through and the brain perceives pain; when gates are closed, impulses are stopped and perception is altered
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| A fibers | larger diameter fibers that conduct sharp and localized pain impulses; associated with acute pain
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| C fibers | small diameter fibers that slowly conduct dull and nonlocalized pain impulses; associated with chronic pain
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| pain control | The ultimate goal when addressing pain with a patient
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| Step 1 | the use of nonopioids with or without adjuvant medications once the pain has been identified and assessed
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| Step 2 | the use of opioids with or without nonopioids and with or without adjuvant medications
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| Step 3 | the use of opiods indicated for moderate to sever pain, administered with or without nonopioids or adjuvant medications
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| opioids | drugs that bind to opiate receptors to relieve pain
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| alter | Opiates ______ the perception of pain and do nothing to cure or heal what is causing the pain.
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| remove | You must ______ the old patch first.
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| Narcan | antidote for opiate overdosage; opiate antagonist; also reverses pain relief
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| opioid tolerant | patient has been receiving opiates for extended period of time and requires higher doses to control pain at same level
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| withdrawal symptoms | n/v/d, chills, mental agitation, tachycardia, increased BP, diaphoresis, runny nose, cramps
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| opiate naive | patients are not accustomed to taking opiates and require smaller dosages to relieve their pain
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| respiratory depression | Most serious adverse effect of opiates (think ABC)
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| histamine | All opiates cause the release of ______, which can lead to redness and itching.
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| Change positions slowly. Siderails should be up, call light within reach. | Because histamine causes vasodilation -> orthostatic hypotension, what precautions should be in place?
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| liver | Opiates may cause an increase in ______ enzymes, which means the nurse should assess them.
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| NSAIDs | work by suppressing some part of the inflammatory process and reduces the amounts of pain-mediating chemicals
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| stomach | NSAIDs are very hard on the _____ and you must assess for increased bleeding, abdominal pain
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| coontraindicated | NSAIDs are ___________ in patients with history of GI bleed, ulcers, anticoagulatnt/antiplatelet, renal problems
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| reduce blood flow | All NSAIDs except aspirin _____ _____ ____ to the kidneys
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| hepatotoxic | Tylenol is extremely _______ with acute overdose
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| acetylcysteine (Mucomyst) | treatment for Tylenol overdose; smells like rotten eggs, mix with juice and give with straw
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| LFTs | Examples: AST, ALT, alk. phos.
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| sedatives | reduce nervousness, excitability, and irritability without causing sleep
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| hypnotics | cause sleep and have a much more potent effect on the CNS
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| sedative-hypnotics | drugs that can act in the body as a sedative or a hypnotic
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| 3 | How many groups of sedative-hypnotics are there?
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| barbiturates | a class of drugs used to induce sedation; highly habit forming and narrow therapeutic window; NO antidote
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| ital | common ending of barbiturates
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| REM | Barbiturates deprive people of _____ sleep.
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| Maintain airway | Main consideration with barbiturate overdose
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| benzodiazepines | drugs most frequently prescribed as anxiolytic drugs
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| pam, lam | common endings for benzodiazepines
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| flumazenil (Romazicon) | benzo antidote used in extreme cases
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| muscle relaxers | used for the relief of skeletal muscle spasticity; relieve pain
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| Flexeril (cyclobenzaprine) | highly sedating; must watch for altered sensorium; high fall risk; take at bedtime
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| Lioresal (baclofen) | given to relieve extreme spasms in paraplegia and quadriplegia
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| Dantrium (dantrolene) | used for acute management of malignant hyperthermia; can cause liver problems
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| malignant hyperthermia | genetic predisposition when patients receive anesthesia; uncontrolled shivering, extreme increase in temp
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| drive | Cannot _____ when taking a muscle relaxer
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| CNS stimulants | drugs that stimulate specific areas of the brain or spinal cord
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| ADHD | symptoms of inability to maintain attention span, presence of hyperactivity must be present for greater than 6 months and occur in 2 different settings
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| narcolepsy | syndrome characterized by sudden sleep attacks, cataplexy, sleep paralysis, and visual or auditory hallucinations at the onset of sleep
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| amphetamines | drugs used to treat ADHD and narcolepsy
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| mental alertness | Amphetamines stimulate areas of the brain associated with _____ ________
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| C-II | Which classification of scheduling are amphetamines?
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| speed up | Amphetamines _____ ___ all body systems
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| never | CNS stimulants should ______ be given at bedtime
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| baseline height and weight | Key assessment point when taking amphetamines
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| anorexiants | drugs used to control or suppress appetite
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| cardiac patients | Phentermine (an anorexiant) is contraindicated in
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| lipase | What enzyme does orlistat (Xenical) inhibit, leading to oily stool?
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| migraine | common type of recurring painful heachace with throbbing, pain, and photophobia caused by vasodilation; can last 4 to 72 hours
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| aura | predictive set of altered visual or other senses
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| antimigraine medications | drugs that stimulate the serotonin receptors, causing vasoconstriction
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| abortive | Antimigraines are used as an _______ therapy, not prophylaxis
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| triptan | common ending for antimigraines
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| cardiovascular, hypertension | Antimigraines are contraindicated in patients with:
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| analeptics | drugs used to stimulate respirations; stimulates parts of CNS that control respiration, mainly medulla and spinal cord
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| caffeine | CNS stimulant contained in many foods, drinks, and drugs
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| yes | Can you overdose on caffeine?
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| Doxapram | hastens arousal and treats respiratory depression from anesthesia
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| peptic ulcer, cardiac dysrhythmias, MI | Caffeine contraindications
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| unknown | The cause of most seizures is ______
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| primary epilepsy | epilepsy where there is no identified cause
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| secondary epilepsy | epilepsy has a distinct or known cause such as trauma, infection, CVA
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| partial seizures | only part of the brain is involved; also called focal/local seizures
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| simple seizures | patient remains conscious; have one-side movement of an extremity, unusual sensations, increased HR, flushing and epigastric discomfort
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| complex seizures | patients loses consciousness for 1-3 minutes; has automatisms
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| generalized seizures | seizures that affect all or most of the brain
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| tonic-clonic seizures | muscles become very rigid and patient loses consciousness (tonic); patient has jerky movements and muscle contraction (clonic)
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| absence seizures | brief loss of consciousness and blank staring; more often in children
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| myoclonic seizures | seizures with sporadic or isolated jerking movements which may involve one or more extremity and may occur on one or both sides of body
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| atonic seizures | seizures with sudden loss of muscle tone for a few seconds followed by a postictal phase
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| status epilepticus | life threatening emergency characterized by tonic-clonic seizures which occur in succession; can cause brain death; treated with Valium, Atavan
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| 2nd | Many physicians will not start medication until after the ____ seizure has occurred
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| neuropathic pain | Anticonvulsants can be used to treat _______ _____ because of the effect they have on neurons.
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| narrow therapeutic windows | The most common antiepileptic drugs have _______ _________ _______.
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| Dilantin (phenytoin) | The gold standard of epilepsy drug therapy
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| 10-20 | Dilantin therapeutic level
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| normal saline | IV Dilantin can only be given with ______ _______
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| drug level, liver function | Key assessments when patient is taking Dilantin
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| gingival hyperplasia | overgrowth of the gums caused by long term Dilantin
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| vitamin D | Patients taking Dilantin may need to take a ______ ___ supplement because long term use can cause osteoporosis
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| Dilantin facies | a change in appearance by acne, hirsutism, gingival hyperplasia, and hypertrophy of SQ tissue (pudgy)
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| hepatotoxicity, pancreatitis | Depakote fatal side effects
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| 50-100 | Depakote therapeutic level
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| 4-12 | Tegretol therapeutic level
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| Tegretol | has an unusual property called autoinduction; drug increases own metabolism over time
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| Neurontin, Lyrica | commonly used to treat neuropathic pain
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| same time | Patients must take seizure meds at the ____ ____ every day.
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