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Pharm Test 2- Pain meds
n/a
43
Nursing
Undergraduate 4
02/18/2010

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Cards

Term
Damage to ___ creates nociceptor pain.

Damage to ___ creates neuropathic pain.
Definition
Tissue; Nerves
Term
Describe neuropathic pain.
Definition
Burning, shooting, numbing
Term
Tissue/nociceptor pain:

___ makes a sharp localized sensation.
___ makes a dull, throbbing sensation.
Definition
Somatic; Visceral
Term
What is the name for the pain receptors located throughout the body?
Definition
Nociceptors
Term
___ ___ is the neurotransmitter that transmits pain in the spinal cord.

___ act against this neurotransmitter.
Definition
Substance P

Endorphins
Term
Opioids stimulate the ___ and ___ receptors.
Definition
Mu and Kappa
Term
Name 6 opioid analgesics.
Definition
1. Codeine
2. Hydromorphone HCl (Dilaudid)
3. Butorphanol (Stadol)
4. Oxycodone HCl (OxyContin) [Percocet+Acetamin]
5. Hydrocodone [Vicodin5/500+Acetamin]
6. Fentanyl (Sublimaze)
Term
Name 4 mixed opioid analgesics and what is in them.
Definition
Vicodin (Lortab): Hydrocodone + Tylenol
Percocet: Oxycodone + Acetamin
Darvocet: Propoxyphene + Acetamin
Percodan: Oxycodone + ASA
Term
___ (MS Contin) gives excellent pain relief.

It stimulates ___ muscle.
It decreases the ___ to open up the pulmonary bed. This causes better O2/CO2 exchange.
Definition
Morphine

Cardiac

PVR (Pulmonary Vascular Resistance)
Term
Morphine causes ___ but is great for relieving ___ in CHF.
Definition
Euphoria; SOB
Term
S/S of opioid overdose:

___ RR
___ HR
___ skin
Feels ___
Mental ___
___ pupils
Definition
Decreased RR
Decreased HR
Clammy skin
Feels drowsy
Mental confusion
Pinpoint pupils


*Possible select all that apply
Term
Morphine Nursing considerations

Severe ___ distress
Retained CO2 causes ___ and increases IICP
Dizzy and drowsy (___ precautions)
Urinary retention (___)
___ (Toxicity)
Definition
Severe resp distress
Retained CO2 causes vasodilation and increases IICP
Dizzy and drowsy (Fall precautions)
Urinary retention (Toxicity)
Constipation (Toxicity)
Term
What do we use for people retaining CO2 with IICP? Why?
Definition
Vasopressin; It stimulates angiotensin to reverse vasodilation.
Term
Mixed analgesics:

Tylenol: ___ g/day
Aspirin: ___ g/day
Ibuprofen: ___ g/day

*Ibu: Can manage on up to ___ g/day
Definition
Tylenol: 4 g/day
Aspirin: 4 g/day
Ibuprofen: 1.2 g/day

*Ibu: Can manage on up to 3.2 g/day
Term
___ is an opioid antagonist and works on OPIOIDS ONLY!
Definition
Narcan
Term
Narcan can be used to dx opioid overdose. Why should we use caution with it and suspected opioid addiction?
Definition
It can cause severe immediate withdrawal symptoms and seizures
Term
What are 5 S/S of Narcan withdrawal?

What are 2 other things to worry a/b?
Definition
1. Cramping
2. Vomiting
3. HTN
4. Anxiety
5. Tremors

1. V-tach
2. Hyperventilation
Term
A patient on Narcan needs VS checked q___ min. They need continuous ___ monitoring and frequent ___'s.
Definition
3-5 min
EKG
ABG's
Term
Things we should try BEFORE giving Narcan:

Can I ___ them?
Can I stop the ___?
Can I give them ___?
Definition
Awaken
Infusion
O2*

*If COPD, skip O2 and do Narcan
Term
Name 3 types of nonopioid analgesics.
Definition
1. NSAIDS
2. Acetaminophen
3. ASA
Term
NSAIDs inhibit ___, then enzyme that forms ___.
Definition
Cyclooxygenase; Prostaglandins
Term
ASA inhibits ___ and ___.
Definition
Cox-1 and Cox-2
Term
Acetaminophen considerations:

Monitor ___'s
Works directly in the ___.
Dilates ___ blood vessels.
NO ___ PROPERTIES!
Definition
Monitor LFT's
Works directly in the hypothalamus.
Dilates peripheral blood vessels.
NO ANTI-INFLAMMATORY PROPERTIES!
Term
Name the time periods of the 4 stages of Acetaminophen overdose.

Phase 1 (___-___ hrs)
Phase 2 (___-___ hrs)
Phase 3 (___-___ hrs)
Phase 4 (___-___ days)
Definition
Phase 1 (2-24 hrs)
Phase 2 (24-72 hrs)
Phase 3 (72-96 hrs)
Phase 4 (6-7 days)
Term
S/S of Phase 1 of Acet. OD (2)

(__-__ hrs)
Definition
Vomiting, abd pain

2-24 hrs
Term
S/S of Phase 2 of Acetamin OD (4)

__-__ hrs
Definition
Hepatomegaly
RUQ pain
Acute Tubular Necrosis
Elevated LFTs

24-72 hrs
Term
S/S of Phase 3 of Acetamin OD (4)

___-___ hrs
Definition
Jaundice
Confusion
Coma
Dramatic LFT rise

72-96 hrs
Term
Phase 4 of Acetamin OD is called the ___ ___. This means what?

___-___ days
Definition
Crisis point; Pt improves or develops liver failure.

6-7 days
Term
True or False:

Tylenol has anti-inflammatory properties
Definition
FALSE
Term
Acetamin OD: Give ___ ___ within ___ hours.
Definition
Activated charcoal w/in 4 hrs
Term
Acetamin OD: Give oral liquid formation ___. This has a terrible ___ ___ smell.

Where does the acetaminophen go?
Definition
Acetylcysteine; rotten egg smell

Sent out in the feces
Term
What do you do if your client vomits w/in 1 hr of acetylcysteine administration?
Definition
Give them an anti-emetic and re-dose
Term
What 2 systems are a concern with NSAIDs?
Definition
Renal, GI
Term
NSAID considerations:

___ and ___ tests
Can't take if allergic to ___.
Take with ___ to decrease GI upset.
Watch for ___ ___.
___ indicates OD. *If pt shows this, what do we look at next?
Definition
LFT and renal tests
Can't take if allergic to ASA.
Take with food to decrease GI upset.
Watch for GI bleed.
Tinnitus indicates OD.

*Look for GI bleed and S/S bleeding
Term
Celecoxib (Celebrex) is a COX-2 inhibitor. It's contraindicated with:

___ allergy
___ allergy
___ patient*
___ failure and ___*

*Why?
Definition
Sulfa allergy
ASA allergy
CABG patient*
Heart failure and HTN*

*Causes fluid retention
Term
Considerations for ASA:

Not for children <___ yo
Caution with ___ pts.
Anti___ effects
Definition
15; asthma; anti-platelet
Term
ASA is an anti-platelet.

D/C ___ wk(s) before surgery
Good for an ___
Contraindicated with ___.
Definition
1 week; MI; Anticoagulants
Term
What is the danger of giving ASA to kids <15?

Be familiar w/ S/S of it.
Definition
Reye's Syndrome

S/S (Chronologically):
Vomiting, stupor, fatty liver, coma, IICP, hepatic probs, seizure, organ failure, flaccid, high ammonia, death
Term
ASA OD: ___ventilation results in respiratory ___.
Definition
Hyperventilation = Resp Alkalosis
Term
ASA levels 250-400 mcg/mL OD:

Name 5 s/s
Definition
Nausea
Vomiting
Tinnitus
Tachycardia
Diaphoresis
Term
ASA levels >400 mcg/mL OD:

Name 5 S/S.
Definition
Resp alk
Hemorrhage
Seizure
Coma
Resp failure
Term
How do we treat ASA OD?
Definition
Activated charcoal/gastric lavage
Term
Even though Torodol is an NSAID, why do we need a prescription?
Definition
Because it is so hard-hitting on the kidneys.
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