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Chapter 28 & 29
Pharmacology Exam 3
| Question | Answer |
|---|---|
| what class of drugs are the must effective analgesics available? | opioids |
| what are the 3 major classes of opioid receptors? | mu, kappa, and delta |
| _____ is a pure opioid agonists that relives pain by mimicking the actions of endogenous opioid peptides, primarily mu receptors | morphine |
| opioid-induced sedation and _____ can complement pain relief? | euphoria |
| what is the most serious adverse effect of opioids? | respiratory derpession |
| constipation, urinary retention, orthostatic hypotension, emesis, mitosis, birth defects, and elevation of IOP are all adverse effects of what? | opioids |
| oral doses of morphine must be larger than parenteral doses because of what? | the first-pass effect |
| infants need smaller doses of opioids than do older children and adults because of what? | their blood-brain barrier is poorly developed |
| cross-tolerance exists between opioid agonists and general CNS depressants. true or false? | false |
| with prolonged use of opioids, tolerance develops to analgesia, euphoria, sedation, and respiratory depression, but not to what? | constipation and miosis |
| withdrawal from opioids is unpleasant, but not dangerous. true or false? | true |
| patients you should use caution with when prescribing opioids are patients that: | are pregnant, are in labor, have a head injury, or decreased respiratory reserve |
| patients taking opioids should avoid anticholinergic drugs. why? | can exacerbate opioid-induced constipation and urinary retention |
| what are the classic tried of symptoms that opioid overdose can induce? | coma, respiratory depression, pinpoint pupils |
| why should the use of meperidine be avoided? | to prevent accumulation of normeperidine |
| a topic metabolite that comes from meperidine | normeperidine |
| analgesia, sedation, euphoria, respiratory depression, constipation, urinary retention, cough suppression, and miosis are all effects produced by what? | codeine and other moderate to strong opioid agonists |
| how does codeine differ from morphine? | produce less analgesia and respiratory depression and have a lower potential for abuse |
| the combination of codeine with what produces greater pain relief then can be achieved with either alone? | a nonopioid analgesic |
| most agonists-antagonist opioids act as agonists at _____ receptors and antagonists at _____ receptors | kappa; mu |
| _____ and other agonists-antagonist opioids produce less analgesia than morphine and have a lower potential for abuse | pentazocine |
| there is a ceiling to respiratory depression for which class of opioids? | agonist-antagonist |
| what drug is used to reverses respiratory depression, coma, analgesia, and most other effects of pure opioid agonists | naloxone |
| what opioid is naloxone not able to reverse? | methylnatrexone |
| if administered in excessive dosage to an individual who is physically dependent on opioids, _____ can precipitate an immediate withdrawal syndrome | naloxone |
| patients with _____ _____ pain need higher doses than patients with dull pain | sharp, stabbing |
| as a rule, opioid should be administered on a _____ _____ for the first 24 hours postoperatively (with supplemental doses for breakthrough pain) rather than PRN | fixed schedule |
| most PCA devices are electronically controlled pumps that can be activated by the patient to deliver a preset dose of opioid through an indwelling catheter. some PCA devices also deliver what? | a basal opioid infusion |
| a primary chronic disease characterized by an individual pathologically pursing rewards and/or relief by. substance use and other behaviors | addiction |
| a personal, subjective experience that encompasses not only the sensory perception, but also the patient's emotional and cognitive responses to both the sensation and the underlying disease | pain |
| what are the two major forms of pain? | nociceptive and neuropathic pain |
| pain that results from injury to tissues | nociceptive pain |
| pain that results from injury to peripheral nerves | neuropathic pain |
| behavioral observation is a poor substitute for the patient's self-report as a method of assessment. true or false? | true |
| acetaminophen, like other NSAIDs, suppresses inflammation, inhibits platelet aggregation, or promotes gastric ulceration or renal failure. true or false? | false |
| combining nonopioids and opioids can be more effective than either drug alone. why? | they relieve pain by different mechanisms |
| NSAIDs produce their effects by inhibiting what? | cyclooxygenase (COX) |
| most NSAIDs inhibit both COX-1 and COX-2. a few NSAIDs are ____ selective | COX-2 |
| GI injury, acute renal failure, bleeding, and risk ofd thrombotic events are the principal adverse effects of what? | NSAIDs |
| which NSAID does not pose a risk of thrombotic events? | aspirin |
| COX-2 selective inhibitors cause less _____ ______ than nonselective NSAIDs, but pose a greater risk of thrombotic events | GI injury |
| the long-term use of _____ inhibitors is not recommended | COX-2 |
| NSAIDs do not cause tolerance, physical dependence, or psychologic dependence. true or false? | true |
| NSAIDs increase the risk of bruising and bleeding in patients with thrombocytopenia, a common side effect of chemotherapy, by doing what? | inhibiting platelet aggresgation |
| combining CNS depressants with NSAIDs can increase respiratory depression. true or false? | true |
| _____ analgesics can enhance analgesia from opioids, help manage concurrent symptoms that exacerbate pain, and treat side effects cause by opioids | adjuvant |
| ____ are effective against neuropathic pain | adjuvants |
| combining _____ with alcohol, even in moderate amounts, can result in potentially fatal liver damage | acetaminophen |
| opioid analgesics relieve pain by mimicking the actions of _____ _____ _____, primarily at the nu receptors in the CNS | endogenous opioid peptides |
| for most patients, opioids should be given on a fixed schedule ATC, with additional doses provided for breakthrough pain. PRN dosing should be limited to patients with what kind of pain? | intermittent pain |
| intramuscular opioids should be avoided. why? | they are painful |
| what is used to facilitate dosage selection when switching from one opioid to another or from one route to another? | equianalgesic table |
| with opioids, tolerance develops to analgesia, euphoria, respiratory depression, and sedation, but not to what? | constipation and miosis |
| addiction to opioids is very _____ in people taking drugs to relieve pain | rare |
| the brain uses _____ of all oxygen consumption | 20% |
| how many pairs of cranial nerves are there? | 12 |
| what is the primary purpose of CNS agents? | relief of pain, control of seizures, production of anesthesia, and treating psychiatric disorders |
| what part of the brain secrets neurohormones controlling our temperature, thirst, and hunger? | the hypothalamus |
| what part of the brain is just above the hypothalamus that helps with consciousness, awareness, alter ness, and sleep, as well as sensory and sensory cortex neurons. | thalamus |
| a bunch of nerves in the brain that filters out information | reticular activating system |
| women can filter information through their reticular activating system better than men. true or false? | true |
| a part of the brain stem that is important for controlling vital signs. it also contains the coughing and vomiting center and can stimulate or depress drugs and keeps blood pressure under control | medulla oblongata |
| how many spinal nerves do we have? | 31 |
| sedative/hypotics, nonbarbiturates, benzodiazepines, anti anxiety agents, psychotropics, anesthetics, and stimulants are all _____ _____ | CNS drugs |
| what are the two forms of nociceptive pain? | somatic and visceral |
| _____ pain responds poorly to opioids | neuropathic |
| what acronym is used to assess pain systematically? | PQRST |
| a general term defined as any drug, natural or synthetic, that has actions similar to those of morphine (can be created in the lab) | opioid |
| a term that applies only to compounds present in opium, which comes from poppies that cannot be created int he lab | opiate |
| orally, subQ, IM, IV, patch, suppository, and inhalation are all routes by which _____ can be administered | opioids |
| where are opioids metabolized? | the liver |
| _____ are excreted mostly by the kidneys, some through the biliary tract and out in the fecess | opioids |
| what is the onset of action of opioids administered IV? | 7 mins |
| what is the onset of action of opioids administered IM? | 30 mins |
| what is the onset of action of opioids administered subQ? | up to 90 mins |
| how long may the rffects of opioids persist when given IV, IM, or subQ? | 4-5 hrs |
| responses may be delayed by _____ when opioids are administer by spinal injection | hours |
| no one gets morphine if their respiratory rate is less than what? | 12 |
| what is a side effect of opioids that may be caused after the first dose? | constipation |
| how do opioids cause constipation? | by restricting water entry into the GI tract and tightens the anal sphincter |
| a incentive spirometer can be used to encourage _____ in patients that are taking opioids | cough |
| opioids can cause nausea and vomiting by stimulating the medulla, but it usually only occurs on the first dose. true or false? | true |
| we must be cautious when administering opioids to patients with head injuries. why? | it can elevate the intracranial pressure |
| respiratory depression, constipation, orthostatic hypotension, cough suppression, nausea, emesis, urinary retention, elevation of intracranial pressure, euphoria/dysphoria, sedation, and birth defects are all adverse effect of what? | opioids |
| tolerance to opioids doesn't effect what? | constipation |
| cross tolerance develops between opioids and other CNS depressants. true or false? | false |
| abstinence syndrome will occur about _____ after the last dose in patients that have developed physical dependence to opioids | 10 hours |
| how long can withdrawal last if it goes untreated? | 7-10 days |
| it is important to encourage patients to take their medications as prescribed because they have pain, not because they anticipate the pain, in order to prevent what? | the development of physical dependence |
| when opioids are combined with CNS depressants, they have what effect? | increases CNS depression and sleepiness |
| when opioids are combined with anticholinergic drugs, they have what effect? | intensified constipation and causes urinary retention |
| fentanyl is a schedule _____ drug | 2 |
| fentanyl is _____ the potency of morphine | 100x |
| fentanyl (sublimate) is given parenterally for what? | surgical anesthesia |
| the form of fentanyl that is given by patch is called what? | duragesic |
| heat has what effect on duragesic? | increases acceleration of absorption |
| avoiding directly sunlight, excessive exercise, and hot baths prevents what? | duragesic patches from coming off |
| how long are duragesic patches good for? | 72 hrs |
| lozenge on a stick (Actiq), buccal film (onsolis), buccal tablets (fentora), and sublingual tablets (abstral) are all formulations of what? | fentanyl |
| what opioid is widely used in obstetric and sometimes orthopedics? | meperidine |
| does meperidine have a short or long half-life? | short |
| meperidine poses a risk of what? | toxic metabolite accumulation |
| is is recommended that meperidine must not be used for longer than _____ | 48 hours |
| meperidine is occasionally used postop for what? | shivering |
| meperidine does not relax the uterine muscles like other opioids can. true or false? | true |
| methadone is used to treat pain, but is more commonly used for what? | opioid addiction |
| hydromorphone is also known as what? | dilaudid |
| why is hydromorphone being used more and more frequently? | its have tolerances to other pain management drugs |
| how are moderate to strong opioids different from morphine? | produce less analgesia and respiratory depression and have somewhat lower potential for abuse |
| _____ of codeine converts to morphine in the liver | 10% |
| codeine is used for what? | pain and cough suppression |
| codeine is a schedule _____ drug | 2 |
| codeine in cough syrup is a schedule _____ drug | 4 |
| how is codeine usually administered? | orally formulated with aspirin or acetaminophen |
| _____ of codeine produces the same effect as 325 mg of acetaminophen | 30 mg |
| oxycodone is similar to what? | codeine |
| what two formulations of oxycodone, or Percocet, are available? | immediate-release and controlled-release |
| what is the most widely prescribed drug int he US? | hydrocodone |
| hydrocodone is commonly combined with what? | aspirin, acetaminophen, or ibuprofen |
| you should take a patient's pain assessment before the drug is administered and _____ after it's administered | 1 hr |
| tramadol carries the risk of what? | suicide |
| cyclooxygenase inhibitors do what? | suppresses inflammation, relieves pain, and reduces fevers? |
| gastric ulceration, bleeding, and renal impairment are adverse effects of what? | cyclooxygenase inhibitors |
| aspirin, celecoxib, ibuprofen, and naproxen are all NSAIDs that have what? | anti-iflammatory properties |
| GI effects, bleeding, renal impairment, alicylism (tinnitus), Reye's syndrome (children), and pregancy are alll adverse effects of what? | aspirin |
| analgesic, antipyretic, anti-inflammatory, suppression of platelet aggregation, and cancer prevention (colorectal) are all therapeutic uses of what? | aspirin |
| when aspirin is given to women who are pregnant, it may cause what? | anemia, postpartum hemorrhage, and prolonged labor |
| _____ interacts with anticoagulants, glucocorticoids, alcohol, ibuprofen, ACE inhibitors, and ARBs | aspirin |
| ibuprofen, naproxen, indomethacin, and ketorolac are all what? | first-generation NSAIDs |
| second-generation NSAIDs have the advantage of what? | lower risk for GI side effects? |
| second-generation NSAids have the disadvantage of what? | increased risk for MI and stroke |
| _____ can be used to treat osteoarthritis, rheumatoid arthritis, acute pain, and dysmenorrhea | celecoxib |
| dyspepsia, abdominal pain, renal toxicity, sulfonamide allergy (contains allergy), cardiovascular impact, and use in pregnancy are all adverse effects of what? | celecoxib |
| celecoxib may decrease the diuretic effect of what? | furosemide |
| celecoxib may decrease the antihypertensive effect of what? | ACE inhibitors |
| celecoxib may increase levels of what? | lithium |
| levels of celecoxib may be increased by what? | fluconazole |
| celecoxib may negatively interact with what? | warfarin |
| _____ is primarily used as an analgesic and antipyretic, but it doesn't have any anti-inflammatory or anti-rheumatic actions and is not associated with Reye's syndrome | acetaminophen |
| acetaminophen inhibits _____ synthesis in the CNS | prostaglandin |
| acetaminophen can cause what? | hepatotoxicity |
| overdose of acetaminophen can cause what? | hepatic necrosis |
| what are the early signs and symptoms of overdose by acetaminophen? | nausea and vomiting, diarrhea, sweating, and abdominal pain |
| acetaminophen overdose is treated by what? | acetylcysteine |
| acetaminophen interacts with what? | alcohol and warfarin |
| two neuronal pathways cause the sensation of ____ (1) carries pain impulses from their site of origin in the brain (2) originates int he Brian, suppresses impulse conduction, and diminishes pain sensation | pain |
| pain impulses are initiated by activation of what different types of pain receptors? | mechanical, thermal, and chemical |
| the first neuron in the conduction of pain impulse carries impulses from the _____ to a synapse in the spinal cord (neurotransmitters). this action releases glutamate and substrate P | periphery |
| the second neuron in the conduction of pain impulses carries the impulse up the cord to a synapse in the _____ | thalamus |
| pain conduction is suppressed using an endogenous opioid compound, such as: | enkephalins and beta-endorphins |
| primary afferent fibers, small in diameter that are unmyelinated and slow conduction | c fibers |
| c fibers are _____- they respond to more than one type of noxious stimuli | polymodal |
| mechanical, thermal, and chemical pain receptors are what? | c fibers |
| diffuse, dull, boring, and aching pain are from what? | c fibers |
| primary afferent fibers in large diameter that are myelinated and fast conduction | a fibers |
| high-threshold mechanoreceptors that respond to mechanical stimuli over a certain intensity are what? | a fibers |
| what type of pain comes from a fibers? | well-localized, sharp, stinging, pricking |
Created by:
meaganherlein
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