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Pharmacology Test 3
Endocrine/Analgesics
| Question | Answer |
|---|---|
| morphine sulfate, meperidine HCl (Demerol) are classified as ____? | Opioid analgesics |
| ____ MOA is that it acts in the CNS to reduce pain. | morphine sulfate, meperidine HCl (Demerol) |
| What is used to treate moderate to severe pain? | morphine sulfate, meperidine HCl (Demerol) |
| What is the difference between psychologic dependence and physical dependence? What drug class is this related to? | psychologic dependence is the addiction-characterized by impaired control over drug use, compulsive use, continued use despite harm & craving. Physical dependence: state of physciologic adaptation that is manifested by withdrawl. Opioid analgesics |
| Withdrawal syndrome can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. What are the symptoms of withdrawl? | rebound pain, mental agitation, tachycardia, elevated blood pressure, and seizures. In severe cases, these symptoms can become life-threatening |
| ____ induced cardiovascular adverse effects are hypotension, palpitations, flushing | Opioid induced Adverse Cardiovascular effects |
| ___ Induced central nervous adverse effects are: sedation, disorientation, euphoria, lightheadedness, dysphoria, lowered seizure thershold, tremors | Opiod induced CNS Adverse Effects |
| ____ induced Gastrointestinal Adverse effects are N, V, constipation, biliary tract spasm | Opiod Induced Gastrointestinal Adverse Effects |
| ____ induced Genitourinary adverse effect is Urinary retention | Opioid Induced Genitourinary Adverse Effects |
| ____ induced integumentary adverse effect is itching, rash, wheal formation | Opioid induced integumentary adverse effects |
| ____ induced respiratory adverse effect is respiratory depression and aggravation of asthma | Opioid Induced respiratory adverse effects |
| Common side effects of ____ are histamine release, CNS depression, GI tract issues, and urinary retention | Opioid |
| T/F CNS depression can not lead to respiratory depression. | False CNS depression CAN lead to respiratory depression |
| What is opioid tolerance? | a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time. This often leads to the need for progressively higher dosages to maintain the same analgesic effect. |
| T/F Opioid tolerance is a problem for opiod addicted patients | True |
| T/F Meperidine HCl (Demerol) should be used with caution, if at all, in elderly patients & in patients who require long-term analgesia or who have kidney dysfunction | True |
| Use of _____ is contraindicated in patients showing a hypersensitivity to it and in patients currently or recently treated with MAOIs. | Meperidine HCl (Demerol) |
| What happens when you take opioids with other CNS depressants? | Coadministration of opioids with alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine, and other CNS depressants can result in additive respiratory depressant effects. |
| acetaminophen (Tylenol) is classified as a ____? | Nonopioid Analgesic (Nonnarcotics) |
| MOA of ____: inhibits prostaglandin synthesis. | acetaminophen (Tylenol) |
| What does inhibiting prostaglandin synthesis mean? | it blocks peripheral pain impulses. |
| _____ is a hormone that causes inflammation, aggregation of platelets, constrict smooth muslce, etc. | Prostaglandin |
| ______ lowers febrile body temperatures by acting on the hypothalamus, the structure in the brain that regulates body temp. Heat is dissipated through resulting vasodilation & increased peripheral blood flow. | Acetaminophen (Tylenol) |
| _____ is both an analgesic and antipyretic | Acetaminophen (Tyleonl) |
| What does antipyretic mean? | drugs that lower a raised body temperature |
| ____ is a mild to moderate pain and fever reliever | acetaminophen (Tylenol) |
| T/F Acetaminophen (Tylenol) is realtive harmful when taken as directed? | False Acetaminophen (Tylenol) is relatively SAFE when taken as directed |
| Acute overdose of acetaminophen (Tylenol) can cause _____? | hepatic necrosis |
| Long-term ingestion of large doses of acetaminophen (Tylenol) can cause _____ | nephropathy |
| What is the standard maximum daily dose of acetaminophen (Tylenol) for healthy adults? | 4000 mg per day or 4 g/day |
| What is the recommended antidote for acetaminophen (Tylenol) toxicity? | Acetylcysteine works by preventing the hepatotoxic metabolites of acetaminophen (Tylenol) from forming |
| How many doses of Acetylcysteine must be given as the antidote for Tylenol toxicity? | intial dose of 140mg/kg orally, followed by 70 mg/kg every 4 hrs for 17 additional doses. If pt vomits w/in 1hr after receving dose it should be given again immediately. All 17 doses must be given to prevent hepatotoxicity. |
| T/F All 17 doses of Acetylcysteine (antidote for Tylenol toxicity) must be given to prevent hepatotoxicity, REGARDLESS of the subsequent acetaminophen serum levels. | TRUE |
| The interactions of acetaminophen (Tylenol) and ____ is potentially the most dangerous? Why? | Alcohol is potentially the most dangerous because of liver toxicity from excessive use. |
| The dose given orally for Morphine is____? Intramuscular? | Oral 30 mg and Intramuscular 10 |
| Meperidine is given intramuscular and orally. What are the normal doses given in each? | Intramuscular 75mg and Orally 300mg |
| If you had been giving 10mg of morphine IM, how much would you give PO? | 30mg |
| NSAIDs stands for? | nonsteroidal anti-inflammatory drugs |
| ____ have an analgesic, anti-inflammatory, antirheumatic, and antipyretic activity | NSAIDs |
| Pain, headache, fever, and inflammation are symptoms of the activation of the _____ pathwway. | arachidonic acid pathway |
| celecoxib (Celebrex) is classified as what type of drug? | Antiinflammatory Agents (NSAIDs) |
| _____ MOA: inhibits the arachidonic acid pathways | celecoxib (Celebrex) |
| ___ is used when there is a strong risk factors for developing coronary artery disease or stroke. | celecoxib (Celebrex) |
| ___ is used to treat the pain associated with headache, neuralgia, myalgia, and arthralgia, as well as other pain syndromes resulting from inflammation. | celecoxib (Celebrex) |
| ____ treats arthritis, pleurisy, and pericarditis as well as Pt with systemic lupus erythematosus my benefit from aspirin therapy because of its antirheumatic affect. | celecoxib (Celebrex) |
| In general, NSAIDs can cause ____ and _____. | GI distress and bleeding |
| colchicine is classified as what type of drug? | Antiinflammatory Agents (Antigout) |
| Colchicine reduce the inflammatory response to what? | reducing the inflammatory response to the deposits of urate crystals in joint tissue. Possibly due to that it inhibits polymorphonuclear leukocyte metabolism, mobility, and chemotaxis |
| ____ is used to treat Acute attacks of Gout. | colchicine |
| One of the side effects of colchicine is Short-term leukopenia. Why? | powerful inhibitor of cell mitosis |
| An adverse effect of colchicine is bleeding. Where? | GI and GU |
| Renal failure is an adverse effect of _____? | colchicine |
| sulfaslazine (Azulfidine) is classified as what drug class? | Antiinflammatory Agents (Antirheumatoid) |
| ____MOA: inhibit the movement of various cells into inflammed joints. | sulfasalazine (Azulfidine) |
| ____ treats rheumatoid arthritis and it is important to know that these drugs are referrred to as disease-modifying antirheumatic drugs (DMARDs)-they actually prevent the progression of the disease. | sulfasalazine (Azulfidine) durg class: Antiinflammatory Agents (Antirheumatoid) |
| Encourage patients to take ____ with food, milk, or an antacid to prevent/decrease GI irritation | NSAIDs |
| ____ is one of the more common reasons for patients to seek out the care of a physician and leads to some 70 million office visits annually in the US. | Pain |
| ____ is whatever the patient says it is, and it exists whenever he or she says it does. | Pain |
| ____ originated from the opium plant? | Opioid Analgesics |
| ___ are very strong pain relievers. Also used for post-op, cancer, and severe pain. | Opioid Analgesics |
| N/V, Constipation/retention, respiratory depression are adverse effects of ____? | Opioid Analgesics |
| Abuse of opioid analgesics leads to ______ | euphoria |
| With ____ it can lead to dependence and/or tolerance. | Opioid Analgesics |
| ____ bind to ____ receptors in the brain to relieve pain. The three receptors that are most responsive to medication are kappa, delta, and mu. | Opioids; opioid |
| Morphine can be given how? | SC, PO, IV, IM, PR, epidural |
| ____ has an immediate release or a continuous release (MS contin) forms. | Morphine Sulfate |
| ____ should be used with caution - normeperidine is a metabolite that can accumulate and lead to seizures | mederidine HCl (Demerol) |
| _____ are notorious for causing constipation. However, the most serious side effect of ____ is CNS depression, which may lead to ______? | Opioids, Opioids, Respiratory Depression |
| Some of the side effects of ____ are CNS depression, constipation, urinary retention, itching, rash. | Opioids |
| Remember that the effects of ____ are short-lived (1 hour), therefore you may have to REDOSE when using long-acting opioids. It is also the antidote for opioids and is given IV, IM, and SQ. | naloxone (Narcan) |
| Nonopoiod analgesics include ____ and _____. Which is the most widely used nonopioid analgesic? | NSAIDS and Acetaminophen. Acetaminophen is the omst widely used |
| Overdose of this drug can lead to Acute-liver and Chronic kidney failure. | acetaminophen (Tylenol) |
| 18 doses of this drug ___ leads to an overdose. (HINT 4grams) | acetaminophen (Tylenol) |
| ____ have an adverse effects secondary to inactivation of prostaglandins and it accounts for > 5% of all prescriptions. | NSAIDS |
| Do you remember the arachidonic acid pathway? | Arachidonic acid is released in response to injury, Metabolized by PG (prostaglandin) or LT (leukotriene) pathway; results in inflammation |
| What do prostaglandins do? | Transmit pain; increase blood flow to kidneys; protect the lining of the stomach; dilate small vessels leading to inflammation |
| Is a Cox-2 inhibitor; OA, RA, primary dysmenorrhea, there is a controversy with Vioxx and Bextra; and have an increase risk of MI, CVA with this drug? | Celecoxib (Celebrex) |
| Because ____ inhibit prostaglandins (remember that prostaglandins help maintain the normal integrity of the stomach lining), this sets up the perfect environment for heartburn, GI ulceration, & GI bleeding. | NSAIDS |
| The kidneys rely on ____ to stimulate vasodilation and increase renal blood flow. So, if this is blocked....it can precipitate acute or chronic renal failure. Geriatric patients are at greater risk for this. ____ inhibits platelet aggregation. | Kidneys rely on prostaglandins and NSAIDs inhibit platelet aggregation --they also prolong bleeding |
| Patient Teaching: Take ___ with food, milk, or an antacid to prevent GI irritation. | NSAIDs |
| ____ results form inappropriate uric acid metabolism; Uric acid crystals build up in tissues and joint spaces. | Antigout |
| ___ reduces the inflammatory response to the deposits of urate crystals-doesn't effect urinary excretion of uric acid an has no analgesic effect. | Colchicine |
| The Adverse effects of ____ are short-term leukopenia (inhibits cell mitosis), GI/GU bleeding, and renal failure. It is used for acute attacks only. | Colchicine |
| ____ is chronic, destructive, deforming, collagen diseasee...Symmetric inflammation of synovium.....Autoimmune component. | Antirheumatoid |
| DMARDs stands for? | Disease-Modifying Antirheumatic Drugs |
| ____ drug prevents the accumulation of inflammatory cells in diseased joint--so it prevents progression of disease. Also used for colitis. It is also a DMARDs drug. | sulfasalazine (Azulfidine) |
| T/F Morphine-pancreatitis's/pain when you give it comes in different concentrations (possible drug calc on test). If you don't give all of the med you have to waste it with another RN present as a witness? | True |
| After giving an Opioid when do you check the patient after an IV and Orally? | IV-30 mins and Oral-1hr Both you are checking for respiratory distress and pain |
| ____ is a depressed breathing less than 20 and groggy? | Respiratory distress. |
| What do you do to help prevent constipation? | walk pt, increase fluids, and diet (fiber) |
| What can break down mucus and smells like rotten eggs? You want to give it with juice. Teach pt not to take on an empthy stomach and driving is not a good idea. | Acetylcysteine-antidote for acetaminophen toxicity |
| T/F colchicine does not decrease the amount of urate crystals? | True |
| ____ results from an increased amount of uric acid crystals build up in tissues & joint spaces. Usually built up in the big toe. | Gout |
| With what disorder do you ask are they alcoholics, eat alot of red meats, and do you eat organ based meats? | Gout. The meat is because they do not metabolize it very well, which leads to uric acid crystals build up. |
| ____ decreases the level of uric acid | alapuridol |
| T/F DMARDs CAN NEVER CURE IT, JUST PREVENT THE PROGRESSION of the disease? | True |
| ____ is not symmetric inflammation. | Ostioarthritis |
Created by:
cgwayland
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