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pharm nctc unit 1
| Question | Answer |
|---|---|
| Somatic pain | originates from skeletal muscles, ligaments, or joints Usually relieved by NSAIDs |
| Visceral pain | originates from organs and smooth muscles Usually relieved with narcotics |
| Superficial pain | originates from skin or mucous membranes Usually relieved by narcotics |
| Acute pain | sudden onset, sharp and localized, has physiologic response, and usually subsides when treated (MI, appendicitis, surgery, dental procedures, kidney stones) |
| Chronic pain | slow onset, long duration (6 weeks or longer), dull, persistent aching that and recurs Can be very difficult to treat (arthritis, cancer, low back pain, peripheral neuropathy) |
| Vascular pain | originates in vasculature as in migraines |
| Referred pain | originates in organs and is felt in other area |
| Neuropathic pain | results from injury to peripheral nerves and is often present in the absence of disease or pathology |
| Phantom pain | occurs in a body part that has been amputated |
| Cancer pain | has many causes: hypoxia, pressure, metastasis, pathologic fractures, muscle spasms, side effects of radiation, surgery, chemotherapy |
| Psychogenic pain | pain not related to physical conditions or disorders |
| Central pain | results from any condition that yields CNS damage |
| Natural pain killers in the body | endogenous neurotransmitters Enkephalins and endorphins are released whenever the body experiences pain |
| “breakthrough” pain | needs treatment with short-acting forms on a regular schedule Baseline dose requires titrating upward |
| World Health Organization standards for pain management | · 3-step analgesic ladder should be utilized o Non-opioids +/- adjuvant meds o Opioids +/- non-opioids, +/- adjuvant meds o Opioids for moderate or sever pain +/- non-opioids, +/- adjuvant meds |
| OPIOID DRUGS | Relief of moderate to severe pain Provides balanced anesthesia (used in combination with anesthesia agents) Cough suppression Treatment of diarrhea |
| Opioid-tolerant | has received opioid drugs for log times and more likely to require higher dosages |
| Opioid tolerance | long-term exposure leads to diminution of the drug’s effects Leads to higher doses to maintain the same analgesic effect |
| Opioid side effects | All opioids have some histamine release which causes itching, rash, and hemodynamic changes Most serious side effect is respiratory depression GI effects are common (N/V and constipation are most common) |
| what is the reversal agent for opiates? | Naloxone hydrochloride (Narcan) |
| Tylenol overdose | hepatic necrosis in acute overdose Long-term overuse nephropathy Antidote is acetylcysteine 140 mg/kg followed by 70 mg/kg q4h X 17 doses All 17 doses must be given to prevent hepatotoxicity, regardless of subsequent acetaminophen serum levels |
| GENERAL ANESTHETICS | Produce unconsciousness and skeletal muscle relaxation for surgical procedures |
| LOCAL ANESTHETICS | render specific portions of the body insensitive to pain |
| Topical anesthetics | Applied directly to the skin and mucous membranes Available in creams, solutions, powders, gels, ointments, drops, and suppositories |
| Parenteral anesthetics | Administered by injection into the CNS or to areas adjacent to main nerves |
| Local anesthetics combined with vasoconstrictors | (epinephrine, phenylephrine, norepinephrine)help confine anesthetic drug and prevent systemic absorption |
| conscious sedation | Used for diagnostic and minor surgical procedures Usually includes benzodiazepine and opiate analgesic given IV Reduces anxiety, sensitivity to pain, and recall Preserves airway and ability to respond to verbal commands |
| malignant hyperthermia | a drastic and uncontrolled increase in skeletal muscle oxidative metabolism, which overwhelms the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature. |
| nursing diagnosis for a pt in surgery for 4 hours | Close monitoring of all body systems: especially ABCs and vital signs Monitor for elevated temperature during and after anesthesia as indication of malignant hyperthermia |
| when would you use a neuromuscular agent like pancurion | causes paralysis of resp tract for intubation and mechanical ventilation |
| What is the drug that will reverse Sucsocoline | Neostigmine |
| sedatives | Reduce nervousness, excitability, and irritability without causing sleep Can induce sleep if given in large enough doses |
| Hypnotics | Cause sleep Have more potent CNS effect than do sedatives |
| Pentobarbital | interact with other CNS depressants to increase the depressive effects Interaction with MAOIs will prolong the effects of the barbiturates |
| temazepam - why does it make you tired | It is a short acting hypnotic |
| what do you always try before drugs to help pt sleep | Uses nonpharmacologic measures for sleep routines,relaxation exercises etc... |
| treatment for an overdose of secobarbital? | maintain airway, assist respiration, administer O2 and maintain fluid and pressure support Immediate administration of activated charcoal to remove barbiturates from stomach and circulation for removal by GI tract alkalize urine |
| what is choral hydrate and why does it cause tachyphylaxis? | Tachyphylaxis (rapid appearance of progressive decrease in response to a substance after its repetitive administration) can develop quickly, so should be used for short-term only |
| review the things you would teach a pt going home on an antiepileptic drug | States: therapeutic effects, adverse effects, importance of taking drug as directed, dangers of abrupt discontinuation |
| drug of choice for treating statis epilepticus | Diazepam (Valium) |
| dilantin pt going to surgery NPO what do you do about the dose? | long half-life allows dosing bid |
| WHAT IS auto induction? | self cause |
| therapeutic index | range whereby a drug is therapeutic and yet not toxic |
| what happens if a pt suddenly stops taking their antisiezure meds? | Never withdraw drug abruptly or seizures will be induced |
| What happens with the cheese effect? | the brain gets voids like Swiss cheese |
| 27. What is the difference in plain L-dopa and L-dopa and carbido combination? | Levodopa and levodopa-carbidopa directly replace the deficient dopamine in the substantia nigra Used with carbidopa to manage the peripheral effects of the large doses |
| Why do you take antiparkinson drugs? what do you want to see happen over a 3-4 month period? | less tremors more ability to do ADL's Regains normal bowel and bladder patterns |
| Know how the drug Symmetrel works | Stimulates release of dopamine from the nerve endings to cause higher dopamine concentrations in the CNS |
| 30. What are common side effects of anticholinergic drugs? | S – salivation (dry mouth) L – lacrimation (dry eyes, dilated pupils) U – urination (urinary retention) D – diarrhea (constipation) G – increased GI motility (constipation) E – emesis |
| l dopa causes a harmless effect what is it. | Darkening of the urine |
| 32. what is the recommended route of hydroxizizine | po |
| 33. what is the common side effect of tricyclic antidepressants? | CV: tremors, tachycardia, orthostatic hypotension, dysrhythmias CNS: anxiety, confusion, extrapyramidal effects, sedation GI: nausea, constipation, dry mouth Other: blurred vision, urinary retention, weight gain, impotence |
| 34. What is ment by extrapyramidal symptoms? | symptoms of abnormal involuntary movements,alterations in muscle tone, and postural disturbances. |
| 35. what do patients on MAOI need to avoid? | aged mature cheese (cheddar, blue,smoked/pickled meats, fish, or poultry aged/fermented meats, fish, or poultry, yeast extracts, red wines (fava beans)Moderate tyramine content:(bouillon, consomme), pasteurized light beer, and ripe avocados |
| know the common side effects of Thorazine | orthostatic hypertension, drowsiness, sun sensitivty, darkening urine, |
| 37. what should pt on SSI's avoid that is over the counter? | Has potentially fatal interaction with MAOIs |
| 38. Why do we use CNS stimulants? | Act to elevate mood, increase energy and alertness, decrease appetite, enhance performance of tasks impaired by fatigue or boredom |
| 39. Who would you not give Caffeine to? | Contraindicated in patients who are known hypersensitivity Used with caution in persons with PUD, arrhythmias, or recent MI |
| Pt who are on drugs like Merida should avoid what else? | MAOIs |
| How do you dose Ritalin? | by results but need to wean off |
| What is a common side effect of No Doz? | stimulation of gastric secretions, diarrhea, reflex tachycardia, flushing, sweating, elevated respiratory rate, muscle tension and tremors, reduced DTRs |
| What is a common issue that you have to consider with children on Ritalin? | Main concern is possible toxicity characterized by agitation, confusion, delirium, seizures, and coma growth issues |
| Which pts should not use Imitrex? | Is contraindicated in patients with CAD, ischemic heart disease, Prizmetal’s angina, or uncontrolled hypertension Contraindicated with MAOIs, ergots, or other treptans |
| What is the action of Meridia? | Suppresses appetite control centers of the brain and action on various catecholamines |
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