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Chapter 19: Opiate
| Question | Answer |
|---|---|
| how do Nociceptive pain occur? | due to the proper functioning of neural equipment |
| what elements cause the sensation of pain? | Nociceptive pain |
| for nociceptive pain, what does it stimulate? | peripheral nerves |
| where is the recognition of pain in Nociceptive pain? | CNS |
| What do nociceptors do? | respond to tissue injury and painful stimuli |
| types of pain management: | - opioid analgesics - nonopioid analgesics |
| what are some characteristics of pain? | - pain duration can either be acute or chronic |
| what can peripheral sensitization lead to? | patients to perceive normal stimuli as painful |
| what are some types of opioids? | analgesia, sedation, cough and diarrhea suppression |
| opioids are considered first-line therapy for: | - pain associated with procedures - pain due to trauma or cancer - visceral pain |
| why are opioids used? | to relieve acute or chronic pain |
| what do opioids suppress/treat? | suppress cough and treat diarrhea |
| what are opioids? | any molecule that acts on the opioid receptors |
| what are some sources of opioids? | - naturally occurring opiates - synthetic chemicals |
| what are some naturally occurring opiates? | - Morphine and codeine - Hydrocodone, hydromorphone, oxycodone, and oxymorphone |
| what drug is considered synthetic chemicals? | Fentanyl |
| t or f: Tolerance develops to all opioids | true |
| t or f: physical dependence results form long-term daily use | true |
| what are centrally acting analgesics and federally restricted (controlled) substances? | Opioid |
| Endogenous opioid peptides include: | endorphin, enkephlin, dynorphin, nociceptin, and nociststin |
| where do opioid analegsics act selectively? | within the CNS to reduce pain |
| t or f: do not impair the functions of the peripheral nerves | true |
| what are opioid receptors (G-protein receptors)? | - Mu - Mu1 and Mu2 - Kappa - Delta |
| what do each of the endogenous opioid peptides have? | they have a preference for one of the opioid receptors |
| t or f: endogenous opioid peptides may interact with multiple opioid receptors | true |
| what do opioid receptor agonists bind to? | to opioid receptors and mimic the effects of the endogenous opioid peptides |
| what kind of receptors do opioid receptor agonists interact with? | mu and kappa receptors |
| what do opioid receptor agonists inhibit? | neurotransmitter release and nociceptor signals |
| what do opioid receptor agonists reduce/alter? | reduce nerve excitability and alter pain perception |
| what do pure (mu) agonists do? | binds to receptors and produce a response |
| what do partial agonists do? | initiate kappa receptors and partially block mu receptors |
| what do opioid receptor antagonists bind to? | bind to receptors to prevent agonist from binding |
| what do opioid receptor antagonists reverse? | the mu effects of opioids |
| where is the distribution of opioid receptors? | widely distributed outside the CNS |
| what do endogenous peptides do? | modify pain perception and mood |
| what do endogenous peptides regulate? | cardiovascular, respiratory and endocrine function |
| what are the side effects of endogenous peptides? | sedation, euphoria, dysphoria, miosis, constipation, urinary retention, and respiratory depression |
| what are nonanalgesic opioid effects on cardiovascular system? | - opioids do not depress cardiac function - help relieve pain during myocardial infarction - bradycardia and hypo-tension may occur |
| what are nonanalgesic opioid effects on the CNS? | - mood - nausea and vomiting - respiratory depression - miosis |
| what are nonanalgesic opioid effects on smooth muscles (gastrointestinal tract)? | - intermittent muscle contractions or spasms - constipation |
| what are nonanalgesic opioid effects on smooth muscle (bile duct)? | - increased pressure in the gall bladder |
| what are nonanalgesic opioid effects on bronchial tissue? | - spasmogenic action on bronchial smooth muscle - constriction of bronchioles |
| what are nonanalgesic opioid effects on antidiuretic effect? | - decreased urination and urine formation |
| how are opioids available in preparations? | in oral and parenteral preparations |
| what is parenteral? | The injection or introduction of substances into the body (the vein) by any route other than the digestive tract. |
| how long do opioids that are administered oral and parenteral preparations would be scheduled? | administered on a repeated schedule to avoid intense pain |
| what factors determine selection and dosage levels of opioids that are available in oral and parenteral prep? | - intensity and type of pain - tolerance and physical dependence levels |
| what does PCA mean? | patient controlled analgesia |
| t or f: dosing is often not under patient control | false |
| when dosing is under patient control, what does it allow? | allows the use o the lowest effective dose of opioid before the intensity becomes unbearable |
| what types of patient controlled analgesia (PCA) are there? | nasal spray, lozenges, and patches |
| where in the body are drugs absorbed? | in the intestines |
| when drugs are absorbed in the intestines, how are they metabolized? | by the hepatic drug microsomal metabolizing system to produce analgesia |
| when drugs are absorbed in the intestines, where are they excreted? | through the kidneys |
| tubular re-absorption of opioids increases: | - concentration of drug in the blood - risk of developing drug toxicity |
| adverse effects of opioids include: | - mental confusion - somnolence - nausea and vomiting - dry mouth - constipation - urinary retention - respiratory or cardiovascular depression |
| what do opioid-induced histamine release produce? | produce hypo-tension and allergic reactions |
| what will most opioids have in their instructions for use? | black box warnings (cautions and contraindictions) |
| What are black box warnings? | Concise summaries of adverse effects of concern in a box surrounded by a thick black line. |
| t or f: opioids should be given in place of nonopioid analgesics | false |
| patients with these health issues should not be given opioids: | acute bronchial asthma, heavy pulmonary secretions, or respiratory depression, convulsion disorders, biliary obstruction, or head injuries |
| when should the use of opioids be minimized? | during pregnancy |
| what did the FDA approve in September 2018? | the Opioid Analgesic REMS program |
| what do you do in the Opioid Analgesic REMS program? | requires all health-care professionals involved in pain management to be properly educated and trained in the us of all opioid analgesics |
| what is the goal in the Opioid Analgesic REMS program? | to ensure proper products are being selected, used and monitored appropriately |
| what is the long term goal of the Opioid Analgesic REMS program? | to help stifle the current opioid crisis |
| what occurs in drug interactions? | opioid analgesics potentiate the effects of CNS depressants |
| what medications should not be given with MAO inhibitor? | Meperidine and Dextromethorphan |
| what medications cause withdrawal symptoms when administered with methadone? | Rifampin and Phenytoin |
| what may result when mixing parenteral solutions? | drug inactivation |
| when does tolerance develop for drug use? | develops due to changes in the opioid receptors |
| what can tolerance of drug use be towards as a beneficial response? | sedation, drowsiness, or respiratory depression |
| what type of tolerance is not beneficial to the patient? | analgesic tolerance |
| what is relative to the patient's condition and the specific opioid? | cross-tolerance |
| how does physical dependence develop? | develops with the chronic use of opioids |
| what is the treatment of physical dependence? | controlled gradual tapering of the medication |
| how should you remove physical dependence from patients to avoid withdrawal? | remove form patients slowly if not they will go through withdrawal |
| what is addiction? | complex interaction of factors that leads to lack of control over drug use |
| when it comes to addiction, what should be avoided? | withdrawal |
| what drug helps with not producing severe withdrawal symptoms? | Methadone |
| what drug is used to manage opiate addiction? | Levomethadyl acetate |
| what drug helps block the attachment of opioids to receptors? | Buprenorphine |
| is Buprenorphine an agonist or antagonist? | both |
| what are opioid antagonists? | drugs that attach to opioid receptors |
| t or f: displace the analgesic and rapidly reverse respiratory depression | true |
| competitive blocking drugs: | pure |
| what do partial receptors produce? | produce respiratory depression in normal individuals |
| what do partial receptors reverse? | reverse respiratory depression in case of acute opioid poisoning |
| what is the preferred drug for treatment of acute opioid poisoning? | naloxone |
| what is an antagonist treatment for constipation for? | Methylnaltrexone bromide |
| what do Antitussives do? | suppress cough reflexes at therapeutic doses |
| what type of Antitussives are there? | - codeine - hydrocodone - dextromethorphan |
| what are considered cough suppression 2 (opioid antitussives) | combined with agents in order to relieve other cold symptoms |
| what do expectorants do? | alter the volume and viscosity of mucus |
| what do sympathomimetic amines produce? | nasal decongestion |
| what do antihistamines do? | decrease mucus secretions |
| what does alcohol act as? | CNS depressant |
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naf22108
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