Question 1

Management of Pain

Accepted Answer

Treat the cause.
• Select a safe analgesic.
• Select the analgesic that provides effective 
relief.
• Provide psychological support.
• Nursing actions:  position change
and back rub

Question 2

Management of Pain

Accepted Answer

• Need to check client’s/patient’s level of pain. 
Minimizing pain may lead to longer stay in the 
hospital.
Always assess client for pain and not to with hold 
analgesics needed by the client.

Question 3

Analgesics

Accepted Answer

• Analgesic drugs relieve pain without causing loss 
of consciousness.
• Mild to moderate pain like headache or muscle 
pain can be help with acetaminophen, ASA.
• More severe pain can be helped with opioids.
• Anti-inflammatory like ibuprofen (NSAID

Question 4

Uses for Opioid Analgesics

Accepted Answer

• Main use: to alleviate moderate to severe pain
• Opioids are also used for:
▫ Cough suppression, but not for nasal congestion
▫ Diarrhea treatment
The suppressant effect of these agents on the 
motility of the GI are used for the treatment of 
dia

Question 5

Opioid Analgesics – Morphine sulfate

Accepted Answer

• Morphine sulfate is a schedule II controlled 
substance.
• An effective treatment for ischemic chest pain 
or pain caused by acute myocardial infarction .
• It’s prescribed for pulmonary edema that 
accompanies cyanotic congenital heart defects.

Question 6

Opioid Analgesics – Morphine sulfate

Accepted Answer

It relieves pulmonary congestion and reduces 
myocardial oxygen requirements in the heart.
• Used to treat moderate-severe pain

Question 7

Effects of Opioid Analgesics

Accepted Answer

• Euphoria
• Nausea and vomiting
• Respiratory depression – patients with asthma 
are the highest risk
• Urinary retention
• Diaphoresis and flushing
• Pupil constriction (miosis)
• Constipation

Question 8

Complications of Opioid Analgesics

Accepted Answer

• Respiratory implications
• Constipation concerns
• Safe Nsg. Practice 10-4
• Some of the most common adverse effects:
1. orthostatic hypotension
2. Nausea and vomiting
3. constipation

Question 9

Opiates: Opioid Tolerance

Accepted Answer

• A common response to chronic opioid treatment
• Larger dose of opioids is required
• Opioid analgesic use also is associated with the 
development of tolerance and dependence.
• With continued long term use, tolerance 
develops rapidly to the eupho

Question 10

Opiates: Opioid Tolerance

Accepted Answer

Abstinence syndrome develops when the drug is 
abruptly discontinued.
• Body will develop signs and symptoms like 
sweating, restlessness and diarrhea.
• Symptoms associated with abstinence syndrome 
are generally more pronounced if high narcotic 
d

Question 11

Opiates: Physical Dependence

Accepted Answer

• Physiologic adaptation to the presence of an opioid
• If in need of pain relief, give the medication
• The pain should be treated before it becomes 
moderate to severe for the opioids to be most 
effective

Question 12

Opiates: Physical Dependence

Accepted Answer

• Post Operative Clients- Offer pain med the 1
st
24-48 
hrs. Don’t give opioids if the respiration is less than 
12/min.
• Its better to use a fentanyl patch for new post op 
that had undergone major surgery like explore 
laparotomy for the client

Question 13

Opiate Antagonists

Accepted Answer

• Naloxone (Narcan) and naltrexone (ReVia)
pure opioid antagonists and will rapidly 
produce withdrawal symptoms.
▫ Opiate antagonists
▫ Bind to opiate receptors and prevent a response
▫ Used for reversal of opioid-induced respiratory 
depression

Question 14

Opioid Analgesics

Accepted Answer

• PCA- Pt Controlled Analgesia gives patient to 
exercise control over analgesia administration.
• Table 10-6 – Popular Opioid Analgesic 
Combination Products
• Vicodin is a combination product that has a 
lower dose of opioid analgesic but achieves

Question 15

Opioid Analgesics

Accepted Answer

• All opioid analgesics used for epidural or 
intrathecal administration must be preservativefree to avoid nerve tissue damage.

Question 16

Placebos

Accepted Answer

• Placebos are being used to treat clients that has 
chronic pain.
• Placebos are generally used when there is no 
specific or particular treatment or medication 
for the clients pain or illness

Question 17

Placebos

Accepted Answer

• Placebos are sometimes used in clients who have 
not responded to other pain relief measures.
• It is also effective in beginning the self healing 
process.

Question 18

ASA: Side Effects

Accepted Answer

• Gastrointestinal irritation and bleeding
Client must take with food or antacid.
• Increases bleeding time
• Tinnitus  (ringing  in the ears)
• Children: Reye’s syndrome – Children with URI 
or chicken pox with elevated temperature must 
not be tre

Question 19

Other Analgesics

Accepted Answer

• Ergotamine tartrate (Ergostat) are used in 
treating migraine headaches.

Question 20

Other Analgesics

Accepted Answer

• Sumatriptan Succinate ( Imitrex) a new drug 
used to treat migraine headache. Clients using 
this drug must be monitored for hypertension 
and angina ( high blood pressure and chest 
pain).

Question 21

Risks of Injected Anesthetics

Accepted Answer

• Blood pressure changes
• Emergence delirium
• Malignant hyperthermia
Drug of choice is Dantrolene

Question 22

Presurgical Nursing Interventions
•

Accepted Answer

• Important to check vital signs before preanesthetic or 
anesthetic agents are given:
* Provides baseline to check for v/s during
and after procedure

Question 23

Presurgical Nursing Interventions

Accepted Answer

* Alert others for possible problems that 
could result from anesthetizing the client;
* Indicate health problems that might affect
whether or not the procedure will be 
carried out.

Question 24

Surgical Nursing Interventions

Accepted Answer

• Hearing is the last sense to disappear and the 1
st
to 
appear in an unconscious person;
• Swallowing reflex must come back prior to removing the 
airway;

Question 25

Surgical Nursing Interventions

Accepted Answer

• Clients that receive general anesthesia may develop 
hypotension due to the ff:
1. Depression of the vasomotor center of the brain
2. Loss of blood and body fluids
3. Opioid drugs given for relief of pain
• Dantrolene is the drug of choice to treat

Question 26

Post Surgical Nursing Interventions

Accepted Answer

• Clients who received ketamine hydrochloride 
(Ketalar)may have emergence reaction, including 
delirium,  hallucinations, confusion and 
excitement. To minimize, place clients  in a quiet
place and disturb as little as possible.

Question 27

Salicylates

Accepted Answer

•Do not give salicylates to children 
under age 12.
▫ Reye’s syndrome
•Give with food and milk.
Give the largest dose of ASA at 
bedtime to help decrease pain in 
the morning

Question 28

Client Education

Accepted Answer

• Educate clients about precautions.
• Watch for:
▫ Unusual bleeding, abdominal pain, and cardiac 
problems
• Enteric-coated tablets should not be crushed or 
chewed.
• Clients that require intra-articular injections 
often feel better  and may eng

Question 29

Client Education

Accepted Answer

• Clients that require intra-articular injections 
often feel better  and may engage in streneous
activities. 
• Clients must be informed that it is not curative 
and must not put much physical stress on the 
affected joint to cause further damage.

Question 30

Gout

Accepted Answer

• 90 % of primary gout found in men than in 
women.
• 25 % of all close relatives of persons with gout 
exhibit hyperuricemia.
• About 2.1 million individuals in the U.S. have gout
• Gout usually appears in the middle age.

Question 31

• Acute attacks of gout may be 
provoked by

Accepted Answer

by:
a. turkey
b. thiazide diuretics
c. penicillins

Question 32

Acute Attacks Treatments

Accepted Answer

• Acute attacks of gout are treated with:
▫ Nonsteroidal anti-inflammatory drugs 
(NSAIDs)
▫ Corticosteroids

Question 33

Acute Attacks Treatments

Accepted Answer

▫ Colchicine: intravenously or orally
▫ Colchicine is successful in relieving acute 
gouty attacks in about 90% of all clients 
and confirms diagnosis.

Question 34

Drugs used in the treatment of 
acute gout attack

Accepted Answer

•1. Colchicine
•2. Phenylbutazone
•3. Indomethacin

Question 35

Colchicine

Accepted Answer

• Major adverse effects:
▫ Nausea, vomiting, and diarrhea
▫ Gastrointestinal bleeding
▫ Neuritis
▫ Myopathy
▫ Alopecia
▫ Bone marrow depression

Question 36

Uricosuric Agents

Accepted Answer

• Clients  taking uricosuric agents like 
Probenecid ( Benemid)  or 
Sulfinpyrazone (Anturane)
should avoid aspirin and other salicylates
which could antagonize their uricosuric
effects.

Question	Answer
Management of Pain	Treat the cause. • Select a safe analgesic. • Select the analgesic that provides effective relief. • Provide psychological support. • Nursing actions: position change and back rub
Management of Pain	• Need to check client’s/patient’s level of pain. Minimizing pain may lead to longer stay in the hospital. Always assess client for pain and not to with hold analgesics needed by the client.
Analgesics	• Analgesic drugs relieve pain without causing loss of consciousness. • Mild to moderate pain like headache or muscle pain can be help with acetaminophen, ASA. • More severe pain can be helped with opioids. • Anti-inflammatory like ibuprofen (NSAID
Uses for Opioid Analgesics	• Main use: to alleviate moderate to severe pain • Opioids are also used for: ▫ Cough suppression, but not for nasal congestion ▫ Diarrhea treatment The suppressant effect of these agents on the motility of the GI are used for the treatment of dia
Opioid Analgesics – Morphine sulfate	• Morphine sulfate is a schedule II controlled substance. • An effective treatment for ischemic chest pain or pain caused by acute myocardial infarction . • It’s prescribed for pulmonary edema that accompanies cyanotic congenital heart defects.
Opioid Analgesics – Morphine sulfate	It relieves pulmonary congestion and reduces myocardial oxygen requirements in the heart. • Used to treat moderate-severe pain
Effects of Opioid Analgesics	• Euphoria • Nausea and vomiting • Respiratory depression – patients with asthma are the highest risk • Urinary retention • Diaphoresis and flushing • Pupil constriction (miosis) • Constipation
Complications of Opioid Analgesics	• Respiratory implications • Constipation concerns • Safe Nsg. Practice 10-4 • Some of the most common adverse effects: 1. orthostatic hypotension 2. Nausea and vomiting 3. constipation
Opiates: Opioid Tolerance	• A common response to chronic opioid treatment • Larger dose of opioids is required • Opioid analgesic use also is associated with the development of tolerance and dependence. • With continued long term use, tolerance develops rapidly to the eupho
Opiates: Opioid Tolerance	Abstinence syndrome develops when the drug is abruptly discontinued. • Body will develop signs and symptoms like sweating, restlessness and diarrhea. • Symptoms associated with abstinence syndrome are generally more pronounced if high narcotic d
Opiates: Physical Dependence	• Physiologic adaptation to the presence of an opioid • If in need of pain relief, give the medication • The pain should be treated before it becomes moderate to severe for the opioids to be most effective
Opiates: Physical Dependence	• Post Operative Clients- Offer pain med the 1 st 24-48 hrs. Don’t give opioids if the respiration is less than 12/min. • Its better to use a fentanyl patch for new post op that had undergone major surgery like explore laparotomy for the client
Opiate Antagonists	• Naloxone (Narcan) and naltrexone (ReVia) pure opioid antagonists and will rapidly produce withdrawal symptoms. ▫ Opiate antagonists ▫ Bind to opiate receptors and prevent a response ▫ Used for reversal of opioid-induced respiratory depression
Opioid Analgesics	• PCA- Pt Controlled Analgesia gives patient to exercise control over analgesia administration. • Table 10-6 – Popular Opioid Analgesic Combination Products • Vicodin is a combination product that has a lower dose of opioid analgesic but achieves
Opioid Analgesics	• All opioid analgesics used for epidural or intrathecal administration must be preservativefree to avoid nerve tissue damage.
Placebos	• Placebos are being used to treat clients that has chronic pain. • Placebos are generally used when there is no specific or particular treatment or medication for the clients pain or illness
Placebos	• Placebos are sometimes used in clients who have not responded to other pain relief measures. • It is also effective in beginning the self healing process.
ASA: Side Effects	• Gastrointestinal irritation and bleeding Client must take with food or antacid. • Increases bleeding time • Tinnitus (ringing in the ears) • Children: Reye’s syndrome – Children with URI or chicken pox with elevated temperature must not be tre
Other Analgesics	• Ergotamine tartrate (Ergostat) are used in treating migraine headaches.
Other Analgesics	• Sumatriptan Succinate ( Imitrex) a new drug used to treat migraine headache. Clients using this drug must be monitored for hypertension and angina ( high blood pressure and chest pain).
Risks of Injected Anesthetics	• Blood pressure changes • Emergence delirium • Malignant hyperthermia Drug of choice is Dantrolene
Presurgical Nursing Interventions •	• Important to check vital signs before preanesthetic or anesthetic agents are given: * Provides baseline to check for v/s during and after procedure
Presurgical Nursing Interventions	* Alert others for possible problems that could result from anesthetizing the client; * Indicate health problems that might affect whether or not the procedure will be carried out.
Surgical Nursing Interventions	• Hearing is the last sense to disappear and the 1 st to appear in an unconscious person; • Swallowing reflex must come back prior to removing the airway;
Surgical Nursing Interventions	• Clients that receive general anesthesia may develop hypotension due to the ff: 1. Depression of the vasomotor center of the brain 2. Loss of blood and body fluids 3. Opioid drugs given for relief of pain • Dantrolene is the drug of choice to treat
Post Surgical Nursing Interventions	• Clients who received ketamine hydrochloride (Ketalar)may have emergence reaction, including delirium, hallucinations, confusion and excitement. To minimize, place clients in a quiet place and disturb as little as possible.
Salicylates	•Do not give salicylates to children under age 12. ▫ Reye’s syndrome •Give with food and milk. Give the largest dose of ASA at bedtime to help decrease pain in the morning
Client Education	• Educate clients about precautions. • Watch for: ▫ Unusual bleeding, abdominal pain, and cardiac problems • Enteric-coated tablets should not be crushed or chewed. • Clients that require intra-articular injections often feel better and may eng
Client Education	• Clients that require intra-articular injections often feel better and may engage in streneous activities. • Clients must be informed that it is not curative and must not put much physical stress on the affected joint to cause further damage.
Gout	• 90 % of primary gout found in men than in women. • 25 % of all close relatives of persons with gout exhibit hyperuricemia. • About 2.1 million individuals in the U.S. have gout • Gout usually appears in the middle age.
• Acute attacks of gout may be provoked by	by: a. turkey b. thiazide diuretics c. penicillins
Acute Attacks Treatments	• Acute attacks of gout are treated with: ▫ Nonsteroidal anti-inflammatory drugs (NSAIDs) ▫ Corticosteroids
Acute Attacks Treatments	▫ Colchicine: intravenously or orally ▫ Colchicine is successful in relieving acute gouty attacks in about 90% of all clients and confirms diagnosis.
Drugs used in the treatment of acute gout attack	•1. Colchicine •2. Phenylbutazone •3. Indomethacin
Colchicine	• Major adverse effects: ▫ Nausea, vomiting, and diarrhea ▫ Gastrointestinal bleeding ▫ Neuritis ▫ Myopathy ▫ Alopecia ▫ Bone marrow depression
Uricosuric Agents	• Clients taking uricosuric agents like Probenecid ( Benemid) or Sulfinpyrazone (Anturane) should avoid aspirin and other salicylates which could antagonize their uricosuric effects.

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Pharmacology Day3