Pharmacology Chapter 10-16
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| show | massage, accupuncture, theraputic touch, spirituality, relaxation techniques, imagery
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| show | opioid analgesics--commonly used for moderate to severe pain. NSAIDS (non-steroidal antiinflammatory drugs)--the next most common analgesic class.
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| show | either actual or potential tissue damage
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| show | physical, psychologic, and emotional
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| show | It must be individualized to include: the cause of the pain if known, the existing concurrent medical conditions, the characteristics of the pain, and the psychological and cultural characteristics of the pt.
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| show | The number of mu (special character pg 137) receptors in the dorsal horn. This number is controlled by the opioid receptor gene.
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| What characteristics come into play with regard to how a patient will respond to pain? | show 🗑
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| show | postoperative pain, myocardial infarction, appedicitis, dental procedures, kidneystones, surgical procedures
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| Opioids are known to relieve what types of pain? | show 🗑
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| show | nonopioid analgesics
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| Pain by culture: African American | show 🗑
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| Pain by culture: Hispanic Americans | show 🗑
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| show | many are reluctant to express pain
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| Pain by culture: Native Americans | show 🗑
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| show | Anger, anxiety, depression, discomfort, fear, isolation, chronic pain, sleeplessness, and tiredness
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| show | Diversion, empathy, rest, sympathy, medications (analgesics, antianxiety drugs, antidepressants)
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| Examples of chronic pain? | show 🗑
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| show | EX: migraine headaches Tx: Opioids
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| Referred Pain: EX and Tx? | show 🗑
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| Diabetes is associated with which type of pain? | show 🗑
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| Cancer pain tx? | show 🗑
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| What are examples of conditions that cause damage to the CNS that would result in central pain? | show 🗑
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| What substances do tissues release when injured (that some pain meds work by altering the actions and levels of)? | show 🗑
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| What are the 2 basic types of nerve fibers? | show 🗑
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| show | Large, has myelin sheath, fast conduction, and sharp, well-localized pain
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| What are the characteristics of C fibers? | show 🗑
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| The activation of A fibers does what? | show 🗑
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| C fiber stimulation does what? | show 🗑
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| What are considerred to be the body's painkillers? | show 🗑
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| What is responsible for a runner's high? | show 🗑
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| show | A fibers are stimulated, the gate is closed. Recognition of pain impulses from small fibers is reduced. This is the same pathway used by the opioid analgesics to alleviate pain.
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| The gate works at what level? | show 🗑
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| Where is "the gate" located? | show 🗑
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| The brain does what in relation to the "gate"? | show 🗑
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| show | The cells that control the gate
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| What types of chronic pain patients sometimes experience crises periods of acute pain? | show 🗑
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| show | A holistic clinical approach. Including opioid or nonopioid drugs (or both), and nonpharmacologic tx's like: electric nerve stimmulation, massage, medication, biofeedback, relaxation therapy, and psychologic counseling
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| show | b/c of risk for infection
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| What is important with pain from malignancies? | show 🗑
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| show | constipation, nausea, vomiting, sedation and mental clouding, respiratory depression
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| show | 1. use nonopioids (with or without adjuvants) 2. use opioids (with or without non-opioids & with or without adjuvants) 3. use opioids indicated for moderate to severe pain (with or without non-opioids & with or without adjuvants)
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| show | codeine, hydrocodone, propoxyphene
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| strong agonists? | show 🗑
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| Narcotics | show 🗑
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| What is the analgesic ceiling effect? | show 🗑
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| What are the opioid analgesics? | show 🗑
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| What are the 3 opioid analgesics based on structure? | show 🗑
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| What are the 3 classifications of opioid analgesics based on action? | show 🗑
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| show | using a combination of drugs rather than a single drug to produce anesthesia
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| What are some indications for the use of opioid analgesics? | show 🗑
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| show | Known drug allergy, severe asthma or other respiratory insufficiency, elevated intracranial pressure, and pregnancy
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| show | euphoria, CNS depression, N+V, urinary retention, diaphoresis and flushing, pupil constriction (miosis), constipation, itching (AKA puritis)
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| show | Naloxone (Narcan)--drug of choice for resp. depression. Lasts for 1 hour redose as needed. It reverses respiratory depression and pain control. Naltrexone (Revia)--an adjunct for maintenance of opioid free state in addicts.
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| What are signs of opioid abuse? | show 🗑
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| show | anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, constipation, diarrhea
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| show | Additional CNS depression with the use of: ETOH, antihistamines, barbituates, benzo's, and other CNS depressants (MAOI's). Opioids should not be taken with other hepatotoxic drugs
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| What is the most widely used nonopioid analgesic? | show 🗑
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| What are some example of opioid/acetaminophen combinations? | show 🗑
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| show | analgesic and antipyretic. Little to no antiinflammatory effects. Similar to salicylates (ASA). Blocks pain impulses peripherally by inhibiting prostaglandin synthesis.
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| What are the indicationsfor aceteminohen? | show 🗑
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| What is recommended for the overdose of Aceteminophen? | show 🗑
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| Max acetaminophen dose for healthy adults | show 🗑
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| show | by inhibiting prostaglandin synthesis
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| What are some examples of NSAIDS? | show 🗑
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| what is a broad syndrome of CNS function where there is excessive discharges from the cerebral cortex? | show 🗑
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| what is the reason people become primary epileptics? | show 🗑
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| what is a substance or procedure that prevents or reduces the severity of epileptic of other convulsive seizures? | show 🗑
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| what is a metabolic process that occurs when a drug increases its own metabolism over time, leading to lower drug cocncentrations? | show 🗑
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| show | narrow theraputic index (NTI) drugs
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| show | A seizure
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| what is an involuntary spasmodic contraction of any or all voluntary muscles through out the body? | show 🗑
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| show | trauma, infections, CV disorders, brain tumors, etc.
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| what term means stiffening? | show 🗑
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| show | Clonic
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| show | status epilepticus
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| show | Valium (or Ativan) Valium lasts longer
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| what type of seizure has no impaired consciousness, hallucinations, personality changes and Autonomic NS responses? | show 🗑
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| what type of seizure is most often seen in children, and has a temporary lapse in consciousness, often seems to be staring off into space, or daydreaming? | show 🗑
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| What type of seizure has impaired consciousness, memory impairment, behavioral effects, and either tonic, clonic, or both types of convulsions? | show 🗑
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| how long will a person need to be on AED (antiepileptic drugs) typically? | show 🗑
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| with Carbamazepine (tegretol) what type of drugs can have adverse interactions? | show 🗑
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| What is the first line agent drug of choice to keep a person from having seizures? | show 🗑
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| what are some second line agents, those used if the PT doesn’t respond well to 1st line agents? | show 🗑
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| which AED was the prototype, is the initial drug of choice, and should not be switched from generic to trade names? | show 🗑
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| show | Dilantin
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| show | take meds same time each day, do not crush or chew meds, keep a seizure journal
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| show | they are all teratogenic
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| show | dizziness, somnolence, drowsiness, eye problems, and fever
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| show | Parkinson's Disease
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| show | Dopamine producing neurons, causing an imbalance between dopamine and acetylcholine
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| What does dopamine control? | show 🗑
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| what test can indicate abnormalities within the brain for Parkinson's PT's? | show 🗑
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| what are some classic PD symptoms? | show 🗑
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| what type of drug blocks or impedes he activity of the neurotransmitter Ach at the cholinergic receptors of the brain? | show 🗑
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| what is characterized by involuntary, purposeless, rapid moventmts? | show 🗑
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| what is the impaired or distorted voluntary movement due to a disorder in muscle tone? | show 🗑
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| what is the impaired ability to execute voluntary movements? | show 🗑
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| show | when there is to much dopamine- causes rapid spasmodic involuntary movements
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| show | Anticholinrgic , Antihistamines, and Dopamine-receptor agents and indirect acting dopamine-receptor agonists
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| show | Levodopa
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| what are some side effects of large doses of levadopa? | show 🗑
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| show | levadopa/carbidopa (Sinemet)- the mainstay of therapy
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| What Selective MAOl therapy may delay the development of serious debilitating PD for 9-18 yrs? | show 🗑
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| Which drugs work by blocking acetylcholine for PD Pt's? | show 🗑
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| show | urinary retention, NV, constipation, disorientation, dry mouth
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| What are some S/S for PD? | show 🗑
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| What are some important PT teachings for PD patients? | show 🗑
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| What is a down fall of drug holidays? | show 🗑
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| what are some contraindications for PD meds? | show 🗑
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| show | several weeks to a few months
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| What is used when a Pt's condition does not respond adequately to a single drug, or when given combos are know to have more theraputic benefits? | show 🗑
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| show | affective disorders
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| show | akathisia
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| what is the unpleasent state of mind in which real or imagines dangers are anticipated and or exaggerated state of fear? | show 🗑
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| show | anxiolytic
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| show | benzodiazepine
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| show | depression
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| what are symptoms that arise adjacent to the pyrimidal portions to the brain? | show 🗑
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| what are the heterogeneous groups of drugs that are used primairly in the treatment od depression? | show 🗑
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| show | psychosis
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| show | psychotherapeutics
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| what is the group of drugs most commonly perscribed as a psychotherapeutic? | show 🗑
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| what racial group has a lower activity of drug metabolism b/c of various enzyme deficiencies? | show 🗑
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| what two groups of people have poor "mephenytoin pathways"? | show 🗑
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| which group of people respond better to prozac and desipramine for anxiety and depression? | show 🗑
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| this states that mental disorders are associated with abnorma levels of endogenous (produced by the body) chemicals, like neurotransmitters with in the brain? | show 🗑
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| show | BuSpar (buspirone)
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| what are some common benzodiazepine anxiolytics? | show 🗑
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| show | in the lowest effective dosage, and prn for symptomatic control
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| show | Flumazenil (Romazicon)
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| What are some uses for Valium (diazepam)? | show 🗑
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| show | 5mg/ min (1mL/ min)
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| show | anxiety, pre-op sedation, push at 2mg/min
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| show | lithium - push at 0.6-1.2 mEq/L
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| show | depression = decreased seratonin and norepinephrine
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| show | mania = increased norepinephrine, decreased seratonin
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| show | depression = deficiency of neural and synaptic catecholamines. Mania= excess catecholamines
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| show | depression and other affective disorders
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| how long until antidepressants take affect? | show 🗑
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| show | serotonin-selective reuptake inhibitors (SSRIs) and serotonon/norepiephrine reuptake inhibitors (SNRIs)
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| what two types of drugs are superior to the first line drugs of antidepression b/c of no effects on the cardiovascular system and low side effects? | show 🗑
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| show | prozac (fluoxetine), zoloft, paxil, celexa, Cymbalta (duloxetine)
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| show | they inhibit serotonin and norepinephrine reuptake causeing increased seratonin
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| what are some side effects of second generation antidepressants? | show 🗑
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| how do tricyclic antidepressants work? | show 🗑
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| show | Elavin (amitriptyline), endep, sinequan
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| what happens with tricyclic overdoses? | show 🗑
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| show | st. john's wort
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| what should be avoided with MAOIs? | show 🗑
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| show | hypetensive crisis- which can lead to CVA, coma, or death
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| show | at least 2-5 weeks as a "wash-out" period
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| show | Risperdal, zyprexa, and seroquel
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| what drug is commonly used for bipolar disorder? | show 🗑
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| show | they block specific dopamine receptors
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| how long will it take before a pt will feel the therapeutic effects of antidepressants? | show 🗑
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| what can decrease the effectiveness of medication therapy? | show 🗑
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| what are some side effects of HalDol? | show 🗑
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| show | at least 3 weeks
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| 1. What are drugs that stimulate a specific area of the brain or spinal cord? | show 🗑
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| 2. Stimulants are sympathomimetic agents that do what? | show 🗑
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| show | Elevate mood, produce increased energy and alertness, decrease appetite, enhance tasks
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| 4. What are the 5 uses for CNS Stimulants? | show 🗑
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| show | Reversal of anesthesia induced respiratory depression
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| 6. Why are stimulants used for anorexiants? | show 🗑
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| show | ADHD
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| show | Stimulate the areas in the brain responsible for mental alertness and attentiveness
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| 9. What is it called when some someone has abnormal sleeping during normal activity? | show 🗑
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| show | Cataplexy
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| 11. What are some common side effects of stimulants? | show 🗑
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| show | Attention Deficit Disorder without the hyperactivity
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| show | Amphetamine (Adderall), Methylphenidate (Ritalin, Methylin), Dextroamphetamine (Dexadrine), Dexmethyphenidate (Focalin)
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| show | Schedule II, and are highly controlled and potentially abused
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| 15. What does SNRI stand for? | show 🗑
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| 16. What are some SNRI drugs used? | show 🗑
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| 17. What drug is a wake promoting nonamphetamine that is the only medication approved to treat narcolepsy and is considered a controlled Schedule IV? | show 🗑
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| 18. What risks are increased in an obesity person? | show 🗑
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| 19. What anorexiant stimulant is used to treat obesity is a schedule IV controlled, and may cause elevated BP and pulse? | show 🗑
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| 20. Which medication is similar to stimulant; Schedule IV controlled, inhibits reuptake of NE and Serotonin? | show 🗑
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| 21. What are common side effects caused by Sibutramine monohydrate (Meridia)? | show 🗑
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| 22. What nonstimulant Anorexant blocks absorption of fat from GI tract; does not suppress appetite? | show 🗑
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| show | Flatlelince, oily spotting, fecal urgency, and has no effect on pulse or BP. Not controlled
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| 24. What new class of CNS medications is used in the treatment of migraines? | show 🗑
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| 25. What do Triptans do in helping to treat migraines? | show 🗑
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| show | Sumitriptan (Imitrex), Naratriptan (Amerge), Zolmitriptan (Zomig), Rizatriptan (Maxalt), Eletriptan (Relpax), Frovatriptan (Frova), Almotriptan (Axert)
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| 27. What medication can affect height and weight in children? | show 🗑
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| show |
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| What are the 3 classes of sedative-hypnotics? | show 🗑
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| Why are sedatives considered to be dose dependant? | show 🗑
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| What can happen if REM sleep is interrupted? | show 🗑
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| Why is REM interference sleep important? | show 🗑
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| show | Prolonged use of sedative hypnotics
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| Characteristics of barbiturates? | show 🗑
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| What are indications of barbiturates? | show 🗑
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| show | they have the suffix -ITAL: pentobarbital (primarily prescribed for anxiety), phenobarbital (most commonly used to prevent seizures)
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| show | They stimulate liver enzymes that cause the metabolism of many drugs, so drugs are metabolized more quickly and their duration of action is shorter.
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| show | lethargy, vertigo, mental depression, coma, apnea, brochospasms cough, N+V,diarrhea and constipation, agranulocytosis, vasodilation, hypotension, deprivation of REM sleep
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| Barbiturates have addittive effects with which meds? | show 🗑
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| How do bariturates effect lab tests? | show 🗑
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| What are the most commonly prescribed drug classes? | show 🗑
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| What are the suffixes for benzodiazapines? | show 🗑
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| What are the short acting benzos? | show 🗑
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| show | Sedative or anxiolytic
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| show | Sedation, sleep induction, skeletal muscle relaxation, anxiety relief, tx of ETOH withdrawl, depression, epilepsy, balanced ansthesia, moderate or conscious sedation
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| What are adverse effects of benzodiazepines? | show 🗑
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| show | somnolence (not completely awake/alert), coma, diminished reflexes, rarely hypotension and respiratory depression, toxicity usually occurs when combined with other CNS depressants
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| show | Flumazenil (Romazicon)--it has a relatively short half life (1-4 hours) and may need to be given again.
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| What are the benefits of hypnotics? | show 🗑
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| How do most muscle relaxants work? | show 🗑
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| show | MS, cerebral palsy
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| What are side effects of muscle relaxants? | show 🗑
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| Which muscle relaxant drugs are commonly used today? | show 🗑
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| show | diphenhydramine (benadryl) and tylenol PM
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|
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| What a 2 commonly prescribed sedative-hypnotics that are prescribed from the miscellaneous category? | show 🗑
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| show | the combination of alcohol and chloral hydrate which leads to rapid loss of consciouness
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|
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| What is the first long term drug to be approved for treatment of insomnia? | show 🗑
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| show | vitals, including supine and erect blood pressure, and tempurature b/c a rapid drop could occur in blood pressure and other vital parameters such as respiratory rate, so administering the drug per protocol is critacal to pt. safety
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| What should be included in pt. teaching regarding sedative hypnotics? | show 🗑
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| show | use side rails and bed alarm. Assist pt with ambulation. Closely monitor pt level of consciousness
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| What do therapeutic effects of muscle relaxants include? | show 🗑
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| show | pentobarbital sodium, and secobarbitol
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|
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| What are the intermediate -acting barbituates? | show 🗑
|
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| What should be done first in trying to treat a patient with insomnia? | show 🗑
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| A patient who is not sleepy after taking a barbiturate for sleep, is said to be having what type of reaction? | show 🗑
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| What is an example of an intervention that applies to the administration of a nonbenzodiazapine, such as zolpidem? | show 🗑
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| How should a pt be taken off of benzodiazepine? | show 🗑
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| show | An ultra-short barbituate
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| While monitoring a pt who took an overdose of barbiturates, the nurse keeps in mind that the cause of death would be from what? | show 🗑
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| A pt with back muscle spasms is being treated with a skeletal muscle relaxant. These drugs are most effective when used with what? | show 🗑
|
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| show | Flumazenil (Romazicon)--it has a relatively short half life (1-4 hours) and may need to be given again.
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|
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| If a pt has had a barbituate for insomia in the past, why would a physician be less likely to prescribe a barbiturate again now? | show 🗑
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| show | may lead to nightmares
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|
||||
| What is a benefit of using transdermal fentanyl patches in the management of bone pain from the spread of cancer? | show 🗑
|
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| Acetaminophen is contraindicated in patients with what disease? | show 🗑
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| show | inhaled (gas or volatile liquid) and injectable
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| show | etomidate and propofol
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| show | barbituates (thiopental and methohexital) and benzodiazepines(eg. Diazepam, midazolam)
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|
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| Narcotics that are commonly administered IV anesthetic drugs include what? | show 🗑
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| show | both depolarizing (succinylcholine) and nondepolarizing or competitive (eg., pancuronium, d-tubocurarine, vecuronium)
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|
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| What is an example of a true general anesthetic drug in the sense that it is used not only to induce but also to maintain the state of anesthesia? | show 🗑
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| What are the common side effects of anesthetic drugs? | show 🗑
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| show | the greater the effect it produces for anesthesia. Nerve cell membranes are high in fat as is the blood brain barrier
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| show | sight, touch, taste, smell, hearing, and a loss of awareness
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| show | the medullary center is depressed last, and is to be maintained so that breathing and blood pressure are not effected. The medulla is effected in overdose causing CV/respiratory collapse.
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| show | inhaled anesthetics that are also volatile liquids (enflurane, halothane, isoflurane, methoxyflurane, and sevofllurane).
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| show | nitrous oxide "laughing gas"
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| show | ketamine (Ketalar) and thiopental (Penthothal)
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|
||||
| Contraindications of anesthetic drugs? | show 🗑
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| show | droperidol
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|
||||
| What could predispose the patient to anesthetic induced complications like liver toxicity? | show 🗑
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| What types of drugs are anesthetics known to have adverse reactions with? | show 🗑
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| What are the 2 classes of local anesthetics? | show 🗑
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| show | The injection of certain anesthetic drugs into the area near the spinal cord. This is used to block all peripheral nerves that branch out below a selected level of the spinal cord.
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| What does spinal anesthesia produce? | show 🗑
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| What does PACU stand for? | show 🗑
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| show | Anticholinergics--they are used as adjuntive agents with anesthesia to reduce secretions. They are used so that patients don't aspirate. (atropine, glycopyrrolate, scopolamine (also used for sea sickness). They cause dry mouth.
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| show | Central (intrathetcal and epidural) and Peripheral (infiltration, nerve block, and topical)
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|
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| What drug groups suffix is -CAINE? | show 🗑
|
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| show | epinephrine (vasoconstrictor) to keep at local site of action
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| Why are local anesthetics known as membrane-stabilizers? | show 🗑
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| How do local anesthetics produce a "sympathic blockade"? | show 🗑
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| show | Via nerve block (directly into nerve/ganglia/or around nerve trunks) or infiltration anesthesia (administered in a cirular area around the operative field).
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| show | Treatment for a "spinal headache" from spinal anesthesia that involves the anesthetist injecting a small volume (abt 15mL) of a venous blood sample in the pt's epidural space.
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| NMBA | show 🗑
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| show | artificial mechanical ventilation
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| What don't NMBAs do? | show 🗑
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| show | Snake venom
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| show | Depolarizing and Nondepolarizing (nonDep. Has 3 subgroups based on the duration of their action: short-, intermediate-, and long-acting.)
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| What do nondepolarizing NMBAs do? | show 🗑
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| What is the only depolarizing NMBA? | show 🗑
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| show | maintaining controlled ventilation during surgical proceedures, to reduce muscle contraction in an area that needs surgery, endotracheal intubation
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| show | NMBAs nondepolarizing agents: mivacurium (short acting), atracurium and rocurium (intermediate) and pancuronium (long-acting)
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| What is moderate sedation and how is it produced? | show 🗑
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| General nursing considerations when anesthetics are used? | show 🗑
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| Patient teaching with anesthesia? | show 🗑
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| What types of drugs are used to revers muscle paralysis after surgery? | show 🗑
|
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