Pain medications
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| What are the two components pain? | *Physical component, the sensation of pain. *Psychological component, emotional response to pain.
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| What type of pain creates an autonomic response that originates within the sympathetic nervous system, flooding the body with epinephrine? | Acute pain
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| What kind of pain does NOT serve as a warning of tissue damage? | Chronic pain
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| What kind of pain is initiated from the nerves and nervous system and is characterized by Tingling, burning, and shooting pain? | Neuropathic pain
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| Define Addiction: | primary, chronic, neurobiologic disease whose development is influenced by genetic, A psychosocial and environmental factors. Also referred to as Psychologic Dependence.
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| Define Adjuvant analgesic drugs: | Drugs that are added as a second drug for combined therapy and may have additive or independent analgesic properties or both.
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| Define Agonist: | Substance that binds to a receptor & causes a response.
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| Define Antagonist: | Drug that binds to a receptor & prevents (blocks) a response.
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| Define Analgesics: | Medications that relieve pain without causing loss of consciousness
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| Define Narcotics: | a legal term applied to drugs that produce insensibility or stupor. Currently used in clinical setting to refer to any medically used controlled substance.
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| What term is replacing 'Narcotics' in the medical field? | Opioid
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| Define Opioid analgesics: | Synthetic drugs that bind to opiate receptors to relieve pain but are not derived from the opium plant.
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| Define Synergistic effects: | Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater that the sum of the individual effects of the same drugs given alone. *Example 1 + 1 is greater than 2.
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| What are the 5 categories of non-opioid analgesics? | *Salicylates *Acetic Acid derivatives *COX 2 inhibitors *Enolic Acid derivatives *Propionic Acid derivatives
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| What drugs fall under the 'Salicylate' category? | Aspirin, Aspirin products
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| What drugs fall under the 'Acetic acid derivitives' category? | Clinioril, Toradol
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| What drugs fall under the 'COX 2 inhibitors' category? | Celebrex
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| What drugs fall under the 'Enolic Acid derivatives' category | Mobic, Feldene
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| What drugs fall under the 'Propionic Acid derivatives' category? | Ibuprofen, Naproxen
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| What route are non-opioid analgesics eliminated? | Excreted through the liver and kidneys
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| How do non-opioid analgesics block pain impulses? | by inhibiting the enzyme that is necessary for prostaglandin synthesis
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| What is the only exception to non-opioids inhibiting the prostoglandin synthesis? | Tramadol (ultram)
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| How does Tramadol block pain? | Inhibits the re-uptake of norepinephrine and serotonin.
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| what are the three effects non-opioid analgesics have? | *analgesic effects *antipyretic effects *anti-inflammatory effects
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| Why would non-opioids be prescribed with opioids? | increase pain control and allows for a reduced dosage of opioid medication
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| Define Antagonist: | Drug that binds to a receptor & prevents (blocks) a response.
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| Define Analgesics: | Medications that relieve pain without causing loss of consciousness
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| Define Narcotics: | a legal term applied to drugs that produce insensibility or stupor. Currently used in clinical setting to refer to any medically used controlled substance.
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| What is associated with salicylates when administered to children and teens. | Reye’s syndrome
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| What term is replacing 'Narcotics' in the medical field? | Opioid
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| Define Opioid analgesics: | Synthetic drugs that bind to opiate receptors to relieve pain but are not derived from the opium plant.
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| At what dose of acetaminophen is hepatic toxicity possible? | Doses of 150mg/kg
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| Define Synergistic effects: | Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater that the sum of the individual effects of the same drugs given alone. *Example 1 + 1 is greater than 2.
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| What are the 5 categories of non-opioid analgesics? | *Salicylates *Acetic Acid derivatives *COX 2 inhibitors *Enolic Acid derivatives *Propionic Acid derivatives
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| What drugs fall under the 'Salicylate' category? | Aspirin, Aspirin products
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| What drugs fall under the 'Acetic acid derivitives' category? | Clinioril, Toradol
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| What drugs fall under the 'COX 2 inhibitors' category? | Celebrex
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| What drugs fall under the 'Enolic Acid derivatives' category | Mobic, Feldene
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| What drugs fall under the 'Propionic Acid derivatives' category? | Ibuprofen, Naproxen
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| What route are non-opioid analgesics eliminated? | Excreted through the liver and kidneys
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| How do non-opioid analgesics block pain impulses? | by inhibiting the enzyme that is necessary for prostaglandin synthesis
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| What is the only exception to non-opioids inhibiting the prostoglandin synthesis? | Tramadol (ultram)
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| How does Tramadol block pain? | Inhibits the re-uptake of norepinephrine and serotonin.
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| what are the three effects non-opioid analgesics have? | *analgesic effects *antipyretic effects *anti-inflammatory effects
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| Why would non-opioids be prescribed with opioids? | increase pain control and allows for a reduced dosage of opioid medication
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| List some contra-indications of non-opioid analgesics | *Known drug allergy *Bleeding disorders *Third trimester of pregnancy *Peptic Ulcer disease *Severe renal or hepatic disease
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| What are the 'Black box warning' contra-indications of non-opioid analgesics? | *Increased risk for CV thrombotic events, MI, Stroke *Increase risk of serious GI events to include bleeding *ulceration and perforation of stomach or intestines.
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| What is associated with salicylates when administered to children and teens. | Reye’s syndrome
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| What should not be used for the Tx of viral infections or fever in children & teens | salicylates
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| True or False: A better suggested analgesic Tx of pain is combining Salicylates with NSAIDs to reduce the amount of each drug taken, thus reducing the negative side effects of each. | False. Combining Salicylates with NSAIDs increases GI toxicity and provides NO therapeutic advantage
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| At what dose of acetaminophen is hepatic toxicity possible? | Doses of 150mg/kg
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| What is the max standard daily dose (healthy adults) for acetaminophen? | 4,000mg day
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| What is the toxic dose of acetominophen for the elderly or persons with liver disease? | 2,000mg day
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| Define Antagonist: | Drug that binds to a receptor & prevents (blocks) a response.
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| Define Analgesics: | Medications that relieve pain without causing loss of consciousness
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| Define Narcotics: | a legal term applied to drugs that produce insensibility or stupor. Currently used in clinical setting to refer to any medically used controlled substance.
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| What term is replacing 'Narcotics' in the medical field? | Opioid
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| Define Opioid analgesics: | Synthetic drugs that bind to opiate receptors to relieve pain but are not derived from the opium plant.
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| Define Synergistic effects: | Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater that the sum of the individual effects of the same drugs given alone. *Example 1 + 1 is greater than 2.
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| What are the 5 categories of non-opioid analgesics? | *Salicylates *Acetic Acid derivatives *COX 2 inhibitors *Enolic Acid derivatives *Propionic Acid derivatives
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| What drugs fall under the 'Salicylate' category? | Aspirin, Aspirin products
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| What drugs fall under the 'Acetic acid derivitives' category? | Clinioril, Toradol
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| What drugs fall under the 'COX 2 inhibitors' category? | Celebrex
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| What drugs fall under the 'Enolic Acid derivatives' category | Mobic, Feldene
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| What drugs fall under the 'Propionic Acid derivatives' category? | Ibuprofen, Naproxen
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| What route are non-opioid analgesics eliminated? | Excreted through the liver and kidneys
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| How do non-opioid analgesics block pain impulses? | by inhibiting the enzyme that is necessary for prostaglandin synthesis
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| What is the only exception to non-opioids inhibiting the prostoglandin synthesis? | Tramadol (ultram)
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| How does Tramadol block pain? | Inhibits the re-uptake of norepinephrine and serotonin.
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| what are the three effects non-opioid analgesics have? | *analgesic effects *antipyretic effects *anti-inflammatory effects
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| Why would non-opioids be prescribed with opioids? | increase pain control and allows for a reduced dosage of opioid medication
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| List some contra-indications of non-opioid analgesics | *Known drug allergy *Bleeding disorders *Third trimester of pregnancy *Peptic Ulcer disease *Severe renal or hepatic disease
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| What are the 'Black box warning' contra-indications of non-opioid analgesics? | *Increased risk for CV thrombotic events, MI, Stroke *Increase risk of serious GI events to include bleeding *ulceration and perforation of stomach or intestines.
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| What is associated with salicylates when administered to children and teens. | Reye’s syndrome
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| What should not be used for the Tx of viral infections or fever in children & teens | salicylates
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| True or False: A better suggested analgesic Tx of pain is combining Salicylates with NSAIDs to reduce the amount of each drug taken, thus reducing the negative side effects of each. | False. Combining Salicylates with NSAIDs increases GI toxicity and provides NO therapeutic advantage
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| At what dose of acetaminophen is hepatic toxicity possible? | Doses of 150mg/kg
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| What is the max standard daily dose (healthy adults) for acetaminophen? | 4,000mg day
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| What is the toxic dose of acetominophen for the elderly or persons with liver disease? | 2,000mg day
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| What is acute hepatotoxicity treated with? | acetylcysteine (mucomist)
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| Describe the scent of acetylcysteine (mucomist) | Foul smelling (rotten eggs) with an extremely bad taste
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| What are some S&S of hepatoxicity? | *First 24 hours: pallor, diaphoresis, malaise, vomiting *18-72 hrs: Right upper quadrant abdominal tenderness, tachycardia, hypotension *72-96 hrs: jaundice, coagulopathy, GI bleeding
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| What is the most common symptom of chronic Salicylate intoxication in adults? | tinnitus and hearing loss
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| What is the most common symptom of chronic Salicylate intoxication in children? | Hyperventilation and CNS effects
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| What are the late symptoms of Salicylate intoxication? | Mixed respiratory and metabolic acidosis, respiratory failure, confusion and seizures
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| What are the patient teaching topics for non-opioidal analgesics | *Take with a full glass of water *remain upright for 15-30 minutes after administration. *Do not take longer than 10 days Adults 5 days Children
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| Patients on long term therapy must inform HCP of what? | non-opioid analgesic use prior to surgery (risk of bleeding)
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| What are the three opioid classifications | *Meperidine-like drugs *Methadone-like drugs *Morphine like drugs
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| What medications fall under the 'methadone-like drugs' category? | *Methadone *Propoxyphene/Darvon (recently removed from the market by FDA)
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| What medications fall under the 'morphine-like drugs' category? | Morphine, Hydromorphone, Oxymorphone, Codeine, hydrocodone, oxycodone
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| What medications fall under the 'Meperidine-like drugs' category? | Meperidine (Demerol), Fentanyl
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| How much of the opioid administered via PO is absorbed in the GI tract | 50% absorbed from the GI tract
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| True or False: Opioids fall under the many drug categories that DONT cross the placenta. | False. Opioids cross the placenta.
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| What metabolizes opiods? | The liver
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| What excretes opioids? | The kidneys
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| What is the result of Strong opioid analgesics (fentanyl and sufentanil) used in combination with anesthetics? | Balanced anasthesia
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| What is the most serious adverse effect of opioid analgesics? | Respiratory depression/ decrease in respiratory rate & depth
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| List three drugs the negatively interact with opioid analgesics | *Alcohol *Antihistamines *Barbiturates *Benaodiazepines *Phenothiazines *CNS depressants
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| What drugs can cause increased potential for respiratory depression, seizures and hypotension | MOA inhibitors
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| What are some contra-indications of opioids? | *Increased potential for respiratory *Depression, seizures and hypotension
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| What medication can cause a complete or partial reversal of narcotic depression? | Naloxone (narcan)
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| How quickly is naloxone capable of restoring respiratory function? | 1-2 minutes
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| What medication Used in the treatment opioid dependency, blocks the euphoric effects experienced and can be used in the treatment of alcoholism? | Naltrexone (ReVia)
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| List 4 adverse effects of Naloxone (Narcan) | *hypertension *hypotension *cardiac dysrhythmias *pulmonary edema *nausea, vomiting
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| List 4 adverse effects of Naltrexone | *nervousness *headache *withdrawal *pulmonary edema *tachycardia *nausea, vomiting.
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| How long after opioid medication peak should you monitor level of consciousness? | 3-4 hours
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| True or False: Naloxones effects last as long as the opioid its blocking | False. Naloxone usually lasts only 1 hour.
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| When pre-operative medications are given, the nurse must monitor the patient for signs of what? | Respiratory depression
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| What reverses the effects of benzodiazapines such as Valium or Versed? | Romazicon (Flumazenil)
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| How often should the nurse monitor the patient after pre-op opioids are given? | Every 15-30 minutes until the Pt leaves for surgery
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| Define Anasthesia: | Drugs that depress the CNS or peripheral nerves to produce diminution of consciousness, loss of responsiveness to sensory stimulation, or muscle relaxation
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| Define Balanced Anasthesia: | use of combinations of different drug classes rather than a single drug to produce anesthesia
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| What is the therapeutic effect (purpose) of general anasthesia? | to produce anesthesia to where the patient does not recall the surgical procedure
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| What is the therapeutic effect (purpose) of regional anasthesia? | to produce anesthesia that results in loss of sensation to an area of the body.
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