Pharm 3- Pain

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Author:
MeganM
ID:
271080
Filename:
Pharm 3- Pain
Updated:
2014-04-19 20:50:57
Tags:
Pharm
Folders:
TAMHSC
Description:
Anesthesia & Analgesics
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  1. General actions (SE) of opioids (slide on p. 5)
    • analgesia
    • respiratory depression
    • constipation
    • urinary retention
    • cough suppression
    • emesis
    • increased ICP
    • ***watch for hypotension!!!** (decreased preload & afterload)
  2. Most common SE of opioids.
    • constipation
    • nausea
  3. Most SERIOUS ADR of opioids. (slide 29)
    • Respiratory depression
    • OD
    • allergic rxn
    • phys dependence
  4. S/S of opioid OD.
    • cold clammy skin
    • drowsiness, dizziness
    • restlessness, confusion
    • pinpoint pupils (miosis)
    • decreased HR, BP, RR
    • GIVE NARCAN
  5. Dilaudid has a ______ onset but shorter ______ of morphine and is 7-10 times _____ effective than morphine.
    • faster
    • duration
    • more
    • *high abuse potental
  6. Hydrocodone is often combined with ______ or _______. Considerations?
    • acetaminophen (Vicodin) *non anti-inflammatory
    • aspirin (Lortab-ASA) *anti-inflammatory
    • *risk of liver toxicity
  7. Meperidine (Demerol) axn is _____ than morphine.
    shorter (more frequent dosing)
  8. If a pt comes in with pain from GI problems, what med is given and why?
    • Demerol
    • does not increase biliary tract pressure
  9. If a pt comes in with pain from acute asthma, what med is given and why?
    • Demerol
    • less likely to produce histamine release
  10. Problems with Demerol?
    • Neurotoxicity with sickle cell, burn injuries, cancer
    • Severe/fatal rxn with MAOIs
    • increases HR
    • resp depression in COPD pts
    • increased ICP
    • not good for elderly
  11. Common SE of Methadone that can last several weeks.
    orthostatic hypotension
  12. Nursing considerations with Fentanyl?
    • clean, hairless site
    • take old patch off b4 applying new one
    • date patch
    • "waste" it b/c it's a C/S -do not just throw in trash
    • wear gloves
  13. Cautions with butorphanol (Stadol).
    • (opioid agonist-antagonist)
    • -hyptertensive clients
    • -MI (increases wrkld)
    • may increase CSF (monitor ICP)
  14. Caution with pentazocine (Talwin).
    • (opioid agonist-antagonist)
    • -cardiac fxn
  15. Use for nalbuphine (Nubain).
    • (opioid agonist-antagonist)
    • -preop as adjuct to anesthesia
    • -L&D (obstetric analgesia)
  16. Reversal agent for opioid OD.
    • naloxone (Narcan)
    • *contraindicated in acute hepatitis*
  17. Cox-2 receptors are mainly at the _______ but also in the _____ and _____
    • site of injury (mediate local inflammation, sensitize pain)
    • brain (fever & pain perception)
    • kidney (renal vasodilation)
  18. Inhibiting Cox-2 receptors results in?
    • inflammation suppression
    • pain reduction
    • fever reduction
    • renal impairment possible
  19. Advantage of Cox-2 inhibitors over Cox-1?
    • reduced GI effects
    • (but no advantages r/t CAD or CVA risk)
  20. Anesthetic used for young children undergoing minor surgical & diagnostic procedures; problems during recovery?
    • Dissociative anesthetic - ketamine (Ketalar)
    • -hallucinations, disturbing dreams, delerium
  21. Nursing considerations for pts recovering after receiving ketamine (Ketalar).
    • Reduce stimulation
    • keep lights down
    • reorient
    • tell them what you're doing

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