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NSG 533 Advanced Pharmacology EXAM 3 LATEST 2024.2025 @QUESTION AND ANSWER GRADED A+ WITH RATIONALE
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what is the fifth vital sign? pain what is pain threshold? level of stimulus needed to create painful sensation what is pain tolerance? amount of pain one can endure without interfering with normal functioning. somatic pain skin pain muscle pain tissue pain visceral pain organ pain
what are reasons for under treatment of pain? lack of pain assessment health professional attitude towards drug seeking inaccurate information about addiction under dosing patient's cultural beliefs what does unrelieved pain lead to? HTN *** Increased HR Increased RR pneumonia *** Urinary retention ileus confusion weakness
MOA of NSAIDS block cyclo-oxygenase and inhibit synthesis of prostaglandins what does the inhibition of Cox-1 and Cox-2 do? decreases inflammation and pain what does the inhibition of Cox-1 do? decreases protection of the stomach lining why are Cox-2 blockers better than Cox-1 blockers? they decrease the synthesis of prostaglandins without irritating the stomach
what is aspirin? a salicylate NSAID the oldest nonopioid drug what syndrome does aspirin play a role in? Reye syndrome main SE of ASA? decreased platelet aggregation adverse reactions/SE of ASA gastric irritation (if its a COx-1 inhibitor) tinnitus (CN VIII) *** vertigo bronchospasm ***
inhibits prostaglandin synthesis uses of acetaminophen relieves pain, discomfort, and fever what is the maximum dose of acetaminophen per day? 4 g/ day = 4000 mg/day True or false: Acetaminophen is an anti-inflammatory False SE of acetaminophen Rash GI distress Toxic effects/overdose of acetaminophen hepatotoxicity
thrombocytopenia (low PLT) what is the antidote for an acetaminophen overdose? acetylcysteine (mucomyst) what was ASA formally used for in babies? fever what is the only thing that we use ASA for now? prevention of heart attacks where does ASA come from? the bark of willow trees who should you caution the use of ASA with? asthmatics
which nonopioid analgesic is good for patients who don't handle narcotics well? Tramadol (Ultram) why is Ketorolac (Toradol) given IV/IM? because there is a high risk of bleeding if given orally what part of the nervous system do nonopioid analgesics work on? the PNS --> not likely to cause drowsiness what part of the nervous system do opioid analgesics work on? the CNS --> likely to cause drowsiness what is a common skin SE of narcotics? itching! This is safe as long as they dont have a rash with it. Rash is bad
what is the antidote to an opioid overdose? narcan what is a Norco 5/325? Norco 5 + 1 acetaminophen dose where do opioid analgesics work on? they work on the respiratory and cough centers in the medulla of the brainstem causing decreased respirations and decreased cough
to prevent opioid dependency. By day 3-5 you should have lessened pain and should use less potent opioids what was one the first synthetic opioids? Meperidine (demerol) what is Meperidine (demerol) primarily effective in the use of? GI procedures do (demerol) have antitussive properties like other opioids? no why is Demerol so effective for GI procedures and pregnancy/delivery? because it has less GI side effect than morphine does what is the down side to using (demerol)? the metobolites of it cause serious neurotoxic effects such as:
Tremors seizures confusion what is (demerol) commonly used for now? end of life pain control adjunction to surgical anesthesia what do high doses of (demerol) in patients with advanced cancer and older adults cause? neurotoxicity nervousness tremors agitation irritability seizures *** the use of (demerol) is contraindicated in patients with what 2 dysfunctions?
sedation urinary retention tachycardia pupillary constriction in the use of (dilaudid), what does pupillary constriction indicate? toxicity!! what is the average safe dose range of morphine? IV 2.5-10 mg what is the average safe dose range of dilaudid? IV 0.2 - 1 mg ** dosing should never exceed 1 mg *** why are patients with head injuries contraindicated for taking opioids? because they caused decreased respirations thus causing an accumulation of CO
increased CO2 causes vasodilation of the cerebral vessels thus causing an increased ICP what may opioids cause in patients with shock? hypotension if using opioids in patient with asthma or renal failure, what should you be cautious for? opioits decrease respiratory drive while increasing respiratory resistance, thus making it harder for an asthmatic to breathe what is the brand name of hydrocodone and acetaminophen? (vicodin) (Norco) what is the brand name of acetaminophen and codeine? (Tylenol #3) is hydrocodone and acetaminophen (vicoden, norco) natural or synthetic? synthetic
loading dose lock out time why are transdermal opioid analgesics used for chronic cancer pain? because they provide continuous around the clock pain control is fentanyl (duragesic) more or less potent than morphine? more potent for what patients should you caution the use of with when taking fentanyl? patients who weigh less than 110 pounds which drug categories are commonly used for adjuvant therapy with opioids? anticonvulsants antidepressants corticosteroids antidysrhythmics
local anasthetics common examples of adjuvant therapies with opioids? gabapentin (neurontin) amitriptyline (Elavil) Lidocaine patch what is the purpose of using an opioid agonist-antagonist? developed to help decrease opioid abuse what are the 2 opioid agonist-antagonist? pentazocine (Talwin) Butorphanol tartrate (stadol) ` should you use (talwin) or (stadol) if patient has a history of drug abuse? no
