Pharmacology module 8 part A
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- What are therapeutic uses of opioid analgesics? Pg 151
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Alleviate moderate to severe pain
to suppress the medullary cough center
to maintain a balanced state of anesthesia. - which opioid analgesics are often used to control pain after surgery? pg 151
- Morphine, meperidine, and oxycodone
- which opioid analgesics are often used with anesthetics in surgery? pg 151
- fentanyl, sufentamin, and alfentanil
- What would be the most important thing the nurse considers during his/her assessment of this patient before administering a dose of morphine sulfate pg 162
- respiratory depression
- what medications reverse the effects of opioids? pg 158
- opioid antagonists
- what are some opioid antagonists? p 158
- naloxone (Narcan), nalmefene (Revex), naltrexone (ReVia)
- What is the mechanism of action of opioid antagonists? p 158
- They produce their opiod agonist activity by competing w/ opioids for CNS receptor sites
- What should the nurse teach about Opioid analgesics? Pg 166
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Follow the instructions on the med. vial
Contact the physician or health care provider if emesis occurs
side effects
Contact the physician in case of allergic reaction
w/drawl symptoms
Change positions slowly
Inform physician of use of homeopathic remedies
avoid drug interactions w/ OTC medications - What are some typical side effects of opioid analgesics? pg 166
- gi tract upset, constipation, drowsiness, dizziness, headache, sleepiness, tinnitus, blurred vision, palpitations, bradycardia, hypotension
- what are some w/drawl symptoms of opioid analgesics?
- chills, anxiety, irritability, nausea, vomiting, cramps, fainting, fever
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What are adverse effects of
Acetaminophen? Pg 159 -
Side effects: Rash, nausea, vomiting.
Less common side effects: Blood disorders or dyscrasias (anemias) and nephrotoxicity - What is the mechanism of action of acetaminophen? pg 159
- Causes pain impulses to be blocked peripherally
- What is most serious toxic effect of acute acetaminophen overdose? page 159
- hepatic necrosis
- What is the maximum daily dose of acetaminophen for healthy adults? Pg 156
- 4 g/day
- What is the antidote for acetaminophen toxicity? pg 159
- Acetylcysteine
- What is the long term effect of ingesting large does of acetaminophen? pg 159
- Nephropathy
- The patient tells the nurse that he needs to take more medication for the same relief of pain. What is this patient likely to be experiencing? pg 152
- Tolerance
- Compare and contrast the drug effects of acetaminophen and NSAIDS. Pg 159
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Acetaminophen has a week anti-inflammatory effects compared to NSAIDs,
does not have any effect on platelets, though it shares the analgesic and antipyretic effects of NSAIDs,
it does not have many of the unwanted effects. Acetaminophen has no drug effects on the cardiovascular or respiratory systems and is not associated w/ aspirin related acid-base changes, gastric irritation, erosion, prolonged bleeding, or increased excretion of uric acid. - What are 5 (first choice) antiepileptic drugs of choice used in the treatment of partial and generalized seizures? Pg 207-table
- Carbamazepine, Phenobarbital, phenytoin, primidone, valproic acid
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What are 5 antiepileptic drugs used in the treatment of status epilepticus?
Page 207—table - Diazepam, lorazepam, phenobarbitol, phenytoin, fosphenytoin,
- What symptoms should the nurse inform Ms. T. about Dilantin? Pg 212-213, 216, 217
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side effects at toxic levels:
Nystagmus, ataxia, dysarthria, encephalopathy,
if appetite decreases or nausea and vomiting increase, call the dr - What essential information should the nurse teach patients about antiepileptic agents? Pg 217
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Pt needs to fully understand his/her seizure and the importance of consistent tx
Pt should report omissions and any problems w/ dosing
Should carry ID card or wear medical alert bracelet naming dx, meds taken, and any other pertinent facts,
Avoid driving
Keep a log of seizure activity
Do not take w/ alcohol - What vitamins or foods should the nurse teach a pt on levodopa to avoid? Pg. 227
- B6 because it promotes levodopa breakdown and may reverse effects of the drug
- What is the mechanism of action of Levodopa? Page 225
- provides exogenous sources of dopamine that directly replace the deficient neurotransmitter dopamine in the substantia nigra
- What drug (Levodopa or Levodopa-Caridopa) is more efficient in increasing the dopamine level of the brain? pg 225
- Carbidopa
- What is the mechanism of action of Amantadine (Symmetrel)Pg 227
- Believed to work in the CNS by eliciting the release of dopamine from nerve endings, causing higher concentrations of dopamine in the CNS
- What therapeutic response should the nurse assess to evaluate the effectiveness of antiparkinsonian agents? Pg 232
- improved sense of well-being; improved mental status; increase in appetite; ability to perform ADL’s to concentrate, and to think clearly; less intense parkinsonianism manifestations such as: less tremor, shuffling of gate, muscle rigidity, and involuntary movements.
- What is the best explanation to give to a pt on Phenobarbital complaining of being 'easily bothered by small things'? Pg. 212
- One of the side effects is increased irritability, which might account for ‘small things bothering’ the pt
- what is the MOA of phenobarbitol? pg 206
- MOA for AED’s is not known w/ certainty. Evidence shows they alter movement of sodium, potassium, calcium, and magnesium ions. The changes in the movement of these ions induced by AED’s result in stabilized and less responsive cell membranes.
- A 2 year old is taking Phenytoin and develops a skin rash. What two actions should the nurse take? pg 215
- discontinue immediately and call the physician
- why should valproic acid not be taken w/ milk? Pg 215
- Oral forms should not be given w/ milk because this may cause them to dissolve early and irritate local mucosa
- How should the nurse prepare to administer suspension forms of antiepileptic agents to children? Pg 215
- Suspension forms should always be shaken thoroughly before use and an exact graduated device or oral syringe used for more accurate dosing