pharm test 5

The nurse is caring for a patient who is in a treatment program for substance abuse. The nurse is most concerned if the patient makes which statement?

"I have had unprotected sex with other drug addicts."

The nurse is teaching a patient about the use of disulfiram. Which statement by the patient indicates that the teaching has been effective?

"I need to avoid all forms of alcohol, including cough syrups and aftershave."

A patient with chronic pain has a fentanyl patch applied to his right shoulder. The patient reports that his arm hurts and he requests a warm pack to apply to the area. Which statement by the nurse is correct?

"Putting a warm pack on the area where the fentanyl patch is located could accelerate fentanyl release."

The nurse provides teaching for a patient who has been diagnosed with substance use disorder. The nurse determines that teaching has been effective when the patient makes which statement?

"The main reason why people get addicted is because drugs make you feel good."

The nurse is caring for a patient recovering from alcoholism who is taking naltrexone. Which statement made by the patient indicates that the drug is effective?

"This drug reduces the high from drinking alcohol and also helps reduce my craving for it."

The nurse is teaching a patient with cancer about a new prescription for fentanyl patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan?

"With the first patch, it will take about 24 hours before you feel the full effects."

The nurse is teaching a patient with a new prescription for ergotamine. Which statement is most appropriate to include in the teaching plan?

"You should not use this drug more than 1 or 2 days per week."

5 A's for treating tobacco use and dependence

-ASK -ADVISE -ASSESS -ASSIST -ARRANGE

Constipation is a side effect of opioid medications because of which of the following pathophysiologic reasons?

-Decreasing propulsive intestinal contractions. -Increasing nonpropulsive contractions. -Increasing the tone of the anal sphincter. -Reducing fluid secretion into the intestinal lumen.

Which of the following statements about disulfiram are true?

-Disulfiram has no applications outside the treatment of alcoholism. -Acetaldehyde syndrome may occur from drinking less than an ounce of alcohol. -In the absence of alcohol, disulfiram rarely causes significant effects. -Acetaldehyde syndrome symptoms can last 2 weeks after ingesting alcohol.

The nurse is working on a unit in which patients regularly receive controlled substances. Which principles guide the appropriate care of patients receiving these drugs?

-Drugs are categorized into schedules based on their potential for abuse and dependence. -A transfer must be documented every time a controlled substance is purchased or dispensed.

The nurse is caring for a patient who is being treated with opioids for cancer pain. The patient has become agitated and is reporting visual disturbances. The nurse suspects opioid-induced neurotoxicity. The nurse anticipates which management actions?

-IV fluids -decreasing the dose of the opioid -rotating different opioids

heroin patterns of use

-IV works instantly -dysphoria w/ initial use but better after -quickly becoming drug of choice

Which of the following statements about opioid tolerance are true?

-Little or no tolerance can be developed to miosis. -Tolerance to euphoria can be developed. -Cross-tolerance between opioids and other CNS depressants can be developed

The nurse is teaching a patient about malnutrition related to alcohol use. Which of the following statements should the nurse include in the teaching plan?

-Malabsorption results from alcohol-induced damage to the GI mucosa. -B vitamins (thiamin, folic acid, and cyanocobalamin) are especially needed. -Fluid replacement may be necessary because of vomiting or gastritis.

A patient with end-stage breast cancer is experiencing ineffective pain management. Which statement represents the most likely cause of this problem?

-Many cancer patients are reluctant to take pain medication. -Healthcare professionals often fear patient addiction to pain medication. -The healthcare system often places a low priority on pain management

dextromethorphan

-OTC cough suppressant -high doses cause euphoria

An adult patient presents to the emergency department and is diagnosed with a severe migraine headache. Which class of medication would the nurse expect to be ordered for this patient?

-Opioid analgesic -Migraine specific agent -Antiemetic

Which of the following statements about barbiturate tolerance are true?

-Progressively larger doses are needed for the same effect. -Very little tolerance develops to respiratory depression. -Cross-tolerance develops to other CNS depressants.

nicotine and smoking

-abstinence syndrome can occur -acute poisoning- GI symptoms, rapid heart rate, respiratory depression

tolerance and physical dependence related to morphine

-abstinence syndrome w/ sudden withdrawal -BLACK BOX WARNING -schedule 2, withdrawal unpleasant but not lethal

psychedelics

-act on brain's serotonin receptors -alters thinking, feelings, perception, relationship to environment

nicotine inhaler

-adverse: dyspepsia, coughing, rhinitis -frequent puffs over 20 minutes -do not use if asthma

nicotine lozenges

-adverse: mouth irritation, dyspepsia, nausea -allow lozenges to dissolve over 20-30 minutes

nicotine nasal spray

-adverse: rhinitis, watery eyes -nicotine levels increase rapidly

nutritional support

-banana bag (thiamine, folic acid, cyanocobalamin) -might need antibiotics -these people are malnourished

ziconotide

-black box warning (severe neuro symptoms) -intrafecal infusion -reserved for cancer patients who are terminally ill

cocaine

-can produce local anesthesia, vasoconstriction, and cardiac stim

non-pharmacologic measures

-can replace or be adjunctive with drugs -may decrease dosage needed -pain goal is to achieve independence

opioid detoxification

-clonidine assisted withdrawal -most helpful with symptoms related to autonomic activity -does not diminish opioid craving -takes 10 days -substituted for opioid addicted to

cluster headache

-cluster of attacks lasting 15 minutes-2 hours -near eye -primary therapy directed @ prophylaxis

what is the goal of addiction treatment?

-complete cessation -even a change from compulsive to moderate use is beneficial

morphine r/t babies/delivery/pregnancy

-crosses placenta -secreted in breast milk (wait 4-6 hours after taking dose) -do not use during pregnancy or delivery of premature infants

methylenedioxymethamphetamine (ecstasy, MDMA)

-dangerously high body temp -neuro: seizures, spasmodic jerking, teeth clenching, panic

barbiturates

-depressant effects are dose dependent -subjective effects similar to alcohol

Disulfiram aversion therapy

-do not take with alcohol (acetylanhyde syndrome could result-very serious), death can result -CANNOT have a drop of alcohol (cough syrups, some sauces, skin application)

nicotine chewing gum

-doubles cessation success rate -adverse: mouth/throat soreness, belching, hiccups -chew slowly and intermittently for 30 minutes -avoid food up to 15 minutes before -can cause bad dreams

dihydroergotamine

-drug of choice for terminating migraine and cluster headaches -only parenteral or nasal spray

phenycyclidine (PCP) and Ketamine

-effects are based on dose -Ketamine is similar to PCP but shorter duration

acute toxicity of cocaine

-highly lipid soluble- crosses placenta -agitation, dizziness, blurred vision -severe: hyperpyrexia, convulsions, ventricular dysrhythmias, hemorrhagic stroke

inhalants

-laughing gas -subject to abuse -pharm effect: dilation, helps w/ pooling of blood in veins, decrease in systolic BP

morphine toxicity

-monitor for constipation and encourage fluids -coma, respiratory depression, pinpoint pupils

Varenicline

-most effective aid for smoking cessation -adverse: nausea, sleep disturbances, headaches, abnormal dreams, constipation, dry mouth, flatulence -serious neuro: anger, suicidal idealation -FDA banned use in transport jobs

hydrocodone

-most widely prescribed drug in US -combined with aspirin, acetaminophen, or ibuprofen

perception of pain

-occurs in brain -ranges from jerking away to depression

agonist-antagonist opioids

-only produce moderate pain relief -less respiratory depression and lowered potential for dependence -similar contraindications to pure opioid agonists

principal use opioid antagonists

-opioid induced respiratory depression -treat opioid overdose -reversal of postop effects -mgmt of opioid addiction

ergotamine

-overdose can induce ergotism -makes sufferers go berserk -gangrene of hands and feet b/c of constriction to blood supply -sensation of being burned at the stake -overdose = have to react -physical dependence can occur

oxycodone

-oxy's can be in combo with aspirin or acetaminophen -equivalent to codeine

what is the gait control theory?

-pain signals are not free to reach the brain as soon as they are generated at the injured tissue -need to get to neurologic gaits at spinal cord level -gaits are determinants of whether or not pain signal will go to brain

precautions/contraindications with alcohol

-peptic ulcer disease -liver disease -pregnancy/lactation -history of epilepsy -increased cancer risk (liver, rectum, GI)

oxymorphone/levorphanol

-pregnancy category B -pregnancy category D at end of term

type 3 headache

-preventative therapy -beta blockers, tricyclic antidepressants, antiepileptic, some estrogens help

codeine

-prodrug (turns to morphine in liver) -can treat diarrhea -pregnancy category C, changed to D with increased doses -pain and cough suppression

alcohol in moderation w/ exercise can

-prolong life -help decrease dementia risk -help cardio health

Controlled Substances Act

-proper distribution -counting and record keeping -Schedule 1 is most addictive, usually not prescribed in US -pams and -pines are schedule 2 and 3 -schedule 2 drugs must be physically written and given to pharmacy

Acamprosate

-reduces unpleasant feelings brought on by abstinence

bupropion SR

-reduces urge to smoke and reduces some symptoms of nicotine withdrawal (irritability and anxiety) -adverse: dry mouth, insomnia

methamphetamine abuse

-sense of increased physical strength -tx: cog behavioral therapy -renal failure and stroke -sympathomimetic actions -vasoconstriction can be relieved with alpha adrenergic blockers adverse: weight loss, fetal effects

morphine is the drug of choice for what?

-severe/moderate pain -relieving chest pain from MI

Meperidine

-short half life -interacts adversely with several other drugs -toxic metabolite accumulation -do not use for longer than 48 hours -commonly abused among healthcare providers

nicoderm patch

-teach about: no rubbing or heat, apply to upper torso

type 1 headache

-throbbing head pain (moderate to severe) -light sensitivity -highly debilitating -could be hormonal or family hx -migraines w/ or w/o aura

headache

-triggered by a variety of stimuli (stress, fatigue, acute illness -mild or severe

type 2 headache

-use abortive therapy -want to eliminate pain and suppress GI symptoms -early tx is key -not oral medication

Fentanyl

-used for chronic persistent pain -gradually increase -100x more potent than morphine

benzodiazepines

-used to facilitate withdrawal -might begin to see withdrawal symptoms 24-48 hours after last drink (sometimes closer to 12) -if we give med, reassess quickly -safer than barbiturates -rarely lethal -Flumazenil can reverse overdose

Naltrexone

-used to maintain abstinence -decreases craving for alcohol

sumatriptan (serotonin receptor agonists)

-vasoconstriction of intracranial blood vessels -aborts an ongoing migraine attack to relieve headache and associated symptoms -adverse: chest pressure -teratogenic -can cause vertigo, malaise, fatigue, very bad taste

The healthcare provider orders oxycodone oral suspension 10 mg PO every 4 hours PRN. The medication available is oxycodone 20 mg/mL. How many mL will the nurse administer?

0.5 mL

how long does chronic pain last?

6 months

Which of the following measurements would prompt the nurse to hold the sumatriptan dose and contact the provider?

Blood pressure 190/100

A patient is in treatment for drug addiction. The nurse identifies which of the following as the most appropriate goal to discuss with the patient?

Completely abstain from the use of the drug.

Which side effect of morphine does not subside over time?

Constipation

A patient is admitted with a suspected overdose of heroin. This condition is most often manifested by which symptoms?

Decreased respiratory rate and level of consciousness

The nurse should recognize which acute effects of alcohol on the brain?

Depression of the CNS and activation of the reward center

The nurse is caring for a patient with cocaine overdose. Which medication does the nurse anticipate giving to treat this condition?

Diazepam

The nurse knows that which government agency is responsible for carrying out the mandates of the Controlled Substances Act of 1970?

Drug Enforcement Agency

The nurse is caring for a female patient receiving sumatriptan. Which concept guides the nursing care of this patient?

Many patients experience symptoms of chest pressure or heavy arms.

The nurse is working with a group of healthcare professionals at risk for substance abuse. Which opioid agent is commonly abused by nurses and physicians?

Meperidine

A patient is seen daily in a community clinic for the treatment of narcotic addiction. The nurse would anticipate administration of which medication to support the patient's recovery efforts?

Methadone

Which agent is most likely to cause serious respiratory depression as a potential adverse reaction?

Morphine

example of opioid antagonist

NALOXONE (-oxone endings)

A postop patient has an epidural infusion of morphine sulfate. The patient's respiratory rate declines to 8 breaths per minute. Which med would the nurse anticipate administering?

Naloxone (Narcan)

The nurse is preparing to give ergotamine. The agent is effective against headaches of which origin?

No identifiable cause

The nurse is conducting a pain assessment for a patient with cancer. Which data will be the most helpful in assessing the patient's current level of pain?

Patient's description of pain

The nurse is reviewing the patient's current medication list and recognizes that which medication is considered a first-line drug for migraine prevention?

Propranolol

The nurse is reviewing the medication orders for a patient on sumatriptan and sertraline. The nurse notes which of the following possible interactions between these medications?

The combined medications can cause serotonin syndrome.

The nurse is working on a postop unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting?

The development of opioid dependence is rare when opioids are used for acute pain.

A patient takes oxycodone 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects?

The patient should increase fluid and fiber in the diet.

The nurse identifies which appropriate principle of drug addiction treatment based on the guidelines from the National Institute on Drug Abuse (1999)?

The treatment plan must be reassessed continually and modified as indicated.

A patient states that the dose of oxycodone he currently receives does not provide the same pain relief as it used to. The nurse understands that the patient has developed what?

Tolerance

The nurse knows that which neurologic condition can be caused by the direct actions of alcohol or the nutritional deficiences often seen in people with chronic alcoholism?

Wernicke's encephalopathy

addiction

a behavior pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm

physical dependence

a state in which an abstinence syndrome will occur if the dependence-producing drug is abruptly withdrawn -NOT equated with addiction

A patient with chronic pain was admitted to the hospital. The physician orders morphine PO 5 mg every 4 hours. The patient states that he usually takes his home morphine prescription 10 mg every 4 hours and has been for several months. This patient is at risk for which of the following?

abstinence syndrome

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect?

antitussive

mild-moderate headache drugs

aspirin, acetaminophen, ibuprofen

chronic toxicity of cocaine

atrophy of nasal mucosa, loss of sense of smell

treatment of acute toxicity

careful titration of naloxone (short half life, administer every few hours until opioid levels have dropped to safe level)

Wernicke's encephalopathy

causes confusion, nystagmus, reversible w/ thymine

basic pharmacology of alcohol

depressant, inhibits GABA, activates reward system

The nurse is assessing a patient receiving dihydroergotamine for potential side effects. Which symptom, if found, would indicate a side effect of this drug?

diarrhea

What is the major neurotransmitter in the reward circuit of the brain related to addiction?

dopamine

The process in which the brain decreases the amount of dopamine produced and the number of dopamine receptors is known as what?

down-regulation

abuse

drug use that is inconsistent with medical or social norms

effects of alcohol

glucose issues, effects bone, depress respirations, cause gastritis, diuretic, dehydration, can effect kidney fxn

The nurse best describes the schedule class of heroin as what, according to the Controlled Substances Act?

having a high potential for abuse and not being approved for medical use in the US

heroin

high abuse liability, agonist, half life 30 hours

Korsacoff psychosis

inability to convert short term to long term, not reversible

pharmacologic effects of nicotine

increased GI secretions, increased gastric acids, smokers often have reflux, nicotine is safer than tobacco smoke

A nurse administers naloxone to a postop patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication?

increased pain

The nurse is planning care for a patient receiving morphine sulfate by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug?

inserting a Foley catheter

comparison of marijuana and alcohol

less aggressive behaviors, increased appetite

hydromorphone

less nausea, more orthostatic hypotension

metabolism of alcohol

liver

moderate-severe headache drugs

migraine-specific drug

MOA nicotine

mimic cocaine & other addictive substances, inhalation is faster

what kind of pain are NON OPIOIDS used for

minor to moderate

tension type

most common, moderate, non throbbing in headband, episodic or chronic

treatment of morphine toxicity

naloxone

what receptor does nicotine work on

nicotinic

Which condition should the nurse anticipate when the patient has received an intraspinal opioid medication to control cancer pain?

potential for delayed respiratory depression and catheter-related infections

A client verbalizes an intense need for psychoactive drugs. The nurse recognizes this behavior as what?

psychologic dependence

A nurse caring for a patient with a blood alcohol level of 0.2% monitors the patient closely for which priority assessment?

respiratory depression

symptoms of acute toxicity

respiratory depression, coma, pinpoint pupils

long term use of marijuana

schizophrenic effects

The nurse in the ED is caring for a patient admitted with cocaine overdose. Which symptom is most likely associated with this condition?

seizure

what kind of pain are OPIOIDS used for

severe

opioids can

suppress cough, slow GI motility (good for diarrhea, bad for constipation), CNS depression (sedation), intense relaxation can cause respiratory depression, can increase intracranial pressure (severe adverse rxn)

The nurse has just administered naloxone. The nurse will monitor for which symptoms as potential adverse effects of this drug?

symptoms of withdrawal

most common type of headache

tension

what are the four phases of pain transmission?

transduction, transmission, perception, modulation

Methadone

treatment for pain and opioid addicts

antiemetics

used because headaches can lead to nausea

neurobiology of addiction

voluntary users can become compulsive users as a result of molecular changes in the brain

acute alcohol overdose

vomiting, coma, pronounced hypotension and respiratory depression, can lead to renal failure

factors that contribute to drug abuse

what's cheap? what's available? some are more vulnerable genetically

what is pain?

whatever the patient says it is, fifth vital sign

distribution of alcohol

widely distributed everywhere, water soluble