NUR 112 Pharmacology: CNS Drugs, Analgesics Drugs

Benzodiazepines Nursing Actions/Teaching

- Nursing assess consciousness, response, safety, teach patient that they will not operate machinery. - Family must report any over side effect. - Assess BP hold for hypotension. Sit aside the bed or chair, feel ok before ambulate. - low Respiration or shallow but hold medication. Teach patient if they have short of breath. HR < 60, hold medication. - Fatigue. Teach patient for those symptoms.

Pain Classification

-Acute- intense pain over a defined time, Chronic (and acute) pain can interfere with ADLs, and lead to feelings of hopelessness and depression. -Chronic- persisting longer than 6 months

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) drugs

-Advil/Motrin (ibuprofen) -Aleve (naproxen) -Toradol (ketorolac) -Caldalor (ibuprofen IV)

Benzodiazepines Precautions/Contraindications

-Avoid in comatose or CNS depressed patients -Use caution with elderly, Elderly can make more severe side effect -Use caution with small children, the drug cannot process properly because of blood brain barrier not being as mature, more effect to small infant.

Non-Opioid Analgesic Contraindications/Precautions

-Avoid with severe hepatic/renal disease -Caution with moderate hepatic/renal disease

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Contraindications/Precautions

-Avoid with severe renal and hepatic failure and MI -Avoid chronic use in pregnancy (Cat D after 30 weeks gestation) -Use caution with cardiovascular disease and bleeding disorders

Opioid-Narcotics Nursing Actions/Teaching

-Constipation- slows GI tract- may be on stool softener to help prevent , check bowel movement, teach patient to drink a lot of water, increase fiber in diet, give tool softener. -Assess RR, hold if it is low -Check BP, Pulse, hold it they are low -Dizziness & sedation- causes CNS depression- be careful with ambulation etc.... teach patient about safety, do not operate the machinery. -Urinary retention- monitor I&O to ensure that urine output is adequate (at least 30mL/hr), normally check in hospital bed side

Benzodiazepines Side effects

-Dizziness and drowsiness -Confusion -Hypotension -Respiratory depression -Bradycardia

Non-Opioid Analgesic Interactions

-Increased risk of hepatotoxicity if given with other substances that affect the liver (alcohol). Increase renal effects if given with NSAIDS. -Increased risk of bleeding with other medications that cause bleeding.

Drugs for Comfort Pain is about

-Pain is a physiological and emotional experience characterized by unpleasant feelings, may be associated with trauma or disease -Pain is the most common reported symptom

Non-Opioid Analgesic side effects

-Renal and hepatic toxicity (high doses) -Relatively safe (Pregnancy Cat B)

Benzodiazepines interaction

-Significant CNS depression can occur if given with other medications that cause over sedation

Opioid-Narcotics drugs

-Tylenol #3 (acetaminophen/codeine) -Oxycontin (oxycodone) -Percocet (acetaminophen and oxycodone) -Dilaudid (hydromorphone) -Dolophine (methadone) -Duramorph (morphine) -Morphine (morphine) -Sublimaze (fentanyl)

Non-Opioid Analgesic Drugs

-Tylenol (acetaminophen) -Ofirmev (acetaminophen IV)

Benzodiazepines Drugs

-Valium (diazepam) -Ativan (lorazepam) -Versed (midazolam)

A client is prescribed 4 mg of hydromorphone intravenously (IV) every 4 hours, as needed. Hydromorphone is supplied at 10 mg/mL. How many milliliters of hydromorphone will the nurse administer per dose?

0.4 mL

A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance? 1. Alcohol 2. Caffeine 3. Diphenhydramine 4. Ibuprofen

1. Alcohol Acetaminophen and alcohol are both hepatotoxin substances.

Which antipyretic medication may cause Reye syndrome in children? 1. Aspirin 2. Naproxen 3. Ibuprofen 4. Dantrolene

1. Aspirin Aspirin increases the risk of swelling in the brain and liver, which are the main symptom of Reye in children.

A primary health care provider prescribes 0.25 mg of alprazolam by mouth three time a day for a client with anxiety and physical symptoms related to work pressures. For which side effect of this medication will the nurse monitor the client? 1. Drowsiness 2. Bradycardia 3. Agranulocytosis 4. Tardive dyskinesia

1. Drowsiness Alprazolam, a benzodiazepine, potentiates the actions of gamma-aminobutyric acid, enhances presympathetic inhibition, and inhibits spinal polysynaptic afferent pathways. Drowsiness, dizziness, and blurred vision are common side effects. Alprazolam may cause tachycardia, not bradycardia.

When the nurse obtains vital signs of blood pressure 90/60 mm Hg, pulse 96 beats/minute, and respiration rate 10 breaths / minute for a postoperative client who is receiving hydromorphone by a patient-controlled analgesia (PCA) pump, which nursing action would be the priority? 1. Give naloxone intravenously per protocol. 2. Assess the client's pain level on a 10-point scale 3. Document the vital signs in the client record 4. Notify the hospital rapid response team.

1. Give naloxone intravenously per protocol. A respiration rate of 10 breaths/minute is abnormal and indicates over sedation with hydromorphone, which should be treated immediately with naloxone administration.

A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statements? select that apply 1. I need to report any dark tarry stools 2. I will need to stop taking this medication before any scheduled surgery 3. I should change positions slowly 4. I will take the medication on an empty stomach 5. I need to stop taking low-dose aspirin while I take this medication.

1. I need to report any dark tarry stools 2. I will need to stop taking this medication before any scheduled surgery Ibuprofen increases the risk for bleeding, so clients need to report any signs or symptoms of bleeding such as dark tarry stools. They also will need to stop taking this medication before scheduled surgery to prevent excessive bleeding.

Analgesics types of drugs

1. Non-Opioid Analgesic 2. Nonsteroidal Anti-inflammatory Drugs (NSAIDS) 3. Opioid-Narcotics

Which life-threatening complication may occur in clients taking high-dose or long-term ibuprofen? 1. Anaphylaxis 2. Gastrointestinal (GI) bleeding 3. Cardiac dysrhythmia 4. Disulfiram reaction

2. Gastrointestinal (GI) bleeding Ibuprofen irritates the GI mucosa and can cause mucosa erosion while decreasing platelet activity, which can result in GI hemorrhage.

When getting a postoperative client out of bed, which action will the nurse take to avoid postural hypotension? 1. Avoid giving the prescribed PRN morphine sulfate before getting the client up 2. Have the client sit on the edge of the bed for a few minutes before standing up 3. Withhold the prescribes calcium channel blocker until the client is already up. 4. Educate the client about the reasons to avoid getting up soon after surgery.

2. Have the client sit on the edge of the bed for a few minutes before standing up Having a client sit on the edge of the bed for a few minutes will allow the neurocirculatory reflexes to adjust to the force of gravity when an upright position is assumed. Although morphine sulfate administration may lower blood pressure, the nurse would not withhold analgesia from a postoperative client, especially before activity.

Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply 1. Diuresis 2. Pain relief 3. Temperature reduction 4. Bronchodilationterm-2 5. Anticoagulation 6. Reduced inflammation

2. Pain relief 3. Temperature reduction 6. Reduced inflammation

A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical finding warrant immediate follow up by the nurse? Select all that apply 1. Polyuria 2. Unconsciousness 3. Bradycardia 4. Dilated pupils 5. Bradypnea

2. Unconsciousness 3. Bradycardia 5. Bradypnea The central nervous system (CNS) depressant effect of morphine, if severe, can cause unconsciousness, bradycardia , and bradypnea.

A client who had a myocardial infarction receiving 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the medication, the client complains of feeling dizzy. Which action will the nurse take? 1. Determine if this is an allergic reaction 2. Elevate the client's head and keep the extremities warm. 3. Place the client in the supine position and take the vital signs 4. Tell the client that this is not a typical sensation after receiving morphine sulfate.

3. Place the client in the supine position and take the vital signs Dizziness is a symptom of hypotension, a side effect of morphine sulfate. The supine position increases venous return, cardiac output, and blood flow to the brain.

A client takes morphine sulfate for severe metastatic bone pain. The nurse will assess the client for which adverse effect? 1. Diarrhea 2. Addiction 3. Respiratory depression 4. Diuresis

3. Respiratory depression Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest.

An intravenous injection of morphine sulfate, 2 mg, is prescribed for an 8-month-old infant weight 15 lb 7oz (7kg). The recommended dose for an infant is 0.1 mg/kg. The nurse would question the prescription for which reason? 1. This amount of the opioid will be ineffective 2. The information needed to calculate the opioid dosage is incomplete. 3.This amount of morphine sulfate is unsafe for an infant of this weight 4.Administraton of morphine sulfate is contraindicated in infants younger than 1 year

3.This amount of morphine sulfate is unsafe for an infant of this weight The infant should not receive more than 0.7 mg of morphine per dose.

Which medication is safe to take during pregnancy? select all that apply 1. Metronidazole 2. Aspirin 3. Codeine 4. Acetaminophen 5. Diphenhydramine HCI

4. Acetaminophen

Which medicine acts as an antidote to benzodiazepine? 1. Zolpidem 2. Temazepam 3. Suvorexant 4. Flumazenil

4. Flumazenil Flumazenil is a benzodiazepine receptor antagonist and is used to reverse conscious sedation induced by benzodiazepines.

Which client statement indicates that teaching about acetaminophen is effective? 1. I can drink beer with this but not wine 2. I need to limit my intake of acetaminophen to 650 mg a day 3. I should take an emetic if I accidentally overdose on acetaminophen 4. I have to be careful about which over-the-counter cold preparations I take.

4. I have to be careful about which over-the-counter cold preparations I take. Man over-the-counter cold preparations contain acetaminophen; the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated. A typical single dose is 650 mg a day for adults. Acetaminophen should not exceed 3 to 4 g a day.

Which treatment would the nurse anticipate administering to a toddler who has acetaminophen poisoning? 1. Oxygen 2. Naloxone 3. Amyl nitrate 4. N-acetylcysteine

4. N-acetylcysteine

Which relationship reflects the relationship of naloxone to morphine sulfate? 1. Aspirin to warfarin 2. Amoxicillin to infection 3. Enoxaparin to dalteparin 4. Protamine sulfate to heparin

4. Protamine sulfate to heparin Protamine sulfate is the antidote for heparin overdose, and naloxone will reverse the effects of opioids such as moprphine.

After orthopedic surgery, an adolescent reports pain and rates it a 5 on a scale of 0 to 10. The nurse administers the prescribed 5 mg of oxycodone every 3 hours as needed. Three hours after having been given this medication, the adolescent reports pain and rates it a 10 of 10. Which action would the nurse take next? 1. Administer another dose of oxycodone within 30 minutes 2. Report the adolescent's apparent idiosyncratic reaction to oxycodone. 3. Tell the adolescent that additional medication cannot be given for 1 more hour. 4. Request that the primary health care provider evaluate the need for additional medication.

4. Request that the primary health care provider evaluate the need for additional medication. The nurse has made the assessment that the medication has been ineffective in relieving the adolescent's pain for the duration that it was prescribed to cover. This information should be communicated to the primary health care provider for evaluation.

Which adverse effect of morphine indicates the need for naloxone administration? 1. Blurred vision 2. Urinary retention 3. Mental confusion 4. Respiratory depression

4. Respiratory depression Because morphine is a central nervous system depressant, it affects the medulla, the respiratory center in the brain. Respiratory depression may progress to respiratory arrest and death. Naloxone will reverse the effects of an opioid.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) lab

AST, ALT, BUN, Creatinine, Clotting studies

Non-Opioid Analgesic lab

BUN & creatinine Monitor jaundice, ASLT, ALT for liver

Opioid-Narcotics side effects

Constipation Respiratory depression Hypotension, Bradycardia Dizziness and Sedation Urinary Retention

Benzodiazepines can be used to treat all the following conditions except? A. Seizures B. Prior to an invasive procedure C. Anxiety D. Alzheimer's disease E. Insomnia

D. Alzheimer's disease Benzodiazepines are not prescribed to treat Alzheimer's disease.

Demerol (meperidine) is used for...

Demerol- used to treat a variety of conditions (surgery)

Dilaudid is used for...

Dilaudid- potent narcotic, "stronger" than morphine , monitor patient closely

Duramorph usually use in...

Duramorph usually use in surgery, put in spinal space

Duramorph is used for...

Duramorph- long acting morphine, used for spinal anesthesia (cont. pulse ox, last for 24 hours)

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) side effects

GI bleeding, Bleeding Prolonged bleeding times Renal and Hepatic issues

How does Heroin effect in body?

Heroin is actually converted into morphine (this is what causes the "rush" and deep relaxation) Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Interactions

Increased risk of bleeding if given with other drugs that can cause bleeding

Opioid-Narcotics interactions

Increased side effects (CNS depression) if given with other drugs that cause CNS depression/sedation

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Action

Inhibits prostaglandin formation leading to decreased inflammation and pain

Methadone is used for...

Methadone- used for people with substance abuse addictions

Non-Opioid Analgesic Uses

Mild pain (analgesic) and Fever (antipyretic)

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Nursing Actions/Teaching

Monitor blood in stool, they must stop. Monitor lab for renal and hepatic. check put put and weight daily, urine output, not gain weight,

Non-Opioid Analgesic Antidote

Mucomyst (acetylcycteine) Mucomyst, actually it is respiratory drug. Mucomyst is the antidote- 100% effective in preventing liver damage due to overdose if given within 8-10 hours of the overdose Max dose PO 3 grams for adult, peds>12 Max dose PO Renal/Hepatic is 2 grams/day Max IV is 4 grams per day

Opioid-Narcotics Antidote

Narcan (naloxone)

Pain Scale Types

Numerical Rating Scale Visual Analog Scale Wong-Baker Scale (Pediatrics) Neonatal Infant Pain Scale

Pain assessment "OPQRSTU"

O: Onset P: Provoking or Palliating Factors Q: Quality R: Region & Radiation S: Severity T: Time & Treatment U: Understanding & Impact

Benzodiazepines use

One of the most widely prescribed drug classes Uses: Anxiety and sedation Insomnia Acute seizures, seizure disorder Decreased risk of resp. depression if given parentally

Oxycotin is used for...

Oxycontin- used for chronic pain conditions, can be addictive

Patient-Controlled Analgesia (PCA) use for

Patient-controlled analgesia (PCA) is a method of pain control that gives patients the power to control their pain. In PCA, a computerized pump called the patient-controlled analgesia pump, which contains a syringe of pain medication as prescribed by a doctor, is connected directly to a patient's intravenous (IV) line. In most cases, PCA pumps supply opioid pain-controlling medicines such as morphine, fentanyl and hydromorphone

Opioid-Narcotics life threatening side effect

Resp. depression- number one most life threatening side effect, monitor resp rate and depth and LOC closely!! Some medication is worse than others at cause resp. depression.

You're providing education to a patient who is prescribed to take a Benzodiazepine for panic attacks. Which statements below require you to re-educate the patient about this medication? SELECT ALL THAT APPLY: A. "I will monitor my consumption of alcohol and limit myself to 5 beers a day." B. "Driving is not recommended while taking this medication." C. "I will take this medication with Oxycodone to help prevent panic attacks." D. "Signs of toxicity include slow heart rate, decreased respiration, extreme drowsiness, and slurred speech."

The answers are A and C. Patients taking Benzo should AVOID alcohol consumption and opioids (Oxycodone).

Select ALL the statements below that are INCORRECT about Benzodiazepines? A. "Benzodiazepines are CNS stimulants." B. "Benzodiazepines provide the most therapeutic and safest effects when prescribed with opioids." C. "Benzodiazepines can be used to treat seizures." D. "Narcan is the antidote used to reverse toxicity caused by Benzodiazepines."

The answers are A, B, and D. Benzodiazepines are CNS depressants, they should NOT be used with opioids (the FDA has issued a black box warning on this due to the increased risk of overdose), and Flumazenil is the antidote for Benzodiazepines.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Use

Treatment of mild to moderate pain (especially if caused by inflammation)- analgesic (also antipyretic)

Opioid-Narcotics uses

Treatment of moderate to severe pain

Nursing action when use Tylenol #3 and Percocet

Tylenol #3 and Percocet have Tylenol in it, so be careful to check Tylenol not more than 3000 mg/ day

Tylenol #3- codiene us used for ...

Tylenol #3- codiene converts to morphine when metabolized by liver

Non-Opioid Analgesic Nursing Actions/Teaching

Tylenol if you take long term, you can get bleeding side effect. Over dose Tylenol impact renal and hepatic Monitor urine output, not gain weight, check renal lab

Opioid-Narcotics Precautions/Contraindications

Use caution with elderly, pediatric and critically ill patients (think safety)

Benzodiazepines Usually Valium (diazepam) & Ativan (lorazepam) are used for

Valium and Ativan are used for acute seizure. A lot of time Ativan given through IV because CNS depress to stop seizure. Ativan is used to sedate CNS to stop seizure

Benzodiazepines Usually Versed (midazolam) is used for

Versed is used more often because it does produce therapeutic amnesia = conscious sedation (very drowsy)

Opioid-Narcotics action

binds to opiate receptors in the CNS and alter the response to pain

Benzodiazepines action

depresses the CNS= sedation and decreased anxiety

Non-Opioid Analgesic Action

inhibits prostaglandins in the CNS to reduce pain and fever.

Pain scale levels

mild pain = 1-3 moderate = 4-6 severe pain = 7-10