Pharmacology: Chapter 49 Key terms, Notes, PrepU

Use of Morphine Sulfate

The main indication for morphine is to prevent or relieve acute or chronic pain. Other clinical uses include: Before/After Surgrey to promote sedation During labor and delivery Treatment of GI disorders Acute pulmonary edema severe, unproductive cough relief of dyspena

1030

The nurse administers morphine 15 mg oral solution to a client with cancer pain at 0930. When should the nurse reassess the client for peak effect?

Within one to five minutes, an effect may be seen

The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function?

Drowsiness

The nurse is administering morphine to a trauma client for acute pain. What is a common side effect of morphine?

Facial expressions Movement of arms and hands Guarding of the leg

The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain? (Select all that apply.)

The client may begin to demonstrate symptoms of withdrawal.

The nurse is caring for a postoperative client with a history of opioid abuse who has been ordered to receive a dose of an opioid antagonist medication. Which issues should the nurse be prepared to address?

Endorphins

Morphine - like neuropeptides that interact with neuroreceptors t inhibit the transmission of pain signals while also producing a sense of euphoria

Clinical Manifestations of Pain

Site Onset Character Radiation Associations with other symptoms time course (Pattern) Exacerbating/ Relieving factors Severity

Narcan

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

Enkephalins

Morphine like neuropeptides that interrupt the transmission of pain signals at the spinal cord level by modulating pain perception, mood, behavior, and neuroendocrine regulation

endogenous analgesia system

nerve signals that relieve pain by suppressing the transmission of pain signals from peripheral nerves; can be activated by nerve signals entering the brain or by morphine-like drugs

Use of Morphine with home care

- short period of time -it is important to consider nopharmacologic methods for pain -With Cancer, keep PT comfortable -

Action of Naloxone (Narcan)

(Antidote) reverses analgesia and the CNS and respiratory depression caused by agonists

Respiratory depression is a possible side effect of PT taking opioid, but concerns can be minimized by

1) Avoiding concomitant use of other drugs such as alcohol and benzos 2)careful monitoring to response of drug and the dosage

Two Transdermal formulations of fentanyl are available:

1) Ionsys is for short term treatment of acute postoperative pain in hospitalized adults who require opioid analgesics 2) Duragesic is for treatment of chronic and severe malignant pain

codeine.

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain:

Methadone

A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment?

Coach the client to breathe.

A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be most important for the nurse to do?

Opiate naive

A client who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term?

Abrupt reversal of opioid-induced respiratory depression may cause vomiting.

A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone (Narcan). Which explanation by the nurse is correct?

Asking a client to describe his or her pain

A group of students is reviewing various methods for assessing pain. The students demonstrate understanding of the material when they identify what as the most reliable method?

It is extremely unlikely that the client would become addicted to narcotics used for this purpose

A hospital client has been prescribed morphine for the treatment of post-surgical pain. The client tells the nurse, "I'm determined to push through my pain if I can, because there's no way I want to end up addicted to narcotics." What should the nurse teach the client?

Consult with the prescriber about lowering the dosage of the drug.

A nurse is caring for a client with renal impairment. The client has been prescribed an opioid analgesic. Which nursing intervention would be most appropriate?

Pain intensity, respiratory rate, and level of consciousness

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments?

has a shorter half-life than morphine

A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan

Control button activates administration of the drug

A patient is receiving drugs through a PCA infusion pump. Which of the following information should a nurse offer to the patient for proper administration of the drug through the infusion pump?

Bowel Patterns

A trauma client has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the client's what?

True

A-delta fibers are small myelinated fibers that respond quickly to acute pain. True or False

Drugs that increase Morphine Sulfate

Alcohol, Antidepressants, benzo, Antihistamines, Mnoamine Oxidase Other narcotics or opioids

It has a short half-life and is less likely to accumulate, causing toxicity or overdosage.

An 80-year-old male client presents to the emergency department with a fractured ankle and multiple abrasions and contusions. He is admitted to the hospital with an order for oxycodone for pain. Oxycodone may be prescribed for a geriatric client because the drug has which characteristic?

Respiratory Depression

An opioid naïve patient experiences acute pain after surgery and is put on opioid therapy. Which severe adverse reactions of opioid treatment should the nurse monitor for in the patient?

Patient controlled analgsia

Any method used by patients to administer their own pain medications, typically used to indicate administration through a controlled IV pump

Adverse Effects of Morphine Sulfate

CNS - depression, ranging from drowsiness to sleep to unconsciousness; decreased mental and physical activity, respiratory depression, Nausea and vomiting and pupil constriction May cause constipation and smooth muscle spams in the bowel

Naloxone (Narcan)

Class : Opioid Anagonists

They should be given on a regular schedule, around the clock

Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness?

Contradictions of Morphine Sulfate

Contradictions and cautions are respiratory depression, acute or chronic lung disease, liver or kidney disease, prostatic hypertrophy, pregnancy, increased intracranial pressure and head injury, seizure disorders, hypersensitivity

Morphine Sulfate

Duramorph, Infumorph, Kadian, MS Contin, Embeda Prototype is opium alkaloid schedule 2 drug

Superficial somatic pain

Keith, 12 years old, is seen in the emergency department for a severe sunburn. He reports pain, which he rates 7/10. What type of pain is he suffering from?

Acute Pain

May result from injury, trauma, spasm, disease, processes, and treatment or diagnostic procedures that damage body tissues.

Other drugs in the opioid agonists/Antagonists class

Nalbuphine Pentazocine *** Butorphanol

2

Naloxone (Narcan) 2 mg IM has been ordered for a post surgical client. The pharmacy has sent to the floor naloxone 1 mg/mL. How much naloxone will the client receive?

Fentanyl (Duragesic)

Naloxone (Narcan) will reverse the effects of which drug?

Nociceptors

Nerve endings that signal the sensation of pain.

The client living with a chronic noncancer-related illness

Of the following clients, which one will be most likely to develop physical dependence upon the opioid analgesic they are receiving for pain management?

An agonist A partial agonist A mixed agonist-antagonist

Opioid analgesics can be classified as which of the following? Select all that apply:

do not routinely take opioids.

Opioid-naïve clients are defined as those who:

central nervous (CNS) respiratory

Opioids have adverse effects on what body systems that are potentially life threatening? Select all that apply.

Codeine

Opium alkaloid used for analegesic and antitussive effects Schedule 2 drug more effective when given orally

Oxycodone

OxyContin, Roxicodone Derivative of codeine used to relieve moderate pain schedule 2 drug Popular for abuse

Opioid Tolerant

Patient has been taking at least 60mg of morphine or an equianalgesic dose of another opioid for a week or longer

opioid naive

Patients who do not meet opioid-tolerant criteria and have not had at least 60 mg of morphine or an equianalgesic dose of another opioid for a week or longer

Hydromorphone (Dilaudid)

Schedule 2 similar to morphine but more potent

Oxymorphone (Opana)

Schedule two derivative of morphine with actions, uses and adverse effects used for acute ad chronic pain Black Box Warning

Crushing the medication may precipitate an overdose.

The client has difficulty swallowing and requests the nurse to crush all the medications. The nurse notes a client prescribed an extended-release opioid requests that all medications be crushed to facilitate the administration. What information about this form of opioid presents a problem respecting the client's request?

Ask for pain medication before the pain gets severe.

The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery?

a return to normal respiratory rate, rhythm, and depth.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide:

1 to 2 minutes

When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time?

Therapeutic response is achieved and discomfort is reduced. Client maintains adequate nutritional status. An adequate breathing pattern is maintained.

When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.)

Many postoperative clients require less opioid when PCA is used.

When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan?

one who does not routinely take opioids

Which client would the nurse identify as being opioid naive?

withdrawal symptoms

Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids?

Opioids

Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management?

Codeine

While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is:

ceiling effect

a phenomenon of certain drugs that limits the ability to produce a further effect above a particular dosage level

visceral pain

a poorly localized, dull, or diffuse pain that arises from the abdominal organs, or viscera

Cancer Pain

both acute and chronic pain, may be constant or intermittent.

Breakthrough Pain

episodic bursts of intense pain that "breaks through" the pain control of the medication regime

Use of Narcan

has been the drug of choice for over dose begins the reverse of CNS and respiratory depression from OD within mins

Adverse effects with Butorphanol

headache, dizziness, drowsiness, vertigo, constipation, nausea, and or vomitting, dizzines, and euphoria Black Box Warning * Potentially Fatal

Methadone (Dolophine)

is a synthetic drug similar to morphine but with longer duration of action. usually given orally and onset and peak action occur in 30 to 60 mins half life 15 to 30 hours

Action: Butorphanol

is an agonist of kappa opiate receptors and a partial agonist of mu opiate receptors in the CNS, causing inhibition of ascending pain pathways

neuropathic pain

is caused by lesion or pyshiologic changes that injure peripheral pain receptors, nerves, or the CNS

Chronic Pain

lasting three months or longer demand attention less urgently, may not be characterized by visible signs, and is often accompanied by emotional distress, increased irritability, depression, social withdrawal, financial distress, loss of libido, disturbed sleep, diminished appetite, weight loss, and decreased ability to perform daily living

Butorphanol (Stadol)

opioid agonist-antagonist Schedule 4

Tramadol (Ultram)

oral, synthetic schedule 4that acts at the centra opioid receptors for moderate to severe pain

Fentanyl (Duragesic, Sublimaze)

potent opioid agonist schedule 2 drug Should not be administered in opioid naive patients

fentanyl is used for

preanesthetic meds, postop, and chronic pain that requires opioid

Action of Morphine Sulfate

releive pain by binding to receptors in the brain, spinal cord, and peripheral tissues When bound to the drug, receptors function like gates, that close and thereby block or decrease transmission of pain impulses from one nerve cell to the next

Drug therapy opioid anaflesics

relieve moderate to severe pain by inhibiting andenylate cyclase Most opioids are schedule 2 drug

Somatic Pain

results from stimulation of nociceptors in the skin, bone, muscle and soft tissue. localized and described as sharp, burning, gnawing, throbbing or cramping

Hydrocodone (Hysingla)

schedule 3 drug similar to codeine in its analgesic and antitussive effects

Recommendations for use of Morphine with older adults

start with low doses give less frequently monitor for sedation or confusion

Meperidine (Demerol)

synthetic drug similar to morphine in action and adverse effects.

Use of butorphanol

treat moderate to severe pain that has not been adequately managed with alternative treatments is approved for management of pain during labor

Adverse effects of Narcan

tremors, drowsiness, sweating, decreased respirations, hypertension, and nausea and vomiting.