PH Chapter 15 & 16 - Opioid Analgesics & Opioid Antagonists

How quickly does naloxone work to reverse opioid-induced respiratory depression? 1. 1-2 mins 2. 10-15 mins 3. 15-30 mins 4. 30-60 mins

1

Naloxone will reverse the effects of which of the following drugs? 1. Fentanyl 2. Lorazepam (Ativan) 3. Valproic acid (Depakote) 4. Warfarin (Coumadin)

1

The nurse caring for a patient with respiratory depression should include which expected outcome as part of the treatment plan? 1. Provide adequate ventilation of body 2. Provide patients with controlled analgesic pumps 3. Administer prescribed sedatives through IV route 4. Ensure that the patients' rooms are odor free

1

When administering a timed-release medication to a patient, the nurse must be aware that... 1. It should not be crushed 2. The medication is stronger 3. Serious cardiac arrhythmias may develop 4. CNS stimulation is possible

1

A patient presents to the ED with symptoms of an acute opioid overdose. Several mins after the nurse administers the naloxone, the patient's respiratory rate and other symptoms have no changed. This is most likely due to which of the following? 1. The patient was not administered a large enough dose of naloxone 2. The patient is not experiencing an overdose 3. The patient overdosed on multiple opioids 4. The naloxone has not been given enough time to work

2

Which drug would most likely be prescribed for treatment of a patient who is experiencing an opioid overdose? 1. Naltrexone 2. Naloxone 3. Naproxen 4. Nifedipine

2

A patient is a postsurgical recovery unit is prescribed a dose of naloxone. Which of the following interventions should the nurse perform during and after naloxone administration when caring for this patient? Select all that apply 1. Monitor the patient for symptoms of hypotension 2. Make suction equipment available 3. Turn and suction the patient when needed 4. Provide for artificial ventilation if necessary 5. Monitor for hemotologic changes

2, 3, 4

A patient in an ambulatory surgical center is prescribed an opioid antagonist. Which of the following statements in the patient's chart indicates an alert for the use of the opioid antagonist? Select all that apply 1. Liver impairment noted 2. Breastfeeding 2-month old baby 3. Family Hx of renal failure 4. Hypersensitivity to drug

2, 4

A nurse working in an alcohol detoxification clinic may use which of the following to treat patients with alcohol dependence? 1. Naloxone 2. Nalmefene 3. Naltrexone 4. Nifedipine

3

A patient has been prescribed naloxone for respiratory depression. Which of the following interventons should the nurse perform to promote an optimal response in the patient? 1. Monitor for an increase in the patient's body temperature 2. Monitor for any signs of dehydration and water loss in the patient 3. Balance need for continued pain relief with patient's ability to breathe 4. Administer the drug through a rapid IV push

3

Each time the patient requests an opioid, the nurse must... 1. Check the patient's Dx 2. Talk to the patient to see if he is awake 3. Determine the location and intensity of the pain 4. Administer the drug with food to prevent GI upset

3

Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which of the following? 1. Alcohol 2. NSAIDs 3. Opioids 4. Benzodiazepines

3

What is the action when an opioid antagonist is administered? 1. Increases renal clearance of the opioid drug 2. Speeds up the cardiovascular system 3. Displaces the opioid drug from the receptor site 4. Causes the respiratory center to stop functioning

3

When administering opioid analgesics to an older patient, the nurse monitors closely for... 1. Increased HR 2. Euphoria 3. Confusion 4. A synergistic reaction

3

Which of the following drug combos would follow Step 1 of the WHO pain ladder? 1. Morphine orally PO 10 mg q4h and morphine sublingual 1 mg PRN 2. Hydrocodone PO 5 mg and acetaminophen 500 mg 3. naproxen PO 200 mg BID and acetaminophen 325 mg at bedtime 4. meperidine 20 mg with Phenergan IM

3

Which patient, given an opioid analgesic for acute pain, should the nurse monitor most closely for respiratory distress? 1. Patient with cancer taking morphine sulfate regularly 2. Athlete who is taking Percocet for a leg injury 3. Man who has never used an opioid pain medication 4. Methadone patient with a broken arm

3

The nurse explains to the client that some opioids may be used as part of the preoperative medication regimen to... 1. Increase intestinal motility 2. Facilitate passage of an endotracheal tube 3. Enhance the effects of the skeletal muscle relaxant 4. Lessen anxiety and sedate the patient

4

The patient on opioid therapy complains of abd pain. What is the nurse's best response? 1. "Let's see when is the last time you had your pain meds" 2. "Can you rate your pain for me?: 3. "Show me where on your tummy it hurts" 4. "When was your last BM?"

4

Which of the following findings requires the nurse to immediately contact the doctor? 1. HR = 80 bpm 2. Complaint of breakthrough pain 3. Respiratory rate = 20 breaths/min 4. Systolic BP of 140 mmHg

4

This syndrome occurs if a drug is abruptly stopped. It is dependent on the half-life of a drug and the degree of physical dependence

Abstinence syndrome

This term refers to a drugs that bind well to a receptor

Agonist

What is the opioid antagonist, naltrexone primarily used for?

Alcohol dependence and to block the effects of suspected opioids if they are being used by a person undergoing treatment for alcohol dependence

A ____________ bind to a receptor and cause no response. It can reverse the effects of an agonist

Antagonist

A drug that is a(n) ______________ has a greater affinity for a cell receptor than an opioid drug, and by binding to the cell it prevents a response to the opioid

Antagonist

Large doses of passionflower may cause...

CNS depression

If a patient taking an opioid begins a drop in respiratory rate, what should the nurse do?

Coach the patient through breathing Use narcan if needed

Which opioids are effective for the treatment of mild-moderate pain?

Codeine or pentazocine

Which medications are considered semisynthetic opioids?

Hydromorphone Oxymorphone Oxycodone Heroin

The use of passionflower in conjunction with coumadin may cause...

Increased risk of bleeding

Opioid antagonists are used cautiously in...

Infants of opioid-dependent mothers Cardiovascular disease

Why are opioids not recommended for women who are pregnant or in labor?

It can prolong labor or cause respiratory depression in the fetus

What medications can be used for treatment of opioid dependence?

Levomethdyl and methadone

What is Step 1 of the WHO analgesic ladder?

MILD PAIN Nonopioid analgesic NSAIDs and acetaminophen

What is Step 2 of the WHO analgesic ladder?

MORE SEVERE PAIN Add opioid for mild-moderate pain

Which opioids are effective for the treatment of moderate-severe pain?

Meperidine and levorphanol

Which medications are considered synthetic opioids?

Methadone Levorphanol Remifentanil Meperidine

Which medications are considered natural opioids?

Morphin sulfate Codeine Opium alkaloids Tincture of opium

Which opioid is the most commonly used for moderately severe to severe pain?

Morphine sulfate

______________ is capable of restoring respiratory function within 1-2 mins of administration

Naloxone

Are antagonist drugs selective for specific adverse reactions?

No

This term is used to describe a patient who does not use opioids routinely and is most at risk for respiratory depression

Opioid naive

Which medication has less adverse reactions than morphine sulfate and is safe to use for older adults?

Oxycodone

A ______________ binds to a receptor but the response is limited

Partial agonist

Naloxone is typically used within the controlled settings of the _______________ recovery unit

Postanesthesia

What are opioid antagonists used to treat for?

Postoperative acute respiratory depression Opioid adverse effects (Reversal) Suspected acute opioid overdosage

Passionflower is C/I in patients who are...

Pregnant or taking a MAOI

Opioid antagonists are used for the treatment of postoperative acute _____________ depression

Respiratory

What is Step 3 of the WHO analgesic ladder?

SEVERE PAIN Substitute opioid for moderate to severe pain

If naloxone is being used to reverse respiratory depression, how should it be given?

Slow IV push until respiratory rate increases and somnolence abates. If given too quickly, withdrawal effects may surface and the return of intense pain

How do opioid antagonists work?

They work by competing for opiate receptor sites and displacing the opioid drug

If a patient who is lactating were required to take an opioid, how should it be taken?

Wait at least 4-6 hrs after taking the drug to breastfeed