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Questions and Answers
A client with a history of opioid dependence is prescribed butorphanol for pain management. What is the MOST important nursing action prior to administering the medication?
A client with a history of opioid dependence is prescribed butorphanol for pain management. What is the MOST important nursing action prior to administering the medication?
- Monitor the client's blood pressure for potential hypertension.
- Inquire about the client's recent opioid use and patterns. (correct)
- Administer a test dose of naloxone to assess opioid tolerance.
- Ensure the client has access to opioid medications for breakthrough pain.
A client is prescribed pentazocine for post-operative pain. Which pre-existing condition would be MOST concerning?
A client is prescribed pentazocine for post-operative pain. Which pre-existing condition would be MOST concerning?
- Cardiac insufficiency (correct)
- Type 2 diabetes mellitus
- Controlled hypertension
- A history of migraines
A client receiving butorphanol complains of dizziness when ambulating. What is the MOST appropriate initial nursing intervention?
A client receiving butorphanol complains of dizziness when ambulating. What is the MOST appropriate initial nursing intervention?
- Request an order for a lower dose of butorphanol.
- Monitor the client closely during ambulation and provide assistance. (correct)
- Administer an antiemetic medication.
- Instruct the client to ambulate more quickly to reduce dizziness.
A client has been receiving pentazocine for chronic pain management. Which of the following findings would suggest the client is experiencing opioid withdrawal?
A client has been receiving pentazocine for chronic pain management. Which of the following findings would suggest the client is experiencing opioid withdrawal?
A client's respiratory rate is 10 breaths per minute after administration of butorphanol. What is the priority nursing action?
A client's respiratory rate is 10 breaths per minute after administration of butorphanol. What is the priority nursing action?
Which statement BEST describes the pharmacologic action of opioid agonist-antagonists?
Which statement BEST describes the pharmacologic action of opioid agonist-antagonists?
A client receiving an opioid agonist-antagonist reports feeling anxious and restless. Which of the following interventions is MOST appropriate?
A client receiving an opioid agonist-antagonist reports feeling anxious and restless. Which of the following interventions is MOST appropriate?
The health care provider prescribes pentazocine and naloxone (Talwin NX) orally for a client. What is the purpose of combining these two drugs?
The health care provider prescribes pentazocine and naloxone (Talwin NX) orally for a client. What is the purpose of combining these two drugs?
A nurse is preparing to administer pentazocine to a client. Which assessment finding would be of greatest concern, requiring the nurse to withhold the medication and contact the provider?
A nurse is preparing to administer pentazocine to a client. Which assessment finding would be of greatest concern, requiring the nurse to withhold the medication and contact the provider?
A client with a history of opioid dependence is prescribed butorphanol for postoperative pain. Which of the following is the most important nursing consideration regarding this medication order?
A client with a history of opioid dependence is prescribed butorphanol for postoperative pain. Which of the following is the most important nursing consideration regarding this medication order?
A client is prescribed both an opioid and an opioid agonist-antagonist. What is the expected interaction between these medications?
A client is prescribed both an opioid and an opioid agonist-antagonist. What is the expected interaction between these medications?
A client receiving butorphanol reports dizziness and lightheadedness. What is the most appropriate nursing intervention?
A client receiving butorphanol reports dizziness and lightheadedness. What is the most appropriate nursing intervention?
A client is prescribed intranasal butorphanol for pain management. Which instruction should the nurse include in the client's education?
A client is prescribed intranasal butorphanol for pain management. Which instruction should the nurse include in the client's education?
Which of the following pre-operative orders for pain management should the nurse question?
Which of the following pre-operative orders for pain management should the nurse question?
A client with a history of hypertension is prescribed pentazocine for pain. What is the nurse's priority action?
A client with a history of hypertension is prescribed pentazocine for pain. What is the nurse's priority action?
A client is being discharged home with a prescription for pentazocine for short-term pain relief. Which of the following instructions is most important for the nurse to emphasize?
A client is being discharged home with a prescription for pentazocine for short-term pain relief. Which of the following instructions is most important for the nurse to emphasize?
A client who has been receiving butorphanol regularly for chronic pain suddenly stops taking the medication. Which of the following is the client most at risk for experiencing?
A client who has been receiving butorphanol regularly for chronic pain suddenly stops taking the medication. Which of the following is the client most at risk for experiencing?
Why are opioid agonist-antagonists such as butorphanol and pentazocine generally contraindicated for clients with acute myocardial infarction?
Why are opioid agonist-antagonists such as butorphanol and pentazocine generally contraindicated for clients with acute myocardial infarction?
Flashcards
Opioid Agonist-Antagonists
Opioid Agonist-Antagonists
Relieve moderate to severe pain; act as anesthesia adjuncts.
Examples of Opioid Agonist-Antagonists
Examples of Opioid Agonist-Antagonists
Butorphanol (injection/nasal spray) and pentazocine (oral, with naloxone). Buprenorphine also included.
Pharmacologic Action
Pharmacologic Action
Mu receptor antagonists (block) and kappa receptor agonists (activate).
Effects of Agonist-Antagonists
Effects of Agonist-Antagonists
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Adverse Reactions
Adverse Reactions
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Opioid Withdrawal Manifestations
Opioid Withdrawal Manifestations
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Abstinence Syndrome
Abstinence Syndrome
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Nursing Interventions
Nursing Interventions
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Medication Safety Check
Medication Safety Check
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Medication Clarification
Medication Clarification
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Opioid Agonist-Antagonist Routes
Opioid Agonist-Antagonist Routes
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Vitals Monitoring
Vitals Monitoring
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Respiratory Rate Threshold
Respiratory Rate Threshold
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Client Instructions
Client Instructions
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Contraindications
Contraindications
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Precautions
Precautions
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CNS Depressant Interaction
CNS Depressant Interaction
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Opioid Interaction
Opioid Interaction
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Study Notes
- Opioid agonist-antagonists aid in relieving moderate to severe pain, and act as an adjunct to anesthesia.
Prototype and Other Medications
- Prototype medications include butorphanol and pentazocine.
- Butorphanol is available in injectable or nasal spray form.
- Pentazocine, combined with naloxone, is available in oral form.
- Buprenorphine is another medication in this category.
Expected Pharmacologic Action
- Opioid agonist-antagonists act as mu receptor antagonists and kappa receptor agonists.
- These medications have fewer mu-related adverse effects like respiratory depression, euphoria, and dependence.
- They produce milder analgesic effects than pure opioid agonists.
- Opioid agonist-antagonists can cause withdrawal in clients addicted to opioids, so it is important to know patient's history.
Adverse Drug Reactions
- Adverse reactions include limited respiratory depression, sedation, dizziness, lightheadedness, drowsiness, headache, and nausea.
- Butorphanol and pentazocine increase cardiac workload.
- Abstinence syndrome may occur in clients who become dependent.
- Opioid withdrawal manifestations include abdominal cramps, diarrhea, agitation, anxiety, hypertension, tachycardia, tremors, muscle pain, pupil dilation, runny nose, and insomnia.
Interventions
- Inquire about opioid use before administering.
- Measure baseline vital signs and monitor respirations.
- If respiratory rate falls below 12/min, withhold and stimulate breathing.
- Monitor clients when ambulating for dizziness or lightheadedness.
- Avoid use in clients with myocardial infarction or cardiac insufficiency.
Administration
- Opioid agonist-antagonists can be administered intramuscularly, intravenously, or intranasally.
- Pentazocine is given orally when an invasive route is not warranted.
- Measure baseline vital signs before administration and monitor throughout therapy, and do not administer if respiratory rate is less than 12/min.
- For intranasal butorphanol, give one spray into one nostril and repeat every 60 to 90 minutes as needed.
- For preoperative IM administration, give it 60 to 90 min as prescribed before surgery.
- Monitor therapeutic effects to ensure effective pain relief.
- Avoid abrupt discontinuation after extended use.
Client Instructions
- Take only when needed and on a short-term basis.
- Avoid driving or activities requiring mental alertness.
- Sit or lie down if experiencing dizziness or lightheadedness.
- Changing positions gradually may minimize these effects.
- Do not use for anginal pain due to effect on cardiac output.
- Avoid taking opioids while taking an opioid agonist-antagonist.
Contraindications and Precautions
- Avoid use in clients with acute myocardial infarction or opioid dependence.
- They are schedule IV controlled substances, so use them with caution for clients who have a history of substance use disorder.
- Use caution in clients with head injury or increased intracranial pressure, reduced respiratory reserve, hepatic or renal disease, or cardiac insufficiency, as well as clients who have hypertension.
Interactions
- Avoid with other CNS depressants like barbiturates, phenobarbital, benzodiazepines, and alcohol.
- Administration with an opioid will decrease the effects of the opioid.
Question Answer
- Butorphanol is an unsafe analgesic choice for a client who uses a fentanyl patch for chronic pain.
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