Pain Medication Overview
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Questions and Answers

Which of the following drugs is classified as a Schedule 2 drug?

  • Methadone (correct)
  • Xanax
  • Lyrica
  • Ketamine

Which of these drugs is NOT classified as a Schedule 3 drug?

  • Products with less than 90 milligrams of codeine
  • Testosterone
  • Anabolic steroids
  • Hydromorphone (correct)

What is the main characteristic of drugs classified under Schedule 4?

  • Severe psychological dependence
  • Moderate potential for dependence
  • High potential for abuse
  • Low potential for abuse (correct)

Which drug is an example of a Schedule 5 substance?

<p>Robitussin AC (D)</p> Signup and view all the answers

Which of the following statements is true regarding Schedule 1 drugs?

<p>They are considered to have no accepted medical use in the U.S. (B)</p> Signup and view all the answers

Which type of pain is characterized by localized sensations such as pinprick or sharp stabbing?

<p>Somatic pain (B)</p> Signup and view all the answers

What is a common example of visceral pain?

<p>Kidney stone (D)</p> Signup and view all the answers

Which of the following are common adverse reactions associated with morphine use?

<p>Respiratory depression (A), Flushing (D)</p> Signup and view all the answers

Which of the following is a contraindication for ibuprofen use?

<p>Active GI bleed (D)</p> Signup and view all the answers

What is an essential nursing consideration when administering morphine to opioid naïve patients?

<p>Start with a low dose (A)</p> Signup and view all the answers

What is the maximum daily dose of ibuprofen for adults?

<p>3200 mg (A)</p> Signup and view all the answers

Which of the following opioids can cause respiratory depression and may require naloxone for reversal?

<p>Hydromorphone (B)</p> Signup and view all the answers

Which drug is considered the strongest opioid analgesic listed?

<p>Fentanyl (D)</p> Signup and view all the answers

What key patient education should be emphasized for those taking opioids like morphine?

<p>Store medication safely and prevent sharing (C)</p> Signup and view all the answers

How should naloxone be prepared for administration in cases of opioid overdose?

<p>Diluted in 10 mL of normal saline (A)</p> Signup and view all the answers

Which class of drugs includes substances recognized for having a high potential for abuse and no accepted medical use?

<p>Schedule I (B)</p> Signup and view all the answers

What is a well-known adverse reaction associated with ibuprofen?

<p>GI bleed (A)</p> Signup and view all the answers

Which type of pain is typically described with sensations of burning or tingling?

<p>Neuropathic pain (D)</p> Signup and view all the answers

What is a primary beneficial effect of inhibiting COX 2?

<p>Promotion of vasodilation (D)</p> Signup and view all the answers

Which condition is a contraindication for the use of first generation NSAIDs?

<p>Active GI bleed or ulcer (C)</p> Signup and view all the answers

What is a common adverse effect of both first and second generation NSAIDs?

<p>Gastrointestinal bleeding (B)</p> Signup and view all the answers

What nursing consideration is crucial when administering high doses of first generation NSAIDs?

<p>Hydrate well prior to administration (D)</p> Signup and view all the answers

In which situation should COX 2 inhibitors be used with caution due to cardiovascular risk?

<p>Management of chronic pain (B)</p> Signup and view all the answers

What is a nursing consideration when prescribing acetaminophen?

<p>Evaluate liver function prior to therapy (A)</p> Signup and view all the answers

Which one of the following is NOT a side effect of COX 2 inhibitors?

<p>Gastric ulcer risk (A)</p> Signup and view all the answers

What adverse reaction is specifically associated with high doses of first generation NSAIDs?

<p>Intraventricular hemorrhage (C)</p> Signup and view all the answers

Which of the following is a contraindication for acetaminophen use?

<p>Severe hepatic impairment (D)</p> Signup and view all the answers

What is a potential adverse effect of acetaminophen, especially in children?

<p>Agitation (D)</p> Signup and view all the answers

How does the use of NSAIDs and acetaminophen concurrently affect renal function?

<p>It enhances renal effects (C)</p> Signup and view all the answers

Which of the following drug interactions should be avoided with acetaminophen due to the risk of increased adverse effects?

<p>Other hepatotoxic substances (C)</p> Signup and view all the answers

What is the maximum duration for which adults can safely use acetaminophen?

<p>10 days (B)</p> Signup and view all the answers

Which of the following statements about acetaminophen is correct?

<p>It lacks anti-inflammatory effects. (D)</p> Signup and view all the answers

What is the most effective antidote for acetaminophen overdose when given within 8 hours?

<p>N-acetylcysteine (A)</p> Signup and view all the answers

Which of the following is NOT an indication for the use of acetaminophen?

<p>Inflammation treatment (D)</p> Signup and view all the answers

Flashcards

Schedule 2 Drugs

Drugs with a high potential for abuse, leading to severe physical or psychological dependence, and are considered dangerous.

Schedule 3 Drugs

Drugs with moderate to low potential for physical and psychological dependence; abuse potential is in between Schedule 1/2 and Schedule 4 drugs.

Schedule 4 Drugs

Drugs with low potential for abuse and a low risk of dependence.

Schedule 5 Drugs

Drugs with lower potential for abuse than Schedule 4. Often used as antidiarrheal, antitussive, or analgesic medications.

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Drug Scheduling

A system used by governments to classify drugs according to their potential for abuse and/or medical use.

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Opioid Adverse Reactions

Opioids can cause hypotension, constipation, sedation, flushing, itching, urinary retention, dizziness, miosis, cough suppression, and most seriously, respiratory depression.

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Opioid Nursing Considerations

Start low doses for opioid-naïve patients, assess pain levels before and after medication, watch for breakthrough pain, monitor vital signs (LOC, BP, HR, RR, pulse ox), and assess risk factors for addiction, abuse, and misuse.

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Opioid-induced Constipation

Opioids frequently cause constipation, which must be routinely assessed and managed.

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Opioid Antagonists

Substances that block opioid receptors, primarily used to reverse opioid overdose and respiratory depression.

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Naloxone Use

Naloxone (Narcan) is an opioid antagonist used to reverse respiratory depression and coma from opioid overdose; it must be diluted before administration.

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Somatic Pain

Localized pain, often sharp or stabbing, felt in body parts like muscles, joints, or skin, caused by damage or injury to these areas. Carries signals via A-delta fibers.

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Visceral Pain

Generalized pain that's often described as aching, pressure, or sharp. Arises from internal organs and is carried along C fibers.

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Neuropathic Pain

Pain caused by damage or disease to the nerves. Often described with sensations like burning, tingling, or electric shock. Can be in areas like skin (dermatomal) or not.

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Nociceptive Pain

Pain signaling damage or threat of damage to non-nervous tissue.

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Ibuprofen Contraindications

Conditions where ibuprofen use is not recommended, like active stomach ulcers or bleeding, recent heart surgery, or severe heart problems. Also avoid use in pregnancy after 30 weeks.

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Ibuprofen Adverse Reactions

Potential negative side effects of ibuprofen use, including stomach bleeding/ulcers, heart problems, and rare but serious skin reactions. Also possible renal(kidney) and liver damage.

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Opioid Analgesics (Strong to Weak)

List of pain medications containing opioids, categorized by potency in descending order, including Fentanyl, Buprenorphine and others.

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DEA Schedule 1 Drugs

Drugs with no accepted medical use and a high potential for abuse; not safe for prescription

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Acetaminophen indications

Pain relief, fever reduction but lacks anti-inflammatory properties.

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Aspirin's impact on MI/Stroke prevention

Aspirin can help prevent heart attacks and strokes.

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Acetaminophen overdose antidote

N-acetylcysteine (NAC) is the most effective antidote when given within 8 hours.

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NSAID's effect on the stomach

NSAIDs can cause gastric ulcers.

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Acetaminophen's effect on liver damage

Acetaminophen can cause severe liver damage with overdose.

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Contraindications for medicine use

Conditions where a medicine should not be used due to potential harm.

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Drug-drug interaction involving NSAIDs

Concurrent NSAID use with other hepatotoxic substances can intensify the effects.

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COX-2 inhibitors (Second-Generation NSAIDs)

These NSAIDs target COX-2 enzymes in the body.

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COX-1 Inhibitors

Inhibit the COX-1 enzyme, found in all tissues, impacting gastric mucosa, renal function, and platelet aggregation.

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COX-2 Inhibitors

Inhibit the COX-2 enzyme, mainly found at sites of injury, mediating inflammation and pain.

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1st Generation NSAIDs (like Aspirin)

Inhibit both COX-1 and COX-2, used for pain, fever, arthritis. Caution is needed due to potential harmful effects.

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COXibs

Second-generation NSAIDs specifically targeting COX-2, often used for osteoarthritis and rheumatoid arthritis.

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Acetaminophen

Inhibits prostaglandin synthesis, used for pain and fever, but lacks anti-inflammatory effects.

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Adverse Effects (NSAIDs)

Potential side effects like gastrointestinal bleeding, cardiovascular events, and kidney problems. Be cautious.

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Nursing Considerations (NSAIDs)

Monitor for bleeding, kidney and liver function, and educate patients about risk factors and avoiding excessive use.

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Contraindications (NSAIDs)

Conditions like active GI bleeds, severe heart failure, and certain surgeries limit NSAID use.

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Study Notes

Pain Medication Differentiation

  • Pain is categorized as somatic, visceral, or neuropathic
  • Somatic pain: localized, sharp, pinprick, stabbing. A-delta fibers. Examples include periosteum, joints, muscles, lacerations, burns, and IM injections.
  • Visceral pain: generalized, aching, pressure, or sharp. C fiber activity. Examples include colic pain, appendicitis, kidney stones.
  • Neuropathic pain: radiating or specific, burning, prickling, tingling, electric-like sensations. Can be dermatomal or non-dermatomal. Examples include trigeminal neuralgia, avulsion neuralgia, peripheral neuropathy.

Ibuprofen Contraindications and Adverse Reactions

  • Contraindications: hypersensitivity, active GI bleed/ulcer, CABG surgery, history of MI, severe heart failure, avoid after 30 weeks of pregnancy
  • Adverse reactions: GI bleed (less risk compared to aspirin), cardiovascular events (heart failure, stroke, MI), Stevens-Johnson syndrome, constipation, dyspepsia, nausea, vomiting, headache, and renal failure.
  • Patient teaching: Do not exceed 3200 mg/day for adults, maximum dose for children is 2.4 g/day. Monitor for GI bleeding and symptoms.

Opioid Analgesics

  • Strongest to weakest (descending): fentanyl, buprenorphine, levorphanol, oxymorphone, hydromorphone, phenazocine, methadone, oxycodone, morphine, hydrocodone, tapentadol, dihydrocodeine, tramadol, codeine.

DEA Drug Schedules

  • Schedule 1: Drugs with no currently accepted medical use and a high potential for abuse. Examples include heroin, LSD, marijuana, ecstasy, methaqualone, and peyote.
  • Schedule 2: Drugs with a high potential for abuse, potentially leading to severe psychological or physical dependence. Examples include hydrocodone combination products, cocaine, methamphetamine, methadone, hydromorphone, fentanyl, dexedrine, adderall, and ritalin.
  • Schedule 3: Drugs with a moderate to low potential for physical and psychological dependence, Examples include products with less than 90 milligrams of codeine, ketamine.
  • Schedule 4: Drugs with a low potential for abuse and low risk of dependence. Examples include xanax, soma, darvon, darvocet, valium, ativan, talwin, and ambien.
  • Schedule 5: Drugs with lower potential for abuse than schedule 4 and consist of preparations with limited quantities of certain narcotics for antidiarrheal, antitussive, and analgesic purposes. Examples are cough preparations with less than 200 milligrams of codeine per 100 milliliters and codeine-containing medications.

Opioid Adverse Reactions and Nursing Considerations

  • Adverse reactions: hypotension, constipation, sedation, flushing, itching, urinary retention, dizziness, miosis, cough suppression, and respiratory depression.
  • Nursing considerations: Start low doses for patients naïve to opioids, assess pain regularly, monitor vital signs, watch out for respiratory issues.
  • Teaching: correct storage and disposal methods, education about potential side effects

COX-1 vs COX-2 Inhibitors

  • COX-1: "Good COX", found in all tissues. Protects gastric mucosa, supports renal function, and promotes platelet aggregation
  • COX-2: "Bad COX", is mainly produced at the site of tissue damage, responsible for inflammation, pain, and fever.
  • 1st generation NSAIDS: Inhibits both COX-1 and COX-2.
  • 2nd generation NSAIDS: Primarily inhibits COX-2, less likely to cause gastric issues.
  • Acetaminophen: does not inhibit COX and is used for fever and pain relief.

Acetaminophen Overdose

  • Antidote: N-acetylcysteine (NAC)
  • Effectiveness: Most effective when given within 8 hours of overdose.

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Description

This quiz delves into the differentiation of pain types: somatic, visceral, and neuropathic. It also covers the contraindications and adverse reactions associated with ibuprofen, providing a comprehensive understanding for medical professionals and students.

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