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Questions and Answers
Which of the following medications is associated with the risk of Reye's syndrome in children when given with salicylate therapy?
What is a common sign of salicylate intoxication in children?
What should be emphasized in patient education regarding opioid use?
What cultural consideration should be taken into account when administering medications?
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Which medication is commonly used for managing gout?
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What is a significant risk associated with the use of aspirin in children?
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What is the primary concern when using salicylate therapy in children?
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Which of the following is NOT a recommended practice for patient education regarding opioid use?
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What is a consideration when administering medications to patients from diverse cultural backgrounds?
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What is the recommended way to manage gout pain according to analgesic treatments?
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Which statement about opioid tolerance is true?
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Which medication is notably stronger than morphine and used for severe pain relief?
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What is the critical monitoring requirement before administering opioids?
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What is a significant risk factor when using salicylates in children?
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Which symptom is NOT typically associated with salicylate intoxication in children?
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What is an essential aspect of patient education regarding opioid use?
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What should be considered when providing medication education to patients from different cultural backgrounds?
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Which statement about managing gout is accurate?
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What is a key point to include when teaching about the long-term use of NSAIDs?
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Which recommendation should be given regarding the use of ibuprofen and other NSAIDs?
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What factor can influence the decision-making process in some cultural contexts regarding medication?
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What is the primary mechanism of action of H2-receptor antagonists?
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Which condition is NOT typically treated with H2-receptor antagonists?
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Which of the following is a potential consequence of long-term use of H2-receptor antagonists?
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What factor could impair the absorption of medications when taking H2-receptor antagonists?
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Which of the following is a common side effect associated with H2-receptor antagonists?
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Study Notes
Salicylate (Aspirin) Intoxication in Children
- Hyperventilation and drowsiness are common symptoms
Acetaminophen (Tylenol)
- Do not exceed 4 grams/day to prevent liver damage
- Effective for mild pain and fever reduction
- Preferred for children for pain and fever relief
Ibuprofen (Advil) and NSAIDs
- Reduces inflammation, pain, and fever
- Take with food to avoid GI upset or ulcers
- Prolonged use can increase bleeding risk, especially in elderly or those on anticoagulants
- Avoid alcohol when taking NSAID's
- Long-term use can lead to potential kidney damage, risk for bleeding, and gastric ulcers
Patient Teaching and Discharge Instructions: Opioids
- Educate on the risks of dependence and tolerance
- Teach signs of respiratory depression (e.g., slowed breathing, confusion)
- Discuss safe storage and proper disposal of unused medications to prevent misuse
Patient Teaching and Discharge Instructions: NSAIDs
- Educate on GI risks: Always take with food and report any signs of stomach pain or black stools
- Clarify daily maximums and potential risks with exceeding them
- Contraindicated for patients with renal disease
Cultural Considerations in Medication Administration
- Tailor education to accommodate different cultural preferences (e.g., use interpreters if necessary, provide written instructions in preferred language)
- Understand Health Beliefs: Some cultures may use alternative therapies; respectfully inquire about these practices and provide guidance that incorporates their beliefs
- Family Involvement: In some cultures, family may play a central role in decision-making — include them in patient education when appropriate.
Anti-Gout
- Gout is caused by a buildup of uric acid crystals in the joints, leading to sudden and severe pain, swelling, redness, and tenderness, often in the big toe
- It occurs when the body either produces too much uric acid or cannot remove enough of it.
- Common medications include allopurinol (Zyloprim) and Colchicine
Gastrointestinal Drugs & Bowel Disorder Drugs: Diphenoxylate with atropine (Lomotil)
- OPIOID prescription laxative - Slows intestinal motility to increase fluid absorption, reducing diarrhea
Gastrointestinal Drugs & Bowel Disorder Drugs: Bismuth Subsalicylate (Pepto-Bismol)
- May cause dark-colored stool, dark tongue, and constipation
Gastrointestinal Drugs & Bowel Disorder Drugs: Simethicone (Mylicon)
- Administered for excessive and painful intestinal gas
- Safe for children/babies and adults
Gastrointestinal Drugs & Bowel Disorder Drugs: Calcium Antacids
- Not commonly used due to potential
Gastrointestinal Drugs & Bowel Disorder Drugs: Magnesium-Containing Antacids
- Use cautiously in patients with renal failure due to possible complications
Gastrointestinal Drugs & Bowel Disorder Drugs: H.pylori Infection Treatment
- (e.g., Omeprazole & Antibiotics): Often used to treat H.pylori infections causing peptic ulcers
Gastrointestinal Drugs & Bowel Disorder Drugs: Antacid and Medication Administration
- Administer medications at least 1 hour apart from antacids to avoid interaction
Gastrointestinal Drugs & Bowel Disorder Drugs: Cimetidine Side Effects
- May cause confusion and disorientation in elderly patients
Gastrointestinal Drugs & Bowel Disorder Drugs: PPIs and ICU patients
- Often given to prevent stress ulcers in patients with nasogastric tubes and ventilation
Gastrointestinal Drugs & Bowel Disorder Drugs: PPIs and Osteoporosis
- Long-term use can increase the risk of osteoporosis
Gastrointestinal Drugs & Bowel Disorder Drugs: Overuse of Sodium Bicarbonate
- May cause metabolic alkalosis
Long-Term Laxative Use
- May result in dependency and decreased bowel tone
Histamine (H2)-Receptor Antagonists
- When assessing patients always START with ABCs - considering airway, breathing, and circulation as the PRIORITY and then move on to pain and other findings after ABCs are managed.
Pain Assessment Scales
- Verbal Pain Intensity Scale: No Pain, Mild Pain, Moderate Pain, Severe Pain, Very Severe Pain, Worst Possible Pain
- 0-10 Numeric Pain Intensity Scale: 0 - No Pain, 10- Moderate Pain
- Visual Analogue Scale: Worst Possible Pain, No Pain
-
Wong-Baker FACES® Pain Rating Scale:
- 0: No Pain
- 2: Hurts Little Bit
- 4: Hurts Little More
- 6: Hurts Even More
- 8: Hurts Whole Lot
- 10: Hurts Worst
Terms to Review:
- Opioid Naïve: A person who has not taken opioids on a regular basis or has not taken opioid analgesics in at least 30 days
- Opioid Tolerance: A state of adaptation in which exposure to a drug induces a decrease in the drug's effect over time
- Partial Agonist: A drug that binds to and activates a receptor, but produces less of an effect than a full agonist in other words it's not as potent
- Opioid Dependence: A state of adaptation that occurs when there is a chronic exposure to opioids, leading to a need for a continued intake of the opioid to avoid the development of withdrawal symptoms, and to avoid experiencing unpleasant withdrawal symptoms such as discomfort, anxiety, and muscle aches
Opioid Analgesics: Usage, Management, and Monitoring: Hydromorphone (Dilaudid) vs.Morphine
- Hydromorphone is 7x stronger than Morphine - administer in much smaller doses
- Used for severe pain relief, especially when Morphine is ineffective
Opioid Analgesics: Usage, Management, and Monitoring: Respiratory Depression
- Critical Monitoring: Assess respiratory rate before administering opioids (must be ≥ 12/min). Opioids depress the CNS and can cause fatal respiratory failure
- Older Adult Caution: Post-op patients, especially older adults, are at higher risk
Opioid Analgesics: Usage, Management, and Monitoring: Naloxone (Narcan)
- Commonly used for overdose or with surgical anesthesia
- Opioid Antagonist: Keep available for reversing opioid-induced respiratory depression
- Emergency Use: Administer if respirations drop significantly or patient is unresponsive
Opioid Analgesics: Usage, Management, and Monitoring: Discharge Teaching for Patients on Opioids
- Constipation Management: Encourage fluids, fiber intake, and regular use of stool softeners
- Opioid Safety: Discuss the risk of tolerance (higher doses needed over time) and potential addiction
- Side Effects: Warn about common side effects (drowsiness, dizziness) and advise against driving
Non-Opioid Analgesics and NSAIDs: Aspirin
-
NOT FOR CHILDREN:
- Risk for Reyes Syndrome: Acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Triggered by viral illnesses such as influenza as well as by salicylate therapy itself in the presence of a viral illness.
Mechanism of Action
- H2-receptor antagonists work by blocking histamine H2 receptors on stomach cells responsible for acid production.
- This blocking action decreases the amount of acid secreted by the stomach, leading to a higher pH in the stomach.
- This higher pH helps heal ulcers and reduces the symptoms of GERD.
Clinical Applications
- H2-receptor antagonists are commonly used to treat ulcers in the stomach and duodenum.
- They are also used to manage GERD.
- H2-receptor antagonists can help prevent ulcers in hospitalized patients who are at risk of stress-induced mucosal damage.
- They can also help with indigestion symptoms.
- In rare cases, H2-receptor antagonists are used for Zollinger-Ellison syndrome, a condition that causes excessive stomach acid production.
Drug Interactions
- H2-receptor antagonists can interfere with the absorption of some medications that require an acidic environment.
- This includes ketoconazole, a type of antifungal medication, and some protease inhibitors, which are used to treat HIV infection.
- H2-receptor antagonists can also increase the effects of medications that are broken down by certain liver enzymes.
- Antacids can decrease the absorption of H2-receptor antagonists, so it is recommended to take them separately, with some time in between.
Pharmacokinetics
- H2-receptor antagonists are available in oral, intravenous, and topical formulations.
- The extent of absorption varies between different agents, but most are well-absorbed from the intestines.
- They are mainly broken down in the liver and their byproducts are excreted in the urine.
- The half-life of H2-receptor antagonists typically ranges from one to four hours, which means multiple doses per day or extended-release formulations may be required.
Side Effects
- Common side effects include headache, dizziness, fatigue, and constipation or diarrhea.
- While rare, serious side effects can occur, including confusion, especially in elderly patients, and liver damage.
- H2-receptor antagonist use can increase the risk of gastrointestinal infections because of reduced stomach acidity.
- Long-term use of H2-receptor antagonists could lead to tolerance, meaning they may become less effective over time.
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Description
This quiz focuses on critical aspects of common medications used in pediatric care, including salicylate intoxication, acetaminophen safety, and NSAID usage. Learn how to educate patients and ensure safe medication management to prevent complications and promote effective treatment options.
