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Pharmacology
Exam 8
32
Pharmacology
Not Applicable
12/05/2009

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Term
Nociceptor Pain
Definition
also referred to as somatic or visceral pain; caused by injury to tissues; Somatic pain: sharp, localized sensation; Visceral pain: dull, throbbing or aching pain; responds well to conventional pain relief med
Term
Neuropathic Pain
Definition
caused by injury to nerves; described as burning, shooting, or numb pain; less therapeutic success
Term
Techniques for reducing pain
Definition
acupuncture, biofeedback, massage, heat or cold packs, meditation or prayer, relaxation therapy, art or music therapy, imagery, chiropractic manipulation, hypnosis, therapeutic or physical touch, TENS, energy therapies such as Reiki an Qi gong
Term
endogenous opioids
Definition
endorphins, dynorphins, enkephalins; modify sensory info at the level of the spinal cord
Term
Opioids (Narcotics)Analgesics
Definition
Drug of choice for mod to severe pain that cannot be controlled w/ other analgesics; interact w/ at least 6 types of receptors: mu (1 & 2), kappa, sigma, delta, epsilon; mu and kappa are most important
Term
Opiate uses and teaching
Definition
Uses: pain, general anesthesia, cough suppressant, anti-diarrhea; Teaching: report N/V/D, rash, yellowing of skin, abd. pain, tenderness or distention, change in stool color; report seizure activity
Term
Nursing Considerations for Opioids
Definition
Check for Hx of severe respiratory disorders, increased ICP, seizures, liver or renal disease, allergies; Contraindications: acute asthma, upper airway obstruction
Term
Opioid Antagonists
Definition
Narcan is one; used to reverse opioid OD; Side Effects: thirst, chills, fever, joint/muscle pain, CNS stimulation, drowsiness, dizziness, confusion, HA, N/V/D, rash, rapid pulse and respirations, pulmonary edema, wheezing
Term
Nursing considerations for Narcan
Definition
check VS every 3-5 mins, obtain ABG levels, ECG, monitor for drowsiness, tremors, hyperventilation, V-tach, loss of analgesia; if giving for drug-dependence, monitor for S of w/drawal: cramping, vomiting, HTN, anxiety
Term
NSAIDs
Definition
drug of choice for mild to mod pain; Nrsg considerations: Hx of hypersensitivity, bleeding disorders, peptic ulcers, severe renal/hepatic disease, pregnancy; Side effects: nausea, abd pain, anorexia, dizziness, drowsiness
Term
tension headache
Definition
most common; muscles of head and neck tight from stress; effectively treated w/ OTC analgesics
Term
Migraine
Definition
most painful type of HA; throbbing or pulsating pain, sometimes preceded by an aura; pharmacological goals: to stop migraine in progress, and to prevent them; drug therapy most effective if begun before migraine becomes severe
Term
Migraine Therapy
Definition
triptans and ergot alkaloids (serotonin <5-HT> agents); therapy generally begins w/ NSAIDs or acetaminophen; next drug of choice is triptans (Imitrex); ergot alkaloids are final choice
Term
Nrsg considerations for antimigraine therapy
Definition
Hx of MI, angina, HTN, renal or liver disease, diabetes, pregnancy; Assess AP, resp, BP, LOC, blurred vision, N/V; Side effects: dizziness, drowsiness, vasoconstriction, warming sensation, tingling, light-headedness, weakness, neck stiffness
Term
Morphine (Astramorph, Duramorph)
Definition
binds with mu and kappa receptors to produce profound analgesia; euphoria, constriction of pupils, stimulation of cardiac muscle; used for acute and chronic pain, as preanesthesia, to relieve SOB w/ HF, acute chest pain from MI; Side effects: dysphoria, hallucinations, nausea, constipation, dizziness, itching sensation; OD= resp depression and cardiac arrest; tolerance and cross-tolerance can develop; dependence can deelop if high doses taken for long periods; Contraindications: may intensify or mask pain of gallbladder disease, avoid in cases of acute or severe asthma, GI obstruction, severe hepatic or renal impairment; causes orthostatic hypotension
Term
Naloxone (Narcan)
Definition
opioid antagonist, blocks mu and kappa receptors; used for reversal of opioid effects; administer for RR < 10 bpm; minimal toxicity; reversal of effects of opioids may result in loss of analgesia, increased BP, tremors, hyperventilation, N/V, drowsiness; should not be used for resp depression caused by nonopioid meds; echinacea may increase risk of hepatotoxicity
Term
Aspirin (Acetylsalicylic Acid, ASA)
Definition
inhibits prostaglandin synthesis in process of pain and inflammation, mild to mod relief of fever; anticoag, reduces risk of colorectal cancer; anticoag properties are irreversible, should be dc'd 1 week before elective surgery; excreted in urine and affects urine testing for glucose and other metabolites; at high doses it may cause gastric discomfort and bleeding; Contraindications: should not be given to clients on anticoag therapy; garlic, ginger, gingko may increase bleeding
Term
Sumatriptan (Imitrex)
Definition
acts by causing vasoconstriction of cranial arteries; subc terminates pain in 10-20 mins, can be repeated 60 mins after (max of 2 per day), oral meds should be taken asap after migraine begins; may produce cardiac ischemia, HTN, dysrhythmias, or MI; nurse should monitor LOC and observe for seizures; Side Effects: dizziness, drowsiness, warming sensation, usually not severe; Contraindications: clients w/ recent MI, Hx of angina pectoris, HTN, diabetes; gingko, ginseng, echinacea, St. John's wort may increase toxicity
Term
topical anesthesia
Definition
creams, sprays, suppositories, drops, and lozenges; applied to mucous membranes (eyes, lips, gums, nasal membranes, throat); very safe unless absorbed; used for sunburn, insect bites, hemorrhoids, sore throat, minor wounds
Term
Conscious sedation
Definition
clients are conscious but insensitive to pain and unconnected w/ surroundings; also called neuroleptanalgesia; Innovar is a common drug for this state and is a combo of fentanyl and droperidol
Term
Spinal Anesthesia
Definition
injected into the CSF; affects large, regional area such as the lower abd and legs; monitor for presence of spinal HA
Term
Muscle Spasms
Definition
usually associated w/ excessive use of and local injury to the skeletal muscle; may also be caused by overmedication of antipsychotics, epilepsy, hypocalcemia, pain, and debilitating neurological disorders; clients may experience inflammation, edema, and pain, loss of coordination and reduced mobility
Term
tonic spasm
Definition
single, prolonged contraction
Term
clonic spasm
Definition
multiple, rapidly repeated contractions
Term
Spasticity
Definition
condition in which certain muscle groups remain in a continuous state of contraction, usually resulting from damage to the CNS; the contracted muscles become stiff w/ increased muscle tone; S/Sx: mild to severe pain, exaggerated deep tendon reflexes, muscle spasms, scissoring, and fixed joints; Tx: P.T. and meds; Meds: Botox, Myobloc, Quinamm
Term
Levodopa (Larodopa)
Definition
drug of choice for Parkinson's; precursor of dopamine synthesis; increases biosynthesis of dopamine in nerve terminals; up to 6 months for max effects; abrupt w/drawal can result in Parkinsonian crisis or neuroleptic malignant syndrome; Side Effects: uncontrolled and purposeless movements, involuntary movements, loss of appetite, N/V; Contraindicated in narrow-angle glaucoma
Term
Acetylcholine
Definition
naturally degraded in the synapse by AchE; when AchE is inhibited, Ach levels increase and produce a more profound effect on the receptor
Term
AchE Inhibitors
Definition
indirect acting parasympathomimetic; used to treat Alzheimer's; goal is to improve function in ADLs, behavior, and cognition; these drugs only slow the progression; an increased level of Ach is only effective if there are functioning neurons present; all AchE inhibitors used for AD have equal efficacy; side effects: N/V/D
Term
EPS (extrapyramidal symptoms)
Definition
develop for the same neurochemical reasons as Parkinson's; may be induced by antipsychotics; may occur suddenly and become a medical emergency; client's muscles may spasm or become locked up; fever and confusion; can be treated w/ parenteral Benadryl; untreated acute episodes can be fatal
Term
Antipsychotics
Definition
act through a blockade of dopamine receptors; may induce EPS; phenothiazines are antipsychotics
Term
Anticholinergics
Definition
treat Parkinson's; block the effect of Ach; act on the CNS; side effects: dry mouth, blurred vision, tachycardia, urine retention, constipation; used early in disease when Sx are less sever; take w/ food or milk, avoid driving d/t drowsiness; contraindicated in narrow-angle glaucoma, MG, obstruction of urinary or GI tract
Term
Nursing Considerations for Parkinson's
Definition
monitor clients on therapy for excessive daytime sleepiness, eye twitching, involuntary movements, hand tremors, fatigue, anxiety, mood changes, confusion, agitation, N/V, anorexia, dry mouth, constipation; assist client w/ ADLs; urine and perspiration may darken
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