Analgesic Drugs
A patient with renal cancer needs an opiate for pain control. Which opioid medication would be the safest choice for the patient?
Methadone/Dolophine
What is the difference between General and Local Anesthesia
General - complete loss of consciousness and loss of body reflexes, including paralysis of respiratory muscles
Local Anesthesia - no paralysis of respiratory function; elimination of pain sensation in the tissues innervated by anesthetized nerves
When are Benzodiazepines indicated for use?
Sedation, Sleep induction, Skeletal muscle relaxation, Anxiety relief, Anxiety-related depression, Treatment of acute seizure disorders, Treatment of alcohol withdrawal, Agitation relief, Balanced anesthesia, Moderate or conscious sedation
After reviewing the patient's EMR (Electronic Medication Record), the nurse notices the patient who no seizure history has been prescribed Valproic Acid/Depakote... In what other conditions is this medication used?
Bipolar disorder
Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value?
Sodium - Keeping the sodium level in the normal range (135 to 145 mEq/L) helps to maintain therapeutic lithium levels.
Lithium may become toxic if the patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity.
A patient with bone cancer tells the nurse that he is in pain. The nurse knows that bone pain is classified as which type of pain?
Somatic pain - which includes bone pain, originates from the skeletal muscles, ligaments, and joints.
When assessing a patient under general anesthesia, which change to organ systems does the nurse expect?
Nystagmus - can occur as a result of the use of general anesthesia. Other findings include skeletal muscle relaxation, hypotension, and increased intracranial pressure.
An older adult patient taking multiple medications has a barbiturate added to his medication regimen. When administering a barbiturate to an older adult, what should the nurse expect?
To administer half of the usual dose of the barbiturate (doctor's order should reflect this).
Barbiturates are associated with an increased incidence of falls when used in older adults; therefore, the usual dose is reduced by half whenever possible. Because barbiturates stimulate the action of enzymes in the liver, drugs are usually broken down more quickly, sometimes requiring the dose to be increased. Patients taking barbiturates have decreased amounts of REM sleep and often experience paradoxical restlessness or excitement.
A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse is correct when recognizing autoinduction as which response?
Carbamazepine (Tegretol) is associated with autoinduction of hepatic enzymes. Autoinduction is a process in which, over time, a drug stimulates the production of enzymes that enhance its own metabolism, which leads to lower than expected drug concentrations.
What is the therapeutic range for Lithium and why is Lithium prescribed?
Lithium has a narrow therapeutic range of 0.6 to 1.2meq/l and requires blood level monitoring.
Mood stabilizing Drug used in Bipolar disorder
Gate Theory of Pain Transmission:
What are the two body endogenous neurotransmitters?
Enkephalins and Endorphins - they are produced by the body to fight pain, bind to opioid receptors and inhibit transmission of pain closing the "gate" .
What is Nystagmus?
Nystagmus - is a vision condition in which the eyes make repetitive, uncontrolled movements. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern.
True or False
When giving Hypnotics remember to administer 65 to 120 minutes before bedtime.
False
Hypnotics are administered 30 - 60 minutes before bedtime for maximum effectiveness in inducing sleep (depends on drug's onset too).
The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. What does the nurse suspect?
The patient may be taking this drug for neuropathic pain.
Serotonin Syndrome - What are some common and severe symptoms?
Common: Delirium, agitation, tachycardia, sweating, myoclonus (muscle spasms), hyperreflexia, shivering, course tremors, extensor plantar muscles (sole to foot) response
Severe: Rhabdomyolysis, hyperthermia, seizures, renal failure, cardiac dysrhythmias and DIC (Disseminated intravascular coagulation)
World Health Organizations Three Step Analgesic Ladder: What are they?
1. Nonopioids - after the pain has been identified and assessed.
2. Opioids - with or without nonopioids and with or without adjuvants.
3. Opioids indicated for moderate to severe pain - administered with or without nonopioids or adjuvant medications.
During surgery, the anesthetist notes that the patient’s heart rate is gradually increasing and becoming more irregular, the patient’s blood pressure is becoming unstable, and the patient is starting to sweat profusely. What other assessment should the anesthetist note immediately?
Temperature. (Malignant Hyperthermia)
Other adverse reactions include: Tachypnea, tachycardia, muscle rigidity, temperature over 104. Dantrolene is administered.
True or False
ADHD: Girls are 3 times more likely to be affected than boys and the treatment will change once they become adults...
Boys are 3 times more likely to be affected by ADHD
The drug therapy for both Childhood and Adult ADHD is the same.
Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern?
Low serum albumin levels
Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, and toxicity may occur.
A patient with a diagnosis of delirium tremens is admitted to the acute care facility. Which finding does the nurse expect upon assessment of the patient?
Delirium tremens are characterized by hypertensive crisis, tachycardia, agitation, and hyperthermia and may be life threatening.
A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern?
Respirations - This patient has a history of asthma and allergies, and she will be receiving a drug that can depress respirations.
70% of patients who either experience inadvertent dural puncture during epidural anesthesia or undergo intrathecal anesthesia experience a "spinal headache". What is the treatment?
Bed rest, analgesics, caffeine and a blood patch.
Adequate hydration using IV fluids is often used to increase cerebrospinal fluid pressure. A “blood patch” is often used to help close up or seal the leak. A small amount of blood is taken from the patient and injected into the epidural space. The patient should be positioned flat to prevent spinal headache, and if a patient has a spinal headache, relief is often obtained by lying flat.
A patient wants to take Orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects?
Restricting dietary intake of fat - to less than 30% of total calories can help reduce some of the GI adverse effects of Orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients.
Which drug used for the management of the patient with Parkinson Disease is most likely to cause postural hypotension?
Amantadine, carbidopa-levodopa, and ropinirole are most likely to cause postural hypotension.
Ethanol withdrawal treatment, what is the treatment of choice?
Benzodiazepines - Valium/Diazepam, Ativan/Lorazepam... Severe withdrawal may require to be admitted into ICU.