Migraines and NSAIDs
Your patient just started an NSAID for pain and is experiencing tinnitus and hearing loss. You suspect this patient has started ______ and is experiencing ___________
ASA
Salicylism
A patient is going to be discharged on several days of oxycodone, she asks what side effects to expect
For DMARDs being administered subcutaneously what localized symptoms should be monitored for?
redness, swelling, or pain at injection site after admin
What are the drugs of choice for treatment of Pagets disease?
How do we administer them?
Calcitonin - subq, IM, and intranasal (osteo only)
What is the purpose of ADJUVANT medications used for pain?
They ENHANCE pain relief and target specific types of pain
The only NSAID that does NOT carry the risk of increasing risk for blood clots is what?
32 yo patient has morphine ordered. Which of these findings is a contraindication to administration of this drug specifically? Uncontrollable diarrhea, respiratory rate of 11, cellulitis of the R leg spreading up to the knee
A patient is taking Raloxifene for osteoporosis. You know that this medication is only given to ________ women.
Your patient is providing teach back about considerations for this med and states that she will stop taking it for 2 weeks prior to any surgery. Is this administration consideration accurate?
Postmenopausal (because it is considered HRT)
No, just needs to be stopped 72 hours before periods of immobility (surgery or travel)
A 45 yo patient with osteoporosis is receiving some teaching regarding bisphosphonates. You know she has understood this teaching when she reports:
I will take this medication with a full glass of water and stay sitting up for at least 30 minutes after.
I will use pregnancy prevention methods as this med is CI in pregnancy
I will report any esophageal pain or difficulty swallowing
How do glucocorticoids work in the body as adjuvant pain medications?
Decrease inflammation and suppress immune response
sumatriptans work very well for migraines by ___________ but carry the risk of ___________?
interrupting a migraine after it has already started - causing cerebral vasoconstriction
mild se of dizziness
severe: coronary artery vasospasm/angina - CI in pts with MI hx
A patient asks you what the difference between an opioid agonist and an opioid antagonist is, how do you answer?
An opioid agonist acts ON the opioid receptor and causes analgesic effect in addition to other CNS symptoms. An antagonist binds to the opioid receptor and blocks all analgesia--causing a reversal of opioid effects
A patient who is supposed to start methotrexate wonders when she may start to feel relief of symptoms. You respond that she can expect to feel FULL symptom relief in what time frame?
Start symptom relief in 3-6 weeks. Won't feel full relief until several months of treatment
You are preparing morning meds for a patient with a history of gout. He is receiving 100mg Allopurinol. You will include what in your teaching for this patient regarding their diet and other medications?
absolutely contraindicated with grapefruit and warfarin
What are the three big categories of side effects of tricyclics?
This classification of medications works great for interrupting a migraine after it has already started, but carries the risk of toxicity. What is the medication and what are the symptoms of toxicity?
Ergot alkaloids
muscle pain, paresthesia's, peripheral ischemia
A patient is exhibiting symptoms of opioid toxicity - you as the nurse are aware that means the patient has _____, _______, and _______. You prepare to give _______ to reverse these effects.
Respiratory depression, pinpoint pupils, coma
Naloxone
You are preparing a dose of belimumab for a patient and expect to see orders for what other medications?
Antihistamine (benadryl), Tylenol, and a steroid
What are patient teaching points for someone who is to receive PO calcium supplements?
A patient is prescribed a new medication that works on the neurotransmitters in the brain, cannot be given along with MAOIs and causes mild analgesia, is helpful for insomnia, and depression
A tricyclic antidepressant (amtriptyline, etc)
What patients would be contraindicated to use ketorolac as a pain reliever? (SATA)
A patient on dialysis
A patient with a UTI
A patient with GI bleeding
A patient who has had a stroke 10 years ago
A patient who is receiving anticoagulants for an active DVT
dialysis, GI bleeding, DVT
A patient is prescribed Percocet for two weeks post arthroscopy and has a family history of substance use disorder. She asks you to explain the difference between tolerance and addiction and whether this medication is safe for her.
tolerance - the body's adjustment to a medication that is taken daily after several weeks of use
addiction - Psychological craving despite decreased need
DMARDs are very effective but can cause some life threatening side effects such as?
Liver damage - (report jaundice)
Kidney damage (increase fluid intake to 2L per day to flush)
Immunosuppression/bone marrow suppression (ss of anemia, bleeding, infections)
You are discussing gout with a patient who has a new diagnosis. They tell you that they will be sure to take colchicine every day to prevent a gout attack. Has this patient demonstrated correct understanding of meds used for attacks vs maintenance of gout?
No, colchicine is used for pain relief in a gouty attack only
This adjuvant medication works well as a mild analgesic, improving nausea and vomiting, and for anxiety but has two mild side effects? what is the med?