NU 578-Exam 2 study guide Questions With Correct Solutions, Already Passed!!

This is NOT an all-inclusive guide to the test. However, having a working knowledge of these types of topics/items will help guide you as you prepare for Exam 2. Opioids/Pain Relief Chapter 28 page 274 Use of opioids (when are they initiated?): Tables on p 184-185 are useful. Also take a look at Opioids used in cancer treatment. Ch 92 discusses acute care pain meds • The pure opioids agonists activate mu receptors and kappa receptors. • Morphine is the Prototype of strong opioid analgesics and remains the standard by which newer opioids are measured. The principal indication for morphine is pain relief of moderate to severe pain. This drug can relieve post operative pain, pain of L&D, and chronic pain caused by cancer and other conditions. In addition, morphine can be used to relieve pain of MI and dyspnea associated with L ventricular failure and pulmonary edema. Morphine relieves pain without affecting other senses. The drug is more effective against dull, constant pain than against sharp, intermittent pain. • PATIENT-CENTERED CARE ACROSS THE LIFE SPAN: Opioid Analgesics o Infants: Regular use of opioids during pregnancy can cause physical dependence in the fetus, resulting in withdrawal after delivery o Children: adequately assess pain with a standardized pain scale. Aspirin, as an adjuvant to opioids should be avoided (Reye’s Syndrome). There remains a lack of research regarding best practice in treatment of chronic non-cancer pain in children o Pregnant Women: Taking opioids in early pregnancy can increase the risk of congenital heart defects, spina bifida, and gastroschisis o Breast Feeding Women: Limited data suggest small amounts of opioids are excreted in breast milk. This can result in drowsiness o Older adults: Persistent pain is often undertreated in the frail older population. The American Geriatrics Association recommends that providers consider treating moderate to severe uncontrolled pain with opiates after trial of acetaminophen • Starting opioid therapy with chronic pain should start with immediate release pain killers • Cancer pain: Treating chronic pain of cancer differs substantially from treating acute pain of other disorders. When treating cancer pain, the objective is to maximize comfort. Psychologic and physical dependence are minimal concerns. Patients should be given as much medication as needed to relieve pain. In the words of one pain specialist, “No patient should wish for death because of the physician’s reluctance to use adequate amounts of opioids.” With proper therapy, cancer pain can be effectively managed in about 90% of patients. Cancer can cause neuropathic pain through infiltration of nerves, and visceral pain through infiltration, obstruction, and compression of visceral structures. • Drug therapy in cancer patients (page 210): NSAIDS, opioid analgesics, adjuvant analgesic (amitriptyline, carbamazepine, dextroamphetamine) • Adjuvant drugs (page 302): o TCA: amitriptyline for neuropathic pain o Antiseizure drugs for neuropathic pain: gabapentin and pregabalin, carbamazepine o Topical anesthetics: lidocaine for neuropathic pain o CNS stimulants: dextroamphetamine and methylphenidate can enhance opioid induced analgesia and counteract sedation. In addition, can be used for mood o Glucocorticoids: reduce cerebral and spinal edema, they are essential for emergency management of elevated ICP and epidural spinal compression. Can also improve appetite and impart a general sense of well-being; will help with anorexia and cachexia with terminal illness. These drugs are very safe short term and very dangerous long term (adrenal insufficiency, osteoporosis, glucose intolerance) • Drug selection for Cancer Pain o Preferred Opioids: For all cancer patients, pure opioid agonists are preferred to the agonist-antagonists. If pain is not too intense, a moderately strong opioid (e.g., oxycodone) is appropriate. If pain is moderate to severe, a strong opioid (e.g., morphine) should be used. Because morphine is inexpensive, available in multiple dosage forms, and clinically well understood, this opioid is used more than any other SE and ADRs of opioids, monitoring • Safety Alert! Opioid medications can cause respiratory arrest in both opioid naïve and opioid tolerant patients. Monitor LOC, RR, and O2 saturation in patients receiving opioids. When administering opioids, assess initial VS and withhold medication and notify provider if patient has a decreased LOC or RR 12 BPM • Side Effects: