Nr - 293 pharmacology Exam 2 : units 3
and 4 Questions with Answers
What are analgesic drugs? - correct answers:Pain killers that relieve pain without causing loss of
consciousness.
What are the 2 different class of analgesics? - correct answers:opioids analgesics and adjuvant analgesics
What factors changes a person's perception of pain? - correct answers:Varies by attitude, environment,
culture, ethnicity
Past experience, anxiety, past experience, gender, general mental health
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?
a. Somatic pain
b. Referred pain
c. Visceral pain
d. Neuropathic pain - correct answers:a. Somatic pain, which includes bone pain, originates from the
skeletal muscles, ligaments, and joints. Referred pain occurs when visceral nerve fibers synapse at a level
in the spinal cord close to fibers that supply specific subcutaneous tissues in the body. Visceral pain
originates from organs and smooth muscles. Neuropathic pain usually results from damage to peripheral
or CNS nerve fibers or injury, but may also be idiopathic.
What are adjuvant drugs? - correct answers:Are drugs that assist primary drug in relieving pain such as
NSAIDs, antidepressants, antiepileptics, and corticosteriods
Describe the WHO three-step analgesic ladder - correct answers:Step 1: nonopioids (with or without
adjuvant medications) after the pain has been identified and assessed. If pain persists or increases,
treatment moves to
Step 2: opioids with or without nonopioids and with or without adjuvants. If pain persists or increases,
management then rises to
,Step 3: opioids indicated for moderate to severe pain, administered with or without nonopioids or
adjuvant medications.
What is the opiod ceiling effect? - correct answers:Drug reaches a maximum analgesic effect
Analgesia does not improve, even with higher doses
What are the 3 classifications of opiods? - correct answers:Agonist, Agonists-antagonist, antagonist
why is meriperidine not recommend for long term use? - correct answers:Accumulation of neurotoxic
metabolite - normerperidine which causes seisures
What is the mechanism of Agonist? - correct answers:Bind to an opioid pain receptor in the brain
Cause an analgesic response (reduction of pain sensation)
What is the mechanism of Agonist-antagonist? - correct answers:Bind to a pain receptor
Cause a weaker neurologic response than a full agonist
Exert their effect by binding in different degrees to kappa + mu opiod receptors
Not usually first like pain treatment
Used in OB patients to provide pain relief to mom without sedating fetus
What is the mechanism of antagonist? - correct answers:Competes with and reverses effect of agonist
and agonist-antagonist drugs at receptor site
What are the indications for opiod analgesics? - correct answers:Main use: to alleviate moderate to
severe pain
Often given with adjuvant analgesic drugs to assist primary drugs with pain relief
Opioids are also used for:
Cough center suppression
,Treatment of diarrhea-Imodium
Balanced anesthesia
What are the contraindications for opiod analgesics? - correct answers:Known drug allergy
Severe asthma
Use with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy
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?
Pulse
Blood pressure
Temperature
Respirations - correct answers:Correct answer: D
Rationale: This patient has a history of asthma and allergies, and she will be receiving a drug that can
depress respirations.
Adverse effects of Opiod analgesics? - correct answers:CNS depression
Leads to respiratory depression
Most serious adverse effect
Nausea and vomiting - irritation of GI tract stimulates chemoreceptors zone in CNS.
Urinary retention
, Diaphoresis and flushing
Pupil constriction (miosis)
Constipation - slows peristalsis and increase water absorption from intestinal contents.
Itching
Strong affinity for mu receptors for rapid onset and produce euphoria which leads to high addiction.
Cause histamine relaease -> itching, rash, hemodynamic changes, flushing and orthostatic hyper tension
A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain
management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is
becoming "unbearable." The nurse is reluctant to give him the ordered pain medication because the
nurse does not want the patient to get addicted to the medication. The nurse's actions reflect
appropriate concern for the patient's best welfare.
appropriate caution for a patient who is already on a long-term opioid.
an uncaring attitude toward the patient.
a failure to manage the patient's pain properly. - correct answers:Correct answer: D
Rationale: Patients with severe pain, including metastatic pain or bone pain, may need higher and higher
doses of analgesics. The nurse is responsible for ensuring that the patient experiences adequate pain
relief.
Opioid Analgesics:
Toxicity and Management of Overdose - correct answers:Naloxone (Narcan) - bind to all receptor sites ->
competive antagonists ->
binds to these site.
Withdrawal symptoms directly related to half-life of opioid
Naltrexone (ReVia)
Regardless of withdrawal symptoms, when a patient experiences severe respiratory depression, an
opioid antagonist should be given.
Opioid Analgesics: Interactions - correct answers:Alcohol
and 4 Questions with Answers
What are analgesic drugs? - correct answers:Pain killers that relieve pain without causing loss of
consciousness.
What are the 2 different class of analgesics? - correct answers:opioids analgesics and adjuvant analgesics
What factors changes a person's perception of pain? - correct answers:Varies by attitude, environment,
culture, ethnicity
Past experience, anxiety, past experience, gender, general mental health
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?
a. Somatic pain
b. Referred pain
c. Visceral pain
d. Neuropathic pain - correct answers:a. Somatic pain, which includes bone pain, originates from the
skeletal muscles, ligaments, and joints. Referred pain occurs when visceral nerve fibers synapse at a level
in the spinal cord close to fibers that supply specific subcutaneous tissues in the body. Visceral pain
originates from organs and smooth muscles. Neuropathic pain usually results from damage to peripheral
or CNS nerve fibers or injury, but may also be idiopathic.
What are adjuvant drugs? - correct answers:Are drugs that assist primary drug in relieving pain such as
NSAIDs, antidepressants, antiepileptics, and corticosteriods
Describe the WHO three-step analgesic ladder - correct answers:Step 1: nonopioids (with or without
adjuvant medications) after the pain has been identified and assessed. If pain persists or increases,
treatment moves to
Step 2: opioids with or without nonopioids and with or without adjuvants. If pain persists or increases,
management then rises to
,Step 3: opioids indicated for moderate to severe pain, administered with or without nonopioids or
adjuvant medications.
What is the opiod ceiling effect? - correct answers:Drug reaches a maximum analgesic effect
Analgesia does not improve, even with higher doses
What are the 3 classifications of opiods? - correct answers:Agonist, Agonists-antagonist, antagonist
why is meriperidine not recommend for long term use? - correct answers:Accumulation of neurotoxic
metabolite - normerperidine which causes seisures
What is the mechanism of Agonist? - correct answers:Bind to an opioid pain receptor in the brain
Cause an analgesic response (reduction of pain sensation)
What is the mechanism of Agonist-antagonist? - correct answers:Bind to a pain receptor
Cause a weaker neurologic response than a full agonist
Exert their effect by binding in different degrees to kappa + mu opiod receptors
Not usually first like pain treatment
Used in OB patients to provide pain relief to mom without sedating fetus
What is the mechanism of antagonist? - correct answers:Competes with and reverses effect of agonist
and agonist-antagonist drugs at receptor site
What are the indications for opiod analgesics? - correct answers:Main use: to alleviate moderate to
severe pain
Often given with adjuvant analgesic drugs to assist primary drugs with pain relief
Opioids are also used for:
Cough center suppression
,Treatment of diarrhea-Imodium
Balanced anesthesia
What are the contraindications for opiod analgesics? - correct answers:Known drug allergy
Severe asthma
Use with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy
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?
Pulse
Blood pressure
Temperature
Respirations - correct answers:Correct answer: D
Rationale: This patient has a history of asthma and allergies, and she will be receiving a drug that can
depress respirations.
Adverse effects of Opiod analgesics? - correct answers:CNS depression
Leads to respiratory depression
Most serious adverse effect
Nausea and vomiting - irritation of GI tract stimulates chemoreceptors zone in CNS.
Urinary retention
, Diaphoresis and flushing
Pupil constriction (miosis)
Constipation - slows peristalsis and increase water absorption from intestinal contents.
Itching
Strong affinity for mu receptors for rapid onset and produce euphoria which leads to high addiction.
Cause histamine relaease -> itching, rash, hemodynamic changes, flushing and orthostatic hyper tension
A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain
management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is
becoming "unbearable." The nurse is reluctant to give him the ordered pain medication because the
nurse does not want the patient to get addicted to the medication. The nurse's actions reflect
appropriate concern for the patient's best welfare.
appropriate caution for a patient who is already on a long-term opioid.
an uncaring attitude toward the patient.
a failure to manage the patient's pain properly. - correct answers:Correct answer: D
Rationale: Patients with severe pain, including metastatic pain or bone pain, may need higher and higher
doses of analgesics. The nurse is responsible for ensuring that the patient experiences adequate pain
relief.
Opioid Analgesics:
Toxicity and Management of Overdose - correct answers:Naloxone (Narcan) - bind to all receptor sites ->
competive antagonists ->
binds to these site.
Withdrawal symptoms directly related to half-life of opioid
Naltrexone (ReVia)
Regardless of withdrawal symptoms, when a patient experiences severe respiratory depression, an
opioid antagonist should be given.
Opioid Analgesics: Interactions - correct answers:Alcohol
