NR 546 WEEK 6 TEST CASE STUDY WITH
QUESTIONS AND WELL VERIFIED
ANSWERS GRADED A+[ACTUAL EXAM
100%]
Addiction is often driven by the client's attempts to: - ANS✔✔---self-
medicate an underlying mental health disorder
adverse effects associated with the acute use of opioids: - ANS✔✔----
Itching
-Constipation
-Respiratory depression
-Urinary retention
-Sedation
Opioid medication: Morphine - ANS✔✔----Prototype opioid agonist
-indicated for acute pain
,-binds to opioid receptors in the CNS, inhibiting ascending pain
pathways, altering the perception & response to pain
-also produces CNS depression and potentially respiratory depression
*may be life-threatening, especially if utilized with benzodiazepines,
CNS depressants, or alcohol
onset of action:
-immediate release formulation is patient-dependent, with variable
absorption.
-IV is 5-10 minutes, with a duration 3-5 hours.
-Also available in controlled release formulation (MS Contin) and
extended-release morphine (Avinza).
Opioid medication: Fentanyl - ANS✔✔----has an almost immediate
onset of action when given IV, with a duration of 0.5-1 hour
-More potent than morphine, but short duration of action
-the preferred opioid for those unable to tolerate morphine or
hydromorphone and in those with severe hepatic and renal disease
-same indications as morphine and is also used frequently in
procedural sedation and general anesthesia
-Conversion between fentanyl products is NOT mcg for mcg
Opioid medication: Hydromorphone - ANS✔✔----Similar opioid agonist
as morphine but more potent
-Oral and parenteral doses are not equivalent (parenteral doses up to 5
times more potent)
Opioid medication: Meperidine - ANS✔✔----No longer recommended
as an analgesic, and not widely available.
-Has numerous concerning adverse effects such as seizures and
delirium.
, Opioid medication: Methadone - ANS✔✔----Utilized in detoxification
and maintenance treatment of opioid addiction and heroin addiction,
with high variability among patients
-long acting opioid that binds to and occupies mu-opioid receptors,
reducing craving for opioids and prevents withdrawal symptoms for 24
hours
-potential for abuse, only licensed opioid treatment programs or
licensed inpatient hospital units permitted to order and dispense this
medication
-potential for life threatening respiratory depression and QT
prolongation
-Equianalgesic conversion ratios between methadone and other
opioids are individually variable, with deaths occurring during
conversion from chronic high dose opiate history or opioid abuse to
methadone
-Discontinuation requires a wean to avoid withdrawal
-pregnant, a risk benefit ratio is necessary as fetal outcomes are
improved as compared to illicit drug use, however can have decreased
birth weight, length, head circumference and fetal growth
Opioid medication: Tramadol - ANS✔✔----Opioid agonist, with similar
indications and side effect profile as other opioids, but that also
blocks reuptake of serotonin and norepinephrine.
-Indicated for acute pain management, with added benefit for patients
with neuropathic pain and nociceptive pain.
-Has a lower risk of constipation and dependence than other opioids,
but does have risk of serotonin syndrome.
Opioid medication: Naloxone - ANS✔✔----pure antagonist, with
clinical indication for treatment of acute opioid overdose.
-IV naloxone can dramatically reverse opioids, even in comatose
states
QUESTIONS AND WELL VERIFIED
ANSWERS GRADED A+[ACTUAL EXAM
100%]
Addiction is often driven by the client's attempts to: - ANS✔✔---self-
medicate an underlying mental health disorder
adverse effects associated with the acute use of opioids: - ANS✔✔----
Itching
-Constipation
-Respiratory depression
-Urinary retention
-Sedation
Opioid medication: Morphine - ANS✔✔----Prototype opioid agonist
-indicated for acute pain
,-binds to opioid receptors in the CNS, inhibiting ascending pain
pathways, altering the perception & response to pain
-also produces CNS depression and potentially respiratory depression
*may be life-threatening, especially if utilized with benzodiazepines,
CNS depressants, or alcohol
onset of action:
-immediate release formulation is patient-dependent, with variable
absorption.
-IV is 5-10 minutes, with a duration 3-5 hours.
-Also available in controlled release formulation (MS Contin) and
extended-release morphine (Avinza).
Opioid medication: Fentanyl - ANS✔✔----has an almost immediate
onset of action when given IV, with a duration of 0.5-1 hour
-More potent than morphine, but short duration of action
-the preferred opioid for those unable to tolerate morphine or
hydromorphone and in those with severe hepatic and renal disease
-same indications as morphine and is also used frequently in
procedural sedation and general anesthesia
-Conversion between fentanyl products is NOT mcg for mcg
Opioid medication: Hydromorphone - ANS✔✔----Similar opioid agonist
as morphine but more potent
-Oral and parenteral doses are not equivalent (parenteral doses up to 5
times more potent)
Opioid medication: Meperidine - ANS✔✔----No longer recommended
as an analgesic, and not widely available.
-Has numerous concerning adverse effects such as seizures and
delirium.
, Opioid medication: Methadone - ANS✔✔----Utilized in detoxification
and maintenance treatment of opioid addiction and heroin addiction,
with high variability among patients
-long acting opioid that binds to and occupies mu-opioid receptors,
reducing craving for opioids and prevents withdrawal symptoms for 24
hours
-potential for abuse, only licensed opioid treatment programs or
licensed inpatient hospital units permitted to order and dispense this
medication
-potential for life threatening respiratory depression and QT
prolongation
-Equianalgesic conversion ratios between methadone and other
opioids are individually variable, with deaths occurring during
conversion from chronic high dose opiate history or opioid abuse to
methadone
-Discontinuation requires a wean to avoid withdrawal
-pregnant, a risk benefit ratio is necessary as fetal outcomes are
improved as compared to illicit drug use, however can have decreased
birth weight, length, head circumference and fetal growth
Opioid medication: Tramadol - ANS✔✔----Opioid agonist, with similar
indications and side effect profile as other opioids, but that also
blocks reuptake of serotonin and norepinephrine.
-Indicated for acute pain management, with added benefit for patients
with neuropathic pain and nociceptive pain.
-Has a lower risk of constipation and dependence than other opioids,
but does have risk of serotonin syndrome.
Opioid medication: Naloxone - ANS✔✔----pure antagonist, with
clinical indication for treatment of acute opioid overdose.
-IV naloxone can dramatically reverse opioids, even in comatose
states
