Pharm Test 1

The Nursing Process

Critical thinking is a higher level of thinking (thinking about your thinking); which is important in knowing where to get info, when to step back, and allows for the reevaluation of your actions to talor your care to the individial client.

Assessment, Nursing diagnosis, Planning, Implementation, and Evaluation (Ad Pie)

Reference textbooks, drug manufacturer's inserts, drug handbook, licenced pharmacist, PDA reference, and PDR (Physician' s Desk Reference)

To collect data; both subjective, objective, and environmental.

• Subjective - whatever the pt says.
• Objective - whatever you can record.
• Environmental - whatever can effect the pt.

Perscriptions, reactions, OTCs, home remedies, herbal meds, alcohol, tobacco, caffeine, vitamines, supplements, birth control, street drugs, and ALLERGIES!

Head-to-toe, religion, health beliefs, sociocultural profile, educational level, motor skills, cognitive ability, and developmental stage.

The critical evaluation of all data

The goal is to use the data collected to make a judgment or conclusion about the risk for (or actual) problems/needs of the pt.

The North American Nursing Diagnosis Association; the formal organization responsible for developing nursing diagnosis.

After a diagnosis has been made, the purpose is to identify your PRIORTIES and plan for acting in a TIMELY manner to achieve your actual goals and projected outcomes.

A goal must be specific, objective, measurable, realistic, and within a specific time frame.

Outcomes are specific standards of measure that are patient oriented.

To initiate and complete the nursing care plan as defined by the nursing diagnosis and outcome criteria.

The nurse must follow the "6 rights" of medication administration. Nurses are legally responsible for this, and so, they need to know and understand all the information about the meds and their pt.

• 1) Right drug - check drug orders and med labels, be familiar with generic & trade names. Use reliable sources for info!
• 2) Right dose - check at least 3x before giving the drug. If question, clarify the order. Always check for appropriate dosage, calculations, decimals, age & size.
• 3) Right time - follow institutional policy for times of adm, consider drug-drug & drug-food interactions, drug levels & military time.
• 4) Right route - never assume the route; check!
• 5) Right patient - ask name, check ID band, and allergies.
• 6) Right documentation - if it wasn't documented, it wasn't done.

The 7th right is "System Analysis"; which is an evaluation of the entire system of medication administration (aka a "double-check") - including ordering, dispensing, preparing, administration, and documentation. In other words, it is a look at the process to see what works and what doesn't (to increase safty) and involves the physician, nurse, nursing unit, pharmacy dept, and pt education.

• The "Right to Refuse", which is the pt's right to refuse treatment; however, the nurse should find out why the pt is refusing and try to help convince the pt to comply.
• The "Right Reason" is the appropriate use of meds; misuse is considered chemical restraint.

the right to proper drug storage, proper documentation, accurate dosage calculation, accurate dosage preparation, careful checking or transcription of orders, pt safety, close consideration of special situations, prevention & reporting of med erros, pt teaching, and monitoring for therapeutic effects, adverse effects, and toxic effects.

The goal is to prevent any med errors, which are PREVENTABLE events that may cause or lead to inappropriate med use or pt harm while the med is in control of the health care professional, pt, or consumer.

• Category A: (safest) studies show no risk to human fetus.
• Category B: no risk to animal fetus; info on human fetus not avaliable.
• Category C: adverse effects reported in animal fetus; info on human fetal risk no avaliable.
• Category D: possible fetal risk in humans reported; however, the benefits may out weigh the risk for using this drug in pregnant women.
• Category X: (bad) fetal abnormalities and evidence of fetal risk in human avaliable for both animals and humans. THIS DRUG SHOULD NOT BE USED IN PREGNANT WOMEN!

Similiar product names, abbreviations, labeling/packaging, unclear writting and nurses assuming, miscalcuation, being tired and rushed, order on wrong chart, wrong route, pt, or time; no documentation and 2nd dose given, and drug incompatibilites.

Repeat a verbal order, spell drug aloud, computer entry, purpose fo use with each product, avoid abbreviations, NEVER assume route - if any questions, check with pharmacy or prescriber; ALWAYS read labels 3x - do trailing zeros; don't assume prescriber is correct if a question, and listen to the pt!

The goal is to be an ongoing process of determining the status of the goals and outcomes and determing the need for education and monitoring the pt's response to drug thearpy (i.e expected & unexpected responses, therapeutic effects, side effects, and toxic effects) and outcome criteria.

Any chemical substance other than those required for normal sustenance (ex. water, food) that affects the processes of a living organism and produces a bilogical effect.

The study of science of the manner in which the function of living systems in affected by chemical substances (drugs).

From the Greek "pharmakon" meaning poison or potion... all drugs can be posions.

Aspirin (Acetylsalicylic Acid; ASA); which affects blood thickness and can cause allergic reations, GI issues, and acidosis.

• Chemical name - drug's chemical composition & molecular structure
• Generic name - the nonpropritary name given by the US Adopted Name Council.
• Trade name - the proprietary name that is used for the drug's registerd trademark & restricted by the drug's owner/manufacturer.

study how drugs influence pharmacokinetic/pharmacodynamic activities

how drugs interact with cells, tissues, organs - what the drug does to the body

use of drugs and the clinical indications for drugs to prevent and treat

study of economic factors that influence cost of drug therapy

study of adverse affects of drugs/chemicals on living systems.

study of what the body does to the drug; how body interacts with drugs (absorption, distribution, metabolism, and exrection).

A coated tablet will absorb FASTER than an enteric-coated tablet; which is designed to be survive the stomach acid and later be absorbed and broken down in the small intestine.

absorption, distribution, metabolism, and exrection

the rate at which a drug leaves its site of administration (passage from adminitration site to blood stream) and extent to which absorption occus - how fast it gets to the site.

• Bioavailability - quantifies the extent of drug absorption.
• Bioequivalent - when two drugs have the same bioavailability; meaning they are absorbed equally.

Administration route of the drug, food/fluids administration with the drug (which slows absorption down), other drugs in stomach (esp. antacids), dosage formulation (i.e. special coatings), status of the absorptive surface, rate of blood flow to small intestine, acidity of the stomach, and status of GI motility/gastric emptying time.

• Enteral - drug is absorbed into systemic circulation through the oral or gastric mucosa, the small intestine, or rectum. (ex. oral, sublingual, buccal, and rectal)
• Parenteral - drug is absorbed in cells/tissues by administration (ex. intradermally, subcutaneously, intramusculary, intrathecally/spinal cord, etc.)
• Topical - application to body surfaces

• Parenteral route - Intravenous, intramuscular, subcutaneous, intradermal, intrathecal (epidural), intraarterial, intraosseous, and intraartcular.
• Topical route - skin (including transdermal patches), eyes, ears, nose, lungs (inhalation), and vaginal.

the transport of drug in body by the bloodstream to site of action.

if the drug is bound by protein, then its not free to go to target tissue; however, if 2 or more drugs are highly protein bound, they are more likely to cause toxity and last longer in the body.

1st-pass effect (aka 1st-pass metabolizim) is the amount of oral drug metabolized by the liver before reaching circulation; however, as this effect increases, the liver removes most of the drug and some drugs would be useless - so these drugs are given IV. In other words, the more metabolized, the higher the 1st-pass rate.

it prevents many drugs from entering the CNS.

water soluble vs fat soluble, as well as, circulation, cardiac output, and blood supply affect disturbution.

• Rapid - heart, liver, kidneys, and brain
• Slow - muscle, skin, and fat

Yes

This metabolism occurs in the kidneys, lungs, plasma, and intestinal mucosa, but mainly in the liver; it is called biotransformation.

the biologic transformation of drug into an inactive metabolite, a more soluble compound, or more potent metabolite.

• The condition of the liver
• 1st-pass effect
• chemicals/drugs that stimulate production of transforming enzymes which will speed metabolism of other drugs and possibly decrease their effects (ex. fast acetylator, barbiturates, rifampin therapy) -- more enzyme = less drug
• chemicals/drugs tha decrease production of transforming enzymes which will slow metabolism of other drugs and cause drug accumulation and increase advers effects (ex. cardio dysfunction, renal insufficeinecy, starvation, obstructive jaundice, slow acetatator erythromycin or ketoconazole drug therapy) -- less enzyme = more drug

The level of metabolism of a drug BEFORE it reaches the systemic circulation. Circulation is entered at the gut wall and liver.

When a po drug is extensivelly metabolized by the liver before reaching the systemic circulation.

Drugs given IV are injected directly into the circulation system, and thus by-pass 1st-pass metablolism, allowing more drug to reach the circulation. However, a nurse would usually give a higher dose in po form than they would via IV, because po dose account for the less of active medication during 1st-pass; however, in an IV, no drug is lose - so a smaller amount is required. So, a po dose DOESN'T equal an IV dose.

sublingual, transdermal, buccal, vaginal, intramuscular, intravenous, subcutaneous, intranasal, inhalation, and rectal - which undergoes a higher degree of 1st-pass effect than the others.

A major enzyme system in the body for drug metabolism that uses the Red/ox reaction, which requires molecular oxygen. Humans have 17 families and 39 subfamilies of cytochrome P450 genes. Only 3 are dedicated to metabolising drugs, others maintain homeostasis or cholesterol, bile acids, steroid hormones, and vitamin D3. And though almost all tissues have some, the liver and gut wall have the greatest concentration of P450.

It is called inhibition, and can result in 2 drugs competing for the same enzyme - but the drug with greater affinity (proximity) typically wins, drugs that do get into active sites are slow to dissociate, drugs can accumlate and their actions/effects will be prolonged, and unmetabolized drugs can build to toxic levels.

Grapefruits, which are suicide inhibitors - meaning they destroy some of the CYP3A4 enzyme in the small intestine cause the body to need to make more. However, it takes the body time (usually an entire day) to make more, so the effects can last long after the grapefruit passes through the small intestine and is eliminated. So the pt CANNOT avoid the grapefruit-drug interaction by staggering consumption, and so, this combo can lead to toxicity -- grapefruits and anti-hypertenstion meds are an especially bad combo!

• Reversible increase in enzyme concentration resulting from administration of certain drugs.
• Potential to increase rate of the "inducing" drugs breakdown.
• May increase the metabolism of other drugs taken concurrently.
• Stimulating drug metabolism (inducing) causes diminished pharmacologic effects.

• The elimination of drugs from the body.
• The main organ for excretion is the kidneys, but the liver and bowels (specifically, biliary exreation and enteroheptic circulation) play a part.
• Changes in the pH of urine, usually caused by chemical, food, or drugs, can change excretion of some drugs (ex: the acidity of soda can change pH of urine and effect exrection of a drug).

• Half-life is the time it takes for serum plasma concentrations to decrease by half; a measure of the rate at which drugs are removed from the body. It depends on the rate of excretion and determines the frequency of administration, but isn't dependent on dose.
• It takes 4-5 half-lives to reach a steady state, which is when the drug reaches a steady level in the body and is able to give a steady level of affect.
• After a pt stops taking a drug, it will take 4-5 half-lives before the drug want show up on a drug-screen.

• Absortion - passage of med from administrative site to entry into the blood stream.
• Distribution - transport of med to target tissue, including binding to plasma protein albumin.
• Metabolism (biotransformation) - degradation of med preparation of exretion.
• Excretion - elimnation of med from the body

Age (metablic difference), gender, ethnicty, pathologic alterations, and body size

• Drug actions - the cellular processes involved in the drug and cell interaction
• Drug effect - physiologic reaction of the body to the drug.
• Onset - the time it takes for the drug to elicit a therapeutic response. In other words, how long does it take to start working.
• Peak - the maximum therapeutic response
• Trough - the lowest therapeutic response; occurs right before the next dose.
• Duration - the time a drug concentration is sufficient to elicit a therapeutic response. In other words, how long does it work.

The way by which drugs can produce therapeutic effects. Once the drug is at the site of action, it can modify the rate (increase or decrease) at which the cells or tissues function. A drug can't make a cell or tissue perform a function it wasn't designed to perform.

• Receptor interactions - drug structure is essential. Involves selective joining of drug molecule with reactive site on surface of cell or tissue (a receptor).
• Enzyme interation - enzymes catalyze reactions. For a drug to alter a physiologic response it must inhibit action of specific enzyme.
• Nonspecific interations - no receptor or enzyme. Affect cell membranes or cellular processes. May physically/chemically interfere with cellular processes.

• Agonist - drug binds to receptor and there is a response.
• Partial agonist - drug binds to receptor and ther is a dimished response compared with that elicited by the agonist.
• Antagonist - drug binds to receptor but there is no response. Drug prevents binding of agonist.

• Acute - intensive, critically ill (the ER)
• Maintenance - doesn't eradicate disease, but prevents progression (HIV meds)
• Supplemental - supplies substance needed to maintain normal function because it can't be made or its in deficient supply (Vit C in smokers)
• Pallative - make pt as comfortable as possible (hospic)
• Supportive - maintains the integrity of the body function while the pt is recovering (fluids or anything to keep the pt going)
• Prophylactic - provided to prevent illness or other undersirable outcome (condoms)
• Empiric - provided on basis of practical experience. ("if it looks like a duck...")

The effecitveness of the drug therapy must be evaluated (usually asseted via vital signs). So one must be familiar with the drug's intended therapeutic action (beneficial) and the drug's unintended but potential side effects (predicatable, adverse drug reactions).

• Therapeutic index - is the ratio between which a drug's therapeutic benefits and it's toxic effects. In other words, the range between where you want drugs to be. Some drugs have a narrow range.
• Tolerance - decreasing response to repetitive drug doses
• Dependence - a physiologic or psychological need for a drug
• Interactions - alteration of a drug by other meds (perscribed or OTC) or herbal remedies.

Therapeutic index, drug concentration, pt condition, tolerance, dependence, and interations.

Additive effect, synergistic effect, antgoistic effect, and incompatibility.

• Adverse drug events (aka med errors), which are all preventable and can result in pt harm.
• Adverse drug reactions (aka side effects), which are inherent - a nonpreventable event that occurs in the normal therapeutic use of a drug. Any reaction that is unexpected, undesirable, and occurs at doses normally used. These side effects may be idiosyncratic, hypersensitivity reactions, and drug interactions.

• Adverse effects are any undesirable bodily effects that are a direct response to one or more drugs.
• May include side effects, which are expected, well-known reactions that result in little or no chage in pt management. They have predictable frequency, intensity and occurrence is related to the size of the dose (ex. dry mouth, constipation, diarrhea, utricaria, and drowsiness).

• Annoying side effects can lead to noncompliance. However, if nurses educate the pt about these possible side effects and how to handle or avoid it, they are more likely to continue taking the med. These side effects include: upset stomach, nausea, diarrhea, dizziness, etc.
• Serious/life-threating side effects are things that a pt must be aware of because if they develop them they need to stop taking those meds ASAP! These side effects include: chest pain, dysrrhythmias, palpitations, protracted vomiting or diarrhea, sever headaches, fainting, seizures or convulsions, profound rash, jaundice or ANYTHING that cause breathing issues.

also known as hypersensitivity reactions and involves the pt's immune system. The range of reactions is mild (ie. skin erthems and mild rash) to sever (ie. life-threating issues such as anapylaxies/air-way constriction and tachycardia) and the use of these drugs are contradictory in pts who are allergic to them.

A type of warning that appears in a drug's prescribing info, required by the FDA alerting prescribers of serious adverse events that have occurred with the given drug.

things that happen as result of treatment (ex. change in fluid color, problems with muscles or cells, etc.). In other words, unintentional adverse effects that are treatment induced, which include: dermatologic, renal damage, blood dyscrasis ("blood gone wild"), and hepatic toxicity.

• Teratogenic - results in structual defects in fetuses. (ex. viral disease, chemicals, drugs, etc.)
• Mutagenic - changes in genetic composition. In other words, a change in the structure or number of chromosomes. (ex. radiation, chemicals, drugs - common with chemo-theraphy)
• Carcinogenic - drugs cause caner (ex. drugs and smoking - mostly toxins)

• Addictive effect - 2 drugs with similar mechanisms of action sum their effects. (Ex. alcohol & sedatives both make you drowsy, but together they make you SUPER drowsy) -- 1+1=2
• Synergism/potentiation - 2 drugs with differnent mechanisms produce greater effect (Ex. codeine and aspirin are both painkillers but together they are pain-overkill) -- 1+1=3
• Interference - 1 drug accelerates or slows the metabolism or exretion of another (Ex. Tagamet effects many other drugs)
• Displacement - 2 drugs compete for drug binding sites on albumin (protein)
• Antagonism - the effects of 2 drugs cancel each othe out. In other words, they are the antidote to toxins. (Ex. Narcan reverses an opiate toxicity by preventing their binding to CNS receptors) -- 1+1=0
• Incompatibility - physical interactions of drug interferes with another. In other words, something you can't mix together. (Ex. antacids inactivates antibiotic tetracycline if they are in the stomach) at the same time

Excedrin

• Food slows absorption of most drugs, but usually does not affect action of the drug. There are exceptions:
• Tryamine-containing foods & MAOIs can cause severe hypertension and cranial bleeding.
• Foods with Vit K antagonize action of anticoagulant warfarin (Coumadin)
• Dairy products and tetracyline form an insoluble nonabsorbable compound (chelation).
• Grapefruit juice inhibits metabolism of some drugs and can cause toxicty.
• Acidic foods increase absorption of iron.

Drug names (generic and trade), systems of measurement (metric, household, and apothecary), medical terminology, and following agency policy for abbreviations.

• A vital sign that measures unpleasant sensory and emotional experience associated with either actual or potential tissue damage. Pain is personal and individiual. It is whatever the pt says it is and exists whenever the pt says it does.
• Pain stops you from hurting youself and signals that there is a problem.
• Nociception is another term for pain

Pain tolerance is a subjective, not physiological variable.

• An analgesic is a "painkiller", a med that relieves pain without causing loss of consciousness.
• The purpose is to reduce pain without making the pt too drowsy - the goal isn't to know the pt out.

• Acute pain - sudden onset, usually subsides once treated. Generally subsides over less than 6 weeks.
• Chronic pain - persistent or recurring. Difficult to treat and last longer than 6 weeks.

• Somatic - skeletal muscle, ligaments, and joints.
• Visceral - organs, smooth muscles
• Superficial - skin or mucous membranes
• Vascular - vascular/perivascular (ie. migrains)
• Referred - pain felt elsewhere (ex. gall bladder pain is felt on the back, near the scapula)
• Neropathic - injury to peripheral nerve fibers or CNS
• Phantom - in body part that is removed, burning, itching, tingling, or stabbing
• Cancer - multiple causes
• Psychogenic - real pain due to psychological factors
• Central - tumors, trauma, inflammation of CNS/brain

• P - palliative/provactive factors for the pain (what makes it feel better or worse?)
• Q - quality of pain (burning, stabbing, aching, etc.)
• R - region of body affected
• S - severity of pain (on the pain scale)
• T- timing of pain (when did it start)

The most common theory of pain is the Pain Transmission Gate Theory, or simply the Gate Theory, which uses the analogy of a gate to describe tissues are sensed in the brain via the dorsal horn of the spine. In other words, all tissues sensations must pass through the dorsal horn ("the gate") to be felt; however, if the gate is closed, then no pain in tissues can be felt.

Pain transmission/tissue injury causes the release of bradykinin, histamine, potassium, prostaglandins, and serotonin; these substances stimulate nerve endings, starting the pain process.

• "A" fibers - these "close the gate" and are related to the Myelin sheath, large fiber size, fast conduction, pain transmission inhibition, and is sharp and well-localaized.
• "C" fibers - these "open the gate" and are related to no myelin sheath, small fiber size, slow conduction, facilitation of pain transmission, and is dull and nonlocalized.
• T-cells contl the threshold for pain. The more T-cells the harder it is to feel pain; the less T-cells the easier it is to feel pain.

• Pain fibers enter the spinal cord via the dorsal horn (the gate).
• The gate regulates the flow of sensory impulses to the brain.
• Large "A" fibers close the gate (inhibit pain) while small "C" fibers open the gate and allows pain impulses. The innervated gate allows the brain some control over the gate via T-cells.
• Pain must overcome the threshold (T-cells) to be sent to the brain.
• The impulses travel from the spinal cord up to the brain. The brain evaluates, indentfies, and localizes the pain. It can also control the gate before the gate is open. If no impulses are transmitted to higher centers of the brain, there will be no perception of pain.
• If the brain detects pain, it signals the body to activate its endogenous neurtransmitters, enkephalins and endorphines, which are produced to fight pain by binding to opioid receptors and inhibiting the transmission of pain by closing the gate.

• Rubbing painful areas (ie. message or liniment) stimulates large "A" fibers to close the gate and once the gate is closed, pain is reduced.
• This action is similar to taking opiates because it stimulates/uses the same pathways.

• Lowered (more pain) - anger, anxiety, depression, discomfort, fear, isolation, chronic pain, sleeplessness, and tired.
• Raised (less pain) - diversion, empathy, rest, analgesics, anti-anxiety meds, and antidepressants

• They are pain relievers that contain opium, derived from the opium poppy or chemically related to opium, and are used for moderate to sever pain. They are also the most commonly used class of analgesics, next to NSAIDs. However, these drugs are narcotics (very strong pain relievers) most are schedule II drugs and can't be sold withou a medical prescription.
• Opiates - drugs derived from juice of opium poppy
• Opioids - synthetic substances that have opium-like properties.

• Agonist - bind to receptor and cause response
• Partial agonist -binds to receptors and causes limited response
• Antagonist - bind to receptor and exert not response or reverse the effects of agents on pain receptors.

• The legal term established under the Harrison Antinarcotic Act of 1914 originally applied to drugs that produced insensibility and stupor, especially the opioids. (ex. morphine and heroin). Currently, it is used to refer to any illicit or street drug.
• The term currently used in clinical settings refers to any medically adminred controlled substance.

• Natural opium alkaloids - codeine sulfate and morphine sulfate
• Semi-synthetic analogs - Hydromorphone (Dilaudid) and Oxycodone hydrochloride
• Synthetic Compounds - meperidine HCl (Demerol), Fentanyl (Sublimaze), and Methadone HCl (Dolophine)
• Opioid/Acetaminophen compounds - percocet/Tylox (oxycodone + acetaminophen), Vicodin (hydrocodone bitartrate + acetaminophen), and Darvocet

Because it cause dysrhythmias.

• Morphine is the golden standard for pain meds. It is a major narcotic of opium plant and is used to treat pain and relieve anxiety caused by myocardial infarction (MI) by decreasing the workload of the heart in pulmanary edema.
• Meperidine, codeine, and methodone are more effective than morphine when given po.

• Severe- Morphine and meperidine (Demerol)
• Moderate - Codeine
• Withdrawl- Methadone (Dolophine)

• 80-100mg merpridine
• IV Fentanyl

slow

People with gall bladder problems.

Mu, Kappa, and Delta

• Opioids
• Constipation, respiratory depression, inhibited cough reflex, postural hypotension (BP drops when standing), pupil constriction (miosis; "pinpoint" pupils), nausea and vomitting, euphoria (mu receptors), lethargy/sleepy/poor concentration, urinary retention, diaphresis/flushing, and itching/rash (related to histamine).

a fibrous matrial

Narcane

• Drug allergies and sensitivites
• If there is a head injury or increased intracranial pressure look for things that may be masked by narcotics - monitor for consciouness, resp rate, altered reation to light.
• If pt has acute asthma, chronic airway problems, low resp rate due to COPD, obesity, pregancy, and prostate problems monitor extremley close.
• Use caution with elderly pts, or pts with severe renal, pulmonary disease, CHF, liver disease, alcoholism, undiagnosed pain, and BPH
• Discourage "PCA by Proxy", family members adminstering PCA doest for the pt. Caregivers need to be educated - tell the family NOT to push the button.

• 600mg/d
• 48 hours

• Tolerance - a common physiologic result of chronic opioid treatment. Resulting in larger doses of opioids being required to maintain the same level of analgesia.
• Physical Dependence - the physiologic adaptation of the body to the presence of an opioid. NOT ADDICTION!
• Psychological dependence - addiction; a pattern of compulsive druge use characterized by a contiuned craving for an opioid and the need to use the opioid for effects other than pain relief.

• Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with psychological dependence/addiction.
• Misunderstanding of these terms leads to ineffective pain managment and contributues to the problem of undertreatment.

When the opioid is abruptly discontinued or when an opioid atagonist is administered causing narcotic withdrawl and opioid abstinence syndrome.

• something that assist the primary agent in relieving pain and allows the use of smaller doese of opioids, decreases side-effects, and approaches pain stimulus from another mechanism with synergistic effects.
• NSAIDS, Antidepressants, Anticonvulsants, and Coticosteriods

• Ultram is a centrally acting analgesic with a dual mechanism of action that uses a weak bond to Mu-receptors and inhibits reuptake of serotonin and norepinephrine. It is not currently a controlled substance, but you need a perscription for it.
• It is for moderate to moderatly sever pain.
• Side effects are drowsiness, dizziness, headache, nausea, and constipation. It may cause seizures.
• Use caution with tricyclic antidperessants, SSRIs, MAOIs, neuroleptics, and other drugs that reduce the seizure threshold. Don't use if on psych drugs.
• It's not effected by food

Ultrum and acetaminophen

Opioids

• Naloxone (Narcan) and Naltrexone (Revia).
• Effects occur within minutes of parenteral adminstration and last 1-2 hours.
• Monitor BP, respt, rhythm, depth, pluse, LOC Q5min, and assess for relapse or resp depression every 10-20 min.

• Acetaminophen (Tylonal) is an analgesic for mild to moderate pain. It is commonly combined with opioids.
• It is antipyretic, meaning it reduces fever, but it is only weak anti-inflammatory.
• It doesn't effect cardio, resp, or platelets; nor does it cause acid-base and gastric problems.
• Do use for pts with Yellow Dye #5 or sacchrin allergies.
• Tell pt to take will full glass of water, and not to take with alcohol - which can cause liver damage.

• Acetaminophen
• bruising, petechia, and hematuria

A newly approved intrathecal analgesic (not an opioid) syntheised from protein found in sea snails. Injected into subarachnoid space of the spinal cord. Given for sever chronic pain. Side effects are psychotic, mood changing, adn halluninations.

• Get a throughoug history
• Abtain baseline vital signs, I & O, and pain assessment.
• Medicate before pain is severe.
• Give meds with food.
• Withhold med and contact doctor if resp drops below 12 breath/min.
• Instruct pt to avoid alcohol and to make position changes slowly to avoid orthostatic hypotension.
• Administer IV meds slowly.
• Ask about constipation and monitor for other side effects.