1
Q
What vital sign is most important to monitor with morphine?
A
Respiratory rate — hold if RR < 10.
2
Q
What common side effect of morphine is caused by histamine release?
A
Itching.
3
Q
What GI effect requires prevention and monitoring from morphine?
A
Constipation.
4
Q
What happens during transduction?
A
Injury activates nociceptors and chemicals start the pain signal. (NSAIDs & local anesthetics work here.)
5
Q
What medications work at the transduction stage?
A
NSAIDs and local anesthetics (block chemical release or nerve firing).
6
Q
What happens during transmission?
A
Pain signal travels from the spinal cord to the brain. (Opioids block this.)
7
Q
What drug class works at the transmission stage?
A
Opioids (e.g., morphine, fentanyl).
8
Q
What happens during perception?
A
The brain interprets and becomes aware of pain.
9
Q
What key nursing principle applies to the perception stage?
A
“Pain is whatever the patient says it is.”
10
Q
What happens during modulation?
A
The brain releases chemicals (endorphins, serotonin, norepinephrine) to reduce pain.
11
Q
What medications enhance modulation?
A
Opioids, antidepressants, and anti-seizure drugs.
12
Q
What are the 4 stages of pain in order?
A
Transduction → Transmission → Perception → Modulation.
13
Q
Pain
A
is defined as unpleasant sensory and emotional experience associated with tissue damage.
14
Q
—— is a personal and individual experience. ——— is ———
A
Pain is a personal and individual experience. Pain is whatever the patient says it is.
15
Q
Exists when the patient says it exists
A
Pain
16
Q
Why is knowing threshold vs tolerance important in nursing?
A
It helps choose proper interventions and provide empathetic care.
17
Q
What is pain threshold?
A
The point when pain first starts.
18
Q
What is an example of pain threshold?
A
The moment you touch something hot and first feel pain.
19
Q
What increases pain threshold?
A
Distraction, emotional support, rest, and pain meds.
20
Q
What lowers pain threshold?
A
Lack of sleep, anxiety, fear, depression, or isolation.
21
Q
What is pain tolerance?
A
The maximum pain a person can handle before it becomes unbearable.
22
Q
What affects pain tolerance?
A
Personality, culture, ethnicity, and environment.
23
Q
What is acute pain?
A
Short-term, sudden pain that goes away when the cause is treated.
24
Q
Give 2 examples of acute pain.
A
Post-op pain, headache.
25
What body system does acute pain activate?
The sympathetic nervous system (fight-or-flight).
26
List physical signs of acute pain.
↑HR, ↑BP, ↑RR, sweating.
27
What is chronic pain?
Long-term pain lasting 3–6 months or more.
28
Give 2 examples of chronic pain.
Arthritis, chronic back pain.
29
Why is chronic pain harder to treat?
The nervous system changes and processes pain differently.
30
How might chronic pain feel?
Dull, aching, burning, constant, or tingling.
31
What emotional effects can chronic pain cause?
Fatigue, depression, anxiety, sleep problems.
32
Nursing focus for acute pain?
Fast relief and treating the cause.
33
Nursing focus for chronic pain?
Long-term coping, symptom management, emotional support.
34
What is the #1 nursing principle about pain?
Pain is subjective — believe the patient.
35
Referred
Pain shows up somewhere else.
36
Neuropathic
Nerve pain (burning/zapping).
37
Phantom
Pain in a missing limb.
38
Cancer
Pain from tumor or treatment.
39
Central
Pain from brain/spinal cord damage.
40
Vascular
Pain from blood flow problems.
41
A patient is fully awake but reports 8/10 pain after surgery. Which type of medication is appropriate, and why?
An analgesic, because these relieve pain without causing loss of consciousness, allowing the patient to stay alert.
42
A patient on morphine becomes very drowsy and their respiratory rate drops to 8 breaths/min. What should the nurse do first?
Stop the opioid and notify the provider immediately. This is respiratory depression — a dangerous opioid side effect.
43
A patient has a mild headache. Why might acetaminophen be chosen instead of ibuprofen?
Acetaminophen treats pain and fever but is gentler on the stomach. It is good when inflammation is not present.
44
A patient with arthritis reports pain in inflamed joints. Which medication type is most appropriate and why?
An NSAID, because NSAIDs reduce pain, fever, and inflammation.
45
A patient has chronic neuropathic pain described as “burning and zapping.” Why might gabapentin (an adjuvant) be added even if they’re already on an opioid?
Because neuropathic pain responds poorly to opioids. Adjuvants like gabapentin enhance pain control and help lower opioid doses.
46
A patient on hydromorphone (Dilaudid) asks why they’re also taking Tylenol and gabapentin. What is the best nursing explanation?
This is multimodal pain management — using different types of medications together gives better pain control and reduces opioid side effects.
47
A patient has a history of liver disease. Which analgesic requires extra caution, and why?
Acetaminophen, because it can cause hepatotoxicity (liver damage).
48
A patient is taking ibuprofen daily. What key complication should the nurse monitor for?
GI irritation or bleeding, because NSAIDs can damage the stomach lining.
49
A provider orders a new opioid for an elderly patient. What nursing principle should guide dosing?
"Start low, go slow." Older adults are at higher risk for CNS depression and overdose.
50
A patient says their pain is still 7/10 after receiving morphine. What should the nurse assess before giving more medication?
Current pain rating, sedation level, respiratory rate, time since last dose. This avoids overdose and ensures safe administration.
51
Why do nurses always check pain before and after giving analgesics?
To evaluate effectiveness and determine if a dose is safe or adjustments are needed.
52
A postoperative patient becomes constipated while taking opioids. What is the best nursing intervention?
Encourage fluids, fiber, ambulation, and consider stool softeners, since constipation is a common opioid side effect.
53
A patient is on multiple pain meds and asks if this is dangerous. What is the best response?
"Using different medications together can actually be safer because it allows lower doses of each drug and reduces side effects."
54
What are opioids mainly used for?
Moderate to severe pain (surgery, injury, cancer).
55
Name two *other* uses for opioids besides pain control.
Cough suppression, treatment of diarrhea, anesthesia, pulmonary edema.
56
Why do opioids slow body processes?
They depress the central nervous system (CNS).
57
Where do natural opioids come from?
The opium poppy plant.
58
Give two natural opioids.
Morphine, codeine.
59
Give two synthetic/semi-synthetic opioids.
Fentanyl, hydromorphone.
60
Why is “opioid” preferred over “narcotic” in healthcare?
It is more accurate and avoids stigma.
61
What regulates opioids in Canada?
The Controlled Drugs and Substances Act (CDSA), Schedule I.
62
What safety measures do hospitals use for opioids?
Locked storage, strict documentation, double-nurse checks.
63
How do opioids work?
They bind to mu receptors in the brain and spinal cord to block pain signals.
64
What is the main dangerous side effect of opioids?
Respiratory depression.
65
What medication reverses opioid overdose?
Naloxone (Narcan®).
66
What common side effect should patients prevent with fluids and fiber?
Constipation.
67
What substances should be avoided while taking opioids?
Alcohol or other CNS depressants.
68
What two assessments must always be done with opioid administration?
Pain level **before and after**, and respiratory status.
69
What is morphine used for?
Moderate–severe pain (post-op, cancer, trauma).
70
Why is morphine risky in kidney disease?
Its metabolites build up → can cause toxicity and prolonged sedation.
71
What side effects are common with morphine?
Respiratory depression, sedation, constipation, nausea, urinary retention.
72
Does morphine itching mean an allergy?
Usually **no** — it’s histamine release, not a true allergy.
73
How does hydromorphone compare to morphine in potency?
It is **about 5× stronger**.
74
Why is hydromorphone preferred in renal impairment?
It has fewer active metabolites than morphine.
75
What must NEVER be done with controlled-release Dilaudid?
Never crush or cut it.
76
How potent is fentanyl compared to morphine?
About **100× more potent**.
77
Who is the fentanyl patch intended for?
Opioid-tolerant patients with **severe chronic pain**.
78
Why must fentanyl patches never be heated?
Heat increases absorption → overdose risk.
79
How often should a fentanyl patch be changed?
Every **72 hours**.
80
What are the two main uses of methadone?
Chronic pain and opioid addiction treatment.
81
What cardiac risk is associated with methadone?
**QT prolongation**, which can cause arrhythmias.
82
Why must methadone be used cautiously in liver disease?
It is metabolized in the liver → risk of accumulation/toxicity.
83
What is codeine commonly used for?
Mild–moderate pain and cough suppression.
84
Why should codeine not be used in children?
Unpredictable metabolism → may convert too quickly to morphine.
85
What must be monitored when taking Tylenol #2/#3/#4?
Total **acetaminophen** intake (max 4,000 mg/day).
86
What type of pain is oxycodone used for?
Moderate–severe pain.
87
Why must OxyContin (controlled-release) never be crushed?
Crushing causes rapid release → risk of fatal overdose.
88
What combination medication includes oxycodone + acetaminophen?
**Percocet®**.
89
What is the most dangerous opioid side effect?
**Respiratory depression**.
90
At what respiratory rate should opioids be held?
**RR < 10/min**.
91
What medication reverses opioid overdose?
**Naloxone (Narcan®)**.
92
What should patients avoid while taking opioids?
Alcohol or other CNS depressants (benzodiazepines).
93
What system should you always assess before and after giving opioids?
**Pain, respiratory status, and sedation level**.
94
How do opioids relieve pain?
They bind to pain receptors in the brain/spinal cord and block pain signals.
95
Which receptor is responsible for strong pain relief AND respiratory depression?
The **mu (μ)** receptor.
96
What effects are linked to kappa (κ) receptors?
Mild pain relief and mild sedation.
97
What do delta (δ) receptors influence?
Mood and emotional response to pain.
98
What is a mild opioid agonist?
A weak opioid used for mild–moderate pain (e.g., codeine, hydrocodone).
99
Mild opioid agonists are often combined with what medication?
**Acetaminophen** (e.g., Tylenol #3).
100
What is a partial agonist?
A drug that activates opioid receptors weakly and blocks stronger opioids.
101
Example of a partial agonist used in addiction treatment?
**Buprenorphine (Suboxone®).**
102
What is the “ceiling effect” in partial agonists?
Increasing the dose does NOT increase pain relief beyond a certain point.
103
What are strong opioid agonists used for?
Severe pain (post-op, cancer, trauma).
104
Name three strong opioid agonists.
Morphine, hydromorphone, fentanyl.
105
Which opioid is used as the “standard” for comparing others?
**Morphine.**
106
How much stronger is hydromorphone than morphine?
About **5× stronger**.
107
How much stronger is fentanyl than morphine?
About **100× stronger**.
108
What is the most dangerous side effect of strong opioids?
**Respiratory depression.**
109
When should opioids be held and the provider notified?
RR < 10, O₂ sat < 90%, or patient is unarousable.
110
What medication reverses opioid overdose?
**Naloxone (Narcan®).**
111
Which drug class interacts dangerously with opioids?
Other **CNS depressants** (alcohol, benzodiazepines).
112
Why must nurses monitor bowel patterns with opioids?
Opioids commonly cause **constipation**.
113
What should always be assessed before and after giving an opioid?
Pain level, respiratory rate, O₂ saturation, and level of consciousness.
114
What is the mu (μ) receptor?
A main opioid receptor in the brain and spinal cord that controls pain relief, euphoria, sedation, and respiratory depression.
115
What happens when opioids bind to the mu receptor?
Pain signals are blocked, pain perception changes, and calm/euphoria may occur.
116
What determines how strong an opioid’s effects are?
How strongly it activates (binds to) the mu receptor.
117
What is a full agonist?
A drug that fully activates the mu receptor for maximum pain relief.
118
Give two examples of full agonists.
Morphine, fentanyl, hydromorphone, methadone.
119
What major risk comes with full agonists?
Respiratory depression and high addiction potential.
120
What is a partial agonist?
A drug that partially activates the mu receptor and blocks stronger opioids from binding.
121
Example of a partial agonist?
Buprenorphine (Suboxone®).
122
What is the “ceiling effect”?
Increasing the dose does not increase pain relief beyond a certain point.
123
Why are partial agonists used in addiction treatment?
They reduce cravings and prevent misuse without causing a full high.
124
What is an opioid antagonist?
A drug that blocks the mu receptor and reverses opioid effects.
125
Example of an antagonist?
Naloxone (Narcan®).
126
What does naloxone do?
Reverses opioid overdose by displacing opioids from mu receptors.
127
Why may naloxone need repeated doses?
It has a short duration (about 1 hour).
128
What vital sign must be closely monitored with opioids?
Respiratory rate (hold if <10/min).
129
What side effects should nurses assess for?
Drowsiness, confusion, nausea, vomiting, constipation.
130
What emergency medication must be available for all opioid patients?
Naloxone.
131
What should patients avoid when taking opioids?
Alcohol and other CNS depressants.
132
What symptoms must patients report immediately?
Slow breathing, dizziness, confusion, extreme drowsiness.
133
Why is safe storage of opioids important?
To prevent misuse or accidental ingestion.
134
Analgesic Ceiling Effect
Drug reaches a maximum analgesic effect. Analgesia does not improve, even with higher doses.
135
equianalgesia
Giving different opioids or routes that provide the **same level of pain relief**.
136
importance of equianalgesia
Prevents **overdose or underdose** when switching opioids or routes.
137
2 mg hydromorphone equals how much oral morphine?
About **10 mg** oral morphine.
138
situation when equianalgesic conversion is needed
Changing routes (oral → IV), switching opioids, or managing side effects/tolerance.
139
Immediate Release (IR) use
**Breakthrough pain** (fast spikes in pain).
140
Slow Release (SR) use
**Long-term, steady pain control**.
141
Can IR and SR opioids be used together?
Yes — SR for baseline pain, IR for breakthrough pain.
142
what must a nurse check before giving an IR dose
Timing, last dose given, pain score, and risk of **doubling** doses.
143
multimodal pain management
Using **different drug classes together** to improve pain relief and lower opioid doses.
144
example of an opioid + non-opioid combination
Opioid + acetaminophen (e.g., Tylenol #3).
145
major safety concern when combining opioids with acetaminophen
Not exceeding **4000 mg/day** of acetaminophen.
146
why combine opioids with NSAIDs or adjuvants
Better pain relief (**synergy**) and lower opioid side effects.
147
what must nurses always assess before and after giving opioids
**Pain level**, respiratory rate, sedation level.
148
biggest risk when combining SR + IR opioids incorrectly
**Accidental overdose**.
149
what should nurses teach patients about IR doses
Do **not** take extra IR doses “just in case.”
150
what should nurses document after giving an opioid
Pain score, effectiveness, side effects, and time given.
151
purpose of equianalgesic charts
To safely convert one opioid to another while maintaining **equal pain control**.
152
What is a TRUE opioid allergy?
Life-threatening reactions such as angioedema (swelling of face, lips, airway), hives, or difficulty breathing.
153
Is itching/flushing from morphine a true allergy?
No — it’s usually histamine release, not a real allergy unless angioedema is present.
154
What should you do if a patient has symptoms of a true opioid allergy?
Stop the drug immediately and notify the provider.
155
Why are opioids used cautiously in pregnancy?
They cross the placenta → risk of fetal dependence, neonatal withdrawal, and newborn respiratory depression.
156
Why are opioids dangerous in respiratory insufficiency (COPD, asthma)?
They depress the brain’s respiratory center → can cause respiratory failure.
157
What respiratory rate is concerning after giving an opioid?
Less than **10 breaths/min**.
158
Why are opioids avoided in patients with elevated intracranial pressure (ICP)?
Opioids increase CO₂ retention → vasodilation → **worsens intracranial pressure**.
159
Why use caution in morbid obesity or sleep apnea?
High risk of hypoventilation and apnea because opioids further depress breathing.
160
Why are opioids risky for patients with myasthenia gravis?
Weak respiratory muscles + opioid CNS depression → severe breathing difficulty.
161
Why are opioids contraindicated in paralytic ileus?
Opioids slow gut motility → worsens obstruction → risk of perforation.
162
What are dangerous CNS depressant combinations with opioids?
Alcohol, benzodiazepines (lorazepam, diazepam), barbiturates.
163
What happens when opioids are combined with other CNS depressants?
Extreme sedation, low BP, respiratory depression, coma.
164
Key nursing assessments before giving opioids?
Respiratory rate, alertness/LOC, bowel habits, medical history.
165
Patient teaching for opioids?
Avoid alcohol/sedatives; report swelling, severe itching, or breathing trouble immediately.
166
What is the most dangerous opioid adverse effect?
**Respiratory depression** (RR <10/min).
167
What should the nurse do if a patient has RR <10/min after an opioid?
Stop opioid → give **Naloxone** → monitor breathing → notify provider.
168
What early sign can warn of impending respiratory depression?
**Increased sedation** (very sleepy / hard to wake up).
169
Why do opioids cause sedation and confusion?
CNS depression (they slow brain activity).
170
What should the nurse avoid combining with opioids due to sedation risk?
Alcohol, benzodiazepines, sleeping pills, other CNS depressants.
171
What is subacute overdose?
Gradual buildup causing extreme sleepiness + slow respiratory rate.
172
Nursing action for suspected subacute overdose?
Hold next dose(s), reassess vitals/LOC, restart at lower dose.
173
What is opioid-induced hyperalgesia?
Opioids causing **increased sensitivity to pain**.
174
What should the nurse do for opioid-induced hyperalgesia?
Reduce dose, rotate opioid, or switch to non-opioids.
175
Why do opioids cause nausea and vomiting?
They slow stomach emptying + stimulate the vomiting center.
176
Nursing care for opioid-induced nausea?
Give antiemetics, encourage small meals, monitor hydration.
177
What is one of the most common opioid side effects?
**Constipation**.
178
How do opioids cause constipation?
They slow peristalsis + increase water absorption in the bowel.
179
Nursing interventions for opioid constipation?
Hydration, fiber, movement, stool softeners, laxatives, daily BM monitoring.
180
What does opioid-induced urinary retention require?
Scheduled toileting + monitoring bladder fullness.
181
What causes itching (pruritus) with opioids?
Histamine release (especially with morphine).
182
What does new muscle twitching (myoclonus) indicate?
Possible opioid toxicity → notify provider.
183
What vital signs must be monitored regularly with opioids?
**RR, LOC, BP, HR**, and pain level.
184
What are key overdose signs?
Pinpoint pupils, extreme sleepiness, slow breathing.
185
In simple terms, what do opioids do to the body?
**They slow everything down:** breathing, brain, and bowels.
186
drug tolerance
Drug tolerance is when the body becomes less responsive to a medication over time, requiring higher doses to achieve the same effect.
187
why tolerance does NOT equal addiction
Tolerance is a normal physical adaptation to long-term opioid use, while addiction involves psychological craving, loss of control, and continued use despite harm.
188
three common opioid withdrawal symptoms
Anxiety, Sweating or chills, Dilated pupils, Muscle aches, Nausea, vomiting, or diarrhea (Any three count.)
189
difference between physical vs. psychological dependence
Physical dependence: The body requires the drug to avoid withdrawal symptoms. Psychological dependence (addiction): Emotional craving and compulsive drug use despite harm.
190
the 4 C’s of addiction
Craving, Compulsive use, Control loss, Continued use despite harm.
191
why must opioids be tapered gradually
To prevent withdrawal symptoms, because the body has adapted to the presence of the drug.
192
two nursing interventions for opioid withdrawal
Administer medications to manage symptoms (Gravol, Imodium, clonidine, acetaminophen). Provide reassurance and emotional support. Monitor vital signs. Encourage hydration. (Any two accepted.)
193
example of opioid misuse behavior
Taking medication 'just in case' rather than for actual pain.
194
why do withdrawal symptoms occur
The body has adapted to the drug and stops producing its own natural neurotransmitters; when opioids are removed suddenly, the system becomes unbalanced.
195
what should nurses teach about tolerance and dependence
That tolerance and physical dependence are expected with long-term opioid use and do NOT mean addiction—but doses must be monitored and opioids must be tapered safely.
196
Why is IV morphine faster than oral morphine?
IV morphine enters the bloodstream immediately and bypasses absorption and first-pass metabolism in the liver.
197
List three indications for morphine use.
Moderate to severe acute pain (post-surgery, trauma); Chronic cancer or palliative pain; Myocardial infarction for pain and anxiety reduction (Any three count.)
198
What is the main risk of giving morphine to a patient with kidney impairment?
Accumulation of morphine-6-glucuronide → sedation, confusion, respiratory depression, myoclonus (toxicity).
199
Name two signs of morphine toxicity.
Extreme sedation; Respiratory depression; Pinpoint pupils; Confusion (Any two are correct.)
200
Why must sustained-release (Contin) morphine tablets never be crushed?
Crushing releases the full dose at once → risk of overdose and life-threatening respiratory depression.
201
What metabolite builds up in renal failure and causes toxicity?
Morphine-6-glucuronide.
202
What labs should the nurse assess before giving morphine?
Kidney function labs: BUN and creatinine. (Also liver function if needed.)
203
Name two patient teaching points for morphine administration.
Avoid alcohol and sedatives; Do not crush long-acting tablets; Report difficulty breathing or severe drowsiness; Increase fluids and fiber to prevent constipation.
204
What type of pain is immediate-release morphine used for?
Acute pain or breakthrough pain.
205
Why is morphine used in myocardial infarction (heart attack)?
It reduces pain and anxiety, which decreases the heart’s oxygen demand.
206
Hydromorphone is preferred over morphine in patients with renal impairment because:
C. It has fewer active metabolites that accumulate in the kidneys
207
Which statement indicates correct understanding of hydromorphone potency?
C. A small dose of hydromorphone provides the same relief as a much larger dose of morphine
208
A nurse receives an order for Hydromorph Contin®. What is the priority action?
D. Ensure the tablet is swallowed whole
209
Which finding requires IMMEDIATE action in a patient receiving hydromorphone?
B. Respiratory rate of 10/min
210
The nurse should double-check a hydromorphone dose with another nurse because:
B. It has a high potency and a small error can cause overdose
211
Which assessment must be prioritized before administering hydromorphone?
C. Level of consciousness and respiratory rate
212
A patient receiving hydromorphone becomes unresponsive with pinpoint pupils and a RR of 8/min. What is the nurse’s FIRST action?
B. Stop the opioid immediately
213
What is the MOST appropriate nursing intervention during hydromorphone overdose?
B. Administer naloxone as ordered
214
Hydromorphone is safer than morphine in older adults because:
B. It doesn’t create the toxic morphine-6-glucuronide metabolite
215
Which clinical advantage does hydromorphone have?
C. Faster onset and easier titration
216
Why is hydromorphone considered safer for patients with renal impairment?
It does not produce morphine-6-glucuronide, avoiding accumulation and toxicity.
217
What should the nurse monitor regularly when giving hydromorphone?
Respiratory rate
Level of consciousness / sedation
Pain level
Renal and hepatic function
Side effects (nausea, constipation)
218
What should a nurse do if a patient shows signs of opioid overdose?
Stop the opioid, call for help, administer naloxone, apply oxygen, continuously monitor vitals.
219
Why must Hydromorph Contin® tablets NOT be crushed?
Crushing releases the entire long-acting dose at once → fatal overdose.
220
Why does hydromorphone carry a high risk of medication error?
Because it is very potent, and a small miscalculation can lead to respiratory depression or overdose.
221
What are two key clinical advantages of hydromorphone?
Stronger than morphine → smaller doses needed
Safer in renal impairment
Faster onset and easier titration
222
What respiratory rate should cause concern when giving hydromorphone?
RR <12 is concerning; RR <10 = overdose risk.
223
Fentanyl is considered extremely dangerous because:
B. It is 50–100 times more potent than morphine
224
Fentanyl patches should be used only in:
C. Opioid-tolerant patients with chronic pain
225
A patient wearing a fentanyl patch develops a fever. What is the nurse’s priority action?
B. Monitor for signs of overdose
226
When applying a fentanyl patch, the nurse should:
B. Apply to dry, hairless skin
227
Which statement indicates a need for further teaching?
A. “I can keep a heating pad on my back while wearing the patch.”
228
Which finding requires IMMEDIATE action?
B. Respiratory rate of 8/min
229
A caregiver handling a fentanyl patch must be taught to:
A. Wear gloves during application
230
Fentanyl is NOT appropriate for:
C. Opioid-naïve patients with acute back pain
231
What is the correct method for disposing of fentanyl patches (Canada)?
C. Fold it in half and flush it
232
Why are fentanyl patches dangerous for children and pets?
B. Even used patches contain enough drug to cause fatal overdose
233
Why is fentanyl unsafe for opioid-naïve patients?
✔️ Because its extreme potency increases the risk of fatal respiratory depression.
234
Name two major risks of fentanyl use.
✔️ Respiratory depression ✔️ Bradycardia / hypotension ✔️ Sedation ✔️ Overdose if exposed to heat (Any two count.)
235
How long does a fentanyl patch last?
✔️ 72 hours (3 days).
236
Why must fentanyl patches be applied to clean, dry, hairless skin?
✔️ To ensure consistent absorption and prevent patch loosening.
237
What are two signs of fentanyl toxicity?
✔️ Pinpoint pupils ✔️ Severe drowsiness ✔️ Respiratory rate <10 ✔️ Cyanosis (Any two count.)
238
Name one reason why heat increases fentanyl overdose risk.
✔️ Heat increases skin permeability → increases drug absorption → causes toxicity.
239
Why must used fentanyl patches be folded before disposal?
✔️ Folding seals the remaining drug inside so no one can touch or ingest it.
240
How long does it take for a fentanyl patch to reach full effect?
✔️ 12–24 hours.
241
What should the nurse document when giving a fentanyl patch?
✔️ Patch dose, location applied, time applied, and time removed.
242
What medication must always be available when administering fentanyl?
✔️ Naloxone (Narcan®).
243
What type of drug is methadone?
A synthetic (lab-made) opioid analgesic.
244
What are the two main uses of methadone?
Pain relief and treatment of opioid addiction.
245
Why is methadone used in opioid addiction treatment?
It reduces cravings and withdrawal without producing a strong “high.”
246
Does methadone block the effects of drugs like heroin or fentanyl?
Yes — it occupies opioid receptors and prevents a “high.”
247
How often is methadone usually taken?
Once daily due to its long half-life.
248
Why is methadone not a first-line drug for pain?
Dosing is complex and overdose risk is high because it stays in the body for a long time.
249
How long does methadone’s pain relief last?
4–8 hours.
250
How long can methadone stay in the body?
15–60 hours (long half-life).
251
What is the major risk of methadone’s long half-life?
Drug buildup → accidental overdose.
252
Key signs of methadone overdose?
Slow breathing, extreme sedation, pinpoint pupils, cyanosis.
253
What serious heart effect can methadone cause?
QT interval prolongation → risk of torsades de pointes.
254
What monitoring is needed for cardiac safety?
ECG, electrolyte levels (K+, Mg2+).
255
Which organs metabolize methadone?
The liver.
256
Is methadone safer for kidney impairment?
Yes — it does not rely heavily on kidney clearance.
257
Should methadone be used with caution in liver disease?
Yes — it can build up and cause toxicity.
258
Before giving methadone, what should the nurse assess?
Respiratory rate, sedation level, LOC, ECG.
259
After giving methadone, what should be monitored?
Breathing, LOC, sedation, overdose signs, pain relief.
260
What patient education is essential when taking methadone?
Take at the same time daily; avoid alcohol/benzos; don’t take extra doses; report dizziness or palpitations.
261
What class of medications should methadone NOT be combined with due to overdose risk?
Sedatives, benzodiazepines, or alcohol.
262
Why is methadone given under supervision in addiction treatment programs?
To prevent overdose, misuse, or sharing of medication.
263
What type of drug is tramadol?
A synthetic opioid and miscellaneous analgesic.
264
What is the mechanism of action of tramadol?
It weakly binds to the **mu opioid receptor** and **inhibits reuptake of serotonin and norepinephrine**.
265
What level of pain is tramadol indicated for?
Moderate to moderately severe pain.
266
Why is tramadol considered a “miscellaneous” analgesic?
Because it acts through both opioid and non-opioid (serotonin/norepinephrine) mechanisms.
267
Can tramadol be addictive?
Yes — oral forms can be addictive and may produce mild euphoria.
268
What serious adverse effect is associated with tramadol and antidepressants?
Serotonin syndrome.
269
Which patients are at higher risk for serotonin syndrome when taking tramadol?
Those taking SSRIs, SNRIs, MAOIs, tricyclic antidepressants, neuroleptics, or drugs that lower the seizure threshold.
270
What serious neurological adverse effect can tramadol cause?
Seizures.
271
What are common side effects of tramadol?
Drowsiness, headache, constipation, nausea, and respiratory depression.
272
What is Tramacet®?
A combination of **tramadol + acetaminophen**.
273
Why does combining tramadol with acetaminophen (Tramacet®) improve pain control?
Because the two drugs work synergistically, allowing stronger pain relief at lower tramadol doses.
274
What does tramadol’s effect on serotonin and norepinephrine increase the risk of?
Serotonin syndrome and seizures.
275
What is the purpose of an opioid antagonist?
To **block or reverse** the effects of opioids during overdose.
276
Most common opioid antagonist?
**Naloxone (Narcan®)**.
277
When should naloxone be given?
When respiratory rate is **<10/min**, breathing is shallow, or patient is unresponsive.
278
Classic signs of opioid overdose?
**Pinpoint pupils, slow respirations, unresponsiveness.**
279
Mechanism of naloxone?
**Kicks opioids off receptors** and blocks them (competitive antagonist).
280
Fastest route for naloxone?
**IV** (works in 1–2 minutes).
281
Common community route for naloxone?
**Intranasal spray**.
282
How long does naloxone last?
**30–90 minutes**.
283
Why may you need repeat doses of naloxone?
Many opioids last **longer** than naloxone → overdose symptoms can return.
284
What is the priority assessment after giving naloxone?
**Respiratory rate and oxygen saturation.**
285
What is the first thing to do before giving naloxone?
**Check ABCs and call for help.**
286
What side effect can naloxone cause in opioid-dependent patients?
**Acute withdrawal** (agitation, sweating, vomiting, tachycardia).
287
In hospital, why is naloxone titrated slowly?
To reverse **respiratory depression** without triggering severe withdrawal.
288
What position should an unconscious overdose patient be placed in after naloxone?
**Side-lying recovery position** (prevents aspiration).
289
What is the priority even if naloxone causes withdrawal?
**Saving the patient’s life** — restore breathing first.
290
What vitals must be closely monitored after naloxone?
**RR, HR, BP, O₂ saturation.**
291
What symptom suggests naloxone is wearing off?
**Respiratory depression returning** (slow or shallow breathing).
292
Where can people get free naloxone kits in Saskatchewan?
**Four Directions**, **Prairie Harm Reduction**, other harm-reduction sites.
293
What is the goal of naloxone administration?
**Restore respiratory function**, not eliminate all pain meds.
294
Simple definition of naloxone?
A **lifesaving drug** that quickly reverses opioid overdose.
295
What is opioid withdrawal?
Physical reaction when a dependent person suddenly stops or reduces opioid use.
296
Is opioid withdrawal life-threatening?
**Usually no**, but it is very uncomfortable and distressing.
297
When does withdrawal begin?
* **Short-acting opioids:** 6–12 hours
* **Long-acting opioids:** 24–72 hours
298
Early symptoms (first 24 hours)?
Anxiety, restlessness, sweating, runny nose, watery eyes, yawning, muscle aches.
299
Later symptoms (24–72 hours)?
Nausea, vomiting, diarrhea, dilated pupils, tremors, chills, abdominal cramps, ↑HR/BP, insomnia, drug cravings.
300
What vital signs change during withdrawal?
**↑ heart rate, ↑ blood pressure, ↑ temperature.**
301
Key nursing assessments?
Vitals, hydration, GI losses, agitation/anxiety, cravings, safety.
302
Major risks during withdrawal?
Dehydration, hypertension, severe anxiety, unsafe behaviours or relapse.
303
Best way to prevent severe withdrawal?
**Gradually taper opioids** — avoid stopping abruptly.
304
Medications for symptoms?
* Nausea: **ondansetron, dimenhydrinate**
* Diarrhea: **loperamide**
* Aches/fever: **acetaminophen/ibuprofen**
* Anxiety/tremors/BP: **clonidine**
305
Comfort measures?
Hydration, electrolytes, blankets, calm environment, reassurance, rest.
306
What reduces cravings and withdrawal long-term?
Medication-assisted therapy: **methadone or buprenorphine (Suboxone®).**
307
Simple definition of withdrawal?
“The body reacting to the sudden loss of opioids it became dependent on.”
308
What does withdrawal feel like to patients?
“Worst flu ever” + anxiety + intense cravings.
309
Nursing goal during withdrawal?
**Ease symptoms, maintain safety, support hydration, and prevent relapse.**
310
Why is it important to know *why* a patient needs an opioid?
To choose the right opioid, right dose, and right monitoring based on the **type and cause of pain** (ex: post-op vs. cancer vs. chronic pain). It guides **treatment goals** (comfort, mobility, function).
311
A patient has never taken opioids before. What is your biggest concern?
They are **opioid-naïve**, meaning they are at high risk for **respiratory depression and sedation**. → Start low, go slow, and monitor closely.
312
A patient has been taking opioids for years. What does the nurse expect?
The patient is **opioid-tolerant**, so they may require **higher doses** for the same effect, but still need careful monitoring.
313
Why must the nurse check kidney and liver function before giving morphine?
Morphine is **metabolized in the liver** and **excreted by the kidneys**. If either organ is impaired, morphine can **build up → toxicity, sedation, respiratory depression**.
314
Which opioid is safer if the patient has renal failure?
**Hydromorphone** — produces fewer active metabolites than morphine.
315
Why are opioids risky for patients with COPD or sleep apnea?
They already have weak or obstructed breathing → opioids can further depress respirations → **life-threatening hypoventilation**.
316
Why do older adults require lower opioid doses?
They have **slower metabolism** and **increased CNS sensitivity**, making them more prone to **sedation, falls, and overdose**.
317
A patient is prescribed both a benzodiazepine and an opioid. What is the nurse’s priority concern?
**Severe CNS depression** → dangerously slow breathing, sedation, overdose. This combination is a **major safety red flag**.
318
Why must nurses understand opioid potency differences?
Some opioids (like hydromorphone or fentanyl) are **much stronger** than morphine. Wrong conversions = **fatal dosing errors**.
319
Why is fentanyl considered high-risk?
It is **extremely potent**, even in small doses — a 25 mcg patch ≈ **75 mg oral morphine**.
320
Why must nurses reassess pain after giving an opioid?
To ensure: * Pain relief is achieved * No excessive sedation * No respiratory depression * Need for dose adjustment.
321
What’s the purpose of using NSAIDs or acetaminophen alongside opioids?
They act as **adjuvants** and allow the nurse to use **lower opioid doses**, reducing risk of side effects.
322
Before giving an opioid, which vital signs are most important?
**Respiratory rate** (must be ≥12/min * Level of consciousness * Blood pressure and HR → Ensures patient is safe to receive a CNS depressant.
323
Why must the nursing process always be used with opioid administration?
To ensure **accurate assessment**, safe administration, and continuous evaluation of the patient’s response and side effects.
324
Why is documentation important after giving an opioid?
It records: * Pain level * Response to medication * Any adverse effects * Nursing actions → Ensures continuity and legal protection.
325
What is the #1 rule when starting an opioid?
**Start low, go slow** — especially in opioid-naïve, older adults, respiratory disease, or renal/hepatic dysfunction.
326
A patient has osteoarthritis and GI ulcers. Which analgesic is safest?
Acetaminophen
327
A child has a fever. The parent wants to give aspirin. What should the nurse recommend?
Use acetaminophen instead.
328
Why is acetaminophen NOT helpful for sprains or inflammation?
It has no anti-inflammatory properties. It only works for pain and fever, not swelling.
329
A patient with chronic alcohol use asks if they can take Tylenol for a headache. What is the nurse’s priority concern?
Liver toxicity.
330
A patient is taking cold/flu medicine plus Tylenol. What must the nurse assess?
Total daily dose of acetaminophen.
331
What is the MAX safe daily dose of acetaminophen for adults?
4,000 mg/day (or 3,000 mg/day for long-term use).
332
How does acetaminophen reduce fever?
It acts on the hypothalamus → causes vasodilation + sweating → heat loss.
333
A patient asks how Tylenol relieves pain. What is the simplest explanation?
It blocks pain signals in the brain by reducing prostaglandins.
334
Which patient is acetaminophen BEST for?
A patient who needs pain relief but: Has ulcers, Is on blood thinners, Has kidney disease, Cannot tolerate NSAIDs.
335
Why is acetaminophen considered safer than opioids?
It does not cause: Respiratory depression, Sedation, Dependence.
336
A patient reports dull headache pain rated 3/10. What is the right first-line medication?
Acetaminophen
337
What vital organ must nurses monitor with acetaminophen use?
The liver.
338
What makes acetaminophen different from NSAIDs?
No anti-inflammatory effects, No GI irritation, No platelet inhibition, No kidney effects.
339
A patient is shivering, sweating, and febrile. Why is acetaminophen helpful?
It resets the hypothalamus to lower the body’s set-point temperature.
340
A patient has mild joint pain but severe hypertension. Should they take NSAIDs or acetaminophen?
Acetaminophen
341
Most serious adverse effect of acetaminophen?
**Hepatotoxicity** (liver damage).
342
Common side effects of acetaminophen?
Rash, nausea, vomiting.
343
What organ is affected by acetaminophen toxicity?
**Liver**.
344
Who should NOT take acetaminophen?
* Patients with **drug allergy** * **Severe liver dysfunction** or failure * **G6PD deficiency**
345
What increases the risk of acetaminophen toxicity?
**Alcohol** or other **hepatotoxic drugs**.
346
Why is alcohol dangerous with acetaminophen?
Both are **liver-toxic**, increasing the risk of acute liver failure.
347
What must the nurse assess before giving acetaminophen?
**Liver function** (history, labs, alcohol use).
348
What blood disorders can acetaminophen rarely cause?
Anemia, thrombocytopenia (rare adverse effects).
349
What is G6PD deficiency and why does it matter?
A genetic condition causing **increased risk of red blood cell breakdown** with certain drugs, including acetaminophen.
350
What patient teaching is essential with acetaminophen?
Avoid alcohol; check labels for **hidden Tylenol** in cold/flu meds.
351
A patient has pain and inflammation from arthritis. Why are NSAIDs appropriate?
They provide **analgesic**, **anti-inflammatory**, and **antipyretic** effects — all helpful for arthritis swelling and pain.
352
A patient has GI ulcers. Should they take NSAIDs?
**No.** NSAIDs block **COX-1**, which normally protects the stomach lining → leading to **ulcers and GI bleeding**.
353
Why do NSAIDs increase bleeding risk?
They inhibit **platelet aggregation**, especially **aspirin**, leading to prolonged bleeding.
354
Why must kidney function be checked before giving NSAIDs?
NSAIDs reduce **renal blood flow**, which can worsen or cause **kidney impairment**.
355
Which patient should avoid NSAIDs: a) Hypertension b) Chronic kidney disease c) Fever d) Menstrual cramps
**b) Chronic kidney disease** **Why:** NSAIDs decrease renal perfusion → can worsen CKD.
356
What makes selective COX-2 inhibitors (like Celebrex) different?
They block COX-2 (inflammation) but spare COX-1 (stomach protection) → **less GI irritation**.
357
Why is ketorolac limited to a maximum of 5–7 days?
It is very **nephrotoxic** (hard on kidneys) despite strong analgesic effects.
358
A patient takes ibuprofen for fever. How does it reduce temperature?
It acts on the **hypothalamus**, promoting **heat loss** via sweating and vasodilation.
359
Why are NSAIDs potentially dangerous for patients with heart failure?
They can cause **fluid retention**, worsening heart failure symptoms.
360
A patient is on an anticoagulant (blood thinner). Is an NSAID safe?
**No.** NSAIDs increase **bleeding risk** and can cause GI bleeding → dangerous with anticoagulants.
361
What symptoms signal NSAID-induced GI bleeding?
* Black, tarry stools * Coffee-ground vomit * Severe abdominal pain * Dizziness or hypotension
362
Why is aspirin special among NSAIDs?
It provides **antiplatelet effects**, helping prevent **heart attack and stroke**.
363
Which part of the NSAID mechanism causes the stomach to be irritated?
Blocking **COX-1**, which normally helps protect the stomach lining.
364
A patient complains of swelling in the legs after starting NSAIDs. Why?
NSAIDs cause **sodium and water retention**, leading to edema.
365
What should a nurse do before giving an NSAID?
Assess: * **Kidney function (creatinine, GFR)** * **History of ulcers, bleeding, or GI problems** * **Blood pressure** * **Concurrent anticoagulant use**
366
Why do NSAIDs reduce pain, fever, and inflammation?
They **block COX-1 and COX-2 enzymes**, which stops prostaglandin production — the chemicals that cause pain, swelling, and fever.
367
What is the difference between COX-1 and COX-2?
* **COX-1 = protective** (stomach lining, kidneys, platelets) * **COX-2 = inflammatory** (pain, swelling, fever) Blocking COX-1 → stomach problems Blocking COX-2 → pain relief
368
Why can NSAIDs cause stomach ulcers?
Blocking **COX-1** removes protective prostaglandins → stomach lining becomes weak → **ulcers and bleeding**.
369
A patient asks why they must take ibuprofen with food. What’s the best response?
To reduce **stomach irritation** and lower the risk of GI ulcers and bleeding.
370
Which NSAID provides antiplatelet (blood-thinning) action?
**Aspirin (ASA)** only. Other NSAIDs do NOT prevent clots.
371
Why is aspirin used for heart attack or stroke prevention?
It **stops platelets from clumping**, preventing clot formation in the arteries.
372
Why is aspirin NOT safe for children with viral infections?
Risk of **Reye’s syndrome**, a rare but fatal brain and liver disorder.
373
A patient shows black, tarry stools while taking NSAIDs. What does this indicate?
**GI bleeding** — a medical emergency caused by NSAID-induced stomach ulceration.
374
A patient with hypertension and heart failure is taking ibuprofen daily. What is the nurse’s biggest concern?
**Fluid retention**, which can worsen heart failure and blood pressure.
375
Why should NSAIDs be used cautiously in patients with kidney disease?
They reduce **renal blood flow**, increasing the risk of kidney injury.
376
What type of pain is NSAIDs BEST for?
Pain caused by **inflammation**, such as arthritis, sprains, menstrual cramps.
377
What type of NSAID is easier on the stomach?
**COX-2 selective inhibitors** (e.g., celecoxib) — they spare COX-1, the protective enzyme.
378
A patient taking aspirin reports ringing in the ears. What does this suggest?
**Salicylism (aspirin toxicity)** — early warning sign.
379
Which teaching is correct for all NSAIDs?
* Take with **food** * Avoid **alcohol** * Report **bleeding** * Do not combine multiple NSAIDs * Monitor for **stomach pain** or black stools
380
A patient asks why NSAIDs lower fever. What is the simple explanation?
They act on the **hypothalamus** to promote **vasodilation and sweating**, lowering body temperature.
Pharm Lecture
flashcards
Decks in class (17)
# Cards
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Unit 1 (part 1)200
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Unit 2: Drugs Affecting The Autonomic NS278
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Unit 3: coagulation modifiers and anemia medications220
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Unit 3: coagulation modifiers and anemia medications163
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Unit 3: drugs for anemia75
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Lecture 4231
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Lecture 5: Drugs affecting the respiratory system245
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Lecture 6: Drugs Affecting GI131
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Lecture 7255
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Lecture 8184
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Lecture 9380
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Lecture 9 (Pt. 2)122
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Lecture 10225
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Lecture 10 pt. 2121
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Lecture 11168
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Lecture 11 (part 2)132
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Unit 12146
