NUR2474 Pharmacology Module 8 Quiz Review NUR2474 Pharmacology Module 8 Quiz Review Tips: There will be a number of negatively worded questions. Please be mindful of that. Topics review: 1. Physical dependence vs addiction with opiate use a. Tolerance i. Increased doses needed to obtain the same response ii. Develops with analgesia, euphoria, sedation, and respiratory depression iii. Cross-tolerance to other opioid agonists iv. No tolerance to miosis or constipation develops b. Physical dependence i. Abstinence syndrome with abrupt discontinuation ii. About 10 hours after last dose, the initial reaction occurs and includes yawning, rhinorrhea, and sweating iii. Progresses to violent sneezing, weakness, nausea, vomiting, diarrhea, abdominal cramps, bone and muscle pain, muscle spasms, and kicking movements iv. Lasts 7 to 10 days if untreated v. Withdrawal is unpleasant but not lethal, as it may be with CNS depressants vi. Patients dependence does not mean addiction vii. Short-term use does not lead to dependence viii. If used as prescribed, it does not lead to dependence. 1. Wean patient of medication slowly, and they will be fine. c. It is not common for patients to abuse opioids 2. PCA pump patient family education a. Educate family members not to operate the PCA pump, even if patient seems to be in pain. b. ONLY PATIENT USES PUMP! 3. Antidote for opiates a. Naloxone i. Reversal of opioid overdose 1. Drug of choice with pure opioid agonist overdose 2. Titrated cautiously with physical dependence ii. Reversal of postoperative opioid effects 1. Titrated to achieve adequate ventilation and to maintain pain relief iii. Reversal of neonatal respiratory depression 1. Opioids given during labor and delivery may cause respiratory depression in neonate b. Methylnaltrexone i. Selective opioid antagonist ii. Treatment of opioid-induced constipation in late-stage disease for patients
receiving constant opioids iii. Block mu opioid receptors in the gastrointestinal tract 4. Foley catheter use in patients on PCA pump a. An adverse effect of patients of opioids is urinary retention. i. Foley catheter may be required. b. Other pharmacologic actions i. Respiratory depression ii. Constipation iii. Orthostatic hypotension iv. Emesis v. Miosis vi. Cough suppression vii. Biliary colic viii. Tolerance and physical dependence 5. Diphenhydramine vs non-drowsy allergy meds a. DROWSY—First generation H1 i. Produce selective blockade of H1 receptors ii. Used for treatment of mild allergic disorders iii. Diphenhydramine (Benadryl) 1. Highly sedating iv. Block the actions of histamine at H1 receptors v. Do not block H2 receptors vi. Some bind to muscarinic receptors vii. Talk to doctor if concerned about sedative effect, can change to second generation antihistamine which have less or no sedative effect. b. Non-drowsy allergy meds second generation i. Produce selective blockade of H2 receptors ii. Used for treatment of gastric and duodenal ulcers iii. Not used for treatment of allergies iv. Produce much less sedation than first-generation agents v. Cross the blood-brain barrier poorly vi. Have a low affinity for H1 receptors of the CNS vii. Largely devoid of anticholinergic actions c. Second Gen with slight drowsiness i. Cetirizine (Zyrtec) 1. Uses: Allergic rhinitis and chronic idiopathic urticaria 2. Food delays absorption 3. More sedating than other second-generation antihistamines but less sedating than first-generation drugs ii. Levocetirizine (Xyzal) 1. Uses: Allergic rhinitis and chronic idiopathic urticaria 2. More sedating than other second-generation antihistamines but less sedating than first-generation agents 3. Most common side effects: Drowsiness, fatigue, muscle weakness, dry mouth 4. Avoid alcohol and other CNS depressants
6. Patient education for diphenhydramine administration a. Do not take in the morning b. Do not drink alcohol c. Do not drive 7. Non drowsy anti-allergy meds (memorize names) a. Second generation antihistamines i. Fenofexadine (Allegra) 1. Uses: Oral therapy of seasonal allergic rhinitis and for chronic idiopathic urticaria 2. Of second-generation antihistamines, offers best combination of efficacy and safety 3. Use with caution in patients with renal impairment 4. Do not take with fruit juice ii. Loratadine (Claritin) 1. Use: Seasonal allergic rhinitis 2. Generally well tolerated 3. Food delays absorption 4. Use with caution in patients with significant hepatic and renal impairment iii. Desloratadine (Clarinex) 1. Uses: season allergic rhinitis, perennial allergic rhinitis, and chronic idiopathic urticaria 8. Acetaminophen a. Therapeutic uses i. Analgesic, antipyretic ii. Does not have any anti-inflammatory or antirheumatic actions iii. Not associated with Reye’s syndrome b. Action i. Inhibits prostaglandin synthesis in central nervous system c. Adverse effects i. Very few at normal doses ii. Stevens-Johnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), and toxic epidermal necrolysis (TEN) iii. Signs of poisoning 1. Hepatotoxicity a. With overdose or in patients with liver failure 2. Overdose: Hepatic necrosis a. Signs and symptoms of hepatic failure, coma, death b. Early symptoms i. Nausea and vomiting ii. Diarrhea iii. Sweating iv. Abdominal pain 3. Treatment for overdose: Acetylcysteine (Mucomyst)