Exam (elaborations)
Pharmacology For Nursing Practice (NR-293) REVIEW FOR EXAM 2 PHARMACO
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- Chamberlain College Nursing
Pharmacology For Nursing Practice (NR-293)
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REVIEW FOR EXAM 2 PHARMACOLOGY Toxicity acetaminophen – liver disease
The ingestion of large amounts of acetaminophen, as in acute overdose, or
chronic unintentional misuse can cause hepatic necrosis. Acute ingestion of
acetaminophen doses of 150 mg/kg (approximately 7 to 10 grams) or more may
result in hepatotoxicity. Acute hepatotoxicity can usually be reversed with
acetylcysteine, whereas long-term toxicity is more likely to be permanent.
The first you want to assess – respiration rate
Antidote for opiates – narcan
Respiratory depression is the most serious adverse effect associated with opioids.
Stimulating the patient may be adequate to reverse mild hypoventilation. If this
is unsuccessful, ventilatory assistance using a bag and mask or endotracheal
intubation may be needed to support respiration. Administration of opioid
antagonists (e.g., naloxone) may also be necessary to reverse severe respiratory
depression. Careful titration of dose until the patient begins to breathe
independently will prevent over-reversal. The effects of naloxone are short-lived
and usually last about 1 hour. With long-acting opioids, respiratory depressant
effects may reappear, and naloxone may need to be re-dosed.
Opiates - things you should look out for – respiratory – constipation
GI tract adverse effects are common in patients receiving opioids due to
stimulation of GI opioid receptors. Nausea, vomiting, and constipation are the
most common adverse effects. Opioids can irritate the GI tract, stimulating the
chemoreceptor trigger zone in the CNS, which in turn may cause nausea and
vomiting. Opioids slow peristalsis and increase absorption of water from
intestinal contents. These two actions combine to produce constipation. This is
more pronounced in hospitalized patients who are non-ambulatory
Analgesics - know the difference in pain medication and what is appropriate for your
patient
Neurontin – what kind of drug – convulsion what is the rationale behind that?
If pain is not managed adequately by monotherapy, other drugs or adjuvants
may need to be added to enhance analgesic efficacy. This includes the use of
NSAIDs (for analgesic, anti-inflammatory effects), acetaminophen (for analgesic
effects), corticosteroids (for mood elevation and anti-inflammatory, antiemetic,
and appetite stimulation effects), anticonvulsants (for treatment of neuropathic
pain), tricyclic antidepressants (for treatment of neuropathic pain and for their
innate analgesic properties and opioid-potentiating effects), neuroleptics (for
treatment of chronic pain syndromes), local anesthetics (for treatment of
neuropathic pain), hydroxyzine (for mild antianxiety properties as well as
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, sedating effects and antihistamine and mild antiemetic actions), or
psychostimulants (for reduction of opioid-induced sedation when opioid dosage
adjustment is not effective)
Allopurinol – anti-gout –uric acid
Anesthesia, difference type of anesthesia – general vs local
Local anesthesia of specific peripheral nerves is accomplished by nerve block
anesthesia or infiltration anesthesia. Nerve block anesthesia involves relatively
deep injections of drugs into 177locations adjacent to major nerve trunks or
ganglia. It focuses on a relatively large body region but not necessarily as
extensive as that affected by spinal anesthesia. In contrast, infiltration anesthesia
involves multiple small injections (intradermal, subcutaneous, submucosal, or
intramuscular) to produce a more limited or “local” anesthetic field. Another
subtype of local anesthesia involves topical application of a drug (e.g., lidocaine)
onto the surface of the skin, mucous membranes, or eye. A new method of
administering local anesthetics is via a peripheral nerve catheter attached to a
pump containing the local anesthetic. These pumps are designed to infuse local
anesthetic around the nerves that innervate the surgical site for several days
postoperatively. The catheter is implanted during surgery and is normally taken
out by the patient at home once the anesthetic has been infused. Common trade
names include Pain Buster and On-Q pump.
Ty p e s o f L o c a l A n e s t h e s i a
Central
• Spinal or neuraxial or central anesthesia: Anesthetic drugs are injected into the area near the
spinal cord within the vertebral column. Neuraxial or central anesthesia is commonly
accomplished by one of two injection techniques: intrathecal and epidural.
• Intrathecal anesthesia involves injection of anesthetic into the subarachnoid space.
Intrathecal anesthesia is commonly used for patients undergoing major abdominal or limb
surgery for whom the risks of general anesthesia are too high or for patients who prefer this
technique instead of complete loss of consciousness during their surgical procedure. More
recently, intrathecal injection of anesthetics through implantable drug pumps is even being used
on an outpatient basis in patients with severe chronic pain syndromes, such as those resulting
from occupational injuries.
• Epidural anesthesia involves injection of anesthetic via a small catheter into the epidural
space without puncturing the dura. Epidural anesthesia is commonly used to reduce maternal
discomfort during labor and delivery and to manage postoperative acute pain after major
abdominal or pelvic surgery. This route is becoming more popular for the administration of
opioids for pain management.
Peripheral
• Infiltration: Small amounts of anesthetic solution are injected into the tissue that surrounds
the operative site. This approach to anesthesia is commonly used for such procedures as wound
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