| Drug | Drug Class | Mechanism of Action | Adverse Effects | Nursing Implications |
| Naloxone Hydrochloride
Naltrexone (ReVia) |
____1___ | ____2_______ | Anxiety, irritability, chills, hot flashes, rhinorrhea, diarrhea, confusion, abdominal cramps, nausea vomiting
|
Use with caution in patients with cardiac disease – Monitor for cardiac arrythmias.
****After the nurse had administered to a patient to reverse opioid effect, what should they look for ____3_____
|
| Gabapentin, Venlafaxine, Bupivacaine, Baclofen, Cyclobenzaprine, Ketamine, Duloxetine, Nortriptyline | ___4_____ | Activate innate immune responses to create a local immuno-competent environment at the injection site. | respiratory depression,
sedation, constipation urinary retention nausea
|
Depending upon the medication used. ** |
| Aspirin, Diclofenac, Ibuprofen, Ketoprofen, Ketorolac, Meloxicam, Naproxen, Celecoxib | Non-Opioid analgesics | NSAIDS-Inhibits COX-1 and COX-2, inhibits prostaglandins.
ASA- causes irreversible inhibition of COX (different from NSAIDs) |
GI distress
Peptic Ulcer disease Kidney and liver impairment Tarry stools Blood dyscrasias: thrombocytopenia, leukopenia, neutropenia, hemolytic anemias Bone marrow depression and impaired coagulation |
Monitor (labs): __5___ & __6___ (hint: look at Adverse effects)
Teach Patient: Take with meals or milk to reduce GI irritation Avoid drinking alcohol, smoking and aspirin when taking other NSAIDs
|
| Morphine
Fentanyl Hydromorphone Codeine Sulfate Meperidine (do not use in elderly) Methadone |
____7___ | ___8_____ | 1. ___9_____*
2. ___10____* 3. ____11___* 4.Cough suppression 5. Itching 6. Pupil Constriction 7. Diaphoresis and flushing |
Antidote: ___12________
1. Monitor vital signs (_13_ & _14__) 2. Teach patient to rise slowly. 3. Monitor for constipation
Administered: IV, Transdermal, Transmucosal, Nasal Spray, PO, Sublingual spray
Antidote: 15. ______ (opioid antagonist) |
“Morphine is the opioid of choice for decreasing pain from myocardial infarction. ”
| Drug | Drug Class | Mechanism of Action | Adverse Effects | Nursing Implications |
| Acetaminophen | 16. ____ and 17. ___ (not anti-inflammatory) | Inhibits prostaglandin synthesis | · Can cause 18___ (which main organ) damage
· Dark urine · rash · Clay colored stools |
Antidote: 19. ____
Monitor: 20. _______ Teach: Careful when taking with other medications that already contains 21. ____ (i.e., Percocet) |
| Buprenorphine
(used to treat opioid addiction) |
Agonist-antagonist
|
Indicated for:
Used an 22. ___ and to treat 23. _____ addiction
|
1. Headache
2. Drowsiness 3. Nausea, vomiting 4. Increased sweating 5. Inability to sleep |
Avoid driving or drinking when taking this medication.
Do not take with other narcotics
|
| Pentazocine (nalbuphine, butorphanol
|
Agonist-antagonist
|
Antagonist: Acts on opioid receptor sites
Agonist: produces an antagonistic effect when given to patients taking opioids |
· Respiratory depression**
· Nausea, vomiting diarrhea
· 24. _____*
· Tachycardia
· 25. _____
|
Monitor vitals especially: (hint adverse reaction column) ___26__and ___27___
|
| Naloxone (Narcan) | ___28__ | Blocks and reverses effects. Binds to receptors in the brain | · _29__
· _30___
|
Administration: IV, intranasal, IM, subQ
*if administered before opioid -blocks effects, if administered after opioid, it will reverse the effects of drug |
Adjuvant Medications
| Drug | Drug Class | Mechanism of Action | Adverse Effects | Nursing Implications |
| Lidocaine (Lidoderm) | Topical analgesic | Local anesthetic used to relieve neuropathic pain (postherpetic neuralgia) | · Redness or irritation to skin
· Dizziness · Confusion · Cautioned in patients who are taking Class I antiarrhythmic drugs |
Treat: neuralgia due to herpetic
Wash hands after handling Apply to area that is painful.
|
| Gabapentin (Neurontin)
Treats: Neuropathic Pain |
Antiseizure | 31._______ | · Drowsiness
· Dizziness · Tiredness · Tremors
|
Indication (Used to Treat)
32. _______ 1. Teach patient medication is used to alleviate pain and not for the Rx’s original purpose.
|
| Pregabalin (Lyrica)
Indicated for: neuropathic pain associated with diabetic neuropathy, postherpetic neuralgia |
Antiseizure/Antidepressant
|
binds to calcium channels and decreases the inflow of calcium at nerve endings. | · dizziness*
· Somnolence* which often persist as long as the drug is being taken. · 3. Blurred vision may develop during early therapy, but resolves with continued drug use” |
· Pregabalin (33)does/does not interact with oral contraceptive.
· Does not alter any antiseizure drugs studied (carbamazepine, lamotrigine, phenobarbital, phenytoin, topiramate, valproic acid, and tiagabine)” |
Glucocorticoids
| Drug | Drug Class | Mechanism of Action | Adverse Effects | Nursing Implications |
| Prednisone
Prednisolone |
Glucocorticoids | Decrease Inflammation | Short term:
Weight gain, hyperglycemia
Long term: bone loss, adrenal suppression, exogenous glucocorticoid- Cushing Syndrome |
Monitor: __34___ in clients with diabetes |
| Methotrexate
Other DMARDS
Hydroxychloroquine Leflunomide Sulfasalazine |
Non-biologic
DMARDS |
Slows disease progress and decreased joint destruction | (Methotrexate Only)
Contraindicated in pregnancy. Can cause fetal death and congenital abnormalities. Blackbox Warning (Methotrexate): ______36_______ |
(Methotrexate Only)
Should be taken with __35___(vitamin?) to reduce GI and hepatic toxicity.
Teach: Patient should receive annual influenza.
Avoid people who are sick and perform frequent handwashing
|
Answer Key
- 21. 36.
- 22.
- 23.
- 24.
- 25.
- 26.
- 27.
- 28.
- 29.
- 30.
- 31.
- 32.
- 33.
- 34.
- 35.
16.
17.
18.
19.
20.
