Prepare: Analgesic Drugs

• Analgesic drugs are medications that relieve pain, but do not cause loss of consciousness.

Pain

• Match the terms with the appropriate description.

Self Check: Therapeutic Use and Pharmacologic Action

Treating Pain

• Opioid drugs are used to treat moderate to severe pain. Nonopioid drugs are normally prescribed for mild to moderate pain.

Classifications

• The three classifications of opioid drugs are agonist, agonist-antagonists and antagonists.

Nonopioid Medications

• The most widely used nonopioid medication is acetaminophen. This medication also works as an antipyretic by acting on the hypothalamus, the section of the brain that regulates temperature.

Self Check: Adverse Effects of Acetaminophen

• Which of the following is the most serious adverse effect of acetaminophen?

Self Check: Nonopioid Analgesics

• Do not use nonopioid analgesics with which of the following conditions? Select all that apply.

Reflect: Analgesic Drugs

Pharmacological Action

• What is the pharmacological action of opioid antagonists?

Adverse Effects

• Which of the following are adverse effects of nonopioid analgesic drugs? Select all that apply.

Contraindications of Opioids

• Which of the following is a contraindication for opioid analgesic use? Select all that apply.

Mild Opioid Agonists

• Which of the following are considered mild opioid agonists? Select all that apply.

Strong Opioid Agonists

• Which of the following are considered strong opioid agonists? Select all that apply.

Pharmacological Action

• What is the pharmacological action of opioid agonist-antagonists?

Adverse Effects

• Which of the following are adverse effects of opioid analgesic drugs? Select all that apply.

Pharmacological Action

• What is the pharmacological action of opioid agonists?

Opioid Analgesics (meperidine, fentanyl, methadone, morphine, oxycodone)

Prepare: Opioid Analgesics

Classification of Opioids

• Opioids are classified under which of the following related to their mechanism of action?

Therapeutic Effect

• The therapeutic effect of opioid analgesics is which of the following?

Opioid Overdose

• When an opioid overdose occurs, what medication should be administered?

Self Check: Mechanism of Action

Mechanism of Action

• Opioid analgesics are further classified by their mechanism of action of agonists, which bind to opioid pain receptors in the CNS to alter and reduce the sensation of pain.

Self Check: Naloxone

Naloxone

• When patients experience respiratory depression or overdose from opioid agonist, an opioid antagonist needs to be administrated, which include naloxone and naltrexone.

Self Check: Drug-to-Drug Interaction

Drug-to-Drug Interaction

• Please match the correct drug to drug interaction with the resulting possible outcome.

Self Check: Tolerance, Dependence, and Addiction

Physical Dependence, Addiction, and Tolerance

• Tolerance of/to opioids occurs when larger doses are required to maintain the same drug effect.

Physical Dependence, Addiction, and Tolerance #2

• Physical dependence is when the body adapts to the presence of the opioid.

Reflect: Opioid Analgesics

Main Action

• What is the main action of opioids?

Patient Conditions

• Caution should be taken in giving opioids to which of the following patient conditions? (Select all that apply)

Adverse Effects

• Which of the following are adverse effects of opioids? Select all that apply.

Indications for Use

• Indications of use for opioids include which of the following? Select all that apply.

Opioid Education

• Opioid education should include which of the following? Select all that apply.

Contraindications

• Opioids are contraindicated with which of the following conditions? Select all that apply.

Physical Dependence, Addiction, and Tolerance

• Drag and drop to match the correct term to the definition.

Facts About Opioids

Drag and drop to match the correct facts under the related opioid.

• Meperidine
• Fentanyl
• Methadone
• Morphine
• Oxycodone

Nonopioid Analgesics (acetaminophen)

Prepare: Nonopioid Analgesics

Classification of Acetaminophen

• To which class of medications does acetaminophen belong?

Other Uses for Acetaminophen

• Acetaminophen is used as an analgesic, but additionally has antipyretic effects due to acting on the hypothalamus, the section of the brain that regulates temperature.

Analgesia and Antipyretic

• The therapeutic effect of acetaminophen include analgesia and antipyretic.

Self Check: Use, Effect, and Administration

Therapeutic Effect

• The therapeutic effect of acetaminophen includes which of the following? Select all that apply.

Routes of Administration

• What are the available routes of administration for acetaminophen? Select all that apply.

Self Check: Prostaglandin Synthesis

Prostaglandin Synthesis

• Acetaminophen works by inhibiting prostaglandin synthesis, primarily in the CNS, to alleviate pain and fever.

Self Check: Increased Risk and Chronic Use

Increased Risk

• Acetaminophen-induced liver damage and hepatotoxicity are at increased risk when administered with alcohol, isoniazid, rifampin, rifabutin, phenytoin, barbiturates and carbamazepine.

Chronic Use

• Chronic use of acetaminophen may increase bleeding risk when administered with warfarin.

Reflect: Nonopioid Analgesics

Half-Life

• Drag and drop the correct half-life for acetaminophen in neonates, children, and adults.

Adverse Effects

• Which of the following are adverse effects of acetaminophen? Select all that apply.

Similarity to NSAIDs

• Acetaminophen is similar to nonsteroidal anti-inflammatory drugs (NSAIDs) except for which of the following? Select all that apply.

Pharmacokinetics

• Drag and drop the items to complete the chart with the onset, peak and duration for acetaminophen po, rectal and IV routes.

Contraindication

• Acetaminophen is contraindicated with which of the following conditions?

Drug-to-Drug Interactions

• Please match the outcome of the drug to drug reactions with acetaminophen below.

Pharmacological Action

• What is the pharmacological action of acetaminophen?

Acetaminophen Interactions

• Acetaminophen-induced liver damage and hepatotoxicity are at increased risk when administered with which of the following? Select all that apply.

Miscellaneous Analgesics (tramadol)

Prepare: Miscellaneous Analgesics

Therapeutic Effect

• The therapeutic effect of Tramadol is analgesia.

Class of Medications

• To which class of medications does tramadol belong?

Best Use

• Tramadol is best used for what condition?

Self Check: Use, Effect, and Administration

Routes of Administration

• What are the available routes of administration for tramadol? Select all that apply.

Therapeutic Effect

• The therapeutic effect of Tramadol has been achieved when the patient has which of the following?

Self Check: Pharmacological Action

Pharmacological Action #1

• Tramadol weakly binds to mu opioid receptors and inhibits the reuptake of norepinephrine and serotonin in the CNS.

Phamacological Action #2

• Due to tramadol’s weak bond to opioid receptors, it is not classified as an opioid analgesic.

Self Check: Contraindications

Contraindications

• Below are two lists of contraindications, one for do not use and one for using caution with Tramadol administration. Drag and drop the correct answer (Do Not Use or Use Caution) above the listed information

Reflect: Miscellaneous Analgesics

Conditions

• Which condition would be best treated with tramadol?

Adverse Effects

• Which of the following are adverse effects of tramadol? Select all that apply.

Contraindication

• Which of the following conditions would be a contraindication to administer Tramadol?

Half-Life

• Drag and drop the items to complete the table with the correct half-life for Tramadol.

Pharmacological Action

• What is the pharmacological action of Tramadol?

Half-Life and Specific Conditions

• Half life is increased when taking tramadol with which of the following conditions? Select all that apply.

Pharmacokinetics

• Drag and drop the items to complete the table with the onset, peak and duration for Tramadol PO route and PO extended release.

Nursing Application: Analgesics

Prepare: Nursing Application of Analgesics

Pain Assessment Techniques

• Which of the following is the most accurate pain assessment technique?

Opioids vs. Nonopioids

Match the correct medication under the class of opioid or nonopioid analgesic below.

Administration of Opioid Analgesics

• Which of the following should be assessed prior to administration of opioid analgesics? Select all that apply.

Self-Check: Pain

Pain Scale – Infants

• The most appropriate pain scale for an infant is the FLACC pain scale.

Pain

• Pain is whatever the patient says it is and occurs as described by the patient.

Self-Check: WHO Pain Relief Ladder

WHO Pain Relief Ladder

• Using the WHO Pain Relief Ladder please indicate which patient is on step 2. Select all that apply.

Reflect: The Nursing Application of Analgesics

Cultural Beliefs

• Match the culture with the cultural beliefs that should be incorporated in the nurse’s pain assessment:

WHO Pain Relief Ladder

• Using the WHO Pain Relief Ladder please indicate which patient would be most appropriate for step 3:

Pain Scales

• Which pain scale is appropriate for a 4-year-old child who has difficulty expressing herself with words?

Opioid Analgesic Contraindications

• Which patient has a contraindication for opioid analgesic use?

WHO Pain Relief Ladder

• Using the WHO Pain Relief Ladder please indicate which patient is on step 1. (Select all that apply)

Side Effects of Opioid Analgesics

• The nurse is providing patient teaching for the side effects of opioid analgesics. Which of the following should be included?

Opioid Analgesic Drug Interactions

• The nurse is preparing to administer an opioid analgesic to the patient. Which item in the patient’s current medication list should be a concern to the nurse?

Hormonal Regulation

Prepare: Hormonal Regulation Drugs

Hormonal Regulation Drugs

• Considered the master gland, the pituitary gland receives its primary direction from the hypothalamus gland.

Hormonal Regulation Drugs

• The pituitary gland has two lobes which secrete different hormones.

Hormonal Regulation Drugs

• Hormone regulating medications work with the pituitary gland to maintain homeostasis.

Self-Check: The Hypothalamus

The Hypothalamus

• As one half of the neuroendocrine system, the hypothalamus controls which endocrine gland?

Self-Check: Stopping a Negative Feedback Loop

Stopping a Negative Feedback Loop

• In an attempt to stop a negative feedback loop and return to a state of physiologic homeostasis, the pituitary gland produces and secrete hormones.

Self-Check: Hormone Replacement Therapy

Hormone Replacement Therapy

• Hormone replacement therapy is used in which situations? (Select all that apply.)

Self-Check: Hormone Regulation Drugs

Cosyntropin

• A patient is being treated with Cosyntropin, which stimulates the secretion of cortisol.

Vasopressin

• Vasopressin is a potent vasoconstrictor in larger doses.

Reflect: Hormonal Regulation Drugs

Hormone Imbalances

• The main function of the neuroendocrine system is to maintain physiologic homeostasis. Hormone imbalances trigger a negative feedback loop to restore hormonal balance.

Adverse Effects

• Adverse effects resulting from the vasoconstrictive action of vasopressin include which changes within the body? (Select all that apply.)

Adverse Effects

• In general, the adverse effects of a hormone antagonizing drug will be the opposite of the normal bodily reaction of the hormone on which it acts.

Desmopressin

• Desmopressin is used in the treatment of certain blood disorders such as hemophilia A and type I von Willebrand’s disease.

Common Hormonal Replacement Drugs

• Complete the table by placing each drug in the correct location.

Somatropin

• Somatropin is a growth hormone mimicking drug.

ACTH Mimicking Drugs

• In what ways do ACTH mimicking drugs work? (Select all that apply.)

Growth Hormone (GH) Antagonizing Drug

• The following is a growth hormone antagonizing drug:

Synthetic Thyroid Hormone (levothyroxine)

Prepare: Synthetic Thyroid Hormone (levothyroxine)

Levothyroxine

• Identify which of the following bodily systems and processes thyroid hormones are involved with.

Levothyroxine

Review the questions below about Levothyroxine.

• T3 is secreted by the thyroid gland and is also called triiodothyronine.
• T4 is secreted by the thyroid gland and is also called thyroxine.
• Calcitonin is secreted by the thyroid gland and regulates calcium and phosphorus levels.
• TSH is secreted by the pituitary gland, also called thyrotropin , and causes the release of T3 and T4 into the circulation.
• TRH is secreted by the hypothalamus and causes the release of TSH into the circulation.

Self-Check: Synthetic Thyroid Hormones

Thyroid Replacement Drugs

• Thyroid replacement drugs in general have the same effects on the body’s processes and systems in terms of the endogenous (produced in the body) thyroid hormones they are replacing?

Synthetic Thyroid Hormone

• Choose the correct word(s) to complete these statements:

Self-Check: Adverse Effects and Safety Considerations

Symptoms of Toxicity

• Advise patients receiving levothyroxine to report these possible symptoms of toxicity (select all that apply):

Adverse Effects and Safety Considerations

• Identify and select the adverse effects and safety considerations that apply to levothyroxine. Think about it… levothyroxine is pure T4. Consider what effects T4 has on bodily systems and processes.

Reflect: Synthetic Thyroid Hormone (levothyroxine)

Types of Hypothyroidism and Characteristics

• There are many possible causes for hypothyroidism, classified by where the dysfunction originates. Match the type of hypothyroidism to its characteristics and its place in the negative feedback loop.

Hormones

• Match the hormone in green to its characteristics.

Secondary Hypothyroidism

• In the case of secondary hypothyroidism, the negative feedback loop begins with the pituitary gland not secreting enough TSH.

Thyroid Hormones

Thyroid hormones are involved in various bodily processes and have effects on various bodily systems. Choose the symptom of hypothyroidism that can result from the bodily system or process being adversely effected by thyroid imbalance.

• Cold intolerance can result from hypothyroidism when thermoregulation is affected by thyroid imbalance.
• Goiter formation can result from elevated levels of TSH associated with hypothyroidism when normal growth and development is affected by thyroid imbalance.
• Brittle hair can result from hypothyroidism when normal growth and development is affected by thyroid imbalance.

Serum Thyroid Levels

• Why is it important to monitor serum thyroid levels in a patient receiving levothyroxine?

Thyroid Replacement Drugs

Thyroid replacement drugs are used in various forms to treat hypothyroidism by replacing low levels of thyroid hormones with either natural or synthetic thyroid hormones.

• Synthetic thyroid replacement drugs in general have the same effect on the body’s processes and systems as the endogenous (produced in the body) thyroid hormones they are replacing.
• The most commonly prescribed synthetic thyroid hormone is levothyroxine and is pure T4.
• Levothyroxine common name(s) are (select all that apply):
• Levothyroxine is indicated for achieving euthyroid status, diagnosis of hypothyroidism, and treatment and prevention of goiters.

Levothyroxine Dosing

• It is important to be aware of the dosage unit of medications to avoid giving the patient too much or not enough medication, which can lead to serious adverse effects. Levothyroxine is dosed in micrograms which is abbreviated as mcg.

Thiomide antithyroid (propylthiouracil)

Prepare: Thiomide Antithyroid (propylthiouracil)

Levothyroxine

• Thiomide antithyroid (propylthiouracil) works by decreasing thyroid hormone levels.

Antithyroid Medication

• Which of the following IS NOT an indication for use of the antithyroid medication thiomide antithyroid (propylthiouracil), also known as PTU?

Hyperthyroidism

• Hyperthyroidism refers to overactive thyroid function. The most common cause of hyperthyroidism is/are:

Self-Check: Thyroid Oversecretion

Thyroid Oversecretion

• When the thyroid is not functioning normally, the consequences can be serious because the thyroid impacts so many bodily processes and systems. When the thyroid is over-secreting, this is called hyperthyroidism

Self-Check: Thyroid Storm

Thyroid Storm

• Hyperthyroidism refers to overactive thyroid function. This can be caused by various diseases/conditions including a condition called thyroid storm. Please select the true statements below (select all that apply):

Self-Check: Symptoms of Hyperthyroidism

Symptoms of Hyperthyroidism

• Which of these are symptoms of hyperthyroidism?

Self-Check: Hyperthyroidism

• Depending on the underlying cause of the hyperthyroidism, surgery may be the treatment of choice. Following a thyroidectomy in which all or part of the thyroid gland is surgically removed, thyroid hormone replacement therapy will be required permanently. The most common synthetic thyroid hormone replacement drug used is levothyroxine.

Self-Check: Adverse Effects and Safety Considerations

Adverse Effects and Safety Considerations

• Which safety precautions should the nurse consider when administering propylthiouracil? Select all that apply.

Reflect: Thiomide Antithyroid (propylthiouracil)

Hyperthyroidism

• Thyroid hormones play a part in the function of which systems and processes? Select all that apply.

Hyperthyroidism

• Select the impact of too much thyroid hormone on the body system listed using the drop-menu.

Antithyroid Drugs

• An antithyroid drug, such as propylthiouracil, will result in which possible adverse effects and safety considerations? Select all adverse effects.

Hyperthyroidism