| 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.
Nursing