Review Mixed Agonists/Antagonists

Analgesics and Pain Management Medications > Pharmacology

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Mixed Agonists/Antagonists

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Total Questions : 5

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Question 1:

A nurse is caring for a client who has cancer and is receiving buprenorphine (Buprenex) for pain management.
The nurse should monitor the client for which of the following adverse effects of this medication?

A. Respiratory depression B. Constipation C. Dysphoria D. All of the above.

Answer and Explanation

Choice A:

Respiratory depression is not the only adverse effect of buprenorphine.

Choice B:

Constipation is not the only adverse effect of buprenorphine.

Choice C:

Dysphoria is not the only adverse effect of buprenorphine.

Choice D:

Buprenorphine is an opioid medication that can cause respiratory depression, constipation, and dysphoria as adverse effects. Respiratory depression is a serious condition that can lead to coma and death if not treated promptly. Constipation is a common side effect of opioids that can cause discomfort and bowel obstruction. Dysphoria is a state of unease or dissatisfaction that can affect the mood and mental health of the patient.

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Question 2:

A nurse is preparing to administer butorphanol (Stadol) to a client who has severe pain after surgery. The client tells the nurse that he has been taking morphine (Duramorph) for several months for chronic back pain.
Which of the following responses should the nurse make?

A. “You might experience some withdrawal symptoms when you receive this medication.” B. “You will need a higher dose of this medication to achieve pain relief.” C. “You should not take this medication if you have a history of opioid dependence.” D. “You will have less risk of respiratory depression with this medication.”.

Answer and Explanation

Choice A:

You might experience some withdrawal symptoms when you receive this medication. This is because butorphanol (Stadol) is an agonist-antagonist opioid that can cause abstinence syndrome in opioid-dependent clients. Abstinence syndrome is a group of symptoms that occur when a person who is physically dependent on opioids suddenly stops taking them. Some of the symptoms include vomiting, abdominal cramps, hypertension, fever, and anxiety.

Choice B:

You will not need a higher dose of this medication to achieve pain relief. Butorphanol (Stadol) is a potent analgesic that can provide effective pain relief at lower doses than morphine.

Choice C:

You can take this medication if you have a history of opioid dependence, but you should be monitored for signs of withdrawal and adverse effects. Butorphanol (Stadol) has a lower risk of abuse and respiratory depression than morphine.

Choice D:

You will not have less risk of respiratory depression with this medication. Butorphanol (Stadol) can still cause respiratory depression, especially if taken with other CNS depressants or at high doses. You should have your respiratory rate checked before and after receiving this medication, and an opioid antagonist such as naloxone should be available in case of an overdose.

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Question 3:

A nurse is reviewing the medical record of a client who is receiving nalbuphine (Nubain) for postoperative pain.
The nurse should identify that which of the following findings is a contraindication for this medication?

A. The client has a history of asthma. B. The client has a blood pressure of 150/90 mm Hg. C. The client has a heart rate of 100/min. D. The client has a history of glaucoma.

Answer and Explanation

Choice A:

The client has a history of asthma. This is a contraindication for nalbuphine (Nubain) because it can cause significant respiratory depression and exacerbate bronchospasm. Nalbuphine is also contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus.

Choice B:

A blood pressure of 150/90 mm Hg is not a contraindication for nalbuphine. Nalbuphine has minimal effects on blood pressure and heart rate.

Choice C:

A heart rate of 100/min is not a contraindication for nalbuphine. Nalbuphine has minimal effects on blood pressure and heart rate.

Choice D:

A history of glaucoma is not a contraindication for nalbuphine. Nalbuphine does not increase intraocular pressure.

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Question 4:

A nurse is administering dezocine (Dalgan) to a client who has moderate pain due to kidney stones.
The nurse should explain to the client that this medication works by which of the following mechanisms?

A. It blocks the transmission of pain impulses in the spinal cord. B. It activates mu receptors and blocks kappa receptors in the brain. C. It inhibits prostaglandin synthesis in peripheral tissues. D. It stimulates endorphin release in the central nervous system.

Answer and Explanation

Choice A:

Dezocine does not block the transmission of pain impulses in the spinal cord.
That is the mechanism of action of local anesthetics.

Choice B:

Dezocine is a partial agonist of the μ-opioid receptor and an antagonist of the κ-opioid receptor. It binds with stereospecific receptors at many sites within the central nervous system (CNS) to alter processes affecting both the perception of pain and the emotional response to pain.

Choice C:

Dezocine does not inhibit prostaglandin synthesis in peripheral tissues.
That is the mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs).

Choice D:

Dezocine does not stimulate endorphin release in the central nervous system.

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Question 5:

A nurse is teaching a client who has chronic pain about using a transdermal patch of pentazocine (Talwin).
Which of the following instructions should the nurse include? (Select all that apply.)

A. Apply the patch to a clean, dry, hairless area of skin. B. Change the patch every 24 hours. C. Remove the old patch before applying a new one. D. Dispose of the used patch in a sharps container. E. Avoid exposing the patch to heat sources.

Answer and Explanation

Choice A:

Applying the patch to a clean, dry, hairless area of skin is crucial for the proper absorption of the medication. The skin acts as a barrier to the outside environment and also as a reservoir for the slow release of the drug from the patch. If the skin is not clean, substances on the skin could interact with the medication and alter its absorption. If the skin is not dry, the patch may not adhere properly, which could lead to it falling off and the medication not being delivered. Hair on the skin can also interfere with the patch’s adhesion and the medication’s absorption.

Choice B:

Changing the patch every 24 hours is important to ensure a consistent delivery of the medication. The medication in the patch is designed to be released slowly over a certain period of time, typically 24 hours. After this time, the patch may not have enough medication left to provide effective pain relief. Additionally, the adhesive on the patch may not last longer than 24 hours, so the patch could fall off.

Choice C:

Removing the old patch before applying a new one is necessary to prevent an overdose of the medication. If the old patch is left on, the remaining medication in the old patch could be absorbed along with the medication in the new patch, leading to a higher dose than intended. This could result in side effects or a potentially dangerous overdose.

Choice D:

Disposing of the used patch in a sharps container is not necessary. Sharps containers are typically used for objects that can puncture the skin, such as needles. A used transdermal patch does not pose this risk. However, it is important to dispose of the patch safely where children or pets cannot reach it, as it may still contain some medication.

Choice E:

Avoiding exposing the patch to heat sources is important because heat can increase the absorption of the medication, which could lead to an overdose. Heat sources can include heating pads, hot tubs, heated water beds, heat or tanning lamps, saunas, hot baths, and direct sunlight.

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Mixed Agonists/Antagonists

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