Pharmacology & Pain Management Flashcards

Which class of medications works by inhibiting cyclooxygenase (COX) enzymes to reduce inflammation and pain in orthopaedic patients?

Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs inhibit COX-1 and COX-2 enzymes, thereby reducing prostaglandin synthesis and decreasing inflammation, pain, and fever.

A patient recovering from total knee replacement is on a PCA (patient-controlled analgesia) pump with morphine. The nurse notes a respiratory rate of 8 breaths/min and pinpoint pupils. What is the priority intervention?

Answer: Administer naloxone (Narcan) as prescribed

Respiratory depression with pinpoint pupils indicates opioid toxicity; naloxone is the opioid antagonist that rapidly reverses this life-threatening complication.

Which anticoagulant is most commonly prescribed for venous thromboembolism (VTE) prophylaxis after total hip arthroplasty?

Answer: Rivaroxaban (Xarelto)

Rivaroxaban, a direct factor Xa inhibitor, is widely used for VTE prophylaxis after major joint replacement due to its predictable pharmacokinetics and oral route.

A bisphosphonate such as alendronate is prescribed for an orthopaedic patient with osteoporosis. Which instruction is most important to include in patient teaching?

Answer: Remain upright for at least 30 minutes after taking

Bisphosphonates can cause esophageal irritation and esophagitis; patients must remain upright for 30–60 minutes after ingestion to prevent reflux and mucosal damage.

The maximum recommended daily dose of acetaminophen for an adult without liver disease is:

Answer: 4,000 mg/day

The FDA recommends a maximum of 4,000 mg/day of acetaminophen for healthy adults, though many clinicians recommend ≤3,000 mg/day in at-risk populations.

Which muscle relaxant is commonly used in orthopaedic settings for acute musculoskeletal spasm and carries a risk of anticholinergic side effects?

Answer: Cyclobenzaprine (Flexeril)

Cyclobenzaprine has a tricyclic structure and significant anticholinergic activity, causing dry mouth, urinary retention, and sedation, which nurses must monitor.

When administering ketorolac (Toradol) to a post-operative orthopaedic patient, the nurse should be most concerned about which potential complication with prolonged use?

Answer: Gastrointestinal bleeding and renal impairment

Ketorolac is an NSAID that inhibits prostaglandin synthesis, increasing risk of GI bleeding and reducing renal perfusion, particularly with use beyond 5 days.