Page 1782 - Saunders Comprehensive Review For NCLEX-RN

c. Should be used with caution with severe renal or
hepatic disease
d. Avoid abrupt withdrawal of long-acting preparations
to prevent the rebound effect of severe pain from
myocardial ischemia.
2. Side and adverse effects
a. Headache
b. Orthostatic hypotension
c. Dizziness, weakness
d. Faintness
e. Flushing or pallor
f. Dry mouth
g. Reflex tachycardia

3. Sublingual medications

a. Monitor vital signs.
b. Offer sips of water before giving, because dryness may
inhibit medication absorption.
c. Instruct the client to place under the tongue and leave
until fully dissolved.
d. Instruct the client not to swallow the medication.
e. Instruct the at-home client to take 1 tablet for pain and
to immediately contact emergency medical services if
pain is not relieved; in the hospitalized client, 1 tablet
is administered every 5 minutes for a total of 3 doses
and the PHCP is notified immediately if pain is not
relieved following the 3 doses (the BP is checked
before each administration).
f. Inform the client that a stinging or burning sensation
may indicate that the tablet is fresh.
g. Instruct the client to store medication in a dark, tightly
closed bottle.
h. Instruct the client to take acetaminophen for a
headache.
4. Translingual medications (spray)
a. Instruct the client to direct the spray against the oral
mucosa.
b. Instruct the client to avoid inhaling the spray.
5. Sustained-released medications: Instruct the client to swallow and
not to chew or crush the medication.
6. Transdermal patch
a. Instruct the client to apply the patch to a hairless area,
using a new patch and different site each day.
b. As prescribed, instruct the client to remove the

patch after 12 to 14 hours, allowing 10 to 12 “patch-
free” hours each day to prevent tolerance.

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