03, 04, 05. Pain: Opiates and non-opiates. Flashcards
In order to activate and sensitize pain receptors, The cell produces either (1), or produces (A), (B) and (C).
This causes (X) and (Y)
- Bradykinin
A. Arachidonic acid
B. Cyclooxygenase
C. Prostaglandins
X. Vasodilitation (redness, warmth, swelling) and Y. the notification of pain receptors.
How is pain classified?
By (A), as either (1) or (2),
By (B), as either (1) (2) or (3)
- DURATION as acute or chronic
- ORIGIN as somatic, visceral or neuropathic
3 categories for pain management, and when to use them (in terms of a 1-10 pain scale)
1) Opiates / opioids or narcotics (legal term)
* *9-10 on pain scale
2) Nonopiates
* *1-3 on pain scale
3) Adjuvant
* * In between on the pain scale.
Therapeutic effects of opiates are due to the fact that they _____________ to decrease the level of pain.
Interfere with pain impulses
Most drug have a ________, meaning there is a point where an increased dose will not have any increased effects. Which drug does not?
Ceiling effects, Morphine
What is the prototype for opiates?
MORPHINE
Give three non-opiate prototypes:
Salisilates –> ASPRIN
NSAIDS –> IBUPROFEN (Advil)
Acetaminiphen –> (Tylenol)
______ refers to joint pain
Arthralgia
_______ refers to muscle pain
Myalgia
_______ refers to painful menstrual cycles
Dysmenorrhea
_______ refers to blood in the stool
Melena
______ refers to coughing up blood
Hemoptysis
_______ refers to vomiting blood
Hematemesis
________ refers to blood in the urine
Hematuria
________ refers to a bruise
Hematoma
________ refers to a nose bleed
Epistaxis
_______ means “acting like”
________ interferes with or inhibits
“agonist”
“antagonist”
________ interferes with blood coagulation
Anti-thrombotic
_______ means “prevention”
Prophylaxis
______________ (CVA) means _______
Cerebral vascular accident
STROKE
________ refers to a ringing in the ear
Tinnitus
_________ refers to vomiting
Emesis
(1) Pupil dilates
(2) Pupil constricts
1) Mydriasis
2) Miosis
PCA stands for ___________
Patient Controlled Analgesia
Increased ICP stands for _______
Increased Intracranial Pressure
_________ refers to a loss of appetite.
Anorexia
____________ refers to a low oxygen concentration in the blood.
Hypoxia
_________ refers to passing out, loss of consciousness
Syncope
________ means “from outside the body”
________ means “from inside the body”
Exogenous
Endogenous
Normal BP < ____ / _____
120/80
______ refers to low BP.
______ refers to high BP
Hypotension
Hypertension
According to the WHO, what drug categories should be used to treat a pain category of 1-3?
Non-opiod + adjuvant
According to the WHO, what drug categories should be used to treat a pain category of 4-6?
Opioid for mild to moderate pain
+ Non-opioid
+ Adjuvant
According to the WHO, what drug categories should be used to treat a pain category of 7-10
Opioid for moderate to severe pain
+ Non-opioid
+ Adjuvant
Give three examples of an Adjuvant:
Benzodiazopines
TCA
Corticosteroids
What is an Adjuvant?
A medication that doesn’t treat pain, but treats other symptoms involved with pain. (Some enable sleep, some decrease nausea)
What should you ask about pain?
- 3 things AND
- PQRST
- Location, intensity, relation to time / activity Precipitates / Provokes Quality Radiation Severity Timing
When should you go back and reassess the pain with each type of administration?
- PO
- IM
- IV
- PO: Check back in 40-60 minutes
- IM: Check back in 25-30 minutes
- IV: Go back in 5-10 minutes
4 categories of adverse effects of opiates
- Depresses CNS
- Depresses GI Tract
- Alters psychological responses to pain
- Produces euphoria
3 manifestations of opiates depressing the CNS (Opiates)
- Serious: Drop in Respiration
- Common: Sedation, Dizziness
3 Common manifestations of depressing the GI tract (Opiates)
Nausea, Vomiting, Constipation
5 clinical uses of opiates
- Relief of moderate to severe pain
- Acute pulmonary edema
- Severe non-productive cough
- Invasive diagnostic tests
- Pre-op sedation
Opiates should be sparingly or not at all for _____ because ______________.
- Head trauma with increased intracranial pressure
- Opiates make it difficult to get an accurate neurological exam
What should you do before administering opiates to a patient? (5)
Check vitals to know where you started
- Esp respiratory
- Check pain / pain levels
- Listen to peristalsis
- Ask about allergies
- Tell them drug will make them sleepy / dizzy- “ask for help if you need to reach for something or get up”
______ % of people prescribed opiate for pain relief become addicted.
<1%
Opiate antagonists work by ____________
Displacing the opiate at the receptor site
Name one opioid antagonist - generic and brand name
NALOXONE (Narcan)
How do you care for a patient who has overdosed on opiates? (5)
- Give them Naloxone (Narcan)
- Repeated doses may be needed
- Maintain respirations
- Prepare to handle withdrawl
- Monitor patient (may need to be intubated, on a respirator)
- Name four opiod agonists
- Morphine
- Demerol
- Codeine
- Dilaudid
What is the agonist / antagonist prototype?
PENTAZOCINE
What drug is often used post-partum?
Nalbuphine (Nubane), it’s an agonist/antagonist
List eleven effects of opiate abuse
- Depresses CNS
- Droopy eyelids
- Nodding head
- Pupils are pinpoint and non-reactive to light
- Slurred speech
- Slower respiratory rate
- Lower BP
- Lower HR
- Depresses GI tract
- Dry skin
- Slowed gait
Opiate abuse during pregnancy can result in (3)
- Lowered birthweight
- Stillbirth
- Addicted babies can die from withdrawal
Cold turkey withdrawal from Opiates can last _____, and has the following symptoms: (7)
- *5-7 days
- Deep bone pain
- Deep muscle pain
- Chills
- Fever
- Diarrhea
- Respirations up
- Pulse up
- Two drugs used to treat withdrawal from opiates
- Are they addictive?
- Why are these better to be on than opiates? (3)
- Methadone & Suboxone
- Yes
- Clearer head, prevents negative lifestyle factors involved with drugs, risk of overdosing is lower
ASA
- Name of drug
- Prototype
- Acetylsalicyclic Acid
- ASPRIN
Four characteristics of Asprin
- Analgesic
- Anti-inflammatory
- Antipyretic
- Anti-thrombotic
How many annual deaths from ASA?
16,000
EIGHT adverse side effects of ASA
- Tinnitus
- Reye’s syndrome
- N/V
- GI System
- Bleeding
- Pregnancy issues
- ASA sensitive asthma
- Salsilate poisoning
What is Reye’s syndrome?
- High BP, seizures, brain damage, death
- In children under 12
- Due to taking Asprin during a viral illness
What is salsilate poisoning - 6 characteristics
- Drowsiness, confusion, sweating, thirst
- Imbalanced pH due to high CO2 levels & hyperventilation to balance the pH
NSAID stands for
Non Steroidal Anti-Inflammatory Drugs
NSAID Prototype
Ibuprofen (advil)
NSAID Uses (4)
- Analgesic
- Anti-inflammatory
- Antipyretic
- Antithrombotic
As an anti-thrombotic, how does asprin differ from ibuprofin?
- Asprin binds to the platelet for the life of the platelet
- Ibuprofin binds to the platelet for only 4 hours or so.
- So we really don’t use ibuprofin for its antithrombotic properties.
Adverse effects of NSAIDs
- CNS (tinnitus)
- Eyes
- GI system (ulcers, bleeding - like asprin)
- Renal system (Kidney necrosis - rare)
NSAIDs drug interactions (7)
- Steroids
- Oral anticoagulants
- Lithium
- Oral hypoglycemics
- Alcohol
- Heparin
Acetaminophen prototype
Tylenol
2 therapeutic properties of tylenol
- Analgesic
- Antipyretic
Four examples of when you should use tylenol
- Headache
- Fever
- Children under 12
- People who are allergic to Asprin
Tylenol is contraindicated for patients with ___ or ____.
Liver problems or kidney problems.
Serious (2) and common (3) ADEs of acetametaphen
- SERIOUS: Hepatic or renal toxicity
- COMMON: Rash, urticaria, nausea
Tips for taking OTCs (7):
- Read and follow package directions
- Take at onset of pain
- Don’t drink
- Do not take if pregnant or nursing
- Avoid drug interactions
- Asthmatics should take special care
- Elderly should take special care (due to increased chance of liver issues, and they are more likely to be taking lots of meds)
Risk for acetemetophen overdose / hepatotoxicity starts at ____ grams or ___ tablets.
10 grams, 30 tablets
Acetemetophen overdose: First 24 hours
- 3 symptoms
- Treatment plan
- Diaphoresis, sweating, malaise
- Can treat with acetylcystein (mucomyst)
- Can also do a gastric lavage during the first 24 hours as well
Talk about mucomyst / acetylcystein
- Administration
- What it does chemically
- What it can prevent
- Usually given orally
- Prevents the metabolites from acetametaphen from binding in the proteins in the liver.
- This may prevent liver failure
Acetametophen overdose: 24-48 hours
- 2 symptoms
- Begin to decrease the amount of urine produced
- Pain in upper right quadrant of abdomen due to the start of liver necrosis
Acetometaphen overdose: 2-6 days
- Symptoms (6)
- Bruising
- Eyes become jaundiced
- Renal failure
- Bilirubins, liver enzymes go WAY up
- Coagulation profiles are all out of whack
- Can go into complete liver failure and death
- What is the prototype Cox 2 inhibitor?
- Celecoxib (Celebrex)
Celebrex:
- What are its therapeutic effects (2)
- ADEs?
- Analgesic, anti-inflammatory
- BLACK BOX WARNING! Rx only. Increases platelet activity, thus increasing the risk of clots. Patients at risk of coronary artery disease and carotid artery disease, and puts them at higher risk for myocardial infarction and stroke.
