25. Analgesics Flashcards
Name a prototype nonopioid analgesic
NSAIDs and Acetaminophen
Name a prototype opioid analgesic
Morphine Sulfate
Name a prototype opioid agonist-antagonist
Nalbuphine
Name a prototype opioid antagonist
Nalaxone
What is the nurses role in pain?
- assess pt’s pain
- alleviate pain w/ nonpharmacologic and pharmacologic treatments
- document pain response
- teach pt how to manage pain
level of stimulus needed to create a painful sensation
pain threshold
amount of pain a pt can endure without it affecting normal functioning
pain tolerance
What should a nurse’s pain goal be for the pt?
pain level below tolerance level; not necessarily 0 but low enough it doesn’t affect ADLs
mild, moderate, or severe pain that is usually associated w/ a specific tissue injury; sudden onset and short duration
acute pain
pain with vague origin; gradual onset and prolonged duration (more than 3 months)
chronic pain
unusual sensory disturbance that often involves neural supersensitivity; often due to nervous system disease/injury; described as burning, tingling, or electric shock
neuropathic pain
Purpose of nonopioid analgesics
- used for mild to moderate pain
- usually OTC
MOA of Acetaminophen
- inhibition (weak) of prostaglandin synthesis
- inhibition of hypothalamic heat-regulator center
- works centrally rather than peripherally (doesn’t carry risks of NSAIDs)
Uses for Acetaminophen
decrease pain and fever
Adverse Reactions to Acetaminophen
- elevated liver enzymes (3x upper limit of normal)
- hepatotoxicity
- renal failure
Contraindication of Acetaminophen
hepatic disease
Antidote of Acetaminophen
acetylcysteine
Pt teaching for Acetaminophen
- teach pt to check OTC label for dosage (max dosage is 4g/day)
- avoid alcohol ingestion w/ acetaminophen
Normal therapeutic range of Acetaminophen
- normal: 10-20 mcg/dL
- toxic: > 200 mcg/dL 4 hours after ingestion
Purpose of opioid analgesics
- used for moderate to severe pain
- controlled substances
- act mainly on CNS
MOA of Morphine
- depression of CNS
- depression of pain impulses by binding w/ opiate receptors in CNS
Uses for Morphine
moderate to severe pain
Adverse reactions to Morphine
- hypotension
- urticaria
- seizures
- ileus (slowing of peristalsis)
- psychological dependence
- respiratory depression
Morphine (opioid) antagonist
Naloxone
Nursing interventions for Morphine administration
- monitor vital signs (hypotension and respiratory depression)
- check for pinpoint pupils (can indicate OD)
- have Naloxone available
Pt teaching for Morphine
- don’t drink alcohol or use other CNS depressants
- inform patients of possible addiction
- Pt should inform difficulty breathing, blurred vision, and headaches
Contraindication for opioid analgesics (ex. Morphine)
Head injury (decreased respiration, CO2 retention, and IICP
consists of both NSAID and opioid and used for moderate to severe pain; helps decrease drug dependency
combination analgesics
What is the most common PCA medication?
Morphine
Purpose of transdermal opioid analgesics
- continuous pain control
- NOT for acute pain
Most common transdermal opioid medication
Fentanyl
T/F: Heat on top of a transdermal opioid patch will increase rate of absorption and may cause OD
True
T/F: you should tape a transdermal patch to the pt if it is not sticking
False; will affect rate of absorption -> use a new patch
4 facts about analgesic use in pt’s w/ substance use disorder
- still need a complete pain assessment
- larger doses may be needed
- withholding meds won’t cure addiction
- opioid agonist-antagonists may cause withdrawal
MOA of Nalbuphine
inhibits pain impulses transmitted in the CNS by binding w/ opiate receptors and increasing pain threshold
Adverse reactions to Nalbuphine
- bradycardia
- tachycardia
- hypotension
- hypertension
- dyspnea
MOA of Naloxone
blocks effects of narcotics by competing for receptor sites
Uses of Naloxone
treats respiratory depression caused by narcotics or narcotic OD
Adverse reactions to Naloxone
- N/V
- sweating
- tachycardia
- hypertension
- Atrioventricular fibrillation (LT)
- pulmonary edema (LT)
