6-C I. Managing Pain Flashcards
opioid analgesics
moderate to severe acute and chronic pain, acute MI, intraoperative analgesia, antitussive.
adverse effects
life-threatening: respiratory depression, hypotension, sedation, bradycardia, cough suppression
most common: lightheadedness, dizziness, sedation, nausea/vomiting, sweating, dry mouth, anorexia, urinary hesitancy/retention
contraindications
respiratory failure, pregnancy
head injury, elderly and pediatric patients
alcoholism, hypotension, hepatic dysfunction
opioid agonist-antagonists
uses: mild to moderate pain, adjunct intraoperative analgesia, labor and delivery
adverse effects
reverses other opioids in system
psychotic episodes with very high doses, severe bradycardia, angioneurotic edema and seizures
pentazocine is a high risk drug in the elderly (based on the Beers Criteria) due to adverse CNS effects
contraindications
physical dependence on opioids
pulmonary impairment, cor pulmonale, biliary surgery or disease, hypothyroidism
opioid antagonists
example:naloxone 0.4-2 mg IV every 2 to 3 minutes; may need to repeat in 1 hour
effectively block the action of opioid receptors
uses: reverse adverse effects of opioids including respiratory depression and overdose, neonatal respiratory depression
adverse effects
life-threatening
ventricular fibrillation, cardiac arrest and seizures
initiates acute withdrawal in clients physically dependent
most common: elimination of analgesic effect other
duration of action is shorter than action of opioids
nausea, vomiting, tachycardia, hypertension, hypotension, tremors, withdrawal symptoms, diaphoresis
contraindications: opioid addiction
synthetic diphenylheptane derivative
example: methadone 15-30 mg by mouth for 1 dose then 5-10 mg by mouth every 2 to 4 hours PRN
action: depresses pain impulse transmission at level of spinal cord
Black Box Warning - incomplete cross-tolerance, respiratory depression, cardiac conduction effects, opioid addiction treatment
use: opiate withdrawal, severe pain
adverse effects
life-threatening: respiratory depression, hypotension, respiratory arrest, cardiac arrest, QT prolongation and death
most common: drowsiness, dizziness, headache, nausea, vomiting, anorexia, constipation
contraindications: opioid addiction
non-opioid analgesics
Sub-type: NSAIDs
action: anti-inflammatory, analgesic, antipyretic, antiplatelet
sub-type examples:
cyclooxygenase-1 inhibitor (COX-1 inhibitor)
cyclooxygenase-2 inhibitor (COX-2 inhibitor)
aspirin
Sub-type: acetaminophen
action: blocks pain impulses that occur in response to prostaglandin synthesis, antipyretic: without anti-inflammatory properties
example: acetaminophen 1-2 tablets by mouth every 4 to 6 hours; maximum daily dose not to exceed 4 g (4000 mg)
uses: mild to moderate pain or fever, in combination with opioids
adverse effects
life-threatening: hepatotoxicity, renal failure, thrombocytopenia
toxicity: nausea, vomiting, abdominal pain, cyanosis, thrombocytopenia, delirium, seizures, coma
contraindications
severe hypovolemia
liver or renal failure, alcoholism
anti-migraine headache agents - Triptan
almotriptan 6.25-12.5 mg by mouth, maximum of 2 doses in 24 hours
naratriptan 1 mg or 2.5 mg by mouth, may repeat in 4 hours, do not exceed 5 mg in 24 hours
sumatriptan succinate 25-100 mg by mouth, may repeat after 2 hours if needed, do not exceed 200 mg in 24 hours
action: cause cranial vasoconstriction and migraine headache relief by binding to serotonin (5-HT1) receptor sites
use: treatment but not prevention of acute migraine headache
adverse effects
life-threatening: hypertension, coronary artery vasospasm, ventricular tachycardia and fibrillation
most common: dizziness, myalgia, weakness
other: paresthesia, feeling hot, cold, or strange
contraindications
coronary artery disease, clients with vascular disease, hypertension
older clients, hepatic or renal dysfunction
concurrent use of ergotamine agents, MAO inhibitor
anti-migraine headache agents - ergot derivatives
action: constricts vascular smooth muscle in periphery, cranial vasculature, uterus
examples
ergotamine with caffeine 1/100 1-2 tabs by mouth every 30 minutes as needed until attack subsides, up to 6 mg
Black Box Warning - peripheral ischemia
dihydroergotamine 1 mg IM/IV for 1 dose
Black Box Warning - peripheral ischemia
preventative: beta blockers, tricyclic antidepressants, and antiepileptic drugs
uses: treatment of migraine headaches
adverse effects
life-threatening: coronary vasospasm, hypertension, peripheral vascular ischemia
most common: peripheral numbness, myalgia, nausea
other: numbness of fingers/toes, intermittent claudication, photosensitivity, rebound headache on withdrawal
contraindications: vascular, hepatic, renal impairments and hypertension
Other pain relief agents
Type: local anesthetics
examples
lidocaine topical
lidocaine/prilocaine topical
nursing intervention: cream must be applied 1 hour before pain is anticipated as in a procedure
Type: herbal remedy
example: capsaicin topical
apply 3 to 4 times daily; more effective with consistent use
adverse effects: neurotoxicity, burning (on contact with mucous membranes or eyes), erythema, thermal hyperalgesia
nursing interventions
wear gloves to apply, rub into skin until cream is transparent
wash hands following application
client teaching: burning increases through heat, sweating, humidity, and clothing
Adjunct therapy for Pain Management
Type: antihistamines
example: promethazine, hydrOXYzine
use: preoperative medication, sedation, enhance analgesic effect, nausea
Type: anticonvulsants (see also: anticonvulsants)
example: gabapentin, carbamazepine
use: neuropathic pain
Type: steroids
example: dexamethasone, predniSONE
use: severe bone pain, nerve compression
Type: central nervous system stimulants
example: methylphenidate
uses: counteract sedation associated with medications given for cancer pain
Type: antihypertensive agent and centrally-acting analgesic: alpha-adrenergic agonist
example: cloNIDine - do not confuse with KlonoPIN
use: chronic pain syndromes
