Analgesia

Question 1

how pain is transmitted?

Answer 1

peripheral pain receptors or nociceptors sending message via afferent nerve fibres

to spinal cord: activates the spinothalamic tracts

to the brain: autonomic response (brainstem - HR, RR, pupillary etc)
conscious pain perception (cerebral)
emotional response (limbic)

and descending pain pathway

Question 2

Chemical mediators of pain (tissue damage, inflammation and ischemia)

Answer 2

Prostaglandin
substance P
cytokines

Question 3

Non-opioid analgesics

Answer 3

Corticosteroids
Paracetamol
Aspirin
NSAIDs

Question 4

Pharmacodynamics of Paracetamol

Answer 4

Inhibits prostaglandins (COX1,2 and 3) to reduce pain and fever

Endocannabinoid reauptake inhibitor

Question 5

Adverse effects of Paracetamol

Answer 5

Well tolerated (no anti-inflammatory benefits, no thromboxane and not GIT irritant

However, highly toxic when overdose

Question 6

Pharmacodynamics of NSAIDs

Answer 6

Inhibits COX 1(enzyme maintaining stomach lining) and COX 2 (enzyme that triggers pain) which synthesise prostaglandins causing inflammation and pain

Question 7

NSAID drugs

Answer 7

ibuprofen
naproxen
diclofenac
celecoxib

Question 8

Adverse effects of NSAIDs

Answer 8

GI upset (N&V, diarrhoea, abdominal pain)
HTN
Kidney problem (NSAIDs are nephrotoxic)
Blood clots (stroke)

Question 9

NSAIDs, Beta blockers and aspirin can cause bronchospasm for pts with?

Answer 9

Asthma

Question 10

Nursing cosiderations for taking NSAIDs

Answer 10

Educate pt to:
take it with food to decrease stomach irritation
do not take it with empty stomach

For acid reflux:
administer Omeprazole

Question 11

Selective COX 2 inhibitor meds

Answer 11

Celecoxib
Etoricoxib
Meloxicam

Question 12

Salicylates pharmacodynamics

Answer 12

Analgesic - inhibits prostaglandins
Antipyretic - decrease body temp
Anti-inflammatory - inhibits COX 1&2
Anticoagulant - prolongs bleeding times and inhibits platelets aggregation (Aspirin)

Question 13

Salicylates meds

Answer 13

Aspirin

Question 14

Antidote for Aspirin overdose

Answer 14

Sodium Bicarbonate

Question 15

Antidote for salicylate poisoning

Answer 15

activated charcoal

Question 16

Nursing considerations for taking salicylates

Answer 16

Cease taking salicylates 1 week before major surgery (risk for bleeding)
Monitor GI bleeding

Question 17

Pharmacodynamics for Nonsalicylates

Answer 17

Analgesic and antipyretic (do not have anti-inflammatory or antiplatelet effects)

Question 18

Nonsalicylate meds

Answer 18

Acetaminophen (Tylenol) - for mild to moderate pain, substitute for Aspirin allergies and bleeding tendencies

Question 19

Adverse effects of Nonsalicylates (chornic use or higher dosage)

Answer 19

Hives
Hemolytic anemia
Pancytopenia (low levels of blood cells - RBC, WBC and platelets)
Hypoglycaemia
Hepatoxicity, Hepatic failure and jaundice (yellow skin)

Question 20

Contradictions to Acetaminophen

Answer 20

Liver dysfunction (alcoholism)

Question 21

Nursing considerations for pt taking Acetaminophen

Answer 21

Assess alcohol use
Malnourished pts with chronic alcohol use can have increased risk of liver damage
Limit drug dosage below 2g a day

Question 22

Antidote for Nonsalicylates toxicity

Answer 22

Acetylcysteine (protects liver cells and destroys acetaminophen metabolism)

Question 23

Categorise weak and strong opiates

Answer 23

Strong opiates:
Morphine, fentanyl, oxycodone, methadone, heroin

Weak opiates:
Codeine, tramadol (has SNRI agents)

Question 24

Pharmacodynamics of opioids (opioid agonists)

Answer 24

Generally: Binds to opioid receptors in the brain causing an analgesic sedative and euphoric effect (addictive)

Pain signals sent to brain - Inhibits action potentials (causing hyper polarisation) and release of neurotransmitters in spinal cord

Decrease pain perception: activates descending inhibitory controls in the midbrain
Decrease anxiety (euphoric effect)

Question 25

Long term and short term adverse effects of Opioid analgesics

Answer 25

Long term: Constipation (client doesn’t build tolerance) Short term: Miosis (constricted pupils) Orthostatic hypotension Respiratory depression Pain suppression Itch and rash (histamine release) N&V Euphoria Sedation

Question 26

Opioid tolerance means

Answer 26

the need to increase dosage to maintain a therapeutic effect

Question 27

Opioid dependence means

Answer 27

biological adaptation whereby a dose reduction of cessation will result in withdrawal symptoms

Question 28

Opioid addiction means

Answer 28

behavioural response in which a person seeks and develops compulsive behaviour in obtaining and consuming the substance despite of its adverse effects.

Question 29

symptoms of opioid tolerance and intolerance

Answer 29

tolerance: N&V, sedation, euphoria and respiratory depression intolerance: constipation and miosis

Question 30

Opioid meds

Answer 30

Morphine Codeine Oxycodone Methadone Fentanyl

Question 31

Opioids do NOT produce _______ and ___________ benefits as it is not used for fever, gout/ rheumatoid arthritis.

Answer 31

antipyretic and anti-inflammatory

Question 32

Nursing considerations for pts taking opioids

Answer 32

Constipation: adm laxatives, encourage fluids, fiber and fruits, encourage to defecate when they the feel the urge Respiration: breathing exercise to increase RR adm naloxone if overdosed or RR dropped < 12 Falls: encourage to rise slowly and assist with ambulatory acitivities Opioid meds: TAKE IT WITH FOOD to avoid GI upset DO NOT drink alcohol

Question 33

Pharmacodynamics of Fentanyl

Answer 33

lipophilic (fat soluble) - can cross membranes easily Less histamine release

Question 34

weak opioid agonist with SNRI properties

Answer 34

Tramadol

Question 35

Adverse effects of Tramadol

Answer 35

increased risk of N&V and neurological effects such as hallucinations and seizures risk of serotonin syndrome

Question 36

Pharmacodynamics of Naloxone (opioid antagonist)

Answer 36

Antidote for opioid overdose (causing respiratory depression) Strong affinity for opioid receptors Short half life (monitor pt) Rapid reversal (after adm naloxone) of opiate toxicity can cause: recurring pain seizure hypertension pulmonary oedema severe agitation