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STUDY CARDS > Analgesic > Flashcards

Analgesic Flashcards

1
Q

Analgesics

A

Medications that relieve pain without causing loss of consciousness

“Painkillers”

Opioid analgesics

Adjuvant analgesic drugs

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2
Q

Pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

A personal and individual experience

Whatever the patient says it is

Exists when the patient says it exists

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3
Q

Nociception

Pain results:

These receptors transmit…

A

Pain results from stimulation of sensory nerve fibres called nociceptors.

These receptors transmit pain signals from various body regions to the spinal cord and brain.

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4
Q

Nociception 4 steps?

A
  1. Transduction: injured tissues release chemicals that propagate pain messages. Action potential moves along an afferent fibre to the spinal cord.
  2. Transmission: the pain impulse moves from the spinal cord to the brain
  3. Perception of pain
  4. Modulation: neurons from the brainstem release neurotransmitters that block the pain impulse
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5
Q

Pain Threshold

A

Level of stimulus needed to produce the perception of pain

A measure of the physiological response of the nervous system

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6
Q

Pain Tolerance

A

The amount of pain a person can endure without it interfering with normal function

Varies from person to person

Subjective response to pain, not a physiological function

Varies by attitude, personality, environment, culture, ethnicity

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7
Q

Classification of Pain by Onset and Duration

Acute pain

Persistent pain

A

Acute pain:
Sudden onset
Limited, has an end

Persistent pain (chronic pain):
Persistent or recurring
Lasts 3 to 6 months
More difficult to treat
Tolerance

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8
Q

Six Classification of Pain

A

Referred
Neuropathic
Phantom
Cancer
Central
Vascular

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9
Q

Gate Theory of Pain Transmission

A

Most common and well-described theory

Uses the analogy of a gate to describe how impulses from damaged tissues are sensed in the brain

Many current pain management strategies are aimed at altering this system.

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10
Q

Four Distinct Processes

A

Transduction
Transmission
Perception
Modulation

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11
Q

Transduction

A

Transformation of stimuli into electrochemical energy

Release of pain-medicating chemicals

Nociceptors

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12
Q

Pain Transduction

Tissue injury causes the release of the following:

These substances stimulate :

A

Tissue injury causes the release of the following:

Bradykinin
Histamine
Potassium
Prostaglandins
Serotonin
Substance P

They stimulate nerve endings, starting the pain process.

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13
Q

Pain Transduction

The nerve impulses enter the:

The point of spinal cord entry or the “gate” is the…

This gate regulates the?

A

The nerve impulses enter the spinal cord and travel up to the brain.

The point of spinal cord entry or the “gate” is the dorsal horn.

This gate regulates the flow of sensory impulses to the brain.

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14
Q

Pain Transduction

Closing the gate stops:

If no impulses are transmitted to higher centres in the brain, there is no?

A

Closing the gate stops the impulses.

If no impulses are transmitted to higher centres in the brain, there is no pain perception.

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15
Q

Pain Transmission

Two types of nociceptor pain fibres:

A

Large-diameter, A-delta fibres, and small-diameter C fibres

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16
Q

Pain Perception

Define

The larger the number of mu receptors, the

A

Subjective phenomenon of pain
——Identical stimulus can evoke different pain from one individual to another

“How it is felt”

Complex behavioural, psychological, and emotional factors

The number of mu receptors in the dorsal horn appear to play a crucial role in pain perception and emotional well-being

The larger the number of mu receptors , the less pain is perceived

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17
Q

Pain Modulation

A

Neural activity that controls pain transmission to neurons

Both peripheral and central nervous systems

Descending pain system

Enkephalins and endorphins

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18
Q

Massage

A

Massaging a painful area often reduces the pain.

Large sensory A nerve fibres inhibit impulse transmission

Close the gate

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19
Q

Treatment of Pain in Special Situations

A

Patient-controlled analgesia (PCA)

Patient comfort versus fear of drug addiction

Opioid tolerance

Use of placebos

Recognizing patients who are opioid tolerant

Breakthrough pain

Synergistic effects

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20
Q

Adjuvant Drugs

Examples

A

Drugs from chemical categories other than opioids

Assist primary drugs in relieving pain:

Nonsteroidal anti-inflammatory drugs (NSAIDs)
Antidepressants
Anticonvulsants
Corticosteroids

Example: adjuvant drugs for neuropathic pain

Amitriptyline (antidepressant)
Gabapentin or pregabalin (anticonvulsants)

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21
Q

World Health OrganizationThree-Step Analgesic Ladder

A

Step 1: Nonopioids with or without adjuvant medications after the pain has been identified and assessed. If pain persists or increases, treatment moves to:

Step 2: Opioids with or without nonopioids and with or without adjuvants. If pain persists or increases, management then rises to:

Step 3: Opioids indicated for moderate to severe pain, administered with or without nonopioids or adjuvant medications

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22
Q

Opioid Drugs

A

Synthetic drugs that bind to the opiate receptors to relieve pain

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23
Q

Opioid Drugs

Mild agonists:

A

codeine, hydrocodone

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24
Q

Opioid Drugs

Strong agonists

A

morphine, hydromorphone hydrochloride, oxycodone, meperidine, fentanyl, methadone

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25
Q

Opioid Drugs

Meperidine

A

not recommended for long-term use because of the accumulation of a neurotoxic metabolite, normeperidine, which can cause seizures.

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26
Q

Opioid Ceiling Effect

A

Drug reaches a maximum analgesic effect.

Analgesia does not improve, even with higher doses.

-Codeine phosphate
-Pentazocine
-Nalbuphine

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27
Q

Opioid Analgesics

Three classifications based on their actions:

A

Agonists

Agonists–antagonists

Antagonists (nonanalgesic)

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28
Q

Agonists

A

Bind to an opioid pain receptor in the brain

Cause an analgesic response (reduction of pain sensation)

29
Q

Agonists–Antagonists

A

Binds to a pain receptor and causes a weaker pain response than full agonists

kappa (k) or mu opioid receptors

Also called partial agonists or mixed agonists

used in pts who are addicted to opioids and in obstretical pts (avoid oversedation of mom and fetus)

30
Q

Antagonists

A

Reverse the effects of opioids on pain receptors

Bind to pain receptors and exert no response

Also known as competitive antagonists

31
Q

Equianalgesia

A

Ability to provide equivalent pain relief by
-calculating dosages of different drugs or
-routes of administration that provide comparable analgesia

Examples: morphine, hydromorphone, oxycodone, hydrocodone bitartrate, fentanyl

Continuous release vs. immediate release formulations

32
Q

Opioid Analgesics:Indications

A

Mainly used to alleviate moderate to severe pain

Often first line agents analgesic in immediate post operative setting

Often given with adjuvant analgesic drugs to assist primary drugs with pain relief

Balanced anaesthesia

33
Q

Opioids are also used for:

A

Cough centre suppression

Treatment of diarrhea

34
Q

Opioid Analgesics: Contraindications

Use with extreme caution in patients with the following:

A

Known drug allergy
Severe asthma

Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy

35
Q

Opioid Analgesics: Adverse Effects

A

Central nervous system (CNS) depression
-Leads to respiratory depression
-Most serious adverse effect

Nausea, vomiting, constipation, biliary tract spasm

Urinary retention
Hypotension, palpitations, flushing

Itching, rash, wheal formation

Pinpoint pupils indicating a possible overdose

36
Q

Opioids: Opioid Tolerance

A

A common physiological result of chronic opioid treatment

State of adaptation

Result: larger dose is required to maintain the same level of analgesia

37
Q

Opioids: Physical Dependence

A

Physiological adaptation of the body to the presence of an opioid

Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with psychological dependence (addiction).

38
Q

Opioids: Psychological Dependence

Addiction?

A

Addiction: a pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

39
Q

Opioid Analgesics: Toxicity and Management of Overdose

A

Naloxone hydrochloride

Naltrexone (ReVia®)

Regardless of withdrawal symptoms, when a patient experiences severe respiratory depression, an opioid antagonist should be given.

40
Q

Naloxone reversing an overdose

A

Naloxone has a stronger affinity to opioid receptors than opioids, such as heroin or oxycodone, so it knocks the opioids off the receptors for a short time (30 to 90 minutes). This allows the person to breathe again and reverse the overdose.

41
Q

Toxicity and Management of Overdose

Opioid withdrawal or opioid abstinence syndrome

A

Occur in 2 weeks in opioid-naïve patients

Gradual dosage reduction after chronic opioid use

42
Q

Opioid Analgesics: Interactions

A

Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Promethazine
Monoamine oxidase inhibitors
Others

43
Q

Codeine Sulphate

A

Natural opiate alkaloid

(Schedule I) obtained from opium

Less effective

Ceiling effect

More commonly used as an
antitussive drug

Gastrointestinal (GI) disturbance

44
Q

Fentanyl

A

Synthetic opioid (Schedule I) used to treat moderate to severe pain

Parenteral injections, transdermal patches (Duragesic Mat®), sublingual effervescent tablet (Fentora®)

45
Q

Dilaudid

A

Hydromorphone (Dilaudid®): very potent opioid analgesic; Schedule I drug

1 mg of (IV) or (IM) hydromorphone is equivalent to 7 mg of morphine.

46
Q

Methadone Hydrochloride

A

Synthetic opioid analgesic (Schedule I)

Opioid of choice for detoxification treatment of opioid addicts in methadone maintenance programs

Renewed interest in the use of methadone for chronic (e.g., neuropathic) and cancer-related pain

Prolonged half-life of the drug: cause of unintentional overdoses and deaths

Cardiac dysrhythmias

47
Q

Morphine Sulphate

A

Naturally occurring alkaloid derived from the opium poppy

Drug prototype for all opioid drugs; Schedule I controlled substance

Indication: severe pain

Oral, injectable, and rectal dosage forms; also extended-release forms

48
Q

Oxycodone Hydrochloride

A

Structured similar to morphine
Synthetic opioid

Often combined with acetaminophen (Percocet tablets: typical is 325 mg acetaminophen and 5 mg of oxycodone)

49
Q

Naloxone Hydrochloride (Narcan®)

A

Pure opioid antagonist

Drug of choice for the complete or partial reversal of opioid-induced respiratory depression
Indicated in cases of suspected acute opioid overdose

Failure of the drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose.

50
Q

Nonopioid Analgesics:Acetaminophen (Tylenol®)

A

Analgesic and antipyretic effects

Little to no anti-inflammatory effects

Available over the counter (OTC) and in combination products with opioids

51
Q

Acetaminophen: Mechanism of Action

A

Similar to that of salicylates

Blocks pain impulses peripherally by inhibiting prostaglandin synthesis

52
Q

Acetaminophen: Indications

A

Mild to moderate pain

Fever

Inability to take aspirin products

53
Q

Acetaminophen: Dosage

A

Maximum daily dose for healthy adults is 4 g/day, but Health Canada is considering lowering*
—-2 000 mg for older adults and those with liver disease

Inadvertent excessive doses may occur when different combination drug products are taken together.

Be aware of the acetaminophen content of all medications taken by the patient (OTC and prescription).

*Note: As of the date of writing of this text, Health Canada had not yet made this decision.

54
Q

Acetaminophen: Contraindications and Interactions

Should not be taken in the presence of following:

A

Drug allergy
Liver dysfunction
Possible liver failure
G6PD deficiency

Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic.

55
Q

Acetaminophen: Toxicity and Managing Overdose

A

Even though available OTC, lethal when overdosed

Overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity.

Long-term ingestion of large doses also causes nephropathy.

Recommended antidote: acetylcysteine regimen

56
Q

Miscellaneous Analgesic:Tramadol Hydrochloride

A

Central acting analgesic

Treatment of moderate to moderately severe pain

Potential adverse effects: seizures (with excess dosages) and serotonin syndrome (if taken with SSRIs)

Frequently combined with acetaminophen (Tramacet)

57
Q

Herbal Products: Feverfew

A

Related to the marigold family

Anti-inflammatory properties

Used to treat migraine headaches, menstrual cramps, inflammation, and fever

May cause GI distress, altered taste, muscle stiffness, joint pain

May interact with aspirin and other NSAIDs, as well as anticoagulants

58
Q

Analgesics:Nursing Implications

A

Before beginning therapy, perform a thorough history regarding allergies and use of other medications, including alcohol, health history, and medical history.

Obtain baseline vital signs, intake and output.

Assess for potential contraindications and drug interactions.

Perform a thorough pain assessment, including pain intensity and character, onset, location, description, precipitating and relieving factors, type, remedies, and other pain treatments.
—Level of pain is now considered a “fifth vital sign.”
—Rate pain on a 0–10 or similar scale.

Be sure to medicate patients before the pain becomes severe, so as to provide adequate analgesia and pain control.

Pain management includes pharmacological and nonpharmacological approaches; be sure to include other interventions as indicated.

Patients should not take other medications or OTC preparations without checking with their physicians.

Instruct patients to notify physician about signs of allergic reaction or adverse effects.

59
Q

Opioid Analgesics:Nursing Implications

A

Oral forms should be taken with food to minimize gastric upset.

Ensure safety measures, such as keeping side rails up, to prevent injury.

Withhold dose and contact physician if there is a decline in the patient’s condition or if vital signs are abnormal, especially if respiratory rate is less than 10 breaths/min.

Check dosages carefully.
—Follow proper administration guidelines for IM injections, including site rotation.
—Follow proper guidelines for IV administration, including dilution, rate of administration, etc.

Constipation is a common adverse effect and may be prevented with adequate fluid and fibre intake.

Instruct patients to follow directions for administration carefully and to keep a record of their pain experience and response to treatments.

Patients should be instructed to change positions slowly to prevent possible orthostatic hypotension.

Monitor for adverse effects
—Contact physician immediately if the patient’s vital signs change, condition declines, or pain continues.
—Respiratory depression may be manifested by a respiratory rate of less than 10 breaths/min, dyspnea, diminished breath sounds, or shallow breathing.

60
Q

Opioid Analgesics: Nursing Implications

Monitor for therapeutic effects.

A

Decreased perception of pain

Decreased severity of pain

Increased periods of comfort

Improved activities of daily living, appetite, and sense of well-being

Decreased fever (acetaminophen)

61
Q

Notes

A

opioids- decrease LOC, respirations

pain- is whatever the pt says it is

visceral- organs
somatic- bone, tendons, and muscle, skin

(stimulation of sensory nerve fibres-pain)

Pain threshold

pain tolerance- the amount of pain a person can endure

Neuropathic- nerve pain (diabetes)

gallbladder pain- left side (pain in shoulder/ back/ scapula- referred pain)

phantom pain- damage to BVs and nerves- amputation- still feel the pain

Cancer pain- pressure from the tumours on organs/ tissues

Central- stroke, MS, cancer

Vascular pain- migraine

PhysioMCST-phases nociceptive pain (video)

Transduction-release of chemical picked up by Rs, nerve impulse to the brain

Transmission- fibres activate R in brain

Perception- subjective phenomenon, stimulus can be provoked differently

Modulation- neural 1 activity, control pain transmission

PCA-self medicate, hooked up to an IV for pain

Breakthrough pain they can’t wait for another drug to kick in, so we give them something short-acting

Opioid- respiratory depression

ANGINA- forms lactic acid because it does not get enough oxygen

itch- common AE OF OPIOID

62
Q

Adjuvant

2 Medications

A

assist primary drugs (opioids)

Amitriptyline (antidepressant)
Gabapentin/ pregabalin (diabetic neuropathy)

63
Q

Opioids

Mild agonists

A

codeine (affected by opioid ceiling effect)

hydrocodone

64
Q

Meperidine

A

not recommended

65
Q

Agonits drugs examples

A

morphine, codeine, methadone, fentanyl

66
Q

Agonist-antagonists

A

pentazocine

weaker pain response

partial agonists

67
Q

Antagonists

A

Narcan

reverse effects of opioids

68
Q

vitals of most concern for a pt taking Dilaudid?

A

respirations (ABCs)

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