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Pharm Final > Analgesic Agents > Flashcards

Analgesic Agents Flashcards

1
Q

What are A-fibers?

A

Nerve fibers that carry perceptions of vibration, stretch, and pressure.
There are four types: alpha,beta, gamma, and delta

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2
Q

What are A-delta fibers?

A

Fibers that carry the sensation of pain to the spinal cord (usually acute sharp pain)

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3
Q

What are C fibers?

A

Are un-myelinated nerve fibers (the fact that they’re un-myelinated means the conduction is slower)
- They also carry pain sensation to the spinal cord, but they carry more of a slow, dull aching pain

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4
Q

What are ergot derivatives?

A

Drugs that help with migraines by causing vasoconstriction in the brain and peripheral areas

Have lots of adverse effects

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5
Q

What is gate control theory?

A

The concept that pain is not just about how much damage tissues receive, but about how pain is transmitted through the nerve fibers, and that there are ways that we can close the pain gate with alternative means.

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6
Q

What is a migraine headache?

A

Severe unilateral pain in the head that leads to other effects such as nausea, vomiting, and photophobia and is usually caused by arterial dilation.

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7
Q

What s nociception?

A

The transmission of unpleasant stimuli to the brain

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8
Q

What’s Triptan?

A

Selective serotonin blocker that cause vasoconstriction in the brain and is used as treatment for migraines.

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9
Q

What are opioid receptors responsible for?

A
  • CNS
  • nerves in the periphery
  • cells in the GI tract
  • chemo trigger zone (controls nausea, vomiting, breathing, and cough)
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10
Q

Use of opioids across the lifespan: CHILDREN

A
  • Opioids in children have not proven to be effective or safe for use.
  • Dosage should e carefully calculated
  • Monitor closely for ADE

Methadone should NOT be used in children

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11
Q

What is the antidote for an opioid overdose?

A

Naloxone aka narcan

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12
Q

When should patients take opioids for pain?

A

Take them before the pain is unbearable

If they wait until the pain is unbearable that can increase breakthrough pain and it will take longer to get the pain back under control.

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13
Q

Opioid use across the lifespan for adults:

A
  • encouraged to request pain meds before pain is out of control.
  • caution in pregnancy and lactation (opioids can be used during the labor process, but only to a certain point in labor)
  • narcotics used during labor, monitor and closely for adverse effects
  • babies who were exposed to narcotic use while still in the womb can start to show withdrawal symptoms around 24 to 74 hours after delivery.
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14
Q

Use of opioids across the lifespan: OLDER ADULTS

A
  • before just giving them opioids when their ordered, ask them first if they want pain meds.
  • more likely to experience adverse effects
  • implement safety measures (fall risk)
  • if older adults have renal or hepatic problems are more likely to accumulate the drug and develop toxic levels.
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15
Q

Opioid agonists:

A
  • Drugs that react with opioid receptors
  • Cause analgesia, sedation or euphoria
  • Potential for physical dependence
  • They are controlled substances
  • Rising problem of addiction
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16
Q

Drug class: Opioid agonists
What are the drug names or suffixes?

A

Morphine
Hydromorphone
Codeine
Oxycodone
Fentanyl
Hydrocodone

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17
Q

Drug class: Opioid agonists
What is the action?

A
  • act at specific opioid receptor sites in the central nervous system, and produce analgesic sedation and a sense of well-being.
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18
Q

Drug class: Opioid agonists
What is the indication?

A

-relief of severe, acute or chronic pain and analgesia during anesthesia.

Can be used: during procedures or surgery for moderate sedation, general anesthesia, pain control after surgery, or chronic pain.

19
Q

Drug class: Opioid agonists
What are the contraindications?

A
  • Known allergy
  • Diarrhea caused by poisons
    ^ A strict contraindication of opioid antagonist is when patients have diarrhea caused by poisons.
    This is because he opioid agonist will cause decreased GI motility, which will increase poison absorption (the poison sits in the G.I. tract for longer, allowing more of it to enter the bloodstream)
20
Q

Drug class: Opioid agonists
What are the cautions?

A

-respiratory dysfunction, asthma, emphysema (patients that already have respiratory problems can become worse because of the respiratory depression that comes with opioids)

-pregnancy, lactation, labor

-G.I. or GU surgery (Will complicate recovery by retaining urine and excrement)

-acute abdomen or ulcerative colitis (opioids can mask important symptoms of acute abdomen, which is short term for sudden onset of severe abdominal pain)

-head injuries, alcoholism, delirium tremens, or stroke (CVA).
(Opioids can exacerbate confusion and agitation, which makes management of delirium tremens more challenging, and they can impair consciousness and and cognitive function, which complicates the assessment of neurological status and head injury patients)

21
Q

Drug class: Opioid agonists
What are the adverse effects?

A
  • Respiratory center depression can lead to apnea cardiac arrest or shock.
  • G.I. motility and CTZ stimulation can lead to nausea, vomiting, and constipation.
  • CNS: dizziness, fear, anxiety, and hallucinations.
  • Orthostatic hypotension.
  • to avoid sedative effects try using the extended release forms of the medication instead*
22
Q

Drug class: Opioid agonists
What are the drug-drug interactions?

A
  • barbiturate general anesthetics ( combined with opioids, there is an increased risk of respiratory depression, hypotension, sedation, and coma)
  • SSRIs ( combined with opioids, there is an increased risk of serotonin syndrome)
  • caution should be taken when using opioid agonist with colic agents and antihypertensive agents as this could cause an increase in GI effects and hypotension.
23
Q

Drug class: Opioid agonists- antagonists
What are the drugs or suffixes in this class?

A

-Buprenorphine
-Butorphanol
-Nalbuphine

24
Q

Drug class: Opioid agonists- antagonists
What is the action?

A

Act as partial agonist at the mu-opioid, receptors and antagonist at the Kappa-opioid receptor in the CNS to produce analgesia, sedation, euphoria and hallucinations.

they can treat pain like opioid agonist, but unlike opioid agonist, they can be used as treatment for people with an opioid addiction

25
Q

Drug class: Opioid agonists- antagonists
What is the indication?

A

-Moderate to severe pain
-Some can be used to treat opioid use disorder

26
Q

Drug class: Opioid agonists- antagonists
What are the contraindications?

A

-Known allergy
-Nalbuphine = if sulfa allergy

27
Q

Drug class: Opioid agonists- antagonists
What are the cautions?

A
  • Physical dependence on an narcotic (may trigger withdrawal symptoms)
  • COPD and disease of the respiratory tract
  • Acute MI or documented, coronary artery disease or hypertension (opioids can stimulate the heart exacerbating these conditions)
  • Renal or hepatic dysfunction
  • Pregnancy and lactation (benefit needs to outweigh the risk)
28
Q

Drug class: Opioid agonists- antagonists
What are the adverse effects?

A
  • Respiratory depression
  • GI: Nausea, vomiting, constipation, and biliary spasm actions
  • CNS: Headache, dizziness, psychosis, anxiety, hallucinations
  • Ureteral spasm, urinary retention
  • Sweating and dependence
29
Q

Drug class: Opioid agonists- antagonists
What are the drug-drug interactions?

A

-barbiturate general anesthetics (combined with opioid agonist-antagonists, there is an increased risk of respiratory depression, hypotension, sedation, and coma)
- Narcotic agents (potential overdose)

30
Q

Nursing considerations for Opioid Agonists AND Opioid Agonists- Antagonists
Assessments:

A

When you’re assessing before giving these medications, make sure you perform a thorough pain assessment.

-make sure to have a baseline, cognitive, cardiac and respiratory assessment so that if they do show adverse effects you can gauge the severity of those effects. (monitor respiratory rate in ausculate lungs)
-performing an abdominal assessment will allow you to keep track of any elimination retention.
(palpate abdomen and osculate bowel sounds assess urine output and palpate for bladder distention)
-assess orientation affect reflexes and pupil size.
-Monitor pulse, blood pressure and cardiac output

31
Q

Nursing considerations for Opioid Agonists AND Opioid Agonists- Antagonists
Nursing Diagnoses:

A
  • Altered sensory perception (visual auditory, kineshetic) related to CNS effects
  • Constipation, nausea, vomiting related to G.I. effects
  • Altered gas exchange related to respiratory depression
  • Injury risk related to CNS effects of the drug
32
Q

Nursing considerations for Opioid Agonists AND Opioid Agonists- Antagonists
Implementation:

A
  • when implementing this drug, you want to make sure you have naloxone and respiratory equipment at the bedside in case of an overdose*
  • Perform baseline, and periodic assessments with the patient
  • Have an opioid antagonist and equipment assisted ventilation readily available
  • Monitor injection sites for irritation and extravasion
  • Monitor timing of analgesic dosage
  • Use extreme caution when injecting these drugs into any body area that is chilled or has poor perfusion or shock
  • Use additional measures to relieve pain like stress, reduction, hot packs ice packs
  • Monitor respiratory status before therapy and periodically during therapy.
33
Q

Nursing considerations for Opioid Agonists AND Opioid Agonists- Antagonists
Evaluation:

A
  • Monitor patient response to the drug relief of pain and sedation see if the pain has reduced and make sure they’re still breathing.
  • Monitor for adverse effects of CNS changes, G.I. depression, respiratory depression, arrhythmias, and hypotension.
  • Evaluate patient teaching:
    Patient should report adverse effects such as trouble, breathing, hallucinations, or urination problems.
    They should know how to avoid breakthrough pain, which is to take the medication before the pain becomes too uncomfortable .
34
Q

Drug class: Opioid Antagonists
What are the drug names or suffixes?

A
  • Naloxone
  • Naltrexone
35
Q

Drug class: Opioid Antagonists
What are the actions?

A

Naloxone- reverses adverse effects of opioids diagnosis suspected, acute opioid overdose.
(Patients will quickly notice an increase in pain and a decreased sedation will most likely be agitated)
Naltrexone- used orally in the management of alcohol or opioid dependence- reduces cravings.
(Supports recovery in individuals who have already completed detoxification)

  • if naltrexone is given while they’re still dependent of alcohol or opioids, it can actually increase the cravings*
36
Q

Drug class: Opioid Antagonists
What are the indications?

A

-reversal of the adverse effects of opioids
-treat opioid and or alcoholic dependence

37
Q

Drug class: Opioid Antagonists
What are the contraindications?

A

-the only contradiction is a known allergy

38
Q

Drug class: Opioid Antagonists
What are the cautions?

A

Pregnancy and lactation
(when these are given to pregnant patients it’s because the benefit far outweighs the risk. The risk being that the fetus may have withdrawal symptoms, but it is more important that the patient is alive and breathing)

39
Q

Drug class: Opioid Antagonists
What are the adverse effects?

A

the most common adverse effect is acute opioid, abstinence syndrome, where the symptoms are nausea, vomiting sweating, and tachycardia

-Blood pressure changes, dysrhythmias, anxiety

40
Q

Drug class: Opioid Antagonists
What are the drug-drug interactions?

A
  • the only drug interaction is that when giving an antagonist to treat overdose from agonists- antagonist, you may actually need a larger dose.
    (Larger doses may be needed to reverse effects of opioid agonist antagonists)
41
Q

Nursing considerations for patients receiving Opioid Antagonists
Assessment:

A

-get a neuro baseline, respiratory baseline, and a cardiac baseline.
(This is so that you can monitor for sudden withdrawal symptoms and hopefully address adverse effects before they become severe like an arrhythmia)

42
Q

Nursing considerations for patients receiving Opioid Antagonists
Nursing diagnoses:

A

-Acute pain related to withdrawal and CV effects
-Altered cardiac output related to CV effects
-Injury risk related to CNS effect

43
Q

Nursing considerations for patients receiving Opioid Antagonists
Implementation:

A

when giving this drug, you might be in a code situation so during those times you want to maintain the airway and CPR

  • Be prepared to help the patient deal with withdrawal symptoms
  • Ensure that patient receiving naltrexone have been narcotic free for 7 to 10 days
  • Patient is receiving naltrexone as part of a comprehensive opioid or alcohol withdrawal program advise the patient to wear or carry a medic alert, warning bracelet.
44
Q

Nursing considerations for patients receiving Opioid Antagonists
Evaluation:

A

when evaluating we’re looking to try and get the patient awake and breathing, and no longer experiencing the severe adverse effects of opioids or alcohol dependence or withdrawal symptoms

Pharm Final (9 decks)

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