Analgesic Drugs Flashcards
ACETAMINOPHEN (functional classification)
Nonopioid analgesic, antipyretic
ACETAMINOPHEN (Mechanism of Action)
May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis; does not possess antiinflammatory properties; antipyretic action from inhibition of prostaglandins in the CNS (hypothalamic heat-regulating center)
ACETAMINOPHEN (Uses)
Mild to moderate pain or fever, arthralgia, dental pain, dysmenorrhea, headache, myalgia, osteoarthritis
ACETAMINOPHEN (Contraindication)
Hypersensitivity (allergy)
ACETAMINOPHEN (Side Effects)
CNS: stimulation, drowsiness GI: nausea, vomiting, abdominal pain, HEPATOTOXICITY, HEPATIC SEIZURE (OVERDOSE), GI BLEEDING GU: RENAL FAILURE (HIGH, PROLONGED DOSES) HEMA: LEUKOPENIA, NEUTROPENIA, HEMOLYTIC ANEMIA (LONG-TERM USE), THROMBOCYTOPENIA, PANCYTOPENIA INTEG: rash, urticaria Syst: hypersensitivity Toxicity: CYANOSIS, ANEMIA, NEUTROPENIA, JAUNDICE, PANCYTOPENIA, CNS STIMULATION, DELIRIUM FOLLOWED BY VASCULAR COLLAPSE, SEIZURES, COMA, DEATH
ACETAMINOPHEN (Nursing Considerations)
Assess: -Hepatic Studies (AST, ALT, bilirubin, creatinine before therapy if long-term therapy is anticipated; may cause hepatic toxicity at doses >4g/day with chronic use) -Renal Studies (BUN, creatinine, occult blood, albumin, if patient is on long-term therapy; presence of blood or albumin indicates nephritis) -Blood Studies (CBC, PT if patient is on long-term therapy) -I&O Ratio (decreasing output may indicate renal failure [long-term use]) -For fever and pain (type of pain, location, intensity, duration) -CHRONIC POISONING (RAPID, WEAK PULSE; DYSPNEA; COLD, CLAMMY EXTREMITIES; REPORT IMMEDIATELY TO PRESCRIBER) -HEPATOTOXICITY (DARK URINE; CLAY-COLORED STOOL; YELLOWING OF SKIN, SCLERA; ITCHING; ABDOMINAL PAIN; FEVER; DIARRHEA IF PATIENT IS ON LONG-TERM THERAPY) -ALLERGIC REACTIONS (RASH, URTICARIA; IF THESE OCCUR PRODUCT MAY HAVE TO BE DISCONTINUED)
ACETAMINOPHEN (Overdose Treatment)
Product level, gastric lavage, activated charcoal; administer oral acetylcysteine to prevent hepatic damage; monitor for bleeding
CODEINE (functional classification)
Opiate Analgesic, Antitussive
CODEINE (Chemical Classification)
Opiate, phenathrene derivative
CODEINE (Mechanism of Action)
Depresses pain impulse transmission at the spinal cord level by interaction with opioid receptors; decreases cough reflex, GI motility
CODEINE (Uses)
Moderate to severe pain
CODEINE (Contraindications)
Breastfeeding, hypersensitivity to opiates, respiratory depression, increased intracranial pressure, seizure disorders, severe respiratory disorders
CODEINE (Side Effects)
CNS: Drowsiness, Sedation, dizziness, agitation, dependency, lethargy, restlessness, euphoria, SEIZURES, hallucinations, headache, confusion CV: bradycardia, palpitations, orthostatic hypotension, tachycardia, CIRCULATORY COLLAPSE GI: Nausea, Vomiting, Anorexia, Constipation, dry mouth GU: urinary retention INTEG: flushing, rash, urticaria, pruritus RESP: RESPIRATORY DEPRESSION, RESPIRATORY PARALYSIS, dyspnea SYST: ANAPHYLAXIS
CODEINE (Nursing Considerations)
Assess: -PAIN (intensity, type, location, aggravating, alleviating factors; need for pain medication, tolerance; use pain scoring) -I&O ratio (check for decreasing output; may indicate urinary retention, especially among geriatric patients) -GI function (nausea, vomiting, constipation) -COUGH (type, duration, ability to raise secretion for productive cough; do not use to suppress productive cough) -CNS changes, dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reactions (rash, urticaria) -RESPIRATORY DYSFUNCTION (respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min) Perform/Provide: -Assistance with ambulation if needed -Safety measures (top side rails, night-light, call bell)
CODEINE (Overdose Treatment)
Naloxone 0.4mg ampule diluted in 10ml 0.9% NaCl and given by direct IV push, 0.02mg q2min (adult)
Fentanyl (Functional Classification)
Opioid Analgesic
Fentanyl (Chemical Classification)
Synthetic Phenylpiperidine
Fentanyl (Mechanism of Action)
Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception by binding to opiate receptors
Fentanyl (Uses)
Controls moderate to severe pain; preoperatively, postoperatively; adjunct to general anesthetic, adjunct to regional anesthesia; FenaNYL: anesthesia as premedication, conscious sedation; Actiq: breakthrough cancer pain
Fentanyl (Contraindications)
Hypersensitivity to opiates, myasthenia gravis HEADACHE, MIGRAINE
Fentanyl (Side Effects)
CNS: dizziness, delirium, euphoria, sedation CV: BRADYCARDIA, ARREST, hypo/hypertension EENT: blurred vision , miosis GI: nausea, vomiting, constipation GU: urinary retention INTEG: rash, diaphoresis MS: muscle rigidity RESP: RESPIRATORY DEPRESSION, ARREST, LARYNGOSPASM
Fentanyl (Nursing Considerations)
ASSESS: -VS after parenteral route; note muscle rigidity, drug history, hepatic/renal function tests -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reactions: rash, urticaria -RESPIRATORY DYSFUNCTION: RESPIRATORY DEPRESSION, character, rate, rhythm; notify prescriber if respirations are /=60mg/day oral morphine, >/=30mg/day oxycodone PO, 8mg/day HYDROmorphone, 25mcg YF fentaNYL/hr
Meperidine (Demerol) (Functional Classification)
Opioid Analgesic
Meperidine (Demerol) (Chemical Classification)
Phenylpiperidine derivative
Meperidine (Demerol) (Mechanism of Action)
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Meperidine (Demerol) (Uses)
Moderate to severe pain preoperatively, postoperatively
Meperidine (Demerol) (Contraindications)
Hypersensitivity (allergy)
Meperidine (Demerol) (Side Effects)
CNS: Drowsiness, Dizziness, Confusion, Headache, Sedation, Euphoria, INCREASED INTRACRANIAL PRESSURE, SEIZURES, serotonin syndrome CV: palpitations, bradycardia, hypotension, change in BP, tachycardia(IV) EENT: tinnitus, blurred vision, miosis, diplopia, depressed corneal reflex GI: nausea, vomiting, anorexia, constipation, cramps, biliary spasm, paralytic ileus GU: urinary retention, dysuria INTEG: rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP: RESPIRATORY DEPRESSION SYST: ANAPHYLAXIS
MEPERIDINE (Demerol) (Nursing Considerations)
ASSESS: -PAIN: location, type, character, give product before pain becomes extreme; reassess after 60 min (IM, SUBCUT, PO) and 5-10min (IV) -Renal function prior to initiating therapy; poor renal function can lead to accumulation of toxic metabolite and seizures -I&O ratio; check for decreasing output; may indicate urinary retention -For constipation; increase fluids, bulk in diet; give stimulant laxatives if needed -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reactions with chronic or high-dose use -Allergic reactions: rash, urticaria -RESPIRATORY DYSFUNCTION: depression, character, rate, rhythm; notify prescriber if respirations are <12/min -CNS stimulation: with chronic or high doses PERFORM/PROVIDE: -Safety measures: night-light, call bell within easy reach
Meperidine (Demerol) (Overdose Treatment)
Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors
Methadone (functional classification)
Opioid Analgesic
Methadone (Chemical Classification)
Synthetic diphenylheptane derivative
Methadone (Mechanism of Action)
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors; produces CNS depression
Methadone (Uses)
Severe pain, opioid withdrawal
Methadone (Contraindications)
Hypersensitivity to this product or chlorobutanol (inj); asthma, ileus
Methadone (Side Effects)
CNS: Drowsiness, Dizziness, Confusion, Headache, Sedation, euphoria, SEIZURES CV: palpitations, bradycardia, change in BP, CARDIAC ARREST, SHOCK, hypotension, TORSADES DE POINTES, QT PROLONGATION EENT: tinnitus, blurred vision, miosis, diplopia GI: Nausea, Vomiting, Anorexia, Constipation, Cramps, biliary tract spasm GU: increased urinary output, dysuria, urinary retention, impotence INTEG: Rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP: RESPIRATORY DEPRESSION, RESPIRATORY ARREST
METHADONE (Nursing Considerations)
ASSESS: -PAIN: type, location, intensity, grimacing before, 1 1/2-2 hr after administration; use pain scoring -I&O ratio; check for decreasing output; may indicate urinary retention -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reactions: rash, urticaria -RESPIRATORY DYSFUNCTION: respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min -Opioid detoxification: no analgesia occurs, only prevention of withdrawal symptoms (BP, pulse, ECG; QT prolongation, hypotension, palpitations may occur) -Bowel changes, bulk, fluids, laxatives should be used for constipation PERFORM/PROVIDE: -Assistance with ambulation -Safety measures: night-light, call bell within easy reach
Methadone (Overdose Treatment)
Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors
MORPHINE (Functional Classification)
Opioid Analgesic
MORPHINE (Chemical Classification)
Alkaloid
MORPHINE (Mechanism of Action)
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
MORPHINE (Uses)
Moderate to severe pain
MORPHINE (Contraindications)
Hypersensitivity, addiction (Opioid), hemorrhage, bronchial asthmam, increased intracranial pressure, paralytic ileus, hypovolemia, shock
MORPHINE (Side Effects)
CNS: drowsiness, dizziness, confusion, headache, sedation, euphoria, insomnia, SEIZURES CV: palpitations, BRADYCARDIA, change in BP, SHOCK, CARDIAC ARREST, chest pain, hypo/hypertension, edema, TACHYCARDIA EENT: tinnitus, blurred vision, miosis, diplopia GI: nausea, vomiting, anorexia, constipation, cramps, biliary tract pressure GU: urinary retention HEMA: THROMBOCYTOPENIA INTEG: rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP: RESPIRATORY DEPRESSION, RESPIRATORY ARREST, APNEA
MORPHINE (Nursing Considerations)
ASSESS: -PAIN: location, type, character; give dose before pain becomes severe -Bowel status; constipation common, use stimulant laxative if needed -I&O ratio; check for decreasing output; may indicate urinary retention -BP, pulse, respirations (character, depth, rate) -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction (ABRUPT DISCONTINUATION: gradually taper to prevent withdrawal symptoms; decrease by 50% q1-2days; avoid use of narcotic antagonists -Allergic Reactions: rash, urticaria -RESPIRATORY DYSFUNCTION: depression, character, rate, rhythm; notify prescriber if respirations are <12/min; accidental overdose hase occurred with high-potency oral sols PERFORM/PROVIDE: -Assistance with ambulation -Safety measures: side rails, night-light, call bell within easy reach -Gradual withdrawal after long-term use
Morphine (Overdose Treatment)
Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors
Naloxone (Narcan) (Functional Classification)
Opioid Antagonist, Antidote
Naloxone (Narcan) (Chemical Classification)
Thebaine derivative
Naloxone (Narcan) (Mechanism of Action)
Competes with opioids at opiate receptor sites
Naloxone (Narcan) (Uses)
Respiratory depression induced by opioids, pentazocine, propoxyphene
Naloxone (Narcan) (Contraindications)
Hypersensitivity
Naloxone (Narcan) (Side Effects)
CNS: drowsiness, nervousness, SEIZURES, tremor CV: rapid pulse, increased systolic BP (high dose), VENTRICULAR TACHYCARDIA, FIBRILLATION, hypo/hypertension, CARDIAC ARREST, SINUS TACHYCARDIA GI: nausea, vomiting, HEPATOTOXICITY RESP: hyperpnea, PULMONARY EDEMA
Naloxone (Narcan) (Nursing Considerations)
ASSESS: - WITHDRAWAL: cramping, hypertension, anxiety, vomiting, signs of withdrawal in drug-dependent individuals may occur <10/min, administer naloxone; probably due to opioid overdose; monitor LOC -PAIN: duration, intensity, location before and after administration; may be used for respiratory depression
Naltrexone (Functional Classification)
Opioid Antagonist
Naltrexone (Chemical Classification)
Thebaine derivative
Naltrexone (Mechanism of Action)
Competes with opioids at opioid-receptor sites
Naltrexone (Uses)
Blockage of opioid analgesics; used for treatment of opiate addiction, alcoholism
Naltrexone (Contraindications)
Hypersensitivity, opioid dependence hepatic failure, hepatitis
Naltrexone (Side Effects)
CNS: Stimulation, Drowsiness, dizziness, confusion, SEIZURES, headache, flushing, hallucinations, nervousness, irritability, SUICIDAL IDEATION, syncope, anxiety CV: rapid pulse, PULMONARY EDEMA, hypertension, DVT EENT: tinnitus, hearing loss, blurred vision GI: Nausea, Vomiting, Diarrhea, Heartburn, anorexia, HEPATITIS, constipation, abdominal pain GU: delayed ejaculation, decreased potency INTEG: Rash, urticaria, bruising, oily skin, acne, pruritus, inj site reactions MISC: increased thirst, chills, fever MS: joint and muscle pain RESP: wheezing, hyperpnea, nasal congestion, rhinorrhea, sneezing, sore throat, pneumonia
Naltrexone (Nursing Considerations)
Assess: -Hepatic Status: LFTs, jaundice, hepatitis, hepatic failure -ABGs including PO2, PCO2, LFTs, VS q3-5min -Signs of withdrawal in drug-dependent individuals -Cardiac status: tachycardia, hypertension -RESPIRATORY DYSFUNCTION: RESPIRATORY DEPRESSION, character, rate, rhythm; if respirations <10/min, respiratory stimulant should be administered -Mental status: depression, suicidal
Oxycodone (Functional Classification)
Opiate Analgesic
Oxycodone (Chemical Classification)
semisynthetic derivative
Oxycodone (Mechanism of Action)
Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception
Oxycodone (Uses)
Moderate to severe pain
Oxycodone (Contraindications)
Hypersensitivity, addiction (opiate), asthma, ileus
Oxycodone (Side Effects)
CNS: Drowsiness, Dizziness, Confusion, Headache, Sedation, Euphoria, fatigue, abnormal dreams/thoughts, hallucinations CV: palpitations, bradycardia, change in BP EENT: tinnitus, blurred vision, miosis, diplopia GI: Nausea, Vomiting, Anorexia, Constipation, Cramps, gastritis, dyspepsia, biliary spasms GU: increased urinary output, dysuria, urinary retention INTEG: Rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP: RESPIRATORY DEPRESSION
Oxycodone (Nursing Considerations)
Assess: -PAIN: intensity, location, type, characteristics; need for pain medication by pain/sedation scoring; physical dependence -I&O ratio; check for decreasing output; may indicate urinary retention -CNS CHANGES: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -ALLERGIC REACTIONS: rash, urticaria -RESPIRATORY DYSFUNCTION: respiratory depression, character, rate, rhythm; notify prescriber if respirations are BP, pulse -BOWEL STATUS: constipation; stimulant laxative may be needed with fluids, fiber PERFORM/PROVIDE: -Assistance with ambulation -Safety measures: night light, call bell within reach
Oxycodone (Overdose Treatment)
Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors
Tramadol (Functional Classification)
Analgesic - miscellaneous
Tramadol (Mechanism of Action)
Binds to mu-opioid receptors, inhibits reuptake of norepinephrine, serotonin
Tramadol (Uses)
Management of moderate to severe pain, chronic pain
Tramadol (Contraindications)
Hypersensitivity, acute intoxication with any CNS depressant, alcohol, asthma, respiratory depression
Tramadol (Side Effects)
CNS: dizziness, CNS stimulation, somnolence, headache, anxiety, confusion, euphoria, SEIZURES, hallucinations, sedation, NEUROLEPTIC-MALIGNANT-SYNDROME-LIKE-REACTIONS CV: vasodilation, orthostatic hypotension, tachycardia, hypertension, abnormal ECG EENT: visual disturbances GI: nausea, constipation, vomiting, dry mouth, diarrhea, abdominal pain, anorexia, flatulence, GI bleeding GU: urinary retention/frequency, menopausal symptoms, dysuria, menstrual disorder INTEG: pruritus, rash, urticaria, vesicles, flushing SYST: ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, serotonin syndrome
Tramadol (Nursing Considerations)
Assess: -PAIN: location, type, character, give before pain becomes extreme -I&O ratio: check for decreasing output; may indicate urinary retention -Need for product; dependency -Bowel pattern; for constipation, increase fluids, bulk in diet -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reactions: rash, urticaria -Increased side effects in renal/hepatic disease -SEROTONIN SYNDROME, NEUROLEPTIC MALIGNANT SYNDROME: increased heart rate, shivering, sweating, dilated pupils, tremors, high BP, hyperthermia, headache, confusion; if these occur, stop product, administer serotonin antagonist if needed PERFORM/PROVIDE: -Assistance with ambulation -Safety measures: side rails, night-light, call bell within easy reach
ACETAMINOPHEN (Chemical Classification)
Nonsalicylate, paraaminophenol derivative
