Analgesic Drugs Flashcards
ACETAMINOPHEN (Chemical Classification)
Nonsalicylate, paraaminophenol derivative
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