Analgesic Pharmacology

Question 1

When giving subsequent pain medications, when is it okay to give the second medication?

Answer 1

may give next drug after the peak of the first drug has passed

Question 2

How long should IVP medications be pushed over?

Answer 2

slowly over 1 minute at least

Question 3

What are the 2 words that describe our pain goal when giving pain medications?

Answer 3

tolerable and functional

Question 4

How do NSAIDs work?

Answer 4

NSAIDs block COX enzymes which in turn stop prostaglandins (non-steroidal anti-inflammatory drugs) in 2 pathways:
1. COX 1 – stops constant prostaglandins
* gastric mucosa
* renal perfusion
* platelet

2. COX 2 – stops tissue damage prostaglandins
   * inflammation
   * pain
   * fever
   * platelets

Question 5

acetaminophen
* purpose
* classification
* nursing pro tips

2 nursing pro tips

Answer 5

• purpose: mild pain, fever
• classification: non-narcotic analgesic
• nursing pro tips:
  1. one of the safest analgesics
  2. don’t take too much – may affect the liver

Question 6

aspirin
* purpose
* classification
* nursing pro tips

4 nursing pro tips

Answer 6

• purpose: mild pain; blood thinner; acute MI
• classification: NSAID
• nursing pro tips:
  1. if overdose, monitor for: RR > 28, tinnitus, pH = 7.31, headache, epistaxis
  2. aspirin is contraindicated in pts with gastric ulcers due to anti-coagulant nature
  3. monitor serum albumin – aspirin binds to albumin, so if there isn’t enough albumin in the blood, aspirin in the blood can accummulate to toxic levels
  4. pts taking daily aspirin should take baby aspirin because 325 mg of regular aspirin will increase risk of bleeding

Question 7

-methacin
* purpose
* classification
* nursing pro tips

3 nursing pro tips

Answer 7

• purpose: mild to moderate pain; rheumatoid arthritis
• classification: NSAID
• nursing pro tips:
  1. risk of GI bleeding due to anti-coagulant properties
  2. don’t take with warfarin since it increases risks of bleeding
  3. intended effect – increased mobility of joints without pain

Question 8

-profen
* purpose
* classification
* nursing pro tips

3 nursing pro tips

Answer 8

• purpose: mild to moderate pain; inflammation
• classification: NSAID
• nursing pro tips:
  1. risk of GI bleeding due to anti-coagulant properties, so check for history of PUD
  2. side effect – GI discomfort
  3. can affect clotting times

Question 9

-naproxen
* purpose
* classification
* nursing pro tips

3 nursing pro tips

Answer 9

• purpose: mild to moderate pain; osteoarthritis; inflammation
• classification: NSAID
• nursing pro tips:
  1. adverse effect – occult/GI bleeding
  2. osteoarthritis pts will experience steadier gait as a result
  3. take with food

Question 10

With PCAs, who pushes the button to administer medication?

Answer 10

only the pt

Question 11

morphine
* purpose
* classification
* nursing pro tips

2 nursing pro tips

Answer 11

• purpose: severe pain
• classification: opioid
• nursing pro tips:
  1. adverse effect – constipation
  2. may cause respiratory depression – hold for bradypnea

Question 12

codeine
* purpose
* classification
* nursing pro tips

2 nursing pro tips

Answer 12

• purpose: moderate to severe pain; cough
• classification: opioid
• nursing pro tips:
  1. side effect – constipation
  2. combination of non-narcotics and codeine – often used in one drug to act on different pathways of pain for enhanced pain relief

Question 13

hydromorphone (Dilaudid)
* purpose
* classification
* nursing pro tips

3 nursing pro tips

Answer 13

• purpose: severe pain; cough
• classification: opioid
• nursing pro tips:
  1. 5 - 10 x more powerful than morphine
  2. antidote is naloxone (narcan) – but this will remove pain control aspect of hydromorphone
  3. most commone drug in med-surg for severe pain

Question 14

fentanyl
* purpose
* classification
* nursing pro tips

3 nursing pro tips

Answer 14

• purpose: severe pain
• classification: opioid
• nursing pro tips:
  1. preferred pain medication over analgesics for pts with cirrhosis – analgesics are highly metabolized by the liver
  2. may take up to half a day for patch to start working during first time use
  3. can take supplemental pain med while on fentanyl patch

Question 15

oxycodone
* purpose
* classification
* nursing pro tips

Answer 15

• purpose: moderate to severe pain
• classification: opioid
• nursing pro tips:
  1. short acting oxycodone is the most common analgesic in med-surg
  2. side effect – constipation
  3. short-acting with tylenol = percocet
  4. long-acting = oxycontin