Analgesics

Question 1

Define analgesia.

Answer 1

insensibility to pain without loss of consciousness.

Question 2

Describe the MOA, therapeutic and adverse actions of opioid agonist analgesics, and opioid antagonists.

Answer 2

Agonist - full activation of receptor, dose increases and so does resp depression threshold inccreases.
Antagonist - binds to opiate receptor and blocks it. does not cause respiratory depression - reversal of overdose and allows breathing

Question 3

Describe the MOA, therapeutic and adverse actions and nursing considerations of opioids

Answer 3

Opioids / mOrphine, cOdeine / Analgesic action of opioids include inhibition of substance P, closing the gate in the dorsal horn, thus inhibiting afferent transmission and altering perception and emotional responses to pain.

AR - vitals low [HR, RR, BP], sedating, high abuse potential, physical and mental dependence, CNS depressent

Nursing indic
WH for RR below 12
Vitals monitor incl sedation score
Constipation - laxatives, high fibre diet

Question 4

Describe the MOA, therapeutic and adverse actions and nursing considerations, contra and pt education of NSAIDS

Answer 4

NSAIDS(ibuprofen, celecoxib) NON opioid analgesic
Antipyretic(for fever) and anti flammatory. MOA the inhibition of the enzyme COX which inhibits prostaglandins decreasing inflammation, pain and fever [prostaglandin functions]
Dec pain, inflammation and fever

Contra
Dec renal/liver function
Inc bleeding risk

AR
GI bleeding
HTN
Causing bronchospasm 
Blood clots
Inc bleeding risk
Dec kidney function

Pt education
Take w food never on empty stomach
If pt has tinnitus then sign of toxicity on NSAIDS.
Hydration to assist kidneys

Nursing cons
Monitor kidney function and platelets
Encourage adequate hydration

Question 5

Discuss lifespan considerations for pain management

Answer 5

Opioids - sedating, check for elferly, constipation

Question 6

Discuss the WHO analgesic ladder and side effects to step 2 and 3 and its purpose

Answer 6

Purpose: framework used to guide the pharmacological treatment of pain in chronic pain and palliative care patients.

Step 1 [mild 1-3] non opiod (NSAID or paracetamol) + non pharm adjuvents
Step 2 [moderate 4-6] non opioids (paracetamol + NSAID + weak opioid like codeine or tramadol) + non pharm adju
Step 3 (severe 7-10) Strong opioids (morphine, fentanyl, oxy) non pharm adju. 

Side effects to 2 and 3 - constipation, nausea and vomiting, sedation, resp depression.

Question 7

Three primary types of opioid receptors and the main one

Answer 7

Mu*
Kappa*
Delta*

Main one is MU

Question 8

What is responsible for this mechanism

stimulation of opioid receptors in the dorsal horn in the spinal cord inhibits the release of substance P
Decreased substance P inhibits the afferent transmission of pain signals to the cortex
“closes the gate”
Alters the perception of pain

Answer 8

Opioid agonists

Question 9

function of prostaglandin

Answer 9

• prosta are a group of lipids made up @ site of tissue damage. metabolised by cox enzyme and action in pain is to dec threshold of nociceptors. physiological function - inflammation through vasodilation, platelet aggregation, maintain renal blood flow.

Question 10

NSAIDs should be avoided in late pregnancy due to:

Answer 10

the prolongation of gestation and labour

Question 11

Opioid analgesics are best used in which type of pain?

Answer 11

Opioid analgesics are effective and commonly used for the management of severe acute pain.

Question 12

Opioids can induce the following adverse effects

Answer 12

biliary colic, constipation, pruritus (itching)

Question 13

Stimulation of the following opioid receptors is associated with analgesia

Answer 13

Mu, Kappa (K) and Delta (D)

Question 14

The synthetic analgesic tramadol acts by

Answer 14

binding to the mu opioid receptors

inhibiting the reuptake of noradrenaline

inhibiting the reuptake of 5-HT (serotonin)

Question 15

Tissue injury or tissue inflammation is most likely to cause which type of pain

Answer 15

nociceptive

Question 16

Acupuncture and transcutaneous electrical nerve stimulation (TENS) increase endorphin release. T/F

Answer 16

True

Endorphin release in the body is higher after acupuncture and TENS and both effects may be reversed by the use of naloxone, an opioid antagonist.

Question 17

Compared to naltrexone, the opioid antagonist naloxone has a longer duration of action.

T/F

Answer 17

F

Naloxone is a short-acting opioid antagonist whereas naltrexone is a long-acting opioid antagonist.

Question 18

Mild analgesics should be used initially in managing all types of pain. Stronger analgesics (e.g. opioids) should be reserved for when pain becomes more severe. T/F

Answer 18

F

More severe pain can be treated with higher doses of opioids and/or combinations of analgesics.

Question 19

Regular use of NSAIDs over a long period may cause tolerance or dependence.
T/F

Answer 19

F

The analgesic action of NSAIDs is peripheral and spinal, it does not cause tolerance or dependence or modify psychological reactions to pain. whereas opioids does!

Question 20

Sharp pain is transmitted from the peripheries to the spinal cord via A-delta fibres.

T/F

Answer 20

A-delta fibres transmit sharp, transient fast pain and C-fibres transmit burning, aching, slow, visceral pain.

Question 21

When codeine is taken into the body, it is metabolised to morphine.

T/F

Answer 21

T

Codeine is a pro-drug, being rapidly metabolised in most people to morphine. However, 6-10% of the Caucasian population lack the enzyme to metabolise codeine, hence it has no analgesic effect.

Question 22

A dose of an opioid may have to be increased to control the pain in some individuals with cancer. This is because they have developed drug:

Answer 22

tolerance

Question 23

Naloxone, the opioid antagonist, has the greatest activity on which receptors?

Answer 23

Mu

Question 24

NSAIDs inhibit the synthesis and release of:

Answer 24

prostaglandins

Question 25

Physiological responses to acute pain include:

Answer 25

Increased blood pressure, increased pulse rate, dilated pupils and perspiration are physiological responses to acute pain.

Question 26

Sign/s that a child younger than 2 years might be in pain include/s:

Answer 26

Decreased acitvity, anorexia or crying

Question 27

The mechanism of the analgesic action of opioids (e.g. morphine) includes

Answer 27

Analgesic action of opioids include inhibition of substance P, closing the gate in the dorsal horn, thus inhibiting afferent transmission and altering perception and emotional responses to pain.

Question 28

Which group/s of patients is/are often under-treated for pain?

Answer 28

minority groups, women under 50, men and wome over 70

Question 29

Chronic pain is best treated if analgesics are given only when necessary (prn). T/F

Answer 29

F
Analgesics should be given on a regular basis in chronic pain to optimise blood levels and reduce the conditioning reaction in which periods of pain lead to drug-seeking behaviours.

Question 30

Compared to morphine, tramadol is less likely to cause respiratory depression and drug dependency. T/F

Answer 30

This centrally acting analgesic, which is not chemically related to opioids, may have a lesser potential for respiratory depression and drug dependency.

Question 31

For mild to moderate pain in children, aspirin is the analgesic of choice.

T/F

Answer 31

Aspirin should not be used in children because of its association with Reye?s syndrome, a rare but serious disorder due to damage to hepatic mitochondria.