Analgesics Flashcards
Acetaminophen (APAP)
MOA:
- Analgesic
- Antipyretic
- *Not anti-inflammatory**
- Without the negative side effects of NSAIDS
Route:
- PO/PR & IV
Nursing:
- Educate: max dose 4000mg/24 hrs. (to avoid hepatic failure)
- For malnourished clients the limit is 3000mg/24 hrs
- ETOH use (> 2drinks/day) the limit is 2000mg/24 hrs
- Children age specific max dose
- OD is managed by acetylcysteine
Opioid (General)
MOA:
- Activate the same receptors that endorphins activate in CNS => CNS depressant
- Block the pain stimuli
Side Effects:
- Miosis
- Orthostatic Hypotension
- Respiratory depression
- Pulse/bradycardia
- Happiness/euphoria
- Increase ICP –> contraindicated
- Nausea
- Emesis/vomiting
- Urinary retention/constipation –> need to give a prophylactic laxative
- Sedation/hypnotic
- Dependence/tolerance/abuse
- Aspiration (loss of gag reflex)
Contraindication:
- Recent head trauma or recent CVA
Nursing:
- Caution with respiratory disorders
- Monitor for aspiration
- Monitor VS for low HR & BP –> need to check vitals before administering an opioid
- Monitor for constipation
- Prophylactically give laxative
- Monitor for N/V
- Monitor for urinary retention
“Morphine USDA”
Codeine Sulfate
- Opioid
Indication:
- PRN for cough, diarrhea, mild pain
- Pro-drug: the drug metabolite is morphine
- Route: PO, SubQ, IM, IV
Combination:
- Acetaminophen / codeine (300/30 mg) Rx
- Acetaminophen / codeine (300/60 mg) Rx
Hydrocodone
- Opioid
Indication:
- PRN moderate pain
- Route: Only PO
Combinations
- Hydrocodone / acetaminophen
- Hydrocodone / aspirin
- Hydrocodone / ibuprofen
Oxycodone
- Opioid
Indication:
- PRN moderate pain
Route:
- IV, PO
Combinations:
- Oxycodone / acetaminophen (5, 7.5, 10)
- Oxycodone / ibuprofen
- Oxycodone / aspirin
Tramadol
- Opioid
- Route: PO (Sched IV)
- Pro-drug: the drug metabolite is morphine
- Opioid-like (weaker but similar properties and effects)
- Tramadol ER for around the clock moderate pain mgmt.
- Max dose: 300 mg/24 hrs
Morphine
- Opioid
Indication:
- PRN for severe pain
Route:
- PO, oral drop, PR, IV, IM, epidural, spinal (not subQ*)
- 10x stronger than tramadol
Hydromorphone
- Opioid
Indication:
- PRN for severe pain
- Route: PO, IV, PR, IM, SubQ
- 6x stronger than morphine
Meperidine
- Opioid-like
Routes:
- PO, SubQ, IM, IV
MOA:
- Anticholinergic with secondary analgesic effects**
- Less respiratory side-effects
- Patients allergic to opiates**
- Short duration of action –> hence used in OR
Side effects:
- Neurotoxicity (delirium, seizure)
- Dysrhythmias
Contraindications:
- RF (higher risk of seizure and neurotoxicity)
“Me & Sally Never Drank Roofies” = Meperidine, Anticholinergic Side Effects, Short DOA, Neurotoxicity, Dysrhythmias, RF (contra)
Fentanyl
- Opioid
Routes & Indications:
- IV, IM (indication: anesthesia)
- Transdermal patch 12.0-100 mcg/h (indication: chronic pain
- Oral trans-mucosal lozenge (indication: acute pain in ED)
- 50-100 times more potent then morphine (is a synthetic opioid)
- Short-acting for severe pain (onset immediate; duration 30-60 min)
Methadone
- Opioid
Route:
- PO, SubQ, IM
MOA:
- Long acting opioid
- Reduces craving
Indication:
- Heroine detoxification & maintenance programs
Analgesic Nursing
Assess:
- What has been done prior to this for their pain?
- Baseline VS
Properly Administer:
- DILUTE, 4-5min IVP
- Know the reversal policy & naloxone
Educate:
- Side effects
- Risk of tolerance, dependence & use disorder
Monitor:
- Peds & geri –> developing organs & organ dysfunction
- Obese pts –> opioid retention in adipose tissues
- Misuse, abuse, diversion
Naloxone
- Opioid reversal agent
Indication:
- Treatment of opioid OD by competing for opioid receptors
- Reverse resp & CNS depression rapidly; regaining consciousness and breathing (Life-saving treatment)
- No effects in absence of opioids => used as a test to understand the cause of CNS depression**
- Emergency medicine
Routes:
- IV, intranasal spray, PO
Monitor for acute withdrawal symptoms:
- Abrupt onset of pain, anxiety, sweating, HA, nervousness
- Depression, suicidal ideation, abdominal cramps/pain, N/V, anorexia
- Monitor for dysrhythmia
- Naloxone half life is shorter than opioids
- Monitor for recurrence of resp depression, may need multiple doses
