Analgesics Flashcards
Analgesics
medication that relieves pain without causing loss of consciousness
Opioid Analgesics
moderate to severe pain
Adjuvant Analgesics
drugs or chemicals added to drug regimen
Opioid (common names)
codeine, fentanyl, morphine sulfate, hydromorphone, meperidine, methadone, oxycodone
Opioid (mild agonists)
codeine, hydrocodone
Opioid (strong agonists)
morphine, hydromorphone, oxycodone, meperidine, fentanyl and methadone
Meriperidine (adverse effects)
not recommended long term because of accumulation of neurotoxic metabolite
normeperidine, which can cause seizures
Opioid (indications)
moderate to severe pain
often given with adjuvant analgesic drugs to assist primary drugs with pain relief
also for: cough suppression, treatment of diarrhea, balanced anesthesia
Opiod (contraindications)
do not take it with allergy
severe asthma
use with caution with:
- respiratory insufficiency
-elevated intracranial pressure
- morbid obesity or sleep apnea
- paralytic ileua
- pregnancy
Opioid (adverse effects)
- black box warning: risk of misuse and abuse leading to addiction and death
- itching, pruritis, rash
- peripheral arteries and veins dilate
- CNS depression
- n/v
- urinary retention
- pupil constriction
- constipation
Opioid (withdrawal)
anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal pain, diarrhea, confusion
Opioid (interaction)
- alcohol
- antihistamines
- barbituates,
- benzodiazepines (black box warning for combined effects can sedate or hypotension)
- monoamine oxidase inhibitors
Codeine sulfate
- opioid agonist
- natural opiate alkaloid (schedule II) obtained from opium
- less effective
- celeling effect
- often combined with acetaminophen (schedule III)
- commonly used as atitussive drug (cough medicine/suppressant)
- most common adverse effect (GI disturbance)
Fentanyl
- synthetic opioid (schedule II) used to treat moderate to severe pain
- parenteral injections, transdermal patches (duragesic), buccal lozenges (fentora) and buccal lozenges on stick (actiq)
- 0.1 mg iv of fentanyl is = to 10 mg of morphine IV
- fentanyl patch used for chronic pain
Hydromorphone (Dilaudid)
- very potent, Schedule II drug
- 1 mg of IV or IM hydromorphone is equivalent to 7 mg of morphine
- Exalgo: osmotic extended-release oral deliver. difficult to crush or extract for injection which aids in reducing abuse potential
Meperidine
-synthetic opiod anagesic (schedule II)
- caustion with elderly or with kidney disfunction
- rarely used and not recommended
- use migrane treatment
- post-op shivering
Methadone Hydrocholride (Dolophine)
Schedule II, synthetic
- choice for detoxification treatment of opioid addicts in methadone maintenance programs
- prolonged half-life of the drug: cause of unintentional overdoses and deaths
- can cause cardiac dysrhythmias
Morphine Sulfate
- naturally occurring alkaloid derived from opioid poppy
-drug prototype for all opioid drugs: schedule II - indication: severe pain
- high abuse potential
- oral, injectable, rectal, dosage forms also extended-release
- embeda: morphine and naltrexone is the newest morphine product
Oxycodone hydrochloride
- only given po
- class II
- compare analgesic activity to morphine
- often combined with acetaminophen (Percocet) or with aspirin (Percodan)
- IR and SR
- hydrocodone (weaker often combines with acetaminophen (Vicodin, Norco)
- widely abused
Opioid Overdose
- naloxone (Narcan; received intranasally)
- naltrexone (ReVia)
- regardless of withdrawal symptoms, when in severe respiratory depression, the patient should be given an opioid antagonist
Naloxone Hydrochloride (Narcan)
-PURE opioid antagonist
- drug of choice for the complete or partial reversal of opioid-induced respiratory depression
- indicated in cases of suspected acute opioid overdose
- failure of the drug to significantly reverse the effects of the presumed opioid overdose indicated that the condition may not be related to opioid overdose.
Tramadol Hydrochloride (Ultram)
- centrally acting analgesic with a dual mechanism of action. weak bond to mu-opioid receptors. inhibits the reuptake of norepinephrine and serotonin
- not classified as a controlled substance
- indicated for moderate to moderately severe pain
- adverse effects similar to those of opioids
- careful use in patients taking SSRIs, MAOIs, neuroleptics
Naltrexone
-opioid antagonist
- oral form
- used for alcohol and opioid addiction
Acetampinophen
analgesic and antipyretic effects
- little to no antiinflammatory effects
- available OTC and in combination products with opioids
Acetaminophen (Dosage)
- maximum in adults 3000 mg/day
- maximum in older adults or liver disease 2000 mg/day
- inadvertent excessive doses may happen when different combination drug products are taken together
- may be present in other meds, be aware of acetaminophen content
Acetaminophen (contraindications)
- drug allergy
- liver dysfunction
- possible liver failure
- G6PD deficiency
- dangerous interaction may occur if taken with alcohol or other drugs that are hepatotoxic
Acetaminophen (Toxicity)
- lethal when overdoses
- overdose can cause hepatic necrosis: hepatotoxicity
- long-term ingestion of large doses also causes nephropathy
- Antidote: acetylcysteine regimen
Lidocaine (transdermal)
-topical anesthetic
- indications: postherpetic neuralgia
-left in place no longer than 12 hours (r/t potential systemic absorption and cardiac events)
-minimal adverse effects (skin irritation)
Feverfew
- related to the Marigold family
- antiinflammatory properties
- used to treat migraine headaches, menstrual cramps, inflammation and fever
- may cause GI distress, altered taste, muscle stiffness
- may interact with aspirin and other NSAIDs, as well as anticoagulants
