Analgesics Flashcards
Considerations for Opioid Agents
In Children
- Use opioids ONLY when absolutely necessary
- Dosage carefully calculated
- Monitor closely for Adverse Effects
Considerations for Opioid Agents
In Adults
- Encourage to request pain medication before pain gets out of control
- Caution in pregnancy and lactation
- Narcotics CAN be used in labor - but ONLY before 6 cm. dilation
Considerations for Opioid Agents
In Older Adults
- More likely to experience adverse effects
- More likely to develop toxicity because of renal and hepatic impairment
- Implement safety measures such as fall precautions
- Ask if they need the pain meds before automatically administering what has been ordered
Opioid Agonists
Things to consider regarding safety of using these drugs
- Schedule II Controlled Substance
- Potential for physical dependence
- Rising problem of addiction
Opioid Agonists
Mechanism of Action
- Stimulates opioid receptor sites in the CNS
- Produces analgesia, sedation, and a sense of well-being or euphoria
Opioid Agonists
Drug Names
- Morphine
- Hydromorphine
- Codeine
- Oxycodone
- Fentanyl
- Hydrocodone
Opioid Agonists
Indications
- Relief of severe acute or chronic pain
- Analgesia during anesthesia
- PCA pump used for post surgical pain management
Opioid Agonists
Contraindications
Absolute:
* Allergy
* Diarrhea caused by poisons (opioids cause decreased GI motility which would lead to greater poison absorption)
Cautions:
* Respiratory dysfunction, asthma, emphysema
* Pregnancy, labor, lactation
* GI or GU surgery (because of decreased GI motility)
* Acute abdomen or ulcerative colitis
* Head injuries, alcoholism, delirium tremens, or a CVA (drug would make worsening symptoms hard to differentiate)
Opioid Agonists
Adverse Effects
- 🫁 Respiratory depression with apnea
- 💓 CV: Cardiac arrest, Shock, Orthostatic hypotension
- 🤢 GI: Nausea, vomiting, constipation
- 🧠 CNS: dizziness, fear, hallucinations
Opioid Agonists
Drug Interactions
Many
* Barbituate general anesthetics
* SSRIs (inc. risk of Serotonin Syndrome)
* Cholinergic Agonists
* Antihypertensive Agents
Opioid Agonist-Antagonists
Drug Names
Buprenorphine
Butorphanol
Nalbuphine
Opioid Agonist-Antagonists
Mechanism of Action
- Act as partial agonists at the mu-opioid receptors and antagonists at the kappa-opioid receptors in the CNS
- Produce analgesia, sedation, euphoria, and hallucinations
Opioid Agonist-Antagonists
Indications
- Moderate to severe pain
- Some can be used to treat opioid use disorder (addiction)
Opioid Agonist-Antagonists
Contraindications
Absolute:
* Allergy
* Nalbuphine: Sulfite allergy
Cautions:
* Physical dependence on a narcotic –> can trigger withdrawal symptoms
* COPD and disease of the respiratory tract
* Acute MI or documented CAD, HTN –> stimulates heart, exacerbating these symptoms
* Renal or hepatic dysfunction
* Pregnancy and lactation
Opioid Agonist-Antagonists
Adverse Effects
🫁 Respiratory depression
🤢 GI: Nausea, vomiting, constipation, and biliary spasm actions
🧠 CNS: headache, dizziness, psychoses, anxiety, hallucinations
😶Ureteral spasm, urinary retention
😰Sweating and dependence
Opioid Agonist-Antagonists
Drug Interactions
- Barbiturate general anesthetics
- Narcotic agents (can cause severe respiratory depression, overdose)
Opioid Agonists & Opioid Agonist-Antagonists
Assessment
History:
* Check for allergy, allergy to sulfites, Respiratory disease, Acute MI, CAD, HTN, Renal and hepatic dysfunction, pregnancy or lactation, diarrhea caused by poison, GI or GU surgery, Acute abdomen or ulcerative colitis, head injury, alcoholism, delirium tremens, or CVA
Physical:
* Perform a PAIN assessment
* CNS: affect, orientatio, reflexes, pupil size
* Respiratory: rate and lung sounds
* CV: BP, pulse, cardiac output
* GI: abdomen, bowel sounds
* GU: output, bladder distension
Labs:
* Renal and Liver function tests
Opioid Agonists & Opioid Agonist-Antagonists
Implementation/Patient Teaching
- Baseline pain assessments
- Monitor respiratory status before and during therapy
- Have an opioid antagonist and equipment for assisted ventilation readily available
- Monitor injection sites for irritation and extravasation (leakage of fluid)
- Monitor timing of analgesic doses (make sure to give them at the right time before pain gets out of control)
- Use extreme caution when injecting these drugs into any body area that is chilled or has poor perfusion or shock
- Use additional non-pharmacological measures to relieve pain
- Encourage ambulation and small frequent meals to prevent constipation
Opioid Agonists & Opioid Agonist-Antagonists
Nursing Diagnoses/Conclusions
- Altered sensory perception (r/t to CNS effects)
- Constipation, nausea, vomiting (r/t to GI effects)
- Altered gas exchange (r/t respiratory depression)
- Injury Risk (r/t CNS effects)
Opioid Antagonists
Drug Names
Naloxone
Naltrexone
Opioid Antagonists
Mechanisms of Action
Bind strongly to (but do not activate) opioid receptors to reverse the effects of opioids
Opioid Antagonists
Indications
Naloxone: Nasal spray, quickly reverses adverse effects of opioids, used to diagnose a suspected acute opioid overdose
Naltrexone: Used orally in the management of alcohol or opioid dependence MUST have already completed detoxification
Opioid Antagonists
Contraindications
Absolute:
* Allergy
Cautions:
* Pregnancy and lactation
Opioid Antagonists
Adverse Effects
Acute Opioid Abstinence/Withdrawal Syndrome
* Abdominal cramps, nausea, vomiting, diarrhea
* Runny nose
* Yawning, irritability, insomnia, anxiety, depression
* Muscle aches, sweating, chills
* Blood pressure changes
* Dysrhythmias, tachycardia
Opioid Antagonists
Drug Interactions
- Larger doses may be needed to reverse effects of Opioid Agonist-Antagonists
Opioid Antagonists
Assessment
History:
* Check for allergy, pregnancy, lactation
Physical:
* CNS: level of orientation, affect, reflexes, pupil size
* Respiratory: Rate and lung sounds
* CV: Monitor vital signs and obtain an ECG
Opioid Antagonists
Nursing Diagnoses/Conclusions
- Acute pain (r/t withdrawal and CV effects)
- Altered cardiac output (r/t CV effects)
- Injury Risk (r/t CNS effects)
- Knowledge deficit
Opioid Antagonists
Implementation/Patient Teaching
- Ensure that patient receiving naltrexone has been narcotic-free for 7-10 days
- Maintain open airway and provide artificial ventiliation
- Continuous monitoring
- Wear or carry a medic alert bracelet if receiving Naltrexone
- Comfort and safety measures
What causes migraine headaches?
- Activation of the trigeminal nerve that causes inflammation within the meningeal blood vessels
- Severe throbbing headaches on one side of the head
- Three times more likely to occur in females due to fluctuations in hormones
Considerations for using
Anti-Migraine Agents
In Children
- NOT many drugs are recommended
- DO NOT use Ergot derivatives
- Triptans = can be used in children 6 years and older
- Need to be evaluated for other causes of headache
- Treat first with OTC analgesics
Considerations for using
Anti-Migraine Agents
In Adults
- Need to be evaluated for other causes of headache
- Ergots and triptans are contraindicated in pregnancy - must use barrier contraceptives
- Use alternate methods to feed baby
Considerations for using
Anti-Migraine Agents
In Older Adults
- More likely to have chronic diseases that would be exacerbated by ergots and triptans
- Take the LEAST amount of drug as possible
- Monitor closely for CV effects; report chest pain to provider immediately
Ergot Derivatives
Mechanism of Action
- BLOCK Alpha-adrenergic AND serotonin receptor sites in the brain to cause vasoconstriction of cranial vessels, decrease cranial artery pulsation, and decrease hyperperfusion of the basilar artery bed
Ergot Derivatives
Drug Names
Dihydroergotamine
Ergotamine
Ergot Derivatives
Indications
Prevention or abortion of migraine, vascular, or cluster headaches
Ergot Derivatives
Contraindications
Absolute:
* Allergy
* CAD, HTN, PVD (because of hypertension)
* Impaired Liver function
* Pregnancy or lactation
Cautions:
* Pruritis (made worse with vasoconstriction)
* Malnutrition (triggers CTZ, inc. N&V)
Ergot Derivatives
Adverse Effects
🧠 CNS: Numbness, tingling of extremities, muscle pain
💓 CV: Pulselessness, weakness, chest pain, arrhythmias
🤢 GI: Nausea, vomiting, diarrhea
Ergot Derivatives
Drug Interactions
- Beta Blockers
- Triptans (can cause vasospasms)
Triptans
Mechanism of Action
Bind to selective serotonin receptor sites to cause vasoconstriction of cranial nerves
Triptans
Indications
- Treatment of acute migraine
- NOT used for prevention of migraines
Triptans
Contraindications
Absolute:
* Allergy
* Pregnancy
* CAD
Cautions:
* Elderly
* At risk for CAD
* Lactation
* Renal and hepatic dysfunction
Triptans
Adverse Effects
Related to vasoconstriction
* Numbness, tingling, burning sensations
* Feeling of coldness, weakness
* Dysphasia
* Blood pressure alterations
Triptans
Drug Interactions
- Ergot containing drugs (enhances vasoconstriction)
- MAOIs & SSRIs (increased risk of serotonin syndrome)
CGRP Inhibitors & Serotonin Agonists
Mechanism of Action
CGRP Inhibitors: Inhibits CGRP, a potent vasodilator chemical, released during migraine headache attacks
Serotonin Agonists: Selective serotonin receptor agonist, leading to vasoconstriction
CGRP Inhibitors & Serotonin Agonists
Drug Names
CGRP Inhibitors
Rimegepant
Ubrogepant
Serotonin Agonists
Lasmiditan
(Schedule IV controlled substance)
CGRP Inhibitors & Serotonin Agonists
Indications
CGRP Inhibitors: Acute Migraine headache
Serotonin Agonists: Acute migraine with or without aura in adults
CGRP Inhibitors & Serotonin Agonists
Contraindications
Absolute:
* Allergy
Cautions:
* Pregnancy
CGRP Inhibitors & Serotonin Agonists
Adverse Effects
CGRP Inhibitors:
* Nausea
Serotonin Agonists:
* dizziness
* fatigue
* paresthesia
* sedation
CGRP Inhibitors & Serotonin Agonists
Drug Interactions
Lasmiditan: CNS depressants, serotonergic medications
Lasmiditan and CGRP Inhibitors:
CYP3A4 agents
Anti-Migraine Agents
Assessment
History:
* Check for allergy, pregnancy, lactation, age, CAD, renal & hepatic dysfunction, pruritis, malnutrition
Physical:
* CNS: Orientation, affect, reflexes, numbness and tingling
* Skin: Localized edema, itching, breakdown (for Ergot derivatives)
* Vital signs
* ECG
Labs:
* Renal and hepatic function tests
Anti-Migraine Agents
Nursing Diagnoses/Conclusions
- Impaired comfort (r/t CV and vasoconstrictive effects)
- Altered cardiac output (r/t CV effects)
- Altered sensory perception (r/t CNS effects)
- Injury risk (r/t changes in peripheral sensation, CNS effects)
- Knowledge deficit
Anti-Migraine Agents
Implementation/Patient Teaching
- Administer at the first sign of headache, do not wait until it is severe
- Arrange for safety precautions if CNS or visual issues occur
- Monitor BP of any pt with CAD very closely, discontine use if angina or prolonged hypertension occurs
Which of these is a contraindication of opioid agonists?
A. GI Surgery
B. Pregnancy
C. Asthma
D. Poison induced diarrhea
D. Poison induced diarrhea
Which of these is an adverse effect of Opioid Agonist-Antagonists?
A. Tachypnea
B. Respiratory Depression
C. Tingling in the hands
D. Polyphagia
B. Respiratory Depression
What patient education would you provide to a patient taking an opioid antagonist?
A. You can’t take this if you are pregnant.
B. It’s okay to take your opioid antagonist if you’ve taken an opioid recently.
C. Opioid withdrawal symptoms include: nausea, vomiting, a fast heartrate, and sweating
D. The effects of opioid antagonists can take some time to start working.
C. Opioid withdrawal symptoms include: nausea, vomiting, a fast heartrate, and sweating
How do Ergot Derivatives work?
A. They constrict blood vessels in the brain to reduce pain.
B. They activate opioid receptors to reduce pain.
C. They inhibit chemicals that cause inflammation which reduces pain.
D. They cause increased stimulation of A-fibers which reduces pain.
A. They constrict blood vessels in the brain to reduce pain.
