Analgesics Flashcards
An analgesic is…
an agent that relieves pain
Pain is a subjective experience.
“Pain is defined as whatever the patient says it is, wherever and whenever the patient says it is.”
Pain Scale:
Generally 1-10
Pain Threshold
Physical element
how much pain is your body used to; what you’re feeling
Pain Tolerance
Psychological element
in your head, what can you live with; easier to affect; experience
Can have chronic pain with…
… acute flare-ups
Adjuvant Therapy
Assist primary agents in relieving pain = smaller doses
- decrease side effects
- approaches pain stimulus from another mechanism = synergistic effect
Synergistic
work together to achieve a better outcome; other ways to deal with pain - ice, heat, massage, relaxation technique
-Pharm - an anti-depressant might increase pain tolerance
Drug Tolerance
chemical; need progressively high doses to maintain same analgesic effect
having to bump up the dose
Drug Dependence
- Psychological: pattern of compulsive drug use; euphoria rather than pain relief
- Physical: sudden withdrawal of medication = withdrawal symptoms
Rebound Pain
Pain has returned and is worse than it was before
Withdrawal Symptoms
- Rebound pain, tachycardia, elevated BP, mental agitation
- Opioid withdrawal: anxiety, irritability, chills, hot flashes, joint pain, N/V, abdominal cramps, diarrhea
Moral/Ethical Considerations
- Placebos
- Chronic pain/terminal pain: fear of addiction
Administration
- PO, IM, IV, topical
- PCA
PCA
“Patient Controlled Analgesia”
Smaller doses that can be given more frequently that stabilize pain more
Analgesic Agents
Opioids (narcotics); non-opiods (non-narcotics); NSAIDs, others
Opioid Analgesics
Narcotics
- All considered “controlled substances”
- From the opium poppy plant
- Multiple opioid receptors: mu, kappa, sigma, delta, epsilon
- Endorphins: (endogenous morphine) natural internal mechanism of pain control
Controlled Substances
Dr. must write the order, no refills
Opioid Receptors are?
- Mu
- Kappa
- Sigma
- Delta
- Epsilon
Endogenous Morphine would be considered
A ‘Runner’s High”
Opioid Agonists
Narcotics
Fall under the category of Opioid Analgesics
Opioid Agonists mechanism of action?
- Achieve beneficial effects by their actions on the CNS
- Also act outside the CNS, which is where unwanted effects occur
Opioid Agonists indications?
- Alleviate sever to moderate pain (top of the charts, strongest)
- Cough suppressant - codeine, hydrocodone
- Antidiarrheal preparations (prescribe the drug for its side effect)
Opioid Agonists contraindications?
- Allergy
- Severe asthma, respiratory insufficiency
- Conditions involving elevated intracranial pressure (ICP)
- Pregnancy
This drug decreases breathing
ICP - watch neuro signs
LOC will be down already and opioids decrease LOC
Opioid Agonists side effects and adverse effects?
All of the side effect
- Euphoria, “high”, dizzy, lightheadedness, sedation
- Hypotension, flushing, palpitations
- N/V, constipation, urinary retention
- Respiratory depression, aggravation of asthma
- Dependence; physical and psychological; large amounts, extended period
Opioid Agonists side effects and adverse effects?
NEED TO KNOW
- Sedation
- Constipation
- Respiratory Depression
Opioid Agonists interactions?
- Co-administration with alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazines, or other CNS depressants = additive respiratory depressant effects
- With MAOIs = respiratory depression and hypotension
Opioid Agonists Examples
- Morphine
- Dilaudid (hydromorphone)
- Demerol (meperidine) - not used often anymore
- Codeine - has to go thru 1st pass effect - ORAL ONLY
- Oxycontin (oxycodone)
- Ultram (tramadol) - mild narcotic
Opioid agonists bind with…
… opioid receptors
The receptor that generally causes the “happiness” effect?
Mu
Ultram (tramadol)
In some states it’s a controlled substance
Was originally classified as a “non-narcotic analgesic”
Combination Opioid Analgesics
(very common; PO narcotics)
(Opioid Analgesics)
- Narcotics combined with aspirin (ASA) or acetaminophen (APAP, tylenol)
- Work synergistically with the narcotics, use less narcotic
Combination Opioid Analgesics Examples
-Tylenol #3: Codeine with Tylenol
-Percocet: Oxycodone with Tylenol
-Percodan: Oxycodone with ASA
(Only one that still is combined with aspirin)
-Vicodin/Lortab: Hydrocodone with Tylenol
Patient Education for Combination Opioid Analgesics
When on combination meds, must instruct them to not take any other OTC aspirin or tylenol
Opioid Partial Agonists (agonist-antagonists)
half & half
(Opioid Analgesics)
- Bind to mu receptors and compete with agonists - block mu receptors
- Potent synthetic analgesics
- Misuse potential and addiction liability is less
- Antagonistic activity can produce withdrawal symptoms in opioid dependent patients
Opioid Partial Agonists Examples
- Stadol
- Nubain
- Talwin
Opioid Antagonist
Opioid Analgesics
Naloxone Hydrochloride (Narcan)
*only reverse opioids
Naloxone Hydrochloride (Narcan)
-Pure opioid antagonist; blocks opioid receptors
-Does not produce sedan or respiratory depression (reverses all of it)
-Drug of choice:
*complete or partial reversal of opioid induced
respiratory depression
*diagnosis of suspected opioid overdose
-Very short half life
Narcan very short half life…
… Could come back and seem fine, but could go back to unresponsiveness
Narcan is an emergency med that works…
…within minutes
Narcan Scenario:
Come into ER unresponsive and they suspect overdose on narcotics, they give you an opioid antagonist (Narcan)
Opioid Dependence
-Methadone - an opioid; no euphoria but prevents withdrawal symptoms
- Should also be on withdrawal counseling
- Suboxone - new opioid dependent drug
NonOpioid Analgesics
Non-narcotic analgesics
Acetaminophen (Tylenol) : APAP
Acetaminophen (Tylenol) APAP
NonOpioid Analgesic
- Analgesic, antipyretic
- NOT an anti-inflammatory
- Very few allergies
Acetaminophen (Tylenol): APAP indications
NonOpioid Analgesic
- Fever
- Mild to moderate pain
Be careful with Acetaminophen (Tylenol): APAP because…
…Patients may say they are allergic to tylenol because they really want a narcotic
Acetaminophen (Tylenol): APAP overdose
- Potentially lethal drug when overdosed
- Causes hepatic necrosis (kills your liver); hepatic toxicity; nephropathy (kidney)
Acetaminophen (Tylenol): APAP antidote?
Antidote: Acetylcysteine (Mucomyst)
- Oral that you have to drink
- Smells like rotten eggs
- Drink a cup of it every hour
- Must put a lid on it with a straw because of the smell
Acetaminophen (Tylenol): APAP overdose fact:
One of the most deadly drugs to overdose on
Anti-Inflammatory Agents
- Steroids
2. NSAIDs
Steroids are what kind of agent?
Anti-inflammatory agents
Steroid indications
anti-inflammatory agent
- Bronchial inflammation
- Allergic inflammation
- Joint inflammation
-Have lots of side effects, only used in specific cases and for short term therapy
NSAIDs are what kind of agent?
Anti-inflammatory agents
NSAIDs acronym?
not-steroidal anti-inflammatory drugs
NSAIDs (x1)
- Most commonly prescribed drugs; 70 million prescriptions each year
- 23 different agents
- Patients may respond better to one agent than to another (a lot of inter-client variability)
- Possess analgesic, anti-inflammatory, anti-rheumatic, and antipyretic activity
NSAIDs (x2)
- Used for the relief of mild to moderate pain
- Most common and first drug - salicylic acid = acetylsalicylic acid = aspirin; most widely used drug in the world
- Potential major toxicologic effects = GI intolerance, bleeding, and renal (kidney) impairment with long therm therapy
Main side effect of aspirin is?
GI upset
NSAIDs mechanism of action?
-“Prostaglandin inhibitors” - part of inflammatory process
-Prostaglandins and leukotrienes
*major contributors to the symptoms of
inflammation; including pain, fever and H/A
-Products of arachidonic acid pathway (pain pathway)
NSAIDs indications?
- Pain, gout; inflammation; fever
- Vascular headaches, platelet inhibition; rheumatoid arthritis, osteoarthritis; inflammatory syndromes
- When used concomitantly with opioids; less side effects from opioid (dosage is less)
- Specific drugs work better for some things
NSAIDs contraindications?
- Allergy
- Conditions that include risk of bleeding: peptic ulcer disease
- Not advised for pregnancy in 3rd trimester because risk of bleeding
NSAIDs side effects and adverse effects?
- GI distress
- Precipitate acute or chronic renal failure
NSAID side effect scenario..
…If you see the beginning of renal failure and they are on an NSAID, you need to question why they are taking it
NSAIDs interactions?
- Alcohol, anticoagulant, steroids = increased GI distress
- Hypotensive agents, diuretics = reduced hypotensive and diuretic effects
*if you go on a steroid you will want to stop your NSAID use
NSAIDs toxicity and overdose?
Chronic Intoxication = (short-term high doses; long term high or lower doses) hearing loss, tinnitus; metabolic acidosis and respiratory alkalosis; hypoglycemia
NSAIDs antidote?
No drug antidote, supportive
-Activated charcoal - absorb; fluids, electrolytes, and bicarb; increase elimination; hemodialysis
activated charcoal = it’s charcoal, black, thick, gets everywhere; blocks EVERYTHING (any overdose)
NSAID examples?
- Salicylates
- Ibuprofen and Ibuprofen like
- COX-2 Inhibitors
Salicylates are an example of?
NSAIDs
Salicylates
NSAID example
- Aspirin (acetylsalicylic acid, ASA)
- First ever NSAID
- Only NSAID with anti-platelet abilities
Ibuprofen and Ibuprofen like are examples of?
NSAIDs
Ibuprofen and Ibuprofen like
NSAID examples
-Motrin (ibuprofen)
-Orudis (ketoprofen)
-Naprosyn, Aleve (naproxen)
-Toradol (Ketoralac) - can be given IM & IV, only
NSAID that can
-Clinoril (sulindac)
-Indocin (indomethacin)
COX-2 Inhibitors are an example of?
NSAIDs
COX-2 Inhibitors
NSAID example
-Celebrex (celecoxib)
- Are NSAIDs but specifically block COX-2 receptors
- Treats really bad arthritis pain, but need to be monitored closely for heart issues
Weigh pros (arthritis pain) and cons (heart attack/issues)
Agents to treat migraines?
- Triptans
2. Ergot alkaloids
Triptans are used to?
Treat migraines
Triptans (serotonin agonists)
-Drugs of choice
Oral, SQ, intranasal
-Thought to act by constricting certain intracranial vessels
Triptans (serotonin agonists) side effects?
- Dizziness
- Drowsiness
- Rarely severe
Triptans (serotonin agonists) contraindications?
- Recent MI
- Hypertension
- Angina
- DiabetesBecause of vasoconsrictive properties
Ergot Alkaloids are used to?
Treat migraines
Ergot alkaloids (adrenergic, dopaminergic & serotonin agonists)
- Only for those unresponsive to triptans
- Multiple actions and side effects
- Multiple routes of admin: PO, SL, SQ, suppository, Nasal spray
Headaches may be caused by?
Maybe some sort of vasodilation in the brain, so blood rushes into the brain, but there is no where for it to go.
Miscellaneous Agents
Antineurolgics (therapeutic classification) still in post-marketing surveillance
Antineurolgics mechanism of action?
Work differently in the CNS to decrease excitatory neurotransmitter release (also anticonvulsants)
Originally used to treat seizures
Antineurolgics indications?
- Nerve pain
- Peripheral neuropathy
- Fibromyalgia
Antineurolgics contraindications?
Allergy
Antineurolgics side effects?
- Dizziness
- Ataxia (unstable gate)
- Drowsiness
- Fatigue
- Peripheral edema
Antineurolgics Examples?
- Neurontin (gabapentin)
- Lyrica (pregabapentin)
Antineurolgics can lead to…
People develop a drug tolerance, quickly, to antineurolgics
