Analgesics Flashcards
What is Pain?
- Pain is a ______(1)______ experience with _____(2)______ tissue damage.
- Pain is _______(3)______.
- Pain is an _______(4)______ sensory and emotional experience.
- Pain is ________(5)_______ with different _____(6)___ and pain tolerances
- highly subjective
- actual or potential
- difficult to define
- unpleasant
- individualized
- thresholds
Classification of pain
What type of pain is this?
- Sudden onset and short in duration
Acute pain
Classification of pain
Are we good at treating acute pain?
Yes- we have a lot of meds to treat acute pain
Classification of pain
What are some examples of acute pain?
- MI
- appendicitis
- kidney stones
Classification of pain
What type of pain is this?
- Persistant or recurring; (comes in cycles)
Chronic pain
Classification of pain
Are we good at treating chronic pain?
No- chronic pain is difficult to treat
we can get it under control but it never goes away
Classification of pain
Characteristics of chronic pain
- long duration
- cyclic
Classification of pain
Examples of chronic pain
- RA- rheumatid arthitis
- cancer pain
Classification of pain
What type of pain
- originates from muscles, ligaments, and joints
Somatic pain
Classification of pain
Charactertitics of somatic pain
- localized
- constant
- described as “aching/throbbing”
Classification of pain
What medicatin does somatic pain best repond to?
NSAIDS (treats inflammation)
Classification of pain
Examples of somatic pain
- strains
- sprains
Classification of pain
What type of pain:
- originates from organs (deep pain)
Deep (visceral) pain
Classification of pain
Characteristics of deep (visceral) pain
- often described as “dull/aching” and/or as “referred”
- hard to pin down exactly where it is
Classification of pain
Examples of deep (visceral) pain
- deep pelvic pain
- intestional pain
- transplant organ rejection
Classification of pain
What type of pain is this?
- Pain in a missing body part (amuputation)
Phantom pain
Classification of pain
How is phantom pain described as?
- burning
- itching
- tingling
- stabbing
Classification of pain
What type of pain is this?
- Origin in one place but felt in another
Referred pain
Classification of pain
Examples of referred pain
- MI
- appendicitus
Classification of pain
What type of pain is this?
- Caused by peripheral nerve injury not stimulation
Neuropathic pain
Classification of pain
What is neuropathic pain described as?
- shooting
- burning
- tingling
Classification of pain
Examples of neuropathic pain
- carpel tunnel syndrome
- pinched nerve
Theory of pain transmission and relief
Gate Control Theory
(Melzack and Wall)
Shortcomings of the Gate Control Theory:
- This ____(1)______ is not a _______(2)________.
- It doens’t always ______(3)______ what is happening.
- theory
- physiological principle
- explain
Gate Control Theory
Step 1:
-
Tissue injury → release of _____(1)_____, _____(2)____, _____(3)____, ______(4)______, and _____(5)_____.
- Treatment may work by blocking one or more of these substances
“bananas have potassium, phosphorus, and sugar.”
- Bradykinin
- Histamine
- Potassium
- Prostglandins
- Serotonin
Gate Control Theory
Step 2:
- Sensory _____(1)_____ travel to _____(2)_____ where the “___(3)___” are located.
- nerve impulses
- spinal cord
- gates
Gate Control Theory
Step 3:
- If impulses cannot get through the “gate” then pain does not get to the ____(1)_____ to be _____(2)_____.
- brain
- recognized
Gate Control Theory
Step 4:
- A “___(1)____” pain may not open the ____(2)____.
- Ex: when you sit at first its not painful, but 2 hours later its painful
- pain
- gate
Gate Control Theory
Step 5:
- Large nerve fibers (____(1)____) tend to keep the gate ____(2)___.
- To kill pain, ______(3)______ large nerves, with massage, bite, acupuncture, and pressure
- A fibers
- closed
- stimulate
Gate Control Theory
Step 6:
- Small nerve fibers (____(1)___) tend to ____(2)_____ the gate
- C fibers
- open
Gate Control Theory
Step 7:
- The brain can alson ___(1)_____ the gate and _____(2)_____ pain perceived
- control
- decrease
What are the body’s natural pain killers and can inhibit pain impulses (close the gate)
example of runner’s high
- Endorphins
- Enkephalins
Assessment of Pain
What type of assessment is this?
- Ask the patient to describe their pain in their own words
- We chart it
- Rate it on a scale of 1-10
- Ex: 5/10
Subjective pain
Assessment for Pain
Objective signals patient is in pain:
CHIRPS
“Can’t dance with tense toes”
- Complains
- Hypertension (increase BP)
- Insomnia
- Restlessness
- Pallor
- Sweating
- Can’t concentrate
- Difficulty walking/ more slowly, etc.
- Withdrawal
- Tense muscles
-
Tachycardia (increase heart rate)
12.
Opioid Analgesics
Characteristics
- very strong pain relievers
- originally derived from opium
- now many or synthetic
Assessment of Pain
Should you belive what the patient tells you about their pain?
Yes
Opioid Analgesics
Mechanisms of Action
- _____(1)______ and ______(2)_____ the pain receptors
- Also causes _____(3)______ and _______(4)______.
- Releases _______(5)______ (causing drop in BP & itchy skin)
- Binds to receptors
- blocks
- sedation
- “chill pill”
- euphoria
- “happy juice”
- histamine
Opioid Analgesics
Major CNS S/E
- Sedation
- Disorientation
- Lightheadedness
- Cough suppression (codeine)
Opioid Analgesics
Major CV S/E
- orthostatic hypotension
- flushing
Opioid Analgesics
Major Respiratory S/E
think Morphine
-
respiratory depression
- may lead to death
Opioid Analgesics
What are the three major S/E of opioids?
- Constipation
- Respiratory depression
- Urinary retention
Opioid Analgesics
Major GI S/E
- N/V
- constipation (Lomotil)
Opioid Analgesics
Major GU S/E
- urinary retention
Opioid Analgesics
Major Skin S/E
- itching
- rash
- redness along vein or place of injection
- facial flushing
Opioid Analgesics
Major Psych S/E
- Addiction
- Compulsive craving and need for the euphoria
Toxicity/ Overdose
Respiratory Depression
- Life threatening side efffect of opioids
- Treat with nacrotic antagonist (Naloxone/Narcum)
- May take several does
Toxicity/ Overdose
Physical Dependence/ Physical Tolerance
- Long-term use causes opioid medication to be less effective
- Physical dependence/ physical tolerance is not the same as addition
- Often is associated with cancer treatments
Toxicity/ Overdose
What is Naxolone/Narcan used for?
Why?
To treat severe respiratory depression caused by an opioid
B/c its a narcotic antagonist
Toxicity/ Overdose
Hallucinations
- some very disturbing (change the drug)
- Bugs crawling
- some very pleasant
Toxicity/ Overdose
Do not mix narcotics with ____(1)____, _____(2)___, ____(3)____, and _____(4)____.
B/c of of those are _____(5)_____.
- many medications
- alcohol
- psych meds
- sleeping pills
- “downers”
Morphine
- The Gold Standard powerful pain reliever
- Highest addictive potential
- Causes respiratory depression and constipation
- Routes: PO, IM, IV, patch, rectally
Codeine
- Moderately effective pain reliever
- Addictive
- Mostly for moderate pain and cough suppression
- Routes: PO, rectal, IM, IV
Meperidine/ Demerol
(me-per-i-dine)/ (dem-er-ol)
- Synthetic narcotic
- Highly addictive
- Does not usually cause respiratory depression
- Not good for the elderly or those with renal failure
- Going out of favor d/t so many complications
- Route: IV, PO, IM
Assessment before administration of pain medications (narcotics)
- Assess ___(1)___- find out about it, would something ____(2)____work?
- Scale of ____(3)___
- Assess _____(4)____! before administration
- Don’t give if respiratory rate is <__(5)__ per minute
- Safety- These meds decrease ____(6)___- NO _____(7)___!
- Don’t crush if ___(8)___form!
- Assess ____(9)___use and other drugs.
- pain
- less strong
- 0-10
- respiratory rate
- 12
- alertness
- drive
- “extended release”
- alcohol
Administration Guidelines:
- Assess for ___(1)____, ____(2)___ and ____(3)____ afterwards
- Oral narcotics generally tolerated with ____(4)___
- There are _____(5)____- special counting and _____(6)___ procedure
- Raise ___(7)___ afterward- patient not out of bed d/t disorientation
- Have ____(8)____ available
- Narcotics work better if taken ___(9)___ the pain becomes too bad.
- Keep the gates ___(10)___
- Most institutions’ “___(11)__” is for pain to be a “___(12)__” or less
- respiratory depression
- constipation
- urinary retention
- food
- controlled substances
- documentation
- siderails
- Naloxone/Narcan
- before
- closed
- goals
- 3
Codeine examples
- Tylenol 3
- Percocet (with Tylenol)
- Percodan (with aspirin)
- Vicodin
Naloxone
(Narcan)
- Narcotic antagonist
- Use to reverse narcotic induced respiratory depression or overdose
- Route: IV (only in hospital) and spray (in the community)
Controlled Substances
- ____(1)____ are controlled substances.
- Kept in a ____(2)____
- Must be ____(3)_____ at the beginning and ending of each ____(4)____ (or when a medication giving staff member goes home)
- Counted by _____(5)____ and they ____(6)_____ to verify the count is correct
- Any ___(7)___ or part of a dose that was ____(8)___ from the locked cabinet that cannot be given to the patient must be ____(9)____.
- Another __(11)__ (besides the one wasting the med) must sign that they witnessed the medication being ____(12)___.
- Narcotics
- locked drawer/cabinet
- counted
- shift
- 2 RNs
- sign
- dose
- removed
- wasted
- RN
- wasted
Substance Abuse
Who does it affect?
Affects all ages, races, sexes, and socioeconomic groups
Substance abuse
Psychological Dependence
- ____(1)____ for the ____(2)____ is extremely strong.
- Without the ___(3)____, ___(4)___ and _____(5)____ develop
- Does the body really ____(6)___ it to survive? ____(7)___
- “___________(8)______ are common
- “need”
- euphoria/ pleasant feeling
- drug
- cravings
- physical systems
- NEED
- no
- Drug Seeking Behavior
Substance Abuse
Physiological Dependence
- Characterized by _____(1)______ on a _____(2)___
- If substance is ____(3)_____, _____(4)_____ will develop
- Increasing ______(5)____ to medications- need _______(6)__________
- physiological
- reliance
- stopped
- withdrawal symptoms
- tolerance
- more and more to get effect
Substance Abuse
Withdrawal Peak
- Typically 1-3 days after stopping
Substance Abuse
Withdrawal Duration
- Typically 5-7 days
Commonly Abused Drugs
Opioids
Examples of:
- Codeine
- Morphine
- Meperidine
- heroin
- oxycodone
Commonly Abused Drugs
Opioids
Action (why they take it)
Euphoria
Drowsiness
Commonly Abused Drugs
Opioids
S/S of Withdrawal
- drug seeking
- dilated pupils
- sweating
- insomnia
- HTN
- tachycardia
- runny nose
- teary eyes
Commonly Abused Drugs
Stimulants
Examples
- Amphetamine
- cocaine/crack
- ecstasy
- speed
- methamphetamines
- Ritalin
Commonly Abused Drugs
Stimulants
Actions (why they take it)
- wakefullness
- increased mood
- decreased fatigue
- increased self confidence
- increased concentration
- performance enhancing
Commonly Abused Drugs
Stimulants
S/S of Withdrawal
- depression & social withdrawal
- suicidal thoughts/behavior
- sleep all the time
Commonly Abused Drugs
Depressants
Examples
- Barbiturates-
- “roofies” (sleeping pills)
Commonly Abused Drugs
Depressants
Action (why they take it)
- decreased anxiety
- drowsiness (often mixed with alcohol)
Commonly Abused Drugs
Depressants
S/S of Withdrawal
- agitation
- delirium
- sweating
- muscular weakness
- hyperactivity
- hallucinations
- suicudal thoughts
- convulsions
Commonly Abused Drugs
Alcohol
Action (why they take it)
- “Feel loose” drowsy
- hyperactive (varies)
- decreased inhibitions
Commonly Abused Drugs
Alcohol
S/S of Withdrawal
- HTN
- tachycardia
- insomnia
- tremors
- agitatin
- fever
Commonly Abused Drugs
Nicotine
Examples
- cigarettes
- cigars
- smokeless tobacco
Commonly Abused Drugs
Nicotine
Action (why they take it)
- calms nerves
- helps relax
- but actually excites the nerves
Commonly Abused Drugs
Nicotine
S/S of Withdrawal
- craving
- irritability
- restlessness
