Analgesics & Anxiety

Question 1

Gate control theory

Answer 1

• tissue injury activates noicoreceptors and causes release of chemical mediators that initiate an action potential along a sensory nerve fiber and sensitize pain receptors
• sensory is prioritized over pain
• reason that pressure alleviates pain

Question 2

NSAIDs

Answer 2

• less potent than opioid analgesics
• used for mild to moderate pain, dull/throbbing
• works on peripheral nervous system at pain receptor sites
• hard on kidneys, increases risk of bleeding

Question 3

Acetaminophen

Answer 3

• not an NSAID
• inhibits prostaglandin synthesis
• used for pain and fever only
• max dose 4g/day (2-3g/day for liver issues)
• use caution w/ drugs that are combinations w/ acetaminophen (percocet, vicodin)
• S/E: hepatotoxic, blood dyscrasias
• antidote –> acetylcysteine

Question 4

Opioid analgesics

Answer 4

• for moderate to severe pain
• many possess antidiarrheal effects
• act on CNS to suppress pain impulses, respiration, coughing
• contraindicated w/ head injury
• antidote - naloxone (narcan)

Question 5

Codeine

Answer 5

• mild to moderate pain, antitussive
• opiate SE

Question 6

Morphine

Answer 6

• effective for acute pain like MI, cancer pain, or severe pain
• GI issues, miosis, blurred vision, ortho. hypo., resp depression, urinary retention, dependence
• treat cause first if possible, give prior to pain peak

Question 7

Meperidine

demerol

Answer 7

• synthetic opioid
• primarily effective for GI procedures
• preferred to morphine in pregnancy
• neurotoxicity from metabolites
• caution w/ large doses in older adults and pts w/ advanced cancer
• less constipation and urinary retenton than morphine

Question 8

Hydromorphone

Dilaudid

Answer 8

• synthetic opioid
• analgesic effect appx. 6x more potent than morphine
• S/E: sedation, miosis, tolerance, dependence, resp depression, urinary retention, fewer hypnotic/GI issues than morphine

Question 9

Fentanyl

Answer 9

• synthetic opioid
• analgesic effect 50-100x more potent than morphine
• S/E: sedation, itching, vision issues, resp depression, tolerance/dependence

Question 10

Patient-Controlled Analgesia

PCA pump

Answer 10

• most often morphine, also fentanyl, hydromorphone, ketamine, etc.
• loading dose, predetermined safety measures, near-constant analgesic level from basal rate plus PRN dose

Question 11

Transdermal opioids

Answer 11

• continuous pain control
• chronic, cancer pain
• various strengths
• dispose properly

fentanyl patch good for 72hr

Question 12

Nalbuphine Hydrochloride

Answer 12

• opioid agonist-antagonist –> works on one set of receptors and not other
• some pain control w/ less risk of addiction
• not for cancer –> CNS toxicity w/ chemo
• safe for use during labor

Question 13

Opioid Antagonists

Answer 13

• blocks receptor and displaces opioid
• antidote for opiate overdoses
• reverses effects
• don’t leave pt after admin

naloxone (narcan)

Question 14

Migraine headaches

Answer 14

• unilateral throbbing pain that builds in intensity
• N/V, photophobia, may have aura/vision changes
• d/t vasodilation of cerebral vasculature
• more common in women

Question 15

Cluster headaches

Answer 15

• severe, unilateral non-throbbing pain
• typically ocular, occurs in a series of attacks (flares and goes away)
• no aura or n/v
• more common in males

Question 16

Sumatriptan

Answer 16

• vasoconstriction of cranial arteries
• migraine and cluster headaches
• S/E: increased BP, N/V, paresthesia, seizures, heart issues, suicidal ideation

Question 17

Primary vs. Secondary anxiety

Answer 17

• primary –> not caused by condition or drug use; treated w/ meds
• secondary –> related to selected drug use, medical, or psychiatric conditions; not usually treated w/ meds

Question 18

Benzodiazepines

Answer 18

• -pam/-lam
• inhibit GABA neurotransmission by binding to benzodiazepine receptors
• anxiolytic, antiseizure, sedative-hypnotic, preop, withdrawl, conscious sedation
• S/E: ataxia, resp depression, seizures, neuroleptic malignant syndrome, suicidal ideation
• gradually decrease dose over several days
• antidote –> flumazenil

lorazepam, diazepam, clonazepam, alprazolam, temazepam

Question 19

Withdrawl Symptoms

Answer 19

• develops slowly over 2-10 days, may last several weeks
• tremor, agitation, nervousness, sweating, insomnia, anorexia, muscle cramps, seizures
• can be alleviated by small continued dose & weaning
• can assess w/ CIWA scale

Question 20

Buspirone

buspar

Answer 20

• SDRI, binds to serotonin and dopamine receptors
• takes 1-2 weeks for effects
• less sedation and dependence than benzos
• toxic interaction w/ grapefruit juice