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3. nursing pharmacology > B. Analgesics > Flashcards

B. Analgesics Flashcards

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1
Q

Pain

A
  • unpleasant sensory or emotional experience related to tissue injury - whatever the experiencing person says it is and when - fifth vital sign
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2
Q

Pain experience

A
  1. Perception of pain - ind. subjective 2. Pain threshold- intensity at which stimuli is judged as painful 3. Pain tolerance- max degree of pain intensity a person is will get to endure - variable
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3
Q

Addiction vs. physical dependence

A

….

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4
Q

Types of pain- duration

A
  • acute - sudden -chronic - persistent ( not cancer)
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5
Q

Types of pain - origin

A
  • somatic ( superficial, visceral , vascular) - cancer - referred - phantom - neuropathic ( injury to peripheral nerve fibers)
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6
Q

In tissue injury , body releases these substances that stimulate nerve endings

A
  • bradykinin - histamine - potassium - prostaglandins - serotonin
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7
Q

Endorphins and enkephalins

A

Produced by the body - considered the body’s painkillers “ runners high”

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8
Q

Analgesics - non opioid

A
  • acetaminophen - NSAIDS- aspirin, ibuprofen,naproxen
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9
Q

Opioid analgesics

A
  • morphine, hydromorphone, fentanyl - codeine, hydrocodone, oxycodone
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10
Q

Nonopioid analgesics use and effects

A
  • use for mild to moderate pain - antipyretic ( acetaminophen and NSAIDS) - anti- platelet (aspirin primarily) - anti- inflammatory ( NSAIDS only )
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11
Q

Acetaminophen ( Tylenol)

A
  • analgesic & antipyretic effects - no anti- inflammatory , no anti- platelet - less bleeding - less SE than opioid, avoid respiration depression
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12
Q

Acetaminophen ( Tylenol) Indc/contraindications

A

Indications : mild to moderate pain , fever Contraindications: known drug allergy, severe liver disease, genetic disease ( G6PD- enzyme deficiency)

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13
Q

Acetaminophen ( Tylenol) SE/AE

A
  • generally well tolerated - may experience: rash, nausea & vomiting - less common: blood disorders ( anemia ) , ✨hepatic and nephroticities- esp. taken outside normal ranges ( + alcohol)
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14
Q

Acetaminophen ( Tylenol) Toxicities/ management

A

-potentially lethal when overdosed (150 mg/kg+ at a time ) -✨hepatic necrosis- most serious - long term ingestion of high doses cause nephrotoxicity

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15
Q

Treatment for Acetaminophen ( Tylenol) toxicity

A

Acetylcysteine

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16
Q

Acetaminophen ( Tylenol) interactions

A

Alcohol, other hepatotoxic drugs

17
Q

Acetaminophen ( Tylenol) teaching

A
  • take as directed - MAX DOSE: 4000 mg total in a day - geriatric and people with liver problems : 2000 mg per day or less -be aware of other meds that end with cet: darvocet, lorcet, dulcet … Vicodin, typically, wygesic
18
Q

Tramadol ( ultram ) -

A

moderate to severe pain -SE: N&V , constipation, HA, anxiety, seizures - schedule 4 - but risk of addiction - should be treated like codiene

19
Q

opioids

A

•pain relievers that contain opium, •or derived from the opium poppy •or chemically related to opium •Act primarily in the CNS

20
Q

Controlled substance act

A

“5” schedule categories- based on their potential for abuse

21
Q

addiction ( Psych & physical dependence)

A

A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

22
Q

opioid analgesics-

indication

A

Indications:

  • relieve moderate to severe pain
  • Codeine—mild to moderate pain
  • cough suppression
  • relieve diarrhea

**No Ceiling Effect**

23
Q

Common opioids

A
  • Morphine Sulfate (Roxanol)—PO, IV, IM, SQ, SL,Rectal
  • (MSContin)
  • Hydromorphone (Dilaudid) PO, IV, SC, IM, Rectal
  • Meperidine (Demerol)—PO, IM, IV
  • Fentanyl (Duragesic)—PO, IV, IM, Transdermal, Lozenge (lollipop)-Duragesic Patch

Oxycodone—PO

  • Oxycontin
  • Percocet =Oxycodone+ Acetaminophen
  • Percodan=Oxycodone+Aspirin
  • Hydrocodone—PO
  • Vicodin=Hydrocodone+ Acetaminophen
  • Codeine Sulfate—PO, SQ, IM
  • Tylenol #3 = Codeine + Acetaminophen
24
Q

opioid SE/AE

A

•

CNS depression **MOST SERIOUS**

  • Respiratory depression
  • Treatment—Opioid antagonists:

***Naloxone (Narcan)***

  • Orthostatic hypotension
  • Risk for???? Falls , “get up slowly!”
  • Pupil constriction
  • Urinary retention
25
Q

opioids:

contraindications

A
  • Drug allergy
  • Increased intracranial pressure
  • Severe asthma
  • Other respiratory insufficiency
  • Clients with very low BP (shock)
26
Q

opioid interactions

A
  • CNS depressants
  • Alcohol
  • Sedative-hypnotics
  • Muscle relaxants
  • Major tranquilizers
  • Antipsychotic agents
27
Q

opioid physical dependence

A

if stopped , withdrawal symptoms may occur

28
Q

opioid tolerance

A
  • common physiologic result
  • result-larger doses
29
Q

opioid analgesic:

Nursing processes

A

**Important for administration of any analgesic med**

  • ASSESSMENT
  • Perform a thorough pain assessment, including

nature and type of pain, precipitating and

relieving factors, remedies, and other pain

treatments.

  • “Fifth vital sign”
  • Critical assessments: Respirations, BP, Pain

level/description/location; Last dose

  • DIAGNOSIS
  • Example: Acute pain related to disruption of

tissue secondary to right hip

arthroplasty

•PLAN=”which pain med to give?”

30
Q

opioid :

Implement

A
  • After assessment determine which pain med to administer
  • Patient teaching
  • Oral forms should be taken with food to

minimize gastric upset

  • Ensure safety measures
  • Assess VS
  • Low BP and/or Respiratory depression

–Hold dose and contact physician

•May need to give Opioid antagonist

-Monitor for other side effects

  • Constipation
  • Orthostatic Hypotension
  • Instruct patients to not take other meds or OTC

preparations

Follow proper administration guidelines for IM

injections and IV administration

**CHECK DOSAGES CAREFULLY**

  • Special populations
  • Adjuvant therapy
  • Addiction concerns
31
Q

opioid- evaluation

A
  • Monitor for effects & SE
  • Follow up with pain assessment
32
Q

migraine patho

A

•Caused by inflammation and dilation

of blood vessels

•Imbalance of serotonin

33
Q

migraine treatment/prevention

A

triptans

34
Q

triptan use,action, SE

A

•Use

•Treat migraine headaches

•Action

•Causes vasoconstriction of cranial arteries

•Side effects

•Hypertension, dysrhythmias, thromboembolus

, MI, stroke

•Dizziness, tingling, numbness, warm

sensation, drowsiness, seizures

•Muscle cramps, nausea, vomiting,

diarrhea

35
Q

triptan - nurse implications

A

Teaching regarding: Dissolvable wafers, nasal spray, and self

  • injectable forms
  • Provide specific teaching about correct

administration

  • Avoid food triggers
  • Patients should keep a journal to

monitor response to therapy

  • May ↑ BP
  • Do not take other “triptans ” within 24º of sumatriptan
36
Q

cluster headache

A

severe , unilateral, non-throbbing pain around the eye

3. nursing pharmacology (22 decks)

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