B. Analgesics Flashcards
Pain
- unpleasant sensory or emotional experience related to tissue injury - whatever the experiencing person says it is and when - fifth vital sign
Pain experience
- 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
Addiction vs. physical dependence
….
Types of pain- duration
- acute - sudden -chronic - persistent ( not cancer)
Types of pain - origin
- somatic ( superficial, visceral , vascular) - cancer - referred - phantom - neuropathic ( injury to peripheral nerve fibers)
In tissue injury , body releases these substances that stimulate nerve endings
- bradykinin - histamine - potassium - prostaglandins - serotonin
Endorphins and enkephalins
Produced by the body - considered the body’s painkillers “ runners high”
Analgesics - non opioid
- acetaminophen - NSAIDS- aspirin, ibuprofen,naproxen
Opioid analgesics
- morphine, hydromorphone, fentanyl - codeine, hydrocodone, oxycodone
Nonopioid analgesics use and effects
- use for mild to moderate pain - antipyretic ( acetaminophen and NSAIDS) - anti- platelet (aspirin primarily) - anti- inflammatory ( NSAIDS only )
Acetaminophen ( Tylenol)
- analgesic & antipyretic effects - no anti- inflammatory , no anti- platelet - less bleeding - less SE than opioid, avoid respiration depression
Acetaminophen ( Tylenol) Indc/contraindications
Indications : mild to moderate pain , fever Contraindications: known drug allergy, severe liver disease, genetic disease ( G6PD- enzyme deficiency)
Acetaminophen ( Tylenol) SE/AE
- generally well tolerated - may experience: rash, nausea & vomiting - less common: blood disorders ( anemia ) , ✨hepatic and nephroticities- esp. taken outside normal ranges ( + alcohol)
Acetaminophen ( Tylenol) Toxicities/ management
-potentially lethal when overdosed (150 mg/kg+ at a time ) -✨hepatic necrosis- most serious - long term ingestion of high doses cause nephrotoxicity
Treatment for Acetaminophen ( Tylenol) toxicity
Acetylcysteine
Acetaminophen ( Tylenol) interactions
Alcohol, other hepatotoxic drugs
Acetaminophen ( Tylenol) teaching
- 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
Tramadol ( ultram ) -
moderate to severe pain -SE: N&V , constipation, HA, anxiety, seizures - schedule 4 - but risk of addiction - should be treated like codiene
opioids
•pain relievers that contain opium, •or derived from the opium poppy •or chemically related to opium •Act primarily in the CNS
Controlled substance act
“5” schedule categories- based on their potential for abuse
addiction ( Psych & physical dependence)
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
opioid analgesics-
indication
Indications:
- relieve moderate to severe pain
- Codeine—mild to moderate pain
- cough suppression
- relieve diarrhea
**No Ceiling Effect**
Common opioids
- 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
opioid SE/AE
•
CNS depression **MOST SERIOUS**
- Respiratory depression
- Treatment—Opioid antagonists:
***Naloxone (Narcan)***
- Orthostatic hypotension
- Risk for???? Falls , “get up slowly!”
- Pupil constriction
- Urinary retention
opioids:
contraindications
- Drug allergy
- Increased intracranial pressure
- Severe asthma
- Other respiratory insufficiency
- Clients with very low BP (shock)
opioid interactions
- CNS depressants
- Alcohol
- Sedative-hypnotics
- Muscle relaxants
- Major tranquilizers
- Antipsychotic agents
opioid physical dependence
if stopped , withdrawal symptoms may occur
opioid tolerance
- common physiologic result
- result-larger doses
opioid analgesic:
Nursing processes
**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?”
opioid :
Implement
- 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
opioid- evaluation
- Monitor for effects & SE
- Follow up with pain assessment
migraine patho
•Caused by inflammation and dilation
of blood vessels
•Imbalance of serotonin
migraine treatment/prevention
triptans
triptan use,action, SE
•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
triptan - nurse implications
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
cluster headache
severe , unilateral, non-throbbing pain around the eye
