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Pharm > Ch. 26 - Nonopioid & Opioid Analgesics > Flashcards

Ch. 26 - Nonopioid & Opioid Analgesics Flashcards

1
Q

Pain:

A

Stimulus applied to body = electrical impulses are initiated in the CNS

Impulses perceived in 2 ways (2 DIFFERENT things):

        1. ) Pain threshold
        2. ) Pain tolerance
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2
Q

Pain Threshold:

A

Level of stimulus results in perception of (how body) pain:

    1. ) Physiological
    2. ) About same for everyone
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3
Q

Pain Tolerance (1):

A

Amount of pain an indiv can withstand:

- Without disrupting normal functions
- Without needing analgesic tx
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4
Q

Pain Tolerance (2):

A

Varies by: 

  1. ) Client’s environment
  2. ) Culture
  3. ) personality, etc.
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5
Q

Gate Theory (1):

A

Pain sensations travel along a sensory nerve pathways (like a highway driving back and forth) to brain

-limited # of sensations can travel at one time

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6
Q

Gate Theory (2):

A

Certain cells regulate flow of impulses:

-Stops impulses from reaching brain

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7
Q

Gate Theory (3):

A

Learned response to pain:
= open the gate’ or ‘close the gate’
1.)To allow pain sensations to travel to the brain
2.) Emotions
3.) Distraction techniques (close the gate)

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8
Q

Ascertain Severity of Pain:

A

CRIES Scale:

  • Crying
  • Requires Ox (O2)
  • Increased vital signs
  • Expression
  • Sleeplessness
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9
Q

Types of Pain (1):

A

Acute:

  • Occurs suddenly
  • Responds to tx
    • Mild – moderate - severe
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10
Q

Types of Pain (2):

A

Chronic:

  • Lasts > 6 months
  • Difficult to tx or control
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11
Q

Undertreatment of Pain:

A

Undesirable Effects:

  1. ) Increased heart rate, resp rate, BP
  2. ) Increased stress response
  3. ) Lack of moving/ambulating
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12
Q

Analgesics:

A

Drugs that relieve pain without causing loss of consciousness

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13
Q

Nonopioid Analgesics:

A
  1. ) Less potent than opoid analgesics
  2. ) Tx: mild – moderate pain
  3. ) Usually over-the-counter- (OTC)
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14
Q

NSAIDs:

A
  1. ) ASA
  2. )ibuprofen (Motrin, Advil)
  3. ) naproxen (Aleve)
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15
Q

NSAIDs – Action / Effect:

A
  1. ) Analgesic
  2. ) Antipyretic
  3. ) Antiinflammatory
  • Inhibit synthesis of prostaglandin(released with inflammation & causes pain)
  • Decreases platelet aggregation (clotting) – ASA
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16
Q

NSAIDs Side Effects/Adverse Reactions:

A
  1. ) Gastric irritation

2. ) Hypersensitivity ( tinnitis)

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17
Q

acetaminophen (Tylenol) (1):

A 
Analgesic
Antipyretic 
No antimflammatory effect
Does not	
-STRICTLY FOR PAIN & FEVER
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18
Q

acetaminophen (Tylenol) (2)

A
  • Many products contain acetaminophen!
    • Safe for children
  • Po, rectal
  • Dosage:
    * 325(1 tablet)-650 mg every 4-6h PRN
    - Based on age (for children)
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19
Q

acetaminophen (Tylenol) (3):

A

Overdose (OD) = hepatotoxicity 
-deal d/t hepatic necrosis

  • If OD suspected 
    • Call poison control center IMMEDIATELY
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20
Q

Other Nonopioid Analgesics:

A

-tramadol (Ultram)
*Mod – severe pain
Contraindicated –> Severe alcoholism, with use of opoids:
- n/v
- dizzy
-HA
-seizures

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21
Q

Opioid Analgesics (1):

A

“We’re not in Kansas anymore!”

- (opium comes from “Poppy Seads”)

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22
Q

Opioid Analgesics (2):

A
  • Most potent analgesic
  • Binds onto opioid receptors in CNS
    • Inhibits transmission of pain impulses
    • Alters perception of pain
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23
Q

Opioid Analgesics (3):

A

Variation in potency depends on affinity for opioid receptors
Better fit = greater analgesic response

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24
Q

Opioid Analgesics (4):

A

Mod – severe pain from visceral (organs/GI system) sources

  1. ) Cough suppressant
  2. ) Suppresses GI motility (can be used to treat diarrehea)
  3. ) All types= dependence
    • Controlled substance
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25
Q

Adverse Effects (opiod):

A
  1. ) Respiratory depression = most serious
    • Monitor closely: NOT to p/t with head injuries
  2. )Tolerance & dependence:
    - Abstinence syndrome = withdrawal symptoms
    - Pruritis
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26
Q

Morphine Sulfate:

A

Prototype drug:

-ALL OTHER OPIODS are measured in comparison to MORPHINE:

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27
Q

Morphine Sulfate cont…

A
  1. ) Strong opioid analgesic
  2. ) Good for acute pain
    • Myocardial infarction
    • Cancer
    • Drug of choice for mod-severe pain in children
  3. ) Po, SQ, IM, IV
28
Q

Nursing Process:

A

Acute pain r/t surgical tissue injury:
-AEB(as evidence by): subjective data

*Risk for ineffective breathing patterns r/t excess morphine dosage

29
Q

Nursing Interventions:

A
  1. ) Adm before pain is too severe
  2. ) Monitor VS (vital signs)
    • Resp
30
Q

Nursing Interventions cont…

A
  1. ) Check bowel sounds
  2. ) Check pupil changes (very small = sign of overdose) & reaction
  3. ) Have naloxone ( Narca = life saver) avalible  used for respiratory depression
31
Q

Client Teaching:

A
  1. ) Do not use alcohol or other CNS depressants
  2. ) Teach nonpharmacologic pain relief measures
  3. ) Avoid activities requiring mental alertness
  4. ) Report = difficulty breathing, blurred vision, HA (headache)
32
Q

Evaluation:

A

Evaluate effectiveness of med 30-60min after administration & document

33
Q

Other Opioid Analgesics:

A

meperidine (Demerol) = first synthetic developed in 1950’s

  • Shorter duration of action than morphine
  • Po, SQ, IM, IV
    • Check compatibility before mixing w/ other drugs in same syringe
34
Q

meperidine (Demerol):

A
  1. ) No antitussive property
  2. ) Mod – severe pain
    - Not for chronic pain
  3. ) Major SE = hypotension
35
Q

fentanyl (Duragesic, Sublimaze):

A
  1. ) Potent opioid medication
  2. ) Breakthrough cancer pain
  3. ) Clients with a resistance for/tolerance to other pain medications
    • 50-100 times more potent than morphine! (but not necessarily effective due to mcg [fetninal] – mg [morphine])
36
Q

fentanyl (Duragesic, Sublimaze) cont..

A
  1. ) IM, transdermal patch, lozenge, lollipop
  2. ) Epidural anesthesia
  3. ) Short surgical procedures
37
Q

codeine:

A
  1. ) Po, SQ, IM, IV
  2. )Smaller doses = antitussive (for cough)
    • Pill = pain
    • Liquid = cough
38
Q

methadone:

A
  1. ) Po (usually liquid)
  2. ) Tx: opioid addiction
    • Helps control withdrawal symptoms
    • Adm in OJ or other citrus juice
    • Suboxone (newer = dissolving tablet)
39
Q

Opioid Side Effects:

A
  1. ) Respiratory depression

- Resp

40
Q

Opioid Side Effects cont…

A
  1. ) Constipation***
  2. ) Urinary retention
  3. ) Tolerance
  4. ) Psychological/physical dependence with prolonged use
41
Q

Opioid Contraindications (1):

A
  1. ) Head injuries:
    • Opioids decrease resp = accumulation of CO2

2.) Increase in CO2 retention = vasodilation =increase intracranial pressure (ICP)

42
Q

Opioid Contraindications (2):

A
  1. ) Respiratory disorders
    • Intensifies resp distress
    • Asthma = Decreases resp drive while increases airway resistance
43
Q

Opioid Contraindications (3):

A
  1. ) Shock / very low BP
    • If necessary to use  decrease dosage
  2. ) h/o (history) drug abuse
44
Q

Combination Products:

A
  1. ) ASA or acetaminophen + opioid analgesics
    • Decrease adverse effects
    • Controlled substances
45
Q

Combination Products cont…

A
  1. ) Percodan = oxycodone + ASA (asprin)
  2. ) Percocet = oxycodone + acetaminophen
  • Tylenol w/ codeine No 1 (codeine 7.5 mg)
  • Tylenol w/ codeine No 2 ( “ 15 mg)
  • Tylenol w/ codeine No 3 ( “ 30 mg)
  • Tylenol w/ codeine No 4 ( “ 60 mg)
46
Q

Patient Controlled Analgesia (PCA PUMP) (1):

A
  1. ) IV infusion pump (self-administered pain relief automatically thru IV)
    • morphine**
    • meperidine (Demerol)
    • fentanyl (Sublimaze)
47
Q

Patient Controlled Analgesia (2):

A

Pushes button to self medicate
Pre-set dosage = time interval —>
*Client cannot overdose

48
Q

Opioid Antagonist:

A
  1. ) Compete with same receptor sites as opoiod (has higher affinity which makes good for opioids)
  2. ) Antidote for overdose of opioid analgesics
  3. ) To reverse resp depression
49
Q

Example: naloxone (Narcan):

A
  1. ) Pure opioid antagonist
  2. ) Little to no pharmacologic activitry
  3. ) IV = rpute preferred (fastest acting / route)
50
Q

naloxone (Narcan):

A

***Drug is shorter acting than some opioid analgesics = resp depression may return!

-Pain will return!

51
Q

Opioid Agonist-Antagonist:

A
  • Opioid antagonist added to an opioid agonist

* Help prevent opioid abuse

52
Q

Opioid Agonist-Antagonist –Examples:

A

1.) nalbuphine (Nubain)
2.) butorphanol (Stadol)
3.) pentazocine (Talwin)
^^^Scheduled drugs / controlled substances ^^^

53
Q

Headaches:

A
  1. ) Migraine

2. ) Cluster

54
Q

Migraine HA (1):

A
  1. ) Classic
    • Aura occurs minuted to 1 hr before onset
  2. ) Common migraine
    • Not associated w/ aura
55
Q

Symptoms = how it happens:

A

Dilation of one or more branches of carotid artery ——>

Increased sensitivity of nerve endings supplying artery ——>

Release of substances that increases severity of pain
-Vasodilation occuring

56
Q

Migraine HA (2):

A
  1. ) Recurrent & severe
    • n/v (nausea & vomiting), photophobia(very light sensitive)

2.) Aura

  1. ) Women = affected more often (than men)
    - Lasts from several hrs - days
57
Q

Precipitating Factors:

A
  1. ) Menstrual period
  2. ) Certain foods
    • Red wine, aged cheese, chocolate
  3. ) Stress
58
Q

Cluster HA:

A
  1. ) Occurs in clusters / attacks
  2. ) Not assoc w/ aura or n/v
  3. ) Men more often affected (than woman)
59
Q

Migraine: Preventative Tx …

A

Beta adrenergic blockers (block sympathetic NVS):

 * propranolol (Inderal)
 * atenolol (Tenormin)
60
Q

Migraine: Treatment ….

A

Ergotamine

  1. ) Potent vasoconstrictor
  2. ) Decrease pulsations of cranial arteries
  3. ) Antagonizes action of serotonin
61
Q

Ergotamine with Caffeine:

A

Caffeine

  1. )Cranial vasoconstrictor
  2. ) Enhances vasoconstrictor properties of ergotamine
62
Q

Ergotamine:

A

1.) To prevent or stop migrane attack

**NOT for prolonged use

63
Q

Triptans (1) = most recent & common:

A
  1. ) sumatriptan (Imitrex)

2. ) zolmitriptan (Zomig)

64
Q

Triptans (2):

A
  • Do not prevent migraine

* To treat migrane attack

65
Q

Example: Sumatriptan (Imitrex) (1)…

A

1.) Po, SC, intranasal

  1. ) Adverse Reactions:
    • Hypo/Hypertension
    • Cardiac problems
    • Stroke
66
Q

Example: Sumatriptan (Imitrex) (2)…

A

Contraindications:

  1. ) Coronary Artery Disease (CAD)
  2. ) HTN, DM
  3. ) Obesity
  4. ) Smoking
67
Q

Example: Sumatriptan (Imitrex) cont…

A
  • Quiet, darkened room

* Bedrest x 1-2hrs

Pharm (18 decks)

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