Chapter 10: Analgesic Drugs Flashcards

1
Q

Analgesics

A
  • Medications that relieve pain without causing loss of consciousness
  • “Painkillers”
  • Opioid analgesics
  • Adjuvant analgesic drugs
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2
Q

Pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage
* A personal and individual experience
* Whatever the patient says it is
* Exists when the patient says it exists
* Pain involves:
* Physical factors
* Psychologic factors
* Cultural factors

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3
Q

Pain Management Approach

A

No single approach to effective pain management
* Tailored to each patient’s needs
* Consider:
* Cause of pain
* Existence of concurrent medical conditions
* Characteristics of pain
* Psychological and cultural characteristics
* Requires ongoing reassessment of pain and the effectiveness of treatment

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4
Q

Pain Threshold

A

Level of stimulus needed to produce the perception of pain
* A measure of the physiologic response of the nervous system

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5
Q

Pain Tolerance

A

The amount of pain a person can endure without it interfering with normal function
* Varies from person to person
* Subjective response to pain, not a physiologic function
* Varies by attitude, environment, culture, ethnicity

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6
Q

Acute pain

A
  • Sudden onset
  • Usually subsides once treated
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7
Q

Chronic pain

A
  • Persistent or recurring
  • Lasts 3 to 6 months
  • Often difficult to treat
  • Tolerance
  • Physical dependence
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8
Q

Pain Transmission

A
  • The nerve impulses enter the spinal cord and travel up to the brain.
  • The point of spinal cord entry or the “gate” is the dorsal horn.
  • This gate regulates the flow of sensory impulses to the brain.
  • Closing the gate stops the impulses.
  • If no impulses are transmitted to higher centers in the brain, there is no pain perception
  • Body has endogenous neurotransmitters.
    • Enkephalins
    • Endorphins
  • Produced by body to fight pain
  • Bind to opioid receptors
  • Inhibit transmission of pain by closing gate
  • Rubbing a painful area with massage or liniment stimulates large sensory fibers.
  • Result
    • Closes gate
    • Reduces pain sensation
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9
Q

Treatment of Pain in Special Situations

A
  • PCA and “PCA by proxy”
  • Patient comfort vs. fear of drug addiction
  • Opioid tolerance
  • Use of placebos
  • Recognizing patients who are opioid tolerant
  • Breakthrough pain
  • Synergistic effect
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10
Q

Adjuvant Drugs

A
  • Assist primary drugs in relieving pain
    • NSAIDs
    • Antidepressants
    • Anticonvulsants
    • Corticosteroids
  • Example: adjuvant drugs for neuropathic pain
    • Amitriptyline (antidepressant)
    • Gabapentin or pregabalin (anticonvulsants)
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11
Q

Opioid Drugs

A
  • Synthetic drugs that bind to the opiate receptors to relieve pain
  • Mild agonists: codeine, hydrocodone
  • Strong agonists: morphine, hydromorphone, oxycodone, meperidine,
    fentanyl, and methadone
  • Meperidine: not recommended for long- term use because of the accumulation of a neurotoxic metabolite, normeperidine, which can cause seizures

MOA: binds to opioid receptors in the body

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12
Q

Equianalgesia

A
  • Ability to provide equivalent pain relief by calculating dosages of different drugs or routes of administration that provide comparable analgesia
  • Hydromorphone (Dilaudid): seven times more potent than morphine
  • Example: if morphine 10 mg was given to a patient followed 1 hour later by hydromorphone 1 mg, then the patient would have received an equivalent of 17 mg of morphine.
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13
Q

A patient diagnosed with cholecystitis reports pain in the back and scapular areas. The nurse infers that the patient has which type of pain?

A

Referred pain

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14
Q

what is the PRIMARY indication for the administration of morphine?

A

to relieve acute and chronic pain

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15
Q

Medication used to treat patient experiencing severe adverse effects of an opioid analgesic.

A

Naloxone

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16
Q

which characteristic aligns with chronic pain?

A

Persistent

17
Q

Which opioid is used to relieve coughing?

A

Codeine sulfate

18
Q

Transdermal fentanyl is indicated for which type of pain?

A

severe pain resulting from cancer metastasis

19
Q

pain from ulcers of the mouth is an example of _________ pain.

A

superficial pain

20
Q

which condition is a contraindication for the administration of acetaminophen?

A

severe liver disease

21
Q

A patient admitted to the ER with diagnosis of “acetaminophen overdose”. Which lab value is essential for the nurse to assess?

A

AST & ALT levels

22
Q

Acetylcysteine

A

helps to prevent acetaminophen toxicity

23
Q

fentanyl patch needs to be changed once every ____

A

72 hours

24
Q

adverse effect of Levorphanol

A

constipation

25
Q

gallstones produce which type of pain?

A

Visceral pain

26
Q

Non Opioid (nsaids)

A

Examples: ibuprofen, aspirin, naproxen, ketorolac

Indication: pain, fever, anti platelet

MOA: they block the COX enzyme, which prevents the prostaglandin from producing inflammation that causes pain.

27
Q

Adjuvant drugs

A

Example: Gabapentin

Indication: drugs added to an existing pain regimen to improvement pain control. Used for chronic pain. Also used for Neuropathic pain (nerve related pain).

28
Q

ASA/ Aspirin is contraindicated in _____.

A

Children w/ fever and flu like symptoms . They can develop Reyes Syndrome.

29
Q

Gabapentin (adjuvant)

A

A neurotransmitter in the Nervous System. Causes inhibitory effects for neuropathic pain. It limits the release of excitatory neurotransmitters (helps with pain and seizures by calming the neurons down).

30
Q

Hydromorphone
(Dilaudid)

A

Given for pain reliever.

It also decreases BP, Respiration and heart rate

31
Q

Considerations before giving Opioids

A

A (respiratory) : respiratory depression
B : birth defects / neonatal abstinence syndrome
C : bradycardia & hypotension
D (disability) : drowsiness, memory impairment, sedation. Euphoria and convulsions
E (eyes) : miosis which is pupil constriction
Cns depressants causes eye constriction
F (GI) : slows GI causes constipation & n/v
G (GU) : urinary retention due to depression of urinary sphincter
H : hypersensitive reaction (mild to severe)
P: (itching) pruritis from histamine release

32
Q

Before giving meds: know Basic Needs!

A

A : airway
B: breathing
C : circulation
D: disability (neuro status) LOC

Nursing process:
- Assess
- Intervene
- Reassess

33
Q

Malignant Hyperthermia

A

A genetic disorder of severe reaction from medications during general anesthesia causing life threatening complications.

Caused by using Anesthetic gases and succinylcholine (a muscle relaxant).

S/sx: muscle rigidity, high fever, tachycardia, hyperkalemia.

Treatment: Dantrolene (stops release of calcium going to muscles).

34
Q

Antidote for local anesthesia

A

Phentolamine

35
Q

Which drugs are Opioid agonist-antagonist ?

A

Nalbuphine
Butorphanol
Buprenorphine

36
Q

(Opioid) Lortab adverse effects:

A

Urinary retention
Itching
Constipation
Drowsiness

37
Q

Antidote for Acetaminophen

A

Acetylcysteine

38
Q

Max dose of Acetaminophen in 24hr

A

3,000mg in 24 hr period

39
Q

Antidote for Malignant Hyperthermia

A

Dantrolene