Chapter 10 Drugs Affecting CNS Flashcards
pain management indications
priority in nursing care, individualized to each patient, ongoing assessment and reassessment
nonpharmalogical treatments of pain
Acupuncture, art therapy, behavioral therapy, counseling, meditation, dogs, physical therapy
analgesics
medications that relieve pain without causing loss of consciousness
classes of analgesics:
-opioid analgesics
-adjuvant analgesics
types of pain
somatic, visceral, superficial, deep, neuropathic, phantom
gate theory of pain transmission
- injury - release of substances like bradykinen, histamine, serotonin- stimulates nerve endings to start the pain response
- nerve impulse enters spinal cord is the “gate” aka Dorsal Horn- regulates the flow of sensory impulses to the brain
- endorphins are released to fight pain
opioid tolerance
can increase 20-40% to manage acute pain
breakthrough pain
use of PRN drugs
adjuvants
non opioids
opioids
synthetic drugs that bind to receptors (opiate) to relieve pain - severe pain
3 classifications of opioids
agonists, agonists-antagonists, antagonist
equianalgesia
-ability to provide equivalent pain relief by calculating dosages of different medications or routes that provide a comparable analgesia
-opioids given with adjuvants
opioid contradictions
allergies, severe asthma, sleep apnea, myasthenia gravis, paralytic ileus, pregnancy
opioid adverse effects
black box warnings, strong abuse potential, CNS depression, RESPIRATORY DEPRESSION, histamine release that will cause dilated vessels, itching, rash, flushing
toxicity
RESPIRATORY DEPRESSION!!!!!!!
-nalaxone (narcan)- opioid antagonist, can lead to withdrawal, can be given intranasal or IV
opioid drug interactions
-alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine
-benzodiazepines have major Black Box Warning with opioids!- Respiratory depression
drug examples- opioid agonists
-codeine sulfate (low dose)
-fentanyl (moderate to severe)
-hydromorphone (potent)
-meperidine hydrochloride aka demerol (stops post op shivering, watch kidney function!)
-methadone hydrochloride (used with opioid addicts)
-morphine sulfate
-oxycodone hydrochloride (post op)
drug examples- opioid agonists-antagonists
-for patients with history of opioid addiction
-do not give with opioid agonists, they will reduce their effect
-Stadol, Nubain, Talwin
drug examples- antagonists
-Nalaxone (Narcan)
-reverses effects of opioid induced respiratory depression
-use in suspected OD, intranasal or IV
adverse effects of Narcan
withdrawal, BP changes, dysrhythmias, pulmonary edema, severe vomiting, aggression
non opioid analgesic
acetaminophen
acetaminophen action
block peripheral pain impulses by inhibiting prostaglandin synthesis, act on hypothalamus to decrease temperature
acetaminophen indications
mild pain, fever, minimal to no anti-inflammatory effects
acetaminophen contraindications
allergy, severe liver disease, G6PD deficiency (RBC breakdown)
Acetaminophen adverse effects
well tolerated, dose max = 4 g/day for a healthy adult
Acetaminophen toxicity
hepatic necrosis
high dose pain medications means….
FALL RISK
