Chapter 18: Drugs for the Control of Pain Flashcards
What is Nociceptive pain?
pain d/t injury to tissues
What are two types of nociceptive pain?
- somatic: sharp sensation (localized
- Visceral: Dull, throbbing, aching (form internal organ inflammation or damage
What is Neuropathic Pain?
- dt injury to nerves
- burning, shooting, numbing
What are some examples of Neuropathic pain?
- carpal tunnel syndrom
- Degenerative disk disease
- Diabetic retinopathy
- interactable cancer pain
- phantom limb pain
- Postsurgical pain
- sciatica
What are some nonpharmacologic therapies for pain?
- acupuncture
- biofeedback
- massage
- heat or cold
- meditation/prayer
- relaxation therapy
- art or music
- guided imagery
- chiropractic manipulation
- hypnosis
- physical therapy
- therapeutic physical touch
- TENS
- natural agents applied to skin, producing warming sensation
What treatment is available for intractable cancer pain?
- radiation or chemo
- Relieving nerve stimulation
- surgery
- nerve block
What are Opioids?
Natural or synthetic morphine-like substances responsible for reducing moderate to servere pain
which opioid receptors are most important for pain management?
mu and kappa receptors
What do Opioid agonist drugs do?
stimulate mu and kappa receptors
What are some examples of opioid agonist drugs?
Morphine, OxyContin, Percocet
What do opioid antagonist drugs do?
- block mu and kappa receptors
- reverse symptoms of addition, toxicity, and OD
What is an example of an opioid antagonist drug?
Narcan
What do Opioids with mixed agonist-antagonist activity do?
- stimulate opioid receptor, thus causing analgesia
- withdrawal symptoms and side effects not as intesnse as those of opioid agnosits
What is an example of a mixed agonist-antagonist?
pentazocin
What is the treatment for Opioid dependence?
- switch from IV and inhalation opioids to methadone
- may be needed for many months to years
- does not cure but avoids withdrawal symptoms
- allows pt to be productive
What are some newer treatments for opioid dependence?
- Early treatment: buprenophrine: mixed opioid agonist-antagonist
- admin sublinqual or transdermal
- Later maintenance: bunavail, suboxone, and zubsolv contain bothe buprenorphine and naloxone
What are 4 steps for opioid therapy in the role of a nurse?
- Assess potential for opioid dependency
- Assist with activity
- monitor urine output for retention
- monitor patients bowel habits for constipation
What are non-opioid analgesics used for?
- used for fever, inflammation, and analgesia
- used for mild or moderate pain associated with inflammation
What are examples of non-opioid analgesics?
- NSAIDs
- acetaminophen
- a few centrally acting drugs
What is the role of the Nurse for nonopiod analgesics?
- monitor pts condition and provide education
- assessment for hypersensitivity, bleeding disorders
- assessment for gastric ulcers, severe renal/hepatic disease, pregnancy
- obtain lab tests on renal liver function
- pain assessment
What is the prototype drug for NSAIDs
ibuprofen
what is the MOA of ibuprofen
to inhibit cyclooxygenase and prvent formation of prostaglandins
What is the primary use for iburprofen?
for mild or moderate pain and to reduce inflammation
What are the adverse effects of NSAIDs
GI upset, acute renal failure
W/hat is the prototype drug for selective COX-2 inhibitors?
celecoxib
What is the MOA of celecoxib
similar to the NSAID
What is the primary use for celecoxib?
to relieve pain, fever, and inflammation
What are the adverse effects of celecoxib?
mild and related to GI system
What are the prototype drugs for centrally acting nonopiod analgesics
acetaminophen and tramadol
What is the MOA for acetaminophen
to treat fever at the level of the hypothalamus; causes dilation of peripheral blood vessels, enabling sweating and dissipation of heat
What is the primary use of acetaminophen?
treatment of fever and to relieve pain
What are the adverse effects of acetaminophen
uncommon with therapeutic doses
what is the MOA of tramadol?
weak opioid activity
What is the primary use of tramadol?
as centrally acting analgesic
what are the adverse effects of tramadol
CNS, GI, and CV effects
What type of antimigraine drugs are there
- Triptans
- Ergot alkaloids
- NSAID
what are triptains and how do they act?
- serotonin agonists
- act by constricting certain intracranial vessels
What are Ergot alkaloids and how do they act?
- interact with adrenergic, dopaminergic, and serotonin receptors
- act as vasoconstrictors
- terminate ongoing migraines
What NSAID medication treats mild migraine?
ibuprofen
What is the MOA of Ergot alkaloids?
to promote vasoconstriction
What is the primary use for Ergot alkaloids?
to terminate ongoing migrains
What are the Adverse Effects for Ergot Alkaloids?
- GI upset
- weakness in the legs
- myalgia
- numbness and tinglin in fingers and toes
- angina-like pain, tachycardia
