Chapter 25 : Analgesics Flashcards by Brina Quintanilla Reyes

Pain is also known as what?

Fifth vital sign

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Pain is a what ?

Subjective feeling

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What does pain threshold mean?

Least amount of stimuli needed to feel pain

So like literally a threshold

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What is pain tolerance?

Maximum amount of pain before wishing to avoid it- varies from person to person and with situation

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What is nociceptors?

Sensory receptors for pain

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What is neuropathic pain?

Originating from nerve
( very difficulty to treat and treated differently too )

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What are the two analgesic we are going to talk about?

Opioid
Nonopioid

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What are the types of pain?

Acute
Chronic
Cancer
Somatic-originates in skin, muscles, bones
Superficial
Vascular
Visceral - originated in an organ

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What is the gate theory of pain?

Spinal nerves act like a “gate” to let pain travel up to the brain and signal it

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Under treatment of pain
Up to 80% of patients have unrelieved pain in US
- some are cultural
- afraid to be an addict
- parents afraid to treat pain in children

Unrelieved pain can have consequences
- over stimulated because they have so much internal pain
- withdrawn
- sleep a lot
- mood swings

It’s important to treat pain appropriately

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Nonopioid analgesics

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Nonopioid analgesics are less ___ than opioid analgesics

Potent

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What is the function of use for Nonopioid analgesics?

Mild to moderate pain treatment

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One thing to note about any type of analgesics is that we what?

Should treat the pain initially in order to avoid severe symptoms or further consequences of that pain

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We have NSAIDS which are also nonopioid analgesics, also famous for relieving pain, fevers, inflammation and decrease platelets aggregation !!

What are the 3 OTC medication for NSAIDs?

Aspirin
Ibuprofen
Naproxen

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ASPRIN is the best to help decrease platelet aggregation, which patients would we see normally on this for daily low dose of ASPRIN?

Stroke
Heart attack

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What is another nonopioid analgesics ?

Acetaminophen ( Tylenol )

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Acetaminophen really the only OTC pain medication can safely take if they are on what?

Anticoagulant

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Side effects of acetaminophen
Anxiety
Headache
Insomnia
Fatigue
Constipation
Peripheral edema
Low incidence of GI distress

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What is the maximum dose for acetaminophen?

4g/day
If taken frequently 2g/day

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What are the toxic effects/excess dosing of acetaminophen? (4)

Heptatic/renal failure
Blood dyscrasias & hearing loss

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If a patient who drinks alcohol and taking acetaminophen, what’s the daily dose?

3g/day

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Clinical judgment : acetaminophen
Generate solutions
- the patient will report that pain has decreased within 1 hour after acetaminophen administration

Take action
- check liver enzyme test for abnormalities
- teach patient to keep acetaminophen out of children’s reach
- teach patient to avoid alcohol ingestion while taking acetaminophen
- encourage patient to report side effects
- check serum acetaminophen level if toxicity is suspected

Evaluate outcomes
Pain level before and then 1 hour after
Looking at what they are doing

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Opioid analgesic

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What is the opioid analgesics used for ?

Moderate to severe pain

Opioid analgesics aren’t just used for pain, but can be used for 2 other things like?

Antitussive ( cough medication ) Anti diarrheal

What are the side effects of opioid analgesics? (5)

Constipation Respiratory depression Urinary retention Orthostatic hypotension Sedation

What is the action of opioid analgesics?

Acts on MU and Kappa receptors

Explain to me about the Mu and kappa and how it works with opioid

Mu receptor stimulation causes for respiratory depression Kappa receptor stimulation causes much more sedation Suppress pain impulses Suppress respiration & coughing

For orthostatic hypotension what do we tell patient?

Slowly change position

Since opioids cause sedation we want patients to avoid what?

Any hazards activities

When a patient is in the hospital and you are giving opiates, what do we want to do for them? (2)

Check respiratory rate Increase fiber and water ( maybe even stool softener ) For their constipation

How many opioid drugs will we talk about (3)

Morphine Meperidine Hydromorphone ( dilaudid )

Morphine

What is the function of morphine?

Helps with pain Dyspnea Relieve anxiety preoperatively

What is the side effects of morphine? (5)

Drowsiness Miosis Orthostatic hypotension Dependence Respiratory depression

What is miosis?

Contraction of pupil

What is the antidote for morphine?

Naloxone

All opiates will have what side effects? (5)

Respiratory depression Orthostatic hypotension Drowsiness Constipation Dependence

Clinical judgment : morphine Take action - administer morphine before pain reaches its peak to maximize drug effectiveness - monitor vital signs frequently to detect respiratory changes - check for pupil changes and reaction - have naloxone available as an antidote to reverse respiratory depression if morphine overdose occurs Evaluate outcomes

If your patient looks like they’re sleeping and on an opiate, what should we do?

Assess their respiratory rate Check them out.

Meperidine

Meperidine also known as Demerol Does what? (2)

Usually help with pain for pregnancy ( instead of morphine ) Or used for GI procedures Diverticulitis usually ^

What is the massive caution with large doses in older adults and patient with advanced cancer with meperidine why?

Neurotoxicity

What are the 5 neurotoxicity for meperidine?

Nervousness Agitation Irritability Tremors Seizures

Typically we want to do a baseline of neuro exam when patients are on meperidine why?

Because of the neurotoxicity that can occur

Hydromorphone

Hydromoprhone is also known as your?

Dilaudid

Hydromorphone ( dilaudid) is very famous for what?

Being 6x more potent than morphine So dosing is super important

Patient controlled analgesia

Patient controlled analgesia PCA typically medications used Morphine Fentanyl Hydromorphone What is it?

Helps with pain Patient decides when to use the pain medication Loading dose Predetermined safety limits Lockout Mechanisms Near- constant analgesic level

Transdermal opioid analgesics Transdermal route - provide Continous pain control - helpful for chronic pain - fentanyl more potent than morphine - available in various strengths Titration - downward overtime postoperative - upward for cancer pain relief Rotate sites

What are some drug interactions we want to avoid because it increases CNS depression, like respiratory depression symptoms? (4)

Alcohol Antihistamines Barbiturates Benzodiazepines

MAOI, be careful because or respiratory depression & seizures

Analgesics in special populations Children - educate parents - monitor signs Older adults - weaker usually - multiple medications - decrease function - often issue with balance ( fall ) Cognitively impaired individuals - good baseline - assess side effects Oncology patients - tolerance built up because they are constantly using it - don’t under treat the patients pain - hospice care/cancer you always want their pain to be managed ; side effect may be respiratory depression and that’s okay because it’s like near ending ( sometimes it speeds up the process of it, which can be very troubling it ) Individuals with substance abuse/history disorder - they also have pain and have a right to be treated for their pain - don’t deny their medication

We can use adjuvant therapies Which is? Pretty much like other medications mixed together

Used along with nonopioid and opioid

What are some adjuvant analgesics?

Anticonvulsants Antidepressants Corticosteroids Antidysrthytmics Local anesthetic

Now onto opioid agonist-antagonists

opioid agonist-antagonists what is it?

Do treat pain but don’t really stimulate that CNS, so that euphoria is not much there

opioid agonist-antagonists don’t give it to?

Chronic/cancer pain

opioid agonist-antagonists are safe for what? But not?

Labor Pregnancy

What is an opioid agonist-antagonists drug?

Nalbuphine hydrochloride

Clinical judgment : nalbuphine hydrochloride Concept Pain Recognize cues Assess the type of pain, duration and location before giving the drug Obtain a drug history from the patient Note baseline vital signs for future comparison Analyze cues & prioritize hypothesis Decreased gas exchange, hypotension Generate solutions Patient will report that pain has decreased Take action Monitor vital signs Check bowel sounds and date of last bowel movement to identify constipation Determine urine output Warn patients not to use alcohol or CHS depressants while talking napbuphine Advise patients to report side effects Evaluate outcomes

Opioid antagonists

Opioid antagonists medication?

Narcan

What is Opioid antagonists used for?

Antidote for opiate overdose Reverse effect of respiratory depression, sedation and hypotension

What is the action of Opioid antagonists ?

Blocks kappa and mu receptors so opiates cannot bind to them

So if a patient is having an overdose and we have them Narcan, what will happen after the Narcan takes effect?

They will be a lot of pain

When you give Narcan for patient with substance abuse they come up what?

Swinging

Side effects of opioid antagonist?

Blood pressure effect Increase bleeding Reverse of PTT!!

Migraine and cluster headaches

Migraine and cluster headaches prevention What mediations do we use?

Beta blockers ( propranolol, atenolol ) Anticonvulsants ( valproic acid, Gabapentin ) Tricyclic antidepressants ( amitriptyline, imipramine )

Generally we start with OTC we use for migraines and headaches Analgesics Opioid analgesics Ergot alkaloids Selective serotonin receptors agonists

Practice question 1 A patients pain medication is changes from morphine sulfate to Hydromorphone. Which statement regarding hydromorphone dose the nurse identify as being true? A. Hydromorphone must be administered IV B. Hypertension is a common side effect C. Physical dependence does not occur with Hydromorphone therapy D. Hydromorphone is more potent than morphine

D. Hydromorphone is more potent than morphine

Practice question 2 The nurse assess a patient receiving morphine VIA a PCA pump. The patient has a respiratory rate of 6 breaths/min. The nurse anticipates administration of which of the following drugs? A. Naloxone B. Sumatriptan C. Nalbuphine D. Hydromorphone

A. Naloxone

Practice question 3 The nurse identities which of the following as a common side effect/adverse effect of morphine therapy? A. Diarrhea B. Hypertension C. Urinary retention D. Tachypnea

C. Urinary retention

Practice question 4 A patient recieved morphine sulfate for severe pain. The nurse assess the patient 20mins later. What is the best indication that the medication has been effective? A. Patient verbalizes pain relief B. Patient has an increase in heart rate C. Patient is resting D. Patient has an increase in blood pressure

A. Patient verbalizes pain relief