chpater 11 analgesic drugs - week 5 Flashcards

Question

Opioid Analgesics:  Contraindications

Answer 1

Known drug allergy Severe asthma Use with extreme caution in patients with the following: Respiratory insufficiency Elevated intracranial pressure Morbid obesity or sleep apnea Paralytic ileus Pregnancy

Answer 2

Central nervous system (CNS) depression Leads to respiratory depression Most serious adverse effect Nausea, vomiting, constipation, biliary tract spasm Urinary retention Hypotension, palpitations, flushing Itching, rash, wheal formation Pinpoint pupils indicating a possible overdose

Answer 3

A common physiological result of chronic opioid treatment State of adaptation Result: larger dose is required to maintain the same level of analgesia

Answer 4

Physiological adaptation of the body to the presence of an opioid Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with psychological dependence (addiction).

Answer 5

Addiction: a pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

Answer 6

Naloxone hydrochloride Naltrexone (ReVia®) Regardless of withdrawal symptoms, when a patient experiences severe respiratory depression, an opioid antagonist should be given.

Answer 7

Opioid withdrawal or opioid abstinence syndrome Occur in 2 weeks in opioid-naïve patients Gradual dosage reduction after chronic opioid use

Answer 8

Alcohol Antihistamines Barbiturates Benzodiazepines Promethazine Monoamine oxidase inhibitors Others

Answer 9

Codeine sulphate Natural opiate alkaloid (Schedule I) obtained from opium Less effective Ceiling effect More commonly used as an antitussive drug Gastrointestinal (GI) disturbance

Answer 10

Codeine sulphate Natural opiate alkaloid (Schedule I) obtained from opium Less effective Ceiling effect More commonly used as an antitussive drug Gastrointestinal (GI) disturbance

Answer 11

Synthetic opioid (Schedule I) used to treat moderate to severe pain Parenteral injections, transdermal patches (Duragesic Mat®), sublingual effervescent tablet (Fentora®)

Answer 12

Hydromorphone (Dilaudid®): very potent opioid analgesic; Schedule I drug 1 mg of intravenous (IV) or intramuscular (IM) hydromorphone is equivalent to 7 mg of morphine.

Answer 13

Synthetic opioid analgesic (Schedule I) Opioid of choice for detoxification treatment of opioid addicts in methadone maintenance programs Renewed interest in the use of methadone for chronic (e.g., neuropathic) and cancer-related pain Prolonged half-life of the drug: cause of unintentional overdoses and deaths Cardiac dysrhythmias

Answer 14

Naturally occurring alkaloid derived from the opium poppy Drug prototype for all opioid drugs; Schedule I controlled substance Indication: severe pain Oral, injectable, and rectal dosage forms; also extended-release forms

Answer 15

Pure opioid antagonist Drug of choice for the complete or partial reversal of opioid-induced respiratory depression Indicated in cases of suspected acute opioid overdose Failure of the drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose.

Answer 16

Analgesic and antipyretic effects Little to no anti-inflammatory effects Available over the counter (OTC) and in combination products with opioids

Answer 17

Similar to that of salicylates Blocks pain impulses peripherally by inhibiting prostaglandin synthesis

Answer 18

Mild to moderate pain Fever Inability to take aspirin products

Answer 19

Maximum daily dose for healthy adults is 4 g/day, but Health Canada is considering lowering* 2 000 mg for older adults and those with liver disease Inadvertent excessive doses may occur when different combination drug products are taken together. Be aware of the acetaminophen content of all medications taken by the patient (OTC and prescription). *Note: As of the date of writing of this text, Health Canada had not yet made this decision.

Answer 20

Should not be taken in the presence of following: Drug allergy Liver dysfunction Possible liver failure G6PD deficiency Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic.

Answer 21

Even though available OTC, lethal when overdosed Overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity. Long-term ingestion of large doses also causes nephropathy. Recommended antidote: acetylcysteine regimen

Answer 22

Before beginning therapy, perform a thorough history regarding allergies and use of other medications, including alcohol, health history, and medical history. Obtain baseline vital signs, intake and output. Assess for potential contraindications and drug interactions. Perform a thorough pain assessment, including pain intensity and character, onset, location, description, precipitating and relieving factors, type, remedies, and other pain treatments. Level of pain is now considered a “fifth vital sign.” Rate pain on a 0–10 or similar scale. Be sure to medicate patients before the pain becomes severe, so as to provide adequate analgesia and pain control. Pain management includes pharmacological and nonpharmacological approaches; be sure to include other interventions as indicated. Patients should not take other medications or OTC preparations without checking with their physicians. Instruct patients to notify physician about signs of allergic reaction or adverse effects.

Answer 23

Oral forms should be taken with food to minimize gastric upset. Ensure safety measures, such as keeping side rails up, to prevent injury. Withhold dose and contact physician if there is a decline in the patient’s condition or if vital signs are abnormal, especially if respiratory rate is less than 10 breaths/min. Check dosages carefully. Follow proper administration guidelines for IM injections, including site rotation. Follow proper guidelines for IV administration, including dilution, rate of administration, etc.  Constipation is a common adverse effect and  may be prevented with adequate fluid and  fibre intake. Instruct patients to follow directions for administration carefully and to keep a record of their pain experience and response to treatments. Patients should be instructed to change positions slowly to prevent possible orthostatic hypotension. Monitor for adverse effects Contact physician immediately if the patient’s vital signs change, condition declines, or pain continues. Respiratory depression may be manifested by a respiratory rate of less than 10 breaths/min, dyspnea, diminished breath sounds, or shallow breathing. Monitor for therapeutic effects. Decreased perception of pain Decreased severity of pain Increased periods of comfort Improved activities of daily living, appetite, and sense of well-being Decreased fever (acetaminophen)