Class 10: Analgesics Flashcards
Somatic pain
Fibromyalgia, arthritis, tension headaches; from ligaments, joints and bone
Vascular pain
Leg cramps from; most migraines
Neuropathic pain
Also diabetic with nerve damage: diabetic with foot pain
Central pain
Tumors, inflammation and disease
Examples of acute pain
MI, appendicitis, kidney stones and surgical procedures
Examples of chronic/persistent pain
Arthritis, cancer, lower back pain, peripheral neuropathy
Opioids purpose
Purpose is to alleviate moderate to severe pain
Opioid MOA
-Agonist, partial agonist, antagonist & endorphins
Endorphins
Inhibitors communication of pain signals and produce a feeling of euphoria
Morphine-like drugs
Morphine, heroin, hydromorphone, codeine, hydrocodone & oxycodone
Meperidine-like drugs
Meperidine, fentanyl, remifentanil, sulfentanil and alfentanil
Methadone-like drugs
Methadone
Other opioids
Tramadol & tapentadol
Morphine indications & routes
-Post operative & chronic pain
-IV, suppository, PO (immediate release and sustained release)
Fentanyl indications, onset & routes
-Post operative and procedural pain
-Rapid onset and short duration
-IV, IM, transdermal
Methadone indications & routes
-Use in the detoxification of people addicted to opioids
-PO
Hydromorphone (dilaudid)
-More potent than morphine by 10x
-Common drug error
Meperidine (demerol) indications & routes
-Post operative pain
-IV and IM
Codeine indications & routes
-PO
-May be given alone or in combination
-Cough suppression
Adverse effects of opioids
-Stimulates the chemoreceptor trigger zone in the CNS, slows peristalsis, N/V & constipation
-Urinary retention & anaphylaxis
Opioid adverse effects on the CNS
Sedation, disorientation, euphoria, dysphoria, lightheadedness, tremors and lower seizure thresholds
Opioid CV adverse effects
Hypotension, palpitations & flushing
Opioid respiratory adverse effects
Depression & asthma
Opioid GI adverse effects
N/V, constipation & biliary tract spasm
Opioid GU adverse effects
Urinary retention
Opioid integumentary adverse effects
Itching, rash & wheal formation
Opioid drug interctions
Alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine, demerol and MAO Inhibitors
Opioid lab values to monitor
ALT, Alk Phos, bilirubin, amylase, lipase & CK
Patient controlled analgesic typical ordered set
-PCA only hydromorphone 2mg/ml
-PCA dose 1mg
-PCA lockout 6 minute
-4 hour dose limit (none)
PCA monitoring
Pain, RR, sedation: q1hx4, q2hx8, then q4h for the duration
PCA + end of shift
of attempts recorded, dose given over the shift. Log is reset for each shift on PCA
Acetaminophen MOA
-Blocks peripheral pain impulses by inhibiting prostaglandin synthesis
-Antipyretic effects by acting on hypothalamus
-Weaken anti-inflammatory response
Acetaminophen indications
-Mild to moderate pain
-May be used in the place of aspirin with reduced side effects
-Antipyretic effect for adults and children with the flu
Acetaminophen contraindications
-Severe liver disease
-Glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency
Acetaminophen adverse effects
Rash, N/V, blood disorders or nephrotoxicities
Acetaminophen OD toxicity
-Life-threatening and potentially lethal
-Maximum dose 4000 mg per 24 hr period
-Acute ingestion results in liver toxicity
-Long term ingestion results in nephrotoxicity
Tx of acetaminophen OD
Acetylcysteine
Acetaminophen interactions
-Alcohol, liver disease, hepatotoxic drugs
-Phenytoin, barbiturates, isoniazid, rifampin, β-blockers and anticholinergic drugs
Adjuvant analgesic drugs
NSAIDS, antidepressants, anticonvulsants & corticosteriods
Benefits of adjuvant analgesic drugs
-Decreased opioid use and side effects
-Provides an approach to the pain stimulus by another mechanism of drug action
Antidepressants in adjuvant analgesic therapy
Neuropathic pain (amitriptyline)
Antiseizure agents in adjuvant analgesic therapy
Neuropathic pain (gabapentin & pregabalin)
Corticosteroids in adjuvant analgesic therapy
Inflammation (prednisone)
Muscle relaxants in adjuvant analgesic therapy
Neuropathic pain/muscle spasms (benzodiazepine, baclofen & dantrolene)
Local anesthetics in adjuvant analgesic therapy
Lidocaine
NSAIDS in adjuvant analgesic therapy
Inflammation (ibuprofen, ketorolac (toradol), diclofenac (voltaren), indomethacin, COX-2 inhibitors (celecoxib (Celebrex), meloxicam))
Complementary & alternative therapy (CAM)
-Harmonious with many of the values of nursing:
-Holistic, emphasis on healing, recognition that the provider-patient relationship is a partnership, focus on health promotion rather than illness prevention
Traditional chinese medicine (TCM)
Acupuncture, acupressure, Chinese herbology, massage, cupping, meditative exercise, nutrition & spiritual
Objective physical pain assessment + joints
-Joints; not size, contour, circumference, active & passive ROM
Objective physical pain assessment + muscle/skin
-Color/swelling
-Masses/deformity
-Sensation changes
Objective physical pain assessment + abdomen
-Countour/symmetry
-Guarding/organ size
Objective physical pain assessment + pain behaviour
-Nonverbal cues
-Acute pain behaviour
-Persistent pain behaviour
Acute pain behaviours
Guarding, grimacing, vocalizations such as moaning/crying, agitation, restlessness, stillness, diaphoresis, changes in VS
Persistent (chronic) pain behaviours
Bracing, rubbing, diminished activity, sighing, change in appetite, being with other people, movement, exercise, prayer & sleeping
Slide 40
Pain involves 3 factors
Physical, pyschological & emotional factors
WHO 3 step analgesia ladder tx
-The use of non-opioids (with or without adjuvant medications)
-The use of opioids with or without non-opioids and/or adjuvant medications
-The use of opioids indicated for moderate to severe pain +/- nonopiods and/or adjuvant medications
Nursing interventions for pain
-Monitor response to medications by:
-VS and identifying therapeutic or sub therapeutic response
-Give medications with meals to eliminate GI upset
-Monitor for adverse effects such as hallucinations and treat accordingly
-May have increased effects of medication in the elderly and children (dose reduction)
Pyschological dependence
Taking opioids to deliberately acheive an aMental status
S&S of pyschological dependence
Impaired control over drug use, compulsive use & craving and continued despite harm
Physical dependence
State of physiological adaptation manifested by a drug-class-specific withdrawal syndrome
-Can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and administration of an antagonist
S&S of physical dependence
Rebound pain, mental agitation, tachycardia, elevated BP and seizures
Opioid tolerance
A state of adaptation in which exposure to a drug for an extended period of time induces changes that result in the diminishing of one or more of the drug’s effects over time
S&S of opioid tolerance
Return of uncontrolled pain
