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488 > Class 10: Analgesics > Flashcards

Class 10: Analgesics Flashcards

1
Q

Somatic pain

A

Fibromyalgia, arthritis, tension headaches; from ligaments, joints and bone

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2
Q

Vascular pain

A

Leg cramps from; most migraines

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3
Q

Neuropathic pain

A

Also diabetic with nerve damage: diabetic with foot pain

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4
Q

Central pain

A

Tumors, inflammation and disease

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5
Q

Examples of acute pain

A

MI, appendicitis, kidney stones and surgical procedures

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6
Q

Examples of chronic/persistent pain

A

Arthritis, cancer, lower back pain, peripheral neuropathy

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7
Q

Opioids purpose

A

Purpose is to alleviate moderate to severe pain

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8
Q

Opioid MOA

A

-Agonist, partial agonist, antagonist & endorphins

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9
Q

Endorphins

A

Inhibitors communication of pain signals and produce a feeling of euphoria

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10
Q

Morphine-like drugs

A

Morphine, heroin, hydromorphone, codeine, hydrocodone & oxycodone

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11
Q

Meperidine-like drugs

A

Meperidine, fentanyl, remifentanil, sulfentanil and alfentanil

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12
Q

Methadone-like drugs

A

Methadone

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13
Q

Other opioids

A

Tramadol & tapentadol

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14
Q

Morphine indications & routes

A

-Post operative & chronic pain
-IV, suppository, PO (immediate release and sustained release)

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15
Q

Fentanyl indications, onset & routes

A

-Post operative and procedural pain
-Rapid onset and short duration
-IV, IM, transdermal

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16
Q

Methadone indications & routes

A

-Use in the detoxification of people addicted to opioids
-PO

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17
Q

Hydromorphone (dilaudid)

A

-More potent than morphine by 10x
-Common drug error

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18
Q

Meperidine (demerol) indications & routes

A

-Post operative pain
-IV and IM

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19
Q

Codeine indications & routes

A

-PO
-May be given alone or in combination
-Cough suppression

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20
Q

Adverse effects of opioids

A

-Stimulates the chemoreceptor trigger zone in the CNS, slows peristalsis, N/V & constipation
-Urinary retention & anaphylaxis

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21
Q

Opioid adverse effects on the CNS

A

Sedation, disorientation, euphoria, dysphoria, lightheadedness, tremors and lower seizure thresholds

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22
Q

Opioid CV adverse effects

A

Hypotension, palpitations & flushing

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23
Q

Opioid respiratory adverse effects

A

Depression & asthma

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24
Q

Opioid GI adverse effects

A

N/V, constipation & biliary tract spasm

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25
Q

Opioid GU adverse effects

A

Urinary retention

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26
Q

Opioid integumentary adverse effects

A

Itching, rash & wheal formation

27
Q

Opioid drug interctions

A

Alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine, demerol and MAO Inhibitors

28
Q

Opioid lab values to monitor

A

ALT, Alk Phos, bilirubin, amylase, lipase & CK

29
Q

Patient controlled analgesic typical ordered set

A

-PCA only hydromorphone 2mg/ml
-PCA dose 1mg
-PCA lockout 6 minute
-4 hour dose limit (none)

30
Q

PCA monitoring

A

Pain, RR, sedation: q1hx4, q2hx8, then q4h for the duration

31
Q

PCA + end of shift

A

of attempts recorded, dose given over the shift. Log is reset for each shift on PCA

32
Q

Acetaminophen MOA

A

-Blocks peripheral pain impulses by inhibiting prostaglandin synthesis
-Antipyretic effects by acting on hypothalamus
-Weaken anti-inflammatory response

33
Q

Acetaminophen indications

A

-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

34
Q

Acetaminophen contraindications

A

-Severe liver disease
-Glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency

35
Q

Acetaminophen adverse effects

A

Rash, N/V, blood disorders or nephrotoxicities

36
Q

Acetaminophen OD toxicity

A

-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

37
Q

Tx of acetaminophen OD

A

Acetylcysteine

38
Q

Acetaminophen interactions

A

-Alcohol, liver disease, hepatotoxic drugs
-Phenytoin, barbiturates, isoniazid, rifampin, β-blockers and anticholinergic drugs

39
Q

Adjuvant analgesic drugs

A

NSAIDS, antidepressants, anticonvulsants & corticosteriods

40
Q

Benefits of adjuvant analgesic drugs

A

-Decreased opioid use and side effects
-Provides an approach to the pain stimulus by another mechanism of drug action

41
Q

Antidepressants in adjuvant analgesic therapy

A

Neuropathic pain (amitriptyline)

42
Q

Antiseizure agents in adjuvant analgesic therapy

A

Neuropathic pain (gabapentin & pregabalin)

43
Q

Corticosteroids in adjuvant analgesic therapy

A

Inflammation (prednisone)

44
Q

Muscle relaxants in adjuvant analgesic therapy

A

Neuropathic pain/muscle spasms (benzodiazepine, baclofen & dantrolene)

45
Q

Local anesthetics in adjuvant analgesic therapy

A

Lidocaine

46
Q

NSAIDS in adjuvant analgesic therapy

A

Inflammation (ibuprofen, ketorolac (toradol), diclofenac (voltaren), indomethacin, COX-2 inhibitors (celecoxib (Celebrex), meloxicam))

47
Q

Complementary & alternative therapy (CAM)

A

-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

48
Q

Traditional chinese medicine (TCM)

A

Acupuncture, acupressure, Chinese herbology, massage, cupping, meditative exercise, nutrition & spiritual

49
Q

Objective physical pain assessment + joints

A

-Joints; not size, contour, circumference, active & passive ROM

50
Q

Objective physical pain assessment + muscle/skin

A

-Color/swelling
-Masses/deformity
-Sensation changes

51
Q

Objective physical pain assessment + abdomen

A

-Countour/symmetry
-Guarding/organ size

52
Q

Objective physical pain assessment + pain behaviour

A

-Nonverbal cues
-Acute pain behaviour
-Persistent pain behaviour

53
Q

Acute pain behaviours

A

Guarding, grimacing, vocalizations such as moaning/crying, agitation, restlessness, stillness, diaphoresis, changes in VS

54
Q

Persistent (chronic) pain behaviours

A

Bracing, rubbing, diminished activity, sighing, change in appetite, being with other people, movement, exercise, prayer & sleeping

55
Q

Slide 40

A
56
Q

Pain involves 3 factors

A

Physical, pyschological & emotional factors

57
Q

WHO 3 step analgesia ladder tx

A

-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

58
Q

Nursing interventions for pain

A

-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)

59
Q

Pyschological dependence

A

Taking opioids to deliberately acheive an aMental status

60
Q

S&S of pyschological dependence

A

Impaired control over drug use, compulsive use & craving and continued despite harm

61
Q

Physical dependence

A

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

62
Q

S&S of physical dependence

A

Rebound pain, mental agitation, tachycardia, elevated BP and seizures

63
Q

Opioid tolerance

A

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

64
Q

S&S of opioid tolerance

A

Return of uncontrolled pain

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