Drugs for Pain Flashcards
What are some potential benefits of nonpharmacological pain relief techniques?
May decrease medication doses needed (used in adjunct)
help increase control of pain
may substitute the need for medication
What are some good nonpharmacological pain relief techniques?
Rest and relaxation - (interrupt patient as little as possibe)
Therapeutic touch - massage
Listening to music - patients favorite music
Being respectful of family visitors - can be beneficial for visitors to come, may need to be flexible on having visitors
What are the two main classifications of drugs for pain?
NSAIDs (act in the periphery)
Opioids (act in the CNS)
What are the drugs of choice for mild to moderate pain?
NSAIDs
What is the main action of NSAIDs?
Blocking cox - 1 and cox - 2, this causes an antipyretic, analgesic, and anti-inflammatory effect by inhibiting prostaglandins; also inhibits platelet aggregation (aspirin)
What happens when cox-1 is blocked?
decreased platelet aggregation (bleeding) - this is usually stronger than the increase in aggregation that happens when cox-2 is blocked as well
increased gastric acid secretion (peptic ulcers) - an adverse effects
decreased fever
What happens when cox - 2 is blocked?
anti-inflammation
analgesic
increased platelet aggregation
Would an NSAID be a good idea for someone with peptic ulcer disease or a bleeding disorder?
NO
What is an instance where the decreased platelet aggregation might be used to a patients advantage?
giving aspirin during or to prevent coronary events or strokes
What is the problem with increased gastric acid production and the decreased platelet aggregation combined?
the development of peptic ulcers is bad, but when it is combined with the decreased platelet aggregation they can start to bleed.
What was the hype about celecoxib (Celebrex) and why did the hype go away?
Celebrex was a big deal for the use of pain from arthritis, because all it did was block cox-2, so there was no big risk for bleeding and no risk for peptic ulcers because there was only an analgesic and anti-inflammatory effect. BUT the little increase in the platelet aggregation had a significant increase in risk for MI and stroke.
What are some adverse effects of NSAIDs/salicylates?
GI discomfort, GI bleeding, GI perforation - give with food and monitor for bleeding/abdominal pain (proton pump inhibitor (Prilosec) is helpful)
Renal dysfunction - monitor
Increased risk of heart attack/stroke (celecoxib (Celebrex))
Aspirin toxicity (salicylism): STOP AND NOTIFY PHYSICIAN
- —- Mild: n/v, confusion, lethargy, tinnitus, sweating
- —- Severe: high fever, respiratory depression, dehydration
Reye syndrome (diarrhea, vomiting, lethargy, rapid breathing) - occurs if aspirin given to children with viral illness (dont give aspirin to children under the age of 18)
What are some nursing considerations for NSAIDs/salicylates?
Aspirin can be given for decreased platelet aggregation:
- —- During MI or chest pain: full 325 mg dose
- —- Prevention: baby dose 81 mg
Increased risk for bleeding with anticoagulants
Glucocorticoids increase the risk for GI bleeds
What is ketoralac (Toradol)? Why is it used? What should be monitored? How long should it be used?
an inpatient NSAID (usually IV, can be PO)
its usually given concurrently with opioids to reduce side effects (lower dose of each reduces risk for adverse effects)
Monitor kidney function!!!! REMEMBER THIS
For short-term use only, use for
What are some patient teaching points for NSAIDs/salicylates?
take with a full glass of water or food (increased gastric acid production)
avoid with alcohol (increases risk for ulcers)
Monitor signs of GI bleed (tarry stools, coffee ground emesis)
Report heartburn, abdominal pain, gastric discomfort (formation of ulcers)
Stop aspirin one week before surgery
Report symptoms of salicylism
dont chew or crush enteric coated tablets
avoid taking with other anticoagulants
avoid administering aspirin to children (reyes syndrome)
What is the therapeutic action of acetaminophen?
antipyretic and analgesic (no anti-inflammatory properties), slows the production of prostaglandins in the CNS.
How do you choose tylenol or an NSAID?
If the pain is based on inflammation an NSAID would be the best, if its non-inflammatory then tylenol would bea good choice.
Does tylenol usually have adverse effects while in the therapeutic range?
NO NO NO
What are some adverse effects of tylenol?
Hepatotoxicity! DO NOT EXCEED 4g DAILY
—– acetylcysteine (Mucomyst) for overdose
What is a reversal agent for tylenol overdose?
acetylcysteine (Mucomyst)
What are some nursing considerations for acetaminophen?
teach patients to avoid alcohol (hard on liver)
can increase warfarin (Coumadin) levels
What is SAM DEP S relating to MU and KAPPA receptors?
Sedation (MU/KAPPA)
Analgesia (MU/KAPPA)
Miosis (pinpoint pupils) (MU/KAPPA)
Decrease air hunger/respiratory depression (MU)
Euphoria (MU)
Physical dependence (MU)
Slowed gastric motility (KAPPA)
What severity of pain is opioids (narcotic agonists) a drug of choice for?
moderate to severe that arent being controlled by other classes of drugs
Do opioids have risk for physical and psychological dependence?
YES YES YES (schedule class II-V)
When is an example of morphine being used to decrease pain and air hunger?
for people who are on hospice to make them more comfortable through the dying process.
SO THE RESPIRATORY DEPRESSION/DECREASE IN AIR HUNGER CAN BE EITHER ADVERSE OR THERAPEUTIC DEPENDING ON THE SITUATION
What is the onset of morphine?
Immediate (IV)
What is the half-life of morphine?
2-3 hours (usually prescribed Q4H)
What type of pain is morphine effective for?
Severe Pain
How is fentanyl (Duragesic) administered?
IV (onset: 1 minute, peak: 3-5 minutes)
Patch
How can oxycodone (oxycontin) be administered?
oral
rectal
What are some adverse effects of opioid narcotics?
Respiratory depression
hypotension/orthostatic hypotension (vasodilation)
n/v and constipation
sedation/reduced cough reflex
hallucinations/euphoria
itching/flushing
urinary retention
What are some nursing considerations for opioid narcotics?
Respiratory depression - monitor O2 sats, RR, especially in patients with respiratory difficulties to begin with
Hypotension/orthostatic hypotension - monitor BP
n/v Constipation - closely monitor patients for bowel obstructions
sedation/reduces cough reflex - protect airway! (aspiration), constant neuro assessment
monitor for hallucinations
urinary retention - assess for bladder distention every 4-6 hours, and closely monitor patients with past urinary difficulties like BPH
FALL RISK
What are some other nursing considerations for opioid narcotics not related to the adverse effects?
Avoid in pregnancy/labor (respiratory depression, dependency)
avoid in patients with respiratory disorders
Administer slowly (4-5 minutes, can rapidly depress breathing) - double check dose with another RN
have resuscitation equipment available
reversal agent - naloxone (Narcan)… opioid antagonist
Administer these around the clock for cancer patients
What is the reversal agent for opioid agonists?
naloxone (Narcan) which is an opioid antagonist
- — can cause abstinence syndrome::: will act as if they abruptly stopped taking medication and can cause withdrawal symptoms.
- —- rapid infusion - tachycardia, n/v, HTN
What is the opioid overdose triad?
Come, respiratory depression, miosis
may use narcan to reverse effects
can give providers warning of possible opioid overdose,
Are patients at a fall risk while on opioids?
YES YES YES
Do elderly patients have an increased risk of sedation while on opioids?
YES YES YES
What is PCA?
Patient controlled analgesia, a pump at the bedside that the patient can control, can have a set basal rate that is always infusing some medication (like 1mg/hour) and on top of that the patient can push the button to dose themselves more medication
What are some things to know about PCA?
There is a lock-out dose for safety reasons: so over 4 hours the patient can only receive a certain amount of medication, even the frequency of dosing can have a lock out, it also helps the patient feel more safe about not overdosing themselves (huge safety mechanism to prevent overdose)
PCA is a good way of allowing the patient to premedicate themselves before painful procedures
When switching patient from PCA to oral doses, keep patient on at least the basal rate of PCA until the PO medication has taken effect to not interrupt pain control
Make sure to tell family members that the patient is in control of their PCA not them, there has been instances where the patient is asleep and family has given patient more than they need for pain control
Can morphine be used during an MI, chest pain, or cardiac event?
YES, usually it is used after nitrostat, but it causes dilation of the coronary arteries and reduces cardiac demand.
What is some important patient teaching of opioids?
avoid other CNS depressant/alcohol
avoid driving and other hazardous activities
Take as directed (patients are scared of getting addicted)! dont stop abruptly and dont increase dose!
Manage constipation (very common) - may need bisacodyl (Dulcolax) suppositories
Manage orthostatic hypotension - get up slowly
void every 4 hours and report any urinary retention
cough at regular intervals (protect airway and prevent aspiration)
Is using PCA, teach what was gone over in previous card.
What are the most common form of opioid pain pills patients are sent home on?
combination opioid agonists
IT IS IMPORTANT TO TEACH THE PATIENT ABOUT BOTH MEDICATIONS CONTAINED IN THE PILL
What is the therapeutic action of opioid agonist-antagonists?
acts as antagonist on MU and agonist on KAPPA receptors
What is the advantage of opioid agonist/antagonist medications?
Low potential for abuse (low euphoria)
less respiratory depression
given frequently in labor (less respiratory depression)
What is the main disadvantage of opioid agonist-antagonists?
less analgesic effects when compared to opioid agonists.
What are some nursing considerations for opioid agonist-antagonists?
Fall risk!
PCA dosing teaching
caution with other CNS depressants
have emergency equipment available
have reversal agent available - naloxone (Narcan)
Abstinence syndrome - symptoms of withdrawal if trying dependent on opioid agonists and switching to opioid agonist-antagonist (assess for opioid agonist dependence before giving), it is as if the patient abruptly stopped taking opioid agonist.
What are two patient teaching points for opioid agonist-antagonists?
avoid CNS depressants/alcohol
dizziness - fall risk
What is the therapeutic action/outcome of antigout medications?
reduction of inflammation or decreasing serum uric acid levels - reduce pain, decrease in number of attacks, decrease in uric acid levels
What does colchicine do?
decreases inflammation associated with gout
What does allopurinol do?
inhibits uric acid production
What does probenecid do?
decreases the reabsorption of uric acid
What are some nursing considerations/adverse effects of colchicine?
take with with - causes GI distress
report signs of thrombocytopenia - bleeding
myopathy - muscle pain/weakness
avoid with grapefruit juice
What are some nursing considerations/adverse effects of probenecid?
renal caliculi - kidney stones (drink 3L of fluid daily)
avoid taking with aspirin - makes probenecid less effective and can promote episode
What are some nursing considerations/adverse effects of allopurinol?
renal damage - drink 2-3L fluid daily and monitor kidneys
decreases metabolism of warfarin - increases risk for bleeds! monitor PT and INR
What is the therapeutic outcome of medications for tension headaches and migraines?
vasoconstriction of intracranal blood vessels (decrease blood flow, decrease pressure, decrease HA)
What is the drugs of choice for tension HA and migraines? What are some considerations?
Triptans (sumatriptan)
chest pressure/coronary artery spasms/ peripheral vasoconstriction
do not take within 2 weeks of MAOI (increase serotonin levels)
What are the other drugs used for tension HA and migraines? What are some considerations?
ergot alkaloids (ergostat)
pregnancy category X
chest pressure/coronary artery spasms/ perpipheral vasoconstriction
ergots/triptants should not be taken within 24 hours of each other! (because of vasoconstrictive effects)
