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NURS 320 > Exam 1: Chapter 10&44: Pain And Analgesic Drugs > Flashcards

Exam 1: Chapter 10&44: Pain And Analgesic Drugs Flashcards

1
Q

Analgesics

A

Medications that relieve pain without causing loss of consciousness.
“Pain killers”

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2
Q

Analgesics include

A

Opioid analgesics and Adjuvant analgesic drugs

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3
Q

Pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Personal and individual experience.
It is whatever the patient says it is. Exists when the patient says it exists.

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4
Q

No inception

A

Pain results from stimulation of sensory nerve fibers called nociceptors. These receptors transmit signals from various body regions to the spinal cord and brain.

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5
Q

Acute Pain Characteristics

A 
Sudden (minutes to hours)
Sharp 
Localized
Physiologic Response: tachycardia, sweating, pallor, increased BP
Duration is limited (has an end)
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6
Q

Chronic Pain Characteristics

A

Slow (days to months)
Long duration
Dull, persistent aching
Pain is recurring (endless)

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7
Q

Treatment of Pain in Special Siutations

A 
Not sure if needed but...
PCA  and PCA by proxy
Patient comfort v. Fear of drug addiction
Opioid intolerance
Use of placebos
Recognizing patients who are opioid tolerant
Breaththrough pain
Synergistic effect
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8
Q

Adjuvant Drugs

A

Assists primary drugs in relieving pain.

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9
Q

Adjuvant drugs include

A

NSAIDs
Antidepressants
Anticonvulsants
Corticosteroids

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10
Q

What are some common adjuvant drugs used to treat neuropathic pain?

A

Amitriptyline (antidepressant)

Gabapentin (anticonvulsants)

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11
Q

WHO Three-Step Analgesic Ladder: Step 1

A

Nonopioids (with or without adjuvant medications) after the pain has been identified and accessed.
If pain persists or increases, treatment moves to Step 2.

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12
Q

WHO Three-Step Analgesic Ladder: Step 2

A

Opioids with or without Nonopioids and with or without adjuvants.
If pain persists or increases, management then rises to Step 3.

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13
Q

WHO Three-Step Analgesic Ladder: Step 3

A

Opioids indicated for moderate to severe pain, administered w/ or w/out Nonopioids or adjuvant medications.

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14
Q

Opioid Drugs

A

Synthetic drugs that bind to the opiate receptors to relieve pain.

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15
Q

Opioid Drugs: Mild agonists include

A

Codeine, hydrocodone

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16
Q

Opioid Drugs: Strong agonists include

A 
Morphine
Hydromorphone
Oxycodone
Oxymorphone
Meperidine
Fentanyl 
Methadone
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17
Q

Meperidine Contraindications

A

Not recommended for long term use because of the accumulation of neurotoxic metabolite normeperidine, which can cause seizures.

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18
Q

Opioid Analgesic Agonists: MOA

A

Binds to an opioid pain receptor in the brain. Causes an analgesic response (reduction of pain sensation).

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19
Q

Opioid Analgesic Agonists-Antagonists MOA

A

Binds to a pain receptor. Causes a weaker Neurologic response than a full agonists. (Aka partial agonist or mixed agonist)

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20
Q

Opioid Analgesic Antagonists: MOA

A

Reverse the effects of the drugs on pain receptors.

Binds to pain receptor and exerts no response.

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21
Q

Opioid Analgesics: Indications

A

*Main: To alleviate moderate to severe pain.

Also used for cough center suppression; treatment of diarrhea; balanced anesthesia

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22
Q

Opioid Analgesics: Contraindications

A

Known drug allergy

Severe asthma

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23
Q

Opioid Analgesics should be used with extreme caution in patients with

A 
Respiratory insufficiency
Elevated ICP
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy
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24
Q

Opioid Analgesics: Adverse Effects

A

**CNS depression: leads to respiratory depression (most severe adverse effect)
**Constipation
N/V
Urinary Retention
Diaphoresis and flushing
Pupil constriction (miosis)
Itching

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25
Q

Opioid Tolerance

A

Common physiologic effect of chronic opioid treatment.
Can occur in as little as a week.
RESULT: larger dose is require to maintain the same level of analgesia

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26
Q

Opioids: Physical Dependence

A

Physiologic adaptation of the body to the presence of an opioid.
As with opioid intolerance, physical dependence is expected with long term opioid treatment and should NOT be confused with psychological dependence (addiction)

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27
Q

Opioids: Psychological Dependence

A

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.

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28
Q

Opioid Analgesics: Toxicity and Management of Overdose

A

Main: Naloxone (Narcan)

Naltrexone (ReVia)

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29
Q

Opioid Analgesics: Interactions

A 
Alcohol
Antihistamines
**Barbiturates
**Benzodiazepines
Monoamine oxidase inhibitors
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30
Q

Codeine Sulfate

A

Natural opiate alkaloid (Schedule II) obtained from opium.
Less Effective.
Ceiling Effect
More commonly used as an antitussive drug.

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31
Q

Major adverse effect of Codeine Sulfate

A

GI disturbance: constipation*

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32
Q

Fentanyl

A
  • Synthetic opioid (Schedule II) used to treat moderate to severe pain.
  • Available as Parenteral, Transdermal Patches, buccal lozenges, or buccal lozenges on a stick.
  • 0.1 mg IV dose of Fentanyl is roughly equivalent to 10 mg of morphine IV
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33
Q

Morphine Sulfate

A

Naturally occurring alkaloid derived from the opium poppy.
Drug protype for all opioid drugs
Schedule II controlled substance.

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34
Q

Morphine Sulfate: Indication

A

Severe pain

High abuse potential

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35
Q

Most important adverse effect of morphine sulfate

A

Respiratory depression

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36
Q

Dilaudid

A

Last resort medication.
Aka hydromorphone.
Very potent opioid analgesic; Schedule II drug.
1 mg of IV or IM hydro-morphine is equivalent to 7 mg of morphine.

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37
Q

Methadone Hydrochloride (Dolophine)

A

Synthetic opioid analgesic. (Schedule II)

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38
Q

Methadone Hydrochloride (Dolophine) indications.

A
  • Opioid of choice for the detoxification treatment of opioid addicts in methadone maintenance programs.
  • Renewed interest for chronic and cancer related pain.
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39
Q

What are possible adverse effects of methadone hydrochloride?

A

**Cardiac Dysrhythmias

Unintentional overdoses and deaths (d/t prolonged half-life of the drug)

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40
Q

Naloxone Hydrochloride (Narcan)

A

Pure opioid antagonist

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41
Q

Naloxone Hydrochloride Indications

A
  • Drug of choice for the complete or partial reversal of opioid induced respiratory depression.
  • Indicated in cases of suspected acute opioid overdose.
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42
Q

Failure of Naloxone Hydrochloride (Narcan) to significantly reverse the effects of the presumed opioid overdose indicates what?

A

That the condition may not be related to opioid overdose

43
Q

Nonopioid Analgesics Include

A

Acetaminophen
Clonidine
Tramadol

44
Q

Acetaminophen (Tylenol) Indications

A

Analgesic and Antipyretic Effects (Pain or fever)

Little to no anti-inflammatory effects

45
Q

Acetaminophen: MOA to treat Pain

A

Similar to salicylates (aspirin)

Blocks pain impulses peripherally by inhibiting prostaglandin synthesis.

46
Q

Acetaminophen: MOA to treat fevers

A

Action hypothalamus

Heat dissipate through vasodilation and increased peripheral blood flow.

47
Q

Acetaminophen is an alternative for what drug?

A

Aspirin

48
Q

Acetaminophen Contraindications

A

Drug allergy
Liver dysfunction
Possible liver failure
G6PD deficiency (genetic disease)

49
Q

Acetaminophen Interactions

A

Alcohol or other drugs that are hepatotoxic

50
Q

Acetaminophen: Toxicity

A

Even though available OTC, it is lethal when overdosed.
Overdose causes hepatic necrosis: hepatotoxicity.
Long-term ingestion of large doses also causes nephropathy.

51
Q

Acetaminophen Overdose Antidote

A

Acetylcysteine Regimen

52
Q

Herbal Products: Feverfew

A

Anti-inflammatory properties

53
Q

Herbal Products: Feverfew indications

A

Treat migraine headaches, menstrual cramps, inflammation and fever.

54
Q

Herbal Products: Feverfew Adverse Effects

A

GI distress, altered taste and muscle stiffness.

55
Q

Feverfew Interactions

A

Interact with aspirin and other NSAIDs

Also anticoagulants.

56
Q

Nonsteroidal Anti-Inflammatory Drugs

A 
Large and chemically diverse group of drug with the following properties:
Analgesic
Anti-inflammatory
Antipyretic
Aspirin-platelet inhibition
57
Q

Properties that ALL NSAIDs share include

A

Antipyretic
Analgesic
Anti-inflammatory

58
Q

What are the 5 chemical categories of NSAIDs?

A 
Salicylates
Acetic Acid Derivatives
Cyclooxygenase-2 inhitors
Enolic Acid Derivatives
 Propionic Acid Derivatives
59
Q

NSAIDs: MOA

A

Inhibition of the Leukotriene pathway, the prostaglandin pathway or both.
Blocks the chemical activity of the enzyme COX

60
Q

COX-1 enzyme

A

Has a role in maintaining GI mucosa

61
Q

COX-2 enzyme

A

Has a role in the inflammatory process.

62
Q

NSAIDs: Contraindications

A

Known drug allergy
Patients with aspirin allergy
Conditions that place patient at risk for bleeding such as Vit K deficiency and Peptic Ulcer Disease.

63
Q

NSAIDs: Adverse Effects

A

**GI: heartburn to severe GI bleeding/ulceration
**Tinnitus, hearing loss
Acute renal failure (because NSAIDs work in the kidneys)
Hepatotoxicity
Non-cardiogenic pulmonary edema
Increased risk for MI or stroke
Altered Hemoptysis
Skin eruption, sensitivity reaction

64
Q

Renal function depends partly on

A

Prostaglandins

65
Q

How can NSAIDs affect renal function?

A

NSAIDs disrupt prostaglandin function which at times may be strong enough to precipitate acute or chronic renal failure

66
Q

Renal toxicity can occur in patients with

A 
Dehydration
HF
Liver dysfunction
Diuretic use
ACE inhibitors
67
Q

NSAIDs: Black Box warning

A 
All NSAIDs (except aspirin) share a black box warning regarding increased risk of adverse cardiovascular thrombotic events, including fatal MI or stroke.
NSAIDs may counteract the cardioprotective effects of aspirin
68
Q

Salicylates include

A

Aspirin*

More on PP

69
Q

Salicylate: MOA

A 
Inhibits platelet aggregation
Antithrombotic Effect (used to tx MI and other thromboembolic disorders)
70
Q

Reye’s Syndrome

A

Seen in more children/teenagers.
Inflammation of the liver and brain.
Increases risk if using ASA while sick with virus such as influenza -> progressive Neurologic deficits.

71
Q

Aspirin can be used prophylactically for

A

Adults who have strong risk factors for developing CAD or CVA
Effective after MI

72
Q

Aspirin Uses

A

Headache, neuralgia, myalgia and athralgia.
Pain syndromes resulting from inflammation: arthritis, pleurisy and pericarditis.
Systemic lupus erythematosus: anti-rheumatic effects
Anti-pyretic action

73
Q

Salicylate Toxicity

A

**Tinnitus, hearing loss
Increased HR
N/V/D
Sweating, thirst, hyperventilation, hypoglycemia or hyperglycemia.
Dimness of vision, headache, dizziness, mental confusion and drowsiness.

74
Q

Acetic Acid Derivatives include

A

Indomethacin (Indocin)

Ketorolac (toradol)

75
Q

Indomethacin (Indocin)

A

Analgesic
Anti inflammatory
Antirheumatic
Antipyretic

76
Q

Indomethacin (Indocin) Uses

A 
RA
OA
Acute bursitis or tendinitis
Ankylosis spondylitis
Acute gouty arthritis
PDA
Preterm Labor
77
Q

Ketorolac (Toradol)

A

Some anti inflammatory activity

78
Q

Ketorolac (Toradol) is used primarily for

A

its powerful analgesic effects which are comparable to those of narcotic drugs such as morphine.

79
Q

Ketorolac (Toradol) Indications

A

Short term use (up to 5 days) to manage moderate to severe acute pain.

80
Q

Ketorolac (Toradol) Adverse Effects

A 
Renal impairment
Edema
GI pain
Dyspepsia
Nausea
81
Q

Proponents Acid Derivatives include

A

Ibuprofen (Motrin, Advil)

Naproxen

82
Q

Ibuprofen (Motrin, Advil)

A

Most commonly used NSAID

83
Q

Uses for Ibuprofen

A 
Analgesic effect in the management of:
RA, OA
Primary dysmenorrhea
Gout
Dental Pain
Musculoskeletal disorders 
Antipyretic actions
84
Q

Naproxen

A

Second most commonly used NSAID

85
Q

What is the difference between naproxen and ibuprofen?

A

Somewhat better adverse effect profile than ibuprofen.

Fewer drug interactions w/ ACE inhibitors given for HTN

86
Q

COX-2 Inhibitors include

A

Celecoxib (Celebrex)

87
Q

Celecoxib (Celebrex)

A

First and only remaining COX-2 inhibitor

Little effect on platelet function.

88
Q

Celecoxib (Celebrex) Indications

A

OA, RA
Acute pain symptoms
Ankylosing spondylitis
Primary dysmenorrhea

89
Q

Celecoxib (Celebrex) Adverse Effects

A 
Headache
Sinus Irritation
Diarrhea
Fatigue, dizziness
Lower extremity edema
HTN
90
Q

Celecoxib is not use in patients with

A

Known sulfa allergy

91
Q

Enolic Acid Derivatives includes

A

Nabumetone

92
Q

Enolic Acid Derivative Indications

A

Used to treat mild to moderate OA, RA and gouty arthritis

93
Q

Nabumetone

A

Better tolerated gastrointestinally than some other NSAID’s

94
Q

NSAIDs: Adverse Effects on the GI system

A

Dyspepsia, heartburn, epic Astrid distress, nausea
GI bleeding*
Mucosal lesions* (erosions or ulceration)

*misoprostol can be used to reduce these dangerous effects

95
Q

NSAIDs: Adverse Effects on the renal system

A

Reductions in creatinine clearance

Acute tubular necrosis w/ renal failure

96
Q

NSAIDs: Adverse Effects on the cardiovascular system

A

Noncardiogenic pulmonary edema

97
Q

NSAIDs: Interaction

A 
Anticoagulants
Aspirin
Corticosteroids and other ulcerogenic drugs
Protein bound drugs
Diuretics and ACE inhibitors
98
Q

Analgesics:Nursing Implications

A

Conduct thorough pain assessment -> pain management-> Reassess after intervention

99
Q

Opioid Analgesics: Nursing Implications

A

Oral forms should be taken w/ food to minimize gastric upset.
Safety measures to prevent injury
Constipation is common adverse effect -> adequate fluid and fiber intake

100
Q

Opioid Analgesics: Monitoring

A

Monitor for adverse effects.
Withhold one and contact immediately if VS change, condition declines or pain continues.
Respiratory depression may be manifest ate during by RR <10 breaths/min, dyspnea, diminished breath sounds or shallow breathing.

101
Q

NSAIDs: Nursing Implications

A

Check for contraindications (GI lesions, PUD, bleeding disorders)
Lab Studies
Causes GI distress-> should be taken with food, milk or antacid to avoid irritation.

102
Q

Salicylates should NOT be given to what kind of patient?

A

To children and teenagers because of the risk of Reye’s syndrome

103
Q

Therapeutic effects of NSAIDs may not be seen for

A

3-4 weeks

104
Q

NSAIDs: Patient Education

A

Educate about various adverse effects of NSAIDs and to notify HCP if these effects become severe or if bleeding or GI pain occurs.
Watch closely for occurance of unusual bleeding (i.e in stool)
Don’t crust or chew enteric-coated tablets.

NURS 320 (28 decks)

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