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”
2
Q
Analgesics include
A
Opioid analgesics and Adjuvant analgesic drugs
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.
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.
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)
6
Q
Chronic Pain Characteristics
A
Slow (days to months)
Long duration
Dull, persistent aching
Pain is recurring (endless)
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
8
Q
Adjuvant Drugs
A
Assists primary drugs in relieving pain.
9
Q
Adjuvant drugs include
A
NSAIDs
Antidepressants
Anticonvulsants
Corticosteroids
10
Q
What are some common adjuvant drugs used to treat neuropathic pain?
A
Amitriptyline (antidepressant)
Gabapentin (anticonvulsants)
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.
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.
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.
14
Q
Opioid Drugs
A
Synthetic drugs that bind to the opiate receptors to relieve pain.
15
Q
Opioid Drugs: Mild agonists include
A
Codeine, hydrocodone
16
Q
Opioid Drugs: Strong agonists include
A
Morphine Hydromorphone Oxycodone Oxymorphone Meperidine Fentanyl Methadone
17
Q
Meperidine Contraindications
A
Not recommended for long term use because of the accumulation of neurotoxic metabolite normeperidine, which can cause seizures.
18
Q
Opioid Analgesic Agonists: MOA
A
Binds to an opioid pain receptor in the brain. Causes an analgesic response (reduction of pain sensation).
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)
20
Q
Opioid Analgesic Antagonists: MOA
A
Reverse the effects of the drugs on pain receptors.
Binds to pain receptor and exerts no response.
21
Q
Opioid Analgesics: Indications
A
*Main: To alleviate moderate to severe pain.
Also used for cough center suppression; treatment of diarrhea; balanced anesthesia
22
Q
Opioid Analgesics: Contraindications
A
Known drug allergy
Severe asthma
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
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
25
Opioid Tolerance
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
26
Opioids: Physical Dependence
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)
27
Opioids: Psychological Dependence
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.
28
Opioid Analgesics: Toxicity and Management of Overdose
Main: Naloxone (Narcan)
| Naltrexone (ReVia)
29
Opioid Analgesics: Interactions
```
Alcohol
Antihistamines
**Barbiturates
**Benzodiazepines
Monoamine oxidase inhibitors
```
30
Codeine Sulfate
Natural opiate alkaloid (Schedule II) obtained from opium.
Less Effective.
Ceiling Effect
More commonly used as an antitussive drug.
31
Major adverse effect of Codeine Sulfate
GI disturbance: constipation*
32
Fentanyl
- 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
33
Morphine Sulfate
Naturally occurring alkaloid derived from the opium poppy.
Drug protype for all opioid drugs
Schedule II controlled substance.
34
Morphine Sulfate: Indication
Severe pain
| High abuse potential
35
Most important adverse effect of morphine sulfate
Respiratory depression
36
Dilaudid
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.
37
Methadone Hydrochloride (Dolophine)
Synthetic opioid analgesic. (Schedule II)
38
Methadone Hydrochloride (Dolophine) indications.
- Opioid of choice for the detoxification treatment of opioid addicts in methadone maintenance programs.
- Renewed interest for chronic and cancer related pain.
39
What are possible adverse effects of methadone hydrochloride?
**Cardiac Dysrhythmias
| Unintentional overdoses and deaths (d/t prolonged half-life of the drug)
40
Naloxone Hydrochloride (Narcan)
Pure opioid antagonist
41
Naloxone Hydrochloride Indications
- Drug of choice for the complete or partial reversal of opioid induced respiratory depression.
- Indicated in cases of suspected acute opioid overdose.
42
Failure of Naloxone Hydrochloride (Narcan) to significantly reverse the effects of the presumed opioid overdose indicates what?
That the condition may not be related to opioid overdose
43
Nonopioid Analgesics Include
Acetaminophen
Clonidine
Tramadol
44
Acetaminophen (Tylenol) Indications
Analgesic and Antipyretic Effects (Pain or fever)
| Little to no anti-inflammatory effects
45
Acetaminophen: MOA to treat Pain
Similar to salicylates (aspirin)
| Blocks pain impulses peripherally by inhibiting prostaglandin synthesis.
46
Acetaminophen: MOA to treat fevers
Action hypothalamus
| Heat dissipate through vasodilation and increased peripheral blood flow.
47
Acetaminophen is an alternative for what drug?
Aspirin
48
Acetaminophen Contraindications
Drug allergy
Liver dysfunction
Possible liver failure
G6PD deficiency (genetic disease)
49
Acetaminophen Interactions
Alcohol or other drugs that are hepatotoxic
50
Acetaminophen: Toxicity
Even though available OTC, it is lethal when overdosed.
Overdose causes hepatic necrosis: hepatotoxicity.
Long-term ingestion of large doses also causes nephropathy.
51
Acetaminophen Overdose Antidote
Acetylcysteine Regimen
52
Herbal Products: Feverfew
Anti-inflammatory properties
53
Herbal Products: Feverfew indications
Treat migraine headaches, menstrual cramps, inflammation and fever.
54
Herbal Products: Feverfew Adverse Effects
GI distress, altered taste and muscle stiffness.
55
Feverfew Interactions
Interact with aspirin and other NSAIDs
| Also anticoagulants.
56
Nonsteroidal Anti-Inflammatory Drugs
```
Large and chemically diverse group of drug with the following properties:
Analgesic
Anti-inflammatory
Antipyretic
Aspirin-platelet inhibition
```
57
Properties that ALL NSAIDs share include
Antipyretic
Analgesic
Anti-inflammatory
58
What are the 5 chemical categories of NSAIDs?
```
Salicylates
Acetic Acid Derivatives
Cyclooxygenase-2 inhitors
Enolic Acid Derivatives
Propionic Acid Derivatives
```
59
NSAIDs: MOA
Inhibition of the Leukotriene pathway, the prostaglandin pathway or both.
Blocks the chemical activity of the enzyme COX
60
COX-1 enzyme
Has a role in maintaining GI mucosa
61
COX-2 enzyme
Has a role in the inflammatory process.
62
NSAIDs: Contraindications
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
NSAIDs: Adverse Effects
**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
Renal function depends partly on
Prostaglandins
65
How can NSAIDs affect renal function?
NSAIDs disrupt prostaglandin function which at times may be strong enough to precipitate acute or chronic renal failure
66
Renal toxicity can occur in patients with
```
Dehydration
HF
Liver dysfunction
Diuretic use
ACE inhibitors
```
67
NSAIDs: Black Box warning
```
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
Salicylates include
Aspirin*
| More on PP
69
Salicylate: MOA
```
Inhibits platelet aggregation
Antithrombotic Effect (used to tx MI and other thromboembolic disorders)
```
70
Reye’s Syndrome
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
Aspirin can be used prophylactically for
Adults who have strong risk factors for developing CAD or CVA
Effective after MI
72
Aspirin Uses
Headache, neuralgia, myalgia and athralgia.
Pain syndromes resulting from inflammation: arthritis, pleurisy and pericarditis.
Systemic lupus erythematosus: anti-rheumatic effects
Anti-pyretic action
73
Salicylate Toxicity
**Tinnitus, hearing loss
Increased HR
N/V/D
Sweating, thirst, hyperventilation, hypoglycemia or hyperglycemia.
Dimness of vision, headache, dizziness, mental confusion and drowsiness.
74
Acetic Acid Derivatives include
Indomethacin (Indocin)
| Ketorolac (toradol)
75
Indomethacin (Indocin)
Analgesic
Anti inflammatory
Antirheumatic
Antipyretic
76
Indomethacin (Indocin) Uses
```
RA
OA
Acute bursitis or tendinitis
Ankylosis spondylitis
Acute gouty arthritis
PDA
Preterm Labor
```
77
Ketorolac (Toradol)
Some anti inflammatory activity
78
Ketorolac (Toradol) is used primarily for
its powerful analgesic effects which are comparable to those of narcotic drugs such as morphine.
79
Ketorolac (Toradol) Indications
Short term use (up to 5 days) to manage moderate to severe acute pain.
80
Ketorolac (Toradol) Adverse Effects
```
Renal impairment
Edema
GI pain
Dyspepsia
Nausea
```
81
Proponents Acid Derivatives include
Ibuprofen (Motrin, Advil)
| Naproxen
82
Ibuprofen (Motrin, Advil)
Most commonly used NSAID
83
Uses for Ibuprofen
```
Analgesic effect in the management of:
RA, OA
Primary dysmenorrhea
Gout
Dental Pain
Musculoskeletal disorders
Antipyretic actions
```
84
Naproxen
Second most commonly used NSAID
85
What is the difference between naproxen and ibuprofen?
Somewhat better adverse effect profile than ibuprofen.
| Fewer drug interactions w/ ACE inhibitors given for HTN
86
COX-2 Inhibitors include
Celecoxib (Celebrex)
87
Celecoxib (Celebrex)
First and only remaining COX-2 inhibitor
| Little effect on platelet function.
88
Celecoxib (Celebrex) Indications
OA, RA
Acute pain symptoms
Ankylosing spondylitis
Primary dysmenorrhea
89
Celecoxib (Celebrex) Adverse Effects
```
Headache
Sinus Irritation
Diarrhea
Fatigue, dizziness
Lower extremity edema
HTN
```
90
Celecoxib is not use in patients with
Known sulfa allergy
91
Enolic Acid Derivatives includes
Nabumetone
92
Enolic Acid Derivative Indications
Used to treat mild to moderate OA, RA and gouty arthritis
93
Nabumetone
Better tolerated gastrointestinally than some other NSAID’s
94
NSAIDs: Adverse Effects on the GI system
Dyspepsia, heartburn, epic Astrid distress, nausea
GI bleeding*
Mucosal lesions* (erosions or ulceration)
*misoprostol can be used to reduce these dangerous effects
95
NSAIDs: Adverse Effects on the renal system
Reductions in creatinine clearance
| Acute tubular necrosis w/ renal failure
96
NSAIDs: Adverse Effects on the cardiovascular system
Noncardiogenic pulmonary edema
97
NSAIDs: Interaction
```
Anticoagulants
Aspirin
Corticosteroids and other ulcerogenic drugs
Protein bound drugs
Diuretics and ACE inhibitors
```
98
Analgesics:Nursing Implications
Conduct thorough pain assessment -> pain management-> Reassess after intervention
99
Opioid Analgesics: Nursing Implications
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
Opioid Analgesics: Monitoring
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
NSAIDs: Nursing Implications
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
Salicylates should NOT be given to what kind of patient?
To children and teenagers because of the risk of Reye’s syndrome
103
Therapeutic effects of NSAIDs may not be seen for
3-4 weeks
104
NSAIDs: Patient Education
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.
