Intro Pain Management Flashcards
Acetaminophen AKA Drug Class MOA Dosage Side Effects
aka- tylenol Class: Analgesic MOA: -cox 1 cox2 inhibitor, -decreases pain, BUT NO anti-inflammatory effect -Anti-pyretic
Dosage:
Q4-6hr
Max daily dose 4g
SE:
- liver toxicity
- renal damage
- lethal
Aspirin AKA Drug Class MOA Dosage Side Effects
AKA: Salicylic Acid
Drug Class: Salicylate (inflamm/minor pain)
MOA:
- cox inhibitor
- inhibit platelet aggregation
- reduces inflamm
- Antipyretic
Dosage: ?? As much as you want, no max dosage
SE: -gastric pain & ulcers -renal and liver toxicity -asthma -rash @ toxic levels: -metabolic acidosis -respiratory depression -cardio-toxicity -overdose @ Salicyclism: -N/V -tinnitus
If pt comes in w/ ringing ears what drug may you ask them if they are taking?
Aspirin
NSAIDS AKA Drug Class MOA Dosage Side Effects
AKA:
- ibuprofen
- aleve (naproxen)
Drug Class:NSAID
MOA:
- inhibit cox (less GI toxicity w/ COX2)
- inhibit prostaglandins (thereby inhibiting inflamm, pain, fever, smooth muscle contraction and relaxations, decreased blood flow to kidney)
- antipyretic
Dosage:
- ibuprofen 200, 400mg q4h, max dose=3200mg
- aleve 250-500mg q12h, max dose=1000mg
SE:
- GI: n/v, heartburn, ulcers/bleeding, diarrhea
- photosensitivity
- Renal: salt and h2o retention, HTN, interfere w/ platelet aggregation
CI in pregnant women, ok in lactating women
Considerations for NSAID use:
Gastroduodenal toxicity
- age>65
- use of anticoagulant therapy
- previous GI bleed
- Acute PUD
- use of other steriods (if use both double hitting GI tract for ulcers)
- take w/ food
- give BID or TID
- KNOW RENAL STATUS & OTHER MEDS!
Opioid Pharmacology (action)
exert effects through Mu receptors by inhibiting excitatory NT both pre and post synaptically
Indication of Opioid Use
- acute post op pain
- severe pain for a limited duration
- chronic pain (experience provider)
Management of Opioid Side Effects
SE: n/v constipation urinary retention hypotension bradycardia sedation euphoria respiratory depression tolerance addiction
Management: EDUCATION
- prescribe laxative for potential constipation
- warn of addiction
- warn of sedation
- prescribe anti-emetic for n/v
Medications for Nociceptive pain
Ibuprofen, Aspirin, Acetaminophen
Medications for Neuropathic/Chronic
Anticonvulsants:
- GABA (neurontin)
- Tegratol
- Topamax
- Lamictal
- Lyrica
- cybalta
- Tramadol (not good for chronic)
Medications for Chronic Pain
Tricyclic Antidepressants
Medication for Acute Pain
Opioids:
- Morphine
- Demerol
- Methadone
- Oxycodone
- Fentanyl
- Tramadol
Combo opioids:
- hydrocodone/ acetaminophen
- Hydrocodone/Aspirin
- Codein/Acetaminophen
Morphine Drug class Indication of Use MOA Routes of Admin Life threatening SE
Class; opioid
Use: Severe pain, acute and chronic
MOA:
exert effects through Mu receptors by inhibiting excitatory NT both pre and post synaptically;
dopamine release»>Euphoria
Routes:
IM, IV, oral, rectal, intrathecal, nasal, subQ, buccal, transdermal
SE:
bradycardia
respiratory depression
hypotension
Demerol (Meperidine) Drug class Indication of Use MOA Routes of Admin Life threatening SE
Class; opioid
Use: severe pain
MOA: inhibition of excitatory NT in pre and post synaptically;
dopamine release»>euphoria
Routes:
IV, IM
SE:
bradycardia
hypotension
respiratory depression
Methadone Drug class Indication of Use MOA Routes of Admin Life threatening SE
Class: opioid
Use: treatment of opioid dependence and heroin withdrawl
MOA: inhibits excitatory NT pre and post synaptically
DOES NOT give euphoric sensation like other opiods
Admin:
SE:
hypoglycemia
hyponatremia
death: prolonged QT interval (torsade de pointes)
Narcan (Naloxone) Drug class Indication of Use MOA Routes of Admin Life threatening SE
class; opioid antagonist
use: respiratory depression; overdose of opioid
MOA: not fully understood, competes for same receptors as opioids
Routes: Injection
SE:
increased respiratory status, only use until resp status is good, not until pt is alert
Fentanyl Drug class Indication of Use MOA Routes of Admin Life threatening SE
Class; opioid
Use: surgery, severe pain, anesthesia, sedation
MOA: ???
Routes: IV, patch, suckers
SE: respiratory distress?
Tramadol Drug class Indication of Use MOA Routes of Admin Life threatening SE
Class; Analgesic
Use: moderate to sever pain, neuropathic pain
MOA: bind to opioid receptors, inhibit NE and Serotonin reuptake
Routes: oral?
SE:
HA dizziness
Nausea
Constipation
Tricyclic Antidepressents Drug class Indication of Use MOA Routes of Admin Life threatening SE
class;SSRI selective seritonin reuptake inhibitors
Use: chronic pain, especially neuropathic
MOA:
inhibit serotonin and NE
Routes:
oral?
SE:
arrhhythmia
heart block
MI
Anticonvulsants (5) Drug class Indication of Use MOA Routes of Admin Life threatening SE
class: anticonvulsants
use: neuropathic pain and moderate chronic pain
MOA: bind to GABA»ca release»NT release
Route: oral?
SE: nausea dizziness fatigue mood swings
Medication for Trigeminal Neuralgia???
SE?
Tegretol (Carbamazepine)
SE: Steven Johnson syndrome
n/v
liver toxicity
Drug for Fibromyalgia?
Lyrica (pregabalin)
SE Lamictal?
Steven Johnsons syndrome
rash
ataxia
N/V
Topamax SE
**Loss of apetite
weight loss
Cybalta Drug class Indication of Use MOA Routes of Admin Life threatening SE
class: SNRI seritonin NE reuptake inhibitor
use: diabetic peripheral neuropathy
MOA: inhibits seritonin and NE uptake
Routes: oral?
SE: nausea constipation insomnia AVOID PT W/ HEPATIC OR RENAL DISEASE
Pain Contracts
- purpose
- components
often made when pt on opioids for chronic pain
purpose:
- consent of risk/benefits of opioid treatment
- foster adherence to treatment program & limit abuse
- improve efficacy of program
components:
- risks of addiction
- narcotics only from contracted doc
- agreement to only take prescribed meds
- pt responsible for written rx and refills during REGULAR hrs and pt plan ahead so not to run out
- no refills unless agreed upon
- contract violation termination of opioid treatment
Pain Med dependency, tolerance, and addiction
Dependence: withdrawl-anxiety, volatile mood, HTN, tachycardia, diaphoresis
Tolerance: increasing amount of drug needed to produce same effects of lower dose
Addiction: psychological dependence; extreme behavior w/ getting and consuming the drug
Mech of pain relief using: cold heat TENS accupuncture/accupressure
cold: good for ACUTE musculoskeletal pain; decrease swelling and nociceptive receptors
heat: good for CHRONIC musculoskeletal pain; reduce nociceptive stimuli
TENS: good for chronic pain; frequent electrical impulses stimulates numerous nerve endings and relieves pain from one site.
Accupuncture- relieves pressure?
