Module 10B Analgesic Agents Flashcards
Pain
Definition
◦ Sensory and emotional experience associated with actual or potential tissue damage
Acute or chronic
Drugs Used to Relieve Pain
◦ Narcotics: Opium derivatives used to treat many types of pain
◦ Antimigraine Drugs: Reserved for the treatment of migraine headaches
Gate-Control Theory of Pain
Sensory and emotional experience
Transmission of these impulses can be modulated or adjusted
Interneurons can act as “gates”
Several factors, including learned experiences, cultural expectations, individual tolerance, and
the placebo effect, can activate the descending inhibitory nerves from the upper central nervous
system
Pain Receptors
OPIOID receptorsOpioid receptors
◦ CNS
◦ Nerves in the periphery
◦ Cells in the gastrointestinal (GI) tract
Use of Narcotics and Antimigraine Agents Across the Lifespan Children adult and older adults
children ◦ Safety and efficacy not established ◦ Dosage should be carefully calculated ◦ Monitor closely for ADE Adults ◦ Encourage to request pain medication before pain out of control ◦ Caution in pregnancy/lactation ◦ Narcotics used during labor- monitor mom and baby closely for ADE Older Adults ◦ More likely to experience ADE ◦ More likely to develop toxicity ◦ Implement safety measures
Narcotic Agonists
Drugs that react with opioid receptors Cause analgesia, sedation, or euphoria Potential for physical dependence Controlled substances Rising problem of addiction
Narcotic Agonists
Morphine, hydromorphone, codeine, oxycodone, fentanyl, hydrocodone
Actions
◦ Act at specific opioid receptor sites in the CNS
◦ Produce analgesia, sedation, and a sense of well-being
Indications
◦ Relief of severe acute or chronic pain
◦ Analgesia during anesthesia
◦ Labor
Narcotic Agonists
Contraindications
◦ Known allergy ◦ Diarrhea caused by poisons Cautions ◦ Respiratory dysfunction ◦ Pregnancy, labor, lactation ◦ GI or GU surgery ◦ Acute abdomen or ulcerative colitis ◦ Head injuries, alcoholism, delirium tremens, or CVA ◦ Liver or renal dysfunction
Narcotic Agonists
Adverse Effects
◦ Respiratory depression with apnea, cardiac arrest, shock, orthostatic hypotension, nausea, vomiting,
constipation, dizziness
Drug-to-Drug Interactions
◦ Barbiturate general anesthetics, phenothiazines, and MAOIs
Narcotic Agonists–Antagonists
Buprenorphine, Butorphanol, Nalbuphine, Pentazocine
Actions
◦ Act at a specific opioid receptor sites in the CNS to produce analgesia, sedation, euphoria, and
hallucinations
Indications
◦ Moderate to severe pain
◦ Adjunct to general anesthesia
◦ Relief of pain during labor and delivery
Narcotic Agonists–Antagonists
Contraindications
◦ Known allergy ◦ Nalbuphine- if sulfite allergy Cautions ◦ Physical dependence on a narcotic ◦ COPD and disease of the respiratory tract ◦ Acute MI or documented CAD ◦ Renal or hepatic dysfunction ◦ Pregnancy and lactation
Narcotic Agonists–Antagonists
Adverse Effects
◦ Respiratory depression ◦ Nausea, vomiting, constipation, and biliary spasm actions ◦ Headache, dizziness, psychoses, anxiety, hallucinations ◦ Ureteral spasm, urinary retention ◦ Sweating and dependence Drug-Drug Interactions ◦ Barbiturate general anesthetics ◦ Narcotic agents
Nursing Considerations for Narcotic
Agonists & Narcotic Agonists–Antagonists
Assessment
◦ History and physical exam
◦ Allergies; respiratory dysfunction; MI or CAD; renal or hepatic dysfunction; pregnancy and lactation; history of heart
disease if administering pentazocine; diarrhea caused by toxic poisons; biliary surgery or surgical anastomoses
◦ Perform a pain assessment with the patient
◦ Assess orientation, affect, reflexes, and pupil; monitor respiratory rate and LS; pulse, blood pressure, and cardiac
output; assess abdomen and BS; urine output
◦ Monitor the results of laboratory; ECG- pentazocine
Nursing Diagnoses
◦ Disturbed sensory perception (visual, auditory, kinesthetic) related to CNS effects
◦ Constipation related to GI effects
◦ Impaired gas exchange related to respiratory depression
◦ Risk for injury related to CNS effects of the drug
Implementation
◦ Perform baseline and periodic pain assessments with the patient
◦ Have a narcotic antagonist and equipment for assisted ventilation readily available
◦ Monitor injection sites for irritation and extravasation
◦ Monitor timing of analgesic doses
◦ Use extreme caution when injecting these drugs into any body area that is chilled or has poor perfusion
or shock
◦ Use additional measures to relieve pain (e.g., back rubs, stress reduction, hot packs, ice packs)
◦ Monitor respiratory status before beginning therapy and periodically during therapy
◦ Institute comfort and safety measures
◦ Reassure patients that the risk of addiction is minimal
◦ Provide thorough patient teaching
Narcotic Antagonists
Naloxone
◦ Reverses adverse effects of narcotics; diagnoses
suspected acute narcotic overdose
Naltrexone
◦ Used orally in the management of alcohol or
narcotic dependence
Narcotic Antagonists
action and indication
Actions
◦ Drugs that bind strongly to opioid receptors, but they do not activate the receptors
◦ Reverse effects of opioids
Indications
◦ Reversal of the adverse effects of narcotics
◦ Treat narcotic and/or alcoholic dependence
Narcotic Antagonists
Contraindications
Contraindications ◦ Known allergy Cautions ◦ Pregnancy and lactation ◦ Narcotic addiction ◦ CV disease
Narcotic Antagonists
Adverse Effects
◦ Acute narcotic abstinence syndrome ◦ Nausea, vomiting, sweating ◦ Tachycardia ◦ Blood pressure changes ◦ Dysrhythmias
Narcotic Antagonists
Drug-Drug Interactions
◦ Lagers doses may be needed to reverse effects of: ◦ Buprenorphine ◦ Butorphanol ◦ Nalbuphine ◦ Pentazocine ◦ Propoxyphene
Migraine Headaches
Migraine Headaches
◦ Severe, throbbing headaches on one side of the head
Cluster Headaches
◦ Begin during sleep; involve sharp, steady eye pain, sweating, flushing, tearing, and nasal congestion
Tension Headaches
◦ Usually occur at times of stress; dull band of pain around the entire head
Ergot Derivatives
Cause constriction of cranial blood vessels and decrease the pulsation of cranial arteries. As a
result, they reduce the hyper perfusion of the basilar artery vascular bed.
Dihydroergotamine
Ergotamine
Ergot Derivatives
Actions
indication
◦ Block alpha-adrenergic and serotonin receptor sites in the brain to cause constriction of cranial vessels
Indications
◦ Prevention or abortion of migraine or vascular headaches
Ergot Derivatives
Contraindications
◦ Known allergy ◦ Impaired liver function ◦ Pregnancy or lactation ◦ CAD, HTN, PVD Cautions ◦ Pruritus ◦ Malnutrition
Ergot Derivatives
Adverse Effects
◦ Numbness, tingling of extremities, muscle pain
◦ Pulselessness, weakness, chest pain, arrhythmias
◦ Nausea, vomiting, diarrhea
Drug-Drug Interactions
◦ Beta blockers
Triptans
Cause cranial vascular constriction and relief of migraine headache pain in many patients Common Triptans ◦ Eletriptan ◦ Sumatriptan ◦ Zolmitriptan
Triptans
Actions
indications
◦ Bind to selective serotonin receptors sites to cause vasoconstriction of cranial vessels
Indications
◦ Treatment of acute migraine and are not used for prevention of migraines
Triptans
Contraindications
◦ Known allergy, pregnancy, CAD
Cautions
◦ Elderly, risk factors for CAD, and lactation
◦ Renal and hepatic dysfunction
Triptans
Adverse Effects
◦ Numbness, tingling, burning sensation, feeling of coldness, weakness, dysphasia, blood pressure alterations Drug-Drug Interactions ◦ Ergot-containing drugs ◦ MAOIs
Nursing Considerations for
Antimigraine headaches
Assessment
◦ History and physical Exam
◦ Allergies; history of MI, CAD, or hypertension; hepatic or renal dysfunction; pregnancy or lactation
◦ Orientation, affect, and reflexes; VS and ECG as appropriate
◦ Monitor lab results
Nursing Diagnoses
◦ Acute pain related to CV and vasoconstrictive effects
◦ Decreased cardiac output related to CV effects
◦ Disturbed sensory perception (visual, auditory, kinesthetic, and tactile) related to CNS effects
◦ Risk for injury related to changes in peripheral sensation, CNS effects
◦ Deficient knowledge regarding drug therapy
Implementation
◦ Administer the drug to relieve acute migraines; these drugs are not used for prevention.
◦ Administer at the first sign of a headache and do not wait until it is severe
◦ Arrange for safety precautions if CNS or visual changes occur
◦ Provide comfort and safety measures
◦ Monitor the blood pressure of any patient with a history of CAD, and discontinue the drug if any sign of angina or prolonged
hypertension occurs
◦ Provide thorough patient teaching
