Module 10B Analgesic Agents

Question 1

Pain

Definition

Answer 1

◦ Sensory and emotional experience associated with actual or potential tissue damage
Acute or chronic

Question 2

Drugs Used to Relieve Pain

Answer 2

◦ Narcotics: Opium derivatives used to treat many types of pain
◦ Antimigraine Drugs: Reserved for the treatment of migraine headaches

Question 3

Gate-Control Theory of Pain

Sensory and emotional experience

Answer 3

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

Question 4

Pain Receptors

Answer 4

OPIOID receptorsOpioid receptors
◦ CNS
◦ Nerves in the periphery
◦ Cells in the gastrointestinal (GI) tract

Question 5

Use of Narcotics and
Antimigraine
Agents Across the Lifespan
Children
adult and older adults

Answer 5

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

Question 6

Narcotic Agonists

Answer 6

Drugs that react with opioid receptors
Cause analgesia, sedation, or euphoria
Potential for physical dependence
Controlled substances
Rising problem of addiction

Question 7

Narcotic Agonists

Morphine, hydromorphone, codeine, oxycodone, fentanyl, hydrocodone

Answer 7

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

Question 8

Narcotic Agonists

Contraindications

Answer 8

◦ 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

Question 9

Narcotic Agonists

Adverse Effects

Answer 9

◦ Respiratory depression with apnea, cardiac arrest, shock, orthostatic hypotension, nausea, vomiting,
constipation, dizziness
Drug-to-Drug Interactions
◦ Barbiturate general anesthetics, phenothiazines, and MAOIs

Question 10

Narcotic Agonists–Antagonists

Answer 10

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

Question 11

Narcotic Agonists–Antagonists

Contraindications

Answer 11

◦ 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

Question 12

Narcotic Agonists–Antagonists

Adverse Effects

Answer 12

◦ 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

Question 13

Nursing Considerations for Narcotic

Agonists & Narcotic Agonists–Antagonists

Answer 13

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

Question 14

Narcotic Antagonists

Answer 14

Naloxone
◦ Reverses adverse effects of narcotics; diagnoses
suspected acute narcotic overdose
Naltrexone
◦ Used orally in the management of alcohol or
narcotic dependence

Question 15

Narcotic Antagonists

action and indication

Answer 15

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

Question 16

Narcotic Antagonists

Contraindications

Answer 16

Contraindications
◦ Known allergy
Cautions
◦ Pregnancy and lactation
◦ Narcotic addiction
◦ CV disease

Question 17

Narcotic Antagonists

Adverse Effects

Answer 17

◦ Acute narcotic abstinence syndrome
◦ Nausea, vomiting, sweating
◦ Tachycardia
◦ Blood pressure changes
◦ Dysrhythmias

Question 18

Narcotic Antagonists

Drug-Drug Interactions

Answer 18

◦ Lagers doses may be needed to reverse effects of:
◦ Buprenorphine
◦ Butorphanol
◦ Nalbuphine
◦ Pentazocine
◦ Propoxyphene

Question 19

Migraine Headaches

Migraine Headaches

Answer 19

◦ 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

Question 20

Ergot Derivatives

Answer 20

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

Question 21

Ergot Derivatives
Actions
indication

Answer 21

◦ 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

Question 22

Ergot Derivatives

Contraindications

Answer 22

◦ Known allergy
◦ Impaired liver function
◦ Pregnancy or lactation
◦ CAD, HTN, PVD
Cautions
◦ Pruritus
◦ Malnutrition

Question 23

Ergot Derivatives

Adverse Effects

Answer 23

◦ Numbness, tingling of extremities, muscle pain
◦ Pulselessness, weakness, chest pain, arrhythmias
◦ Nausea, vomiting, diarrhea
Drug-Drug Interactions
◦ Beta blockers

Question 24

Triptans

Answer 24

Cause cranial vascular constriction and relief of migraine headache pain in many patients
Common Triptans
◦ Eletriptan
◦ Sumatriptan
◦ Zolmitriptan

Question 25

Triptans
Actions
indications

Answer 25

◦ 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

Question 26

Triptans

Contraindications

Answer 26

◦ Known allergy, pregnancy, CAD
Cautions
◦ Elderly, risk factors for CAD, and lactation
◦ Renal and hepatic dysfunction

Question 27

Triptans

Adverse Effects

Answer 27

◦ Numbness, tingling, burning sensation, feeling of coldness, weakness, dysphasia, blood pressure
alterations
Drug-Drug Interactions
◦ Ergot-containing drugs
◦ MAOIs

Question 28

Nursing Considerations for

Antimigraine headaches

Answer 28

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