Nonopioid and Opioid Analgesics Flashcards by Christian Nieves

Pain

Classified by origin

Somatic
Neuropathic pain

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Nociceptors

Pain receptors (mechanical, thermal, chemical)

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Somatic Pain

Structural pain from tissue injury

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Neuropathic Pain

Sensory disturbance involving neural hypersensitivity

Burning, tingling, or electric shocks (diabetic neuropathy)

Anticonvulsants can help stabilize pathways and decrease pain

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Natural Suppressors of Pain

Endorphins (these are opioids)
Cortisone

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Under Treated Pain Sxs

Tachycardia, increased respiratory rate, increased stress response, urinary retention, fluid overload, electrolyte imbalance, hyperglycemia, infection

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Nonopioid Analgesic Prototype

Acetaminophen (Tylenol, Robigesic)

Decreases pain and fever

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Acetaminophen (Tylenol, Robigesic) Pregnancy Category

Pregnancy category B

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Acetaminophen (Tylenol, Robigesic) Route

PO/PR (rectal)

There is also now an IV form but it is not used often

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Acetaminophen (Tylenol, Robigesic) Sxs

Anorexia, N/V, rash

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Acetaminophen (Tylenol, Robigesic) Adverse Reactions

Severe hypoglycemia, oliguria, urticarial

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Acetaminophen (Tylenol, Robigesic) Life-threatening Reactions

HEPATOTOXICITY

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Acetaminophen (Tylenol, Robigesic) Contraindications

Severe hepatic or renal dx, alcoholism, hypersensitivity

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Acetaminophen (Tylenol, Robigesic) Drug Interactions

Increased effect with caffeine
Decreased effect with contraceptives, anticholinergics, cholestyramine, and charcoal

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Nonopioid Analgesic (Acetaminophen) Nursing Considerations

Keep out of reach from children (high dose will cause hepatoxicity)
Do not take longer than 10 days, 5 days for children
Call poison control when child has taken large or unknown amount
Death from hepatoxicity within 1-4 days
Do not take more than 3,250 mg/day (adults)

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Acetaminophen (Tylenol, Robigesic) Antidote

Acetylcysteine

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Opioid Analgesic Prototype

Morphine Sulfate (MS Contin, Roxanol)
Depression of CNS and pain impulse
CCS II
Check I-STOP (all opioid medication info related to pt in EMAR, like a digital footprint for nurses as well)

High incidence of addiction
Do not use for more than 3 days

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Morphine Sulfate (MS Contin, Roxanol) Pregnancy Category

Pregnancy category C/D

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Morphine Sulfate (MS Contin, Roxanol) Routes and Onsets

IV onset rapid
IM peak 0.5-1 hour
PO peak 1-2 hours

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Morphine Sulfate (MS Contin, Roxanol) Sxs

Dizziness, drowsiness, sedation, confusion, urinary retention, constipation, N/V

Basically a lot of CNS depressant sxs

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Morphine Sulfate (MS Contin, Roxanol) Adverse Reactions

Hypotension, rash, seizures

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Morphine Sulfate (MS Contin, Roxanol) Life-threatening Reactions

Respiratory depression and increased intracranial pressure

Morphine Sulfate (MS Contin, Roxanol) Drug Interactions

Increased effects with ETOH, sedatives, hypnotics, antipsychotics, anticonvulsants, and muscle relaxants

Basically other things that do CNS depression

Morphine Sulfate (MS Contin, Roxanol) Contraindications

Pts with asthma or respiratory depression, increased intracranial pressure, or shock (morphine will drop pt’s BP even more)

Caution: Respiratory, renal, or hepatic dx, MI (occasionally used in MIs), older adults, young children

Crosses placenta and is excreted in breast milk

Morphine Sulfate (MS Contin, Roxanol) Nursing Considerations

Administer before pain reaches its peak Monitor VS, especially respiratory rate (less than 10 can indicate distress) Monitor for hypotension Measure urine output (urinary retention) Monitor for constipation Narcan is an antidote for overdose Avoid ETOH and other CNS depressants

Morphine Sulfate (MS Contin, Roxanol) Antidote

Narcan

2nd Opioid

Meperidine (Demerol) Pain relief, beneficial in GI procedures due to less constipation and urinary retention

Meperidine (Demerol) Routes

PO/IV/IM

Meperidine (Demerol) Nursing Considerations

Do not use in liver pts Do not use for longer than 48-72 hours (applies to all opioids but especially this one) Monitor for hypotension (will often see NS bag available in case of hypotension)

Semisynthetic Opioid

Hydromorphone (Diluadid) Analgesic effect 6x more potent than morphine, fewer hypnotic effects and less GI distress

Hydromorphone (Diluadid) Routes and Onsets

PO/SQ/IM/IV Faster onset and shorter duration of action than morphine Gradual tolerance increase

Hydromorphone (Diluadid) Nursing Considerations

Gradual tolerance increase IV 2 mg or less over 2-5 minutes Monitor respirations and adequate hydration

Opioid Agonist-Antagonist Prototype

Naluphine (Nubain) Relieve moderate to severe pain Inhibition of pain impulse

Naluphine (Nubain) Pregnancy Category

Pregnancy Category B/D

Naluphine (Nubain) Routes and Onsets

IV 2-3 minutes IM 15 minutes

Naluphine (Nubain) Sxs

Dizziness, confusion, hallucinations Basically CNS depression sxs

Naluphine (Nubain) Adverse Reactions

Bradycardia, tachycardia (tends to come when pt has hypotension), respiratory depression, hypotension

Naluphine (Nubain) Life-threatening Reaction

Respiratory depression

Naluphine (Nubain) Contraindications

Hypersensitivity Caution: high incidence of drug abuse, increased intracranial pressure, impaired respirations, renal or hepatic dx

Naluphine (Nubain) Drug Interactions

CNS depression with ETOH or other CNS depressants

Patient Controlled Analgesia (PCA)

Morphine, fentanyl, and dilaudid IV route Patient controlled Lock-outs for patient to prevent overdose Maintains constant analgesic level, avoiding episodes of severe pain and over sedation

Transdermal Opioid Analgesic

Duragesic (Fentanyl) For chronic pain 24 hour pain control Change patch every 24 hours Also available IV/IM

Migraine

Unilateral throbbing head pain with N/V and photophobia Last 2-24 hours Caused by inflammation of blood vessels in cranium Thought to be a serotonin imbalance 2/3 of women between 20-30 yrs old, decreases during pregnancy and menopause Triggers: red wine, cheese, and chocolate

Cluster Headache

Severe unilateral non-throbbing pain usually around eye Occurs in clusters of severe attacks for several days over several weeks Occurs in men more commonly than women

Prevent Migraines

Beta blockers (Inderal, Tenormin) Anticonvulsants (Valporic Acid), Neurontin TCA (Elavil, Tofranil)

Cessation of Migraines

Analgesics, opioid analgesics, ergot alkaloids, SSRA (Triptans)

5-HT1 Receptor Agonist Prototype

Sumatriptan (Imitrex) Treat migraines and cluster headaches Causes vasoconstriction of cranial arteries

Sumatriptan (Imitrex) Pregnancy Category

Pregnancy Category C

Sumatriptan (Imitrex) Routes and Onsets

PO 30 min SQ 10 min Intra nasal 15 min

Sumatriptan (Imitrex) Sxs

Dizziness, fainting, tingling, N/V/D, abdominal cramps

Sumatriptan (Imitrex) Adverse Effects

HTN (more common than hypotension), hypotension, angina, dysrhythmias, thromboembolism (due to vasoconstriction)

Sumatriptan (Imitrex) Life-threatening Reactions

Coronary artery vasospasm, MI, cardiac arrest

Sumatriptan (Imitrex) Contraindications

Cardiovascular pts, HTN, DM, smoking, CAD, liver or renal dx