Opioid And Non-opioid Medications

Question 1

Physical component of pain

Answer 1

Nerve pathways and brain

Question 2

Psychological component of pain

Answer 2

Anxiety
Previous pain experience
Age
Sex
Culture

Question 3

Acute pain

Answer 3

6 mo or less
Sudden onset
Subsides with treatment

Question 4

Chronic pain

Answer 4

6 mo or more
Persistent or recurring pain
Difficult to treat

Question 5

Visceral pain

Answer 5

Organ pain
May be referred pain

Ex: left arm pain from a MI

Question 6

Somatic pain

Answer 6

Muscular skeletal

Localized, constant

Aching or throbbing

Question 7

Neuropathic pain

Answer 7

Ex: sciatica
Peripheral nerve injury
Pain is called paresthesia
* described as burning, SHOOTING, and tingling

Question 8

Break through pain

Answer 8

Pain that breaks thru med effective window

Question 9

Three main classes of opioid receptors

Answer 9

Mu Receptors

Kappa Receptors

Delta Receptors

Question 10

Mu Receptors

Answer 10

Most important

Response to these being stimulated is analgesia, resp depression, euphoria, and sedation

Question 11

Physical dependence

Answer 11

Becoming so use to it that your body relys on it

Question 12

Kappa receptors

Answer 12

Can produce analgesia and sedation

Question 13

Delta receptors

Answer 13

the opioid analgesics do not affect these

Question 14

Agonist

Answer 14

“to do”
binds with a receptor to produce a maximum response

Question 15

partial agonist

Answer 15

produces a partial response

Question 16

antagonist

Answer 16

“to block”

Question 17

Agonist opioid analgesics

Answer 17

Morphine

Considered the “benchmark” med of this classification

*We use it to see how effective our Mu receptors are

Question 18

Morphine

Answer 18

Produces effects by combining with mu recptor sites

Question 19

Morphine indications

Answer 19

Severe pain
Cardiac pts (has vasodilatation properties, helps decrease workload of heart and increase the oxygen available)

Cough suppression (in low doses) (low dose morphine)
*works by depressing the cough center in brain
*wont work cough r/t post nasal drip
* for coughs due to pressure on the cough center of brain

Question 20

Morphine administration

Answer 20

Oral
IM (discharge dose)
IV (mainly)
SQ
Epidural
Intrathecal
Rectal

Question 21

How is fetanyl usually given

Answer 21

Patch

Question 22

Mu receptor opioid agonists
Adverse Reactions

Answer 22

Seizures (with OD)
Pruritus
Skin rash
**Facial edema/angioedema
**Respiratory depression
Confusion
Tachycardia

Question 23

Opioid agonist
Side Effects

Answer 23

Dizziness
Faintness
Lightheadedness
Fatigue
sleepiness
N/V
increased sweating
constipation
hypotension
*some level of sedation is common

Question 24

moderate to strong opioid agonists

Answer 24

codeine (found in tylenol #3)
*mix of tylenol and codeine

hydrocodone (lortab, vicodin, vicoprofen)
*combination meds

oxycodone (percodan, percocet)

Question 25

opioid agonist-antagonist agents

Answer 25

bind with the kappa receptors and therefore the analgesic relief will not be as strong as opioid agonists SE/AR and addictive properties are less they can percipitate a withdrawal syndrome in pt addicted to the opioid agonists so expect withdrawal s/s *avoid this class with past addicts

Question 26

opioid agonist-antagonists meds

Answer 26

pentazocine (talwin) nalbunphine (nubain) butorphanol (stadol) buprenorphine (buprenex)

Question 27

continuouse infusion thru PCA pumps

Answer 27

Patient controlled analgesia have a button pt can press when they want meds

Question 28

opioid antagonists (the antidote)

Answer 28

antidote to the agonist blocks opioids from binding to mu receptors can precipitate withdrawal s/s

Question 29

what are opioid antagonists used for

Answer 29

OD/Suicide attempts to reverse the post op effects of analgesics to reverse potentially life-threatening ARs dependence/addiction therapy

Question 30

opioid antagonists meds

Answer 30

naloxone (narcan) blocks receptors naltrexone (vivitrol) *big needle into bip, blocks mu receptors and stops craving good for drug addicts and alcohol abuse nalmefene (revex)

Question 31

anytime you are giving an opioid you must be familiar with the what?

Answer 31

antidotes to them and how to use them

Question 32

non-opioid analgesics

Answer 32

for mild to moderate pain acute and chronic dont cause respiratory depression, dependency or abuse and are not regulated under the Controlled Substance Act

Question 33

major meds in non-opioid analgesics class

Answer 33

tramadol (ultram) *moves to controlled substance status due to main abuse clonidine (duraclon) *can cause hypotension Ziconotide (prialt)

Question 34

whats important to gather on a patient before administering meds

Answer 34

a medication history

Question 35

long term medication therapy

Answer 35

riskof gastric and intestinal upset

Question 36

SEs of long term med usage and gastric/GI upsets

Answer 36

localized gastric pain bleeding from rectum (dark or bright red stool) gastric bleeding (vomit or cough dark or bright red blood) prolonged clotting time with long term aspirin or high dose aspirin

Question 37

what do sedative meds do to elderly

Answer 37

paroxymal effect (opposite)

Question 38

opioid use in older adults

Answer 38

cognitive impairment effect pain assessment liver and kidney impairment may reduce drug clearance may ask for less meds to not bother you *overdose is a big problem