pain Flashcards
NSAIDs
-inhibit COX
-do not mess with CNS
-irritate GI
-reduce bloodflow to kidneys
opioids
-act on higher centers of brain
long acting = oral morphine/oxy/hydromorphone and fentynyl patches
short acting= most –> 4 hrs
max dose= 2-3 times lower/min dose
EXTENDED RELEASE ARE NOT PRN
side effects and extended use
short term = 3-5 days
common side effects = nausea, vomitting, constipation, memory/thought changes
RESP DEPRESSION –> naloxone –> may need to apply multiple times because it lasts shorter than opioids
morphine
inactivated by hepatic metabolism when taken orally –> oral doses have to be bigger than parenteral doses –> that’ s true for a lot of drugs
IM and Subq drug administration
painful
absorbtion is unreliable
not ideal route
old ppl and opioids
start low and go slow
dizziness, confusion, and vision changes can happen
adjuvants
treat other stuff but help with pain
good for neuropathic pain
-tricyclic antidepressants (notriptyline)
-anticonvulsants (gabapentin)
-infusional lidocaine
corticosteroids, bisphosphonates, and calcitonin help with inflammation and bone pain
what aren’t analgesics?
-sedatives
-anti anxiety stuff
-muscle relaxants
PCA
usually IV or SubQ, but sometimes oral
-not recommended for opioid naive patients post op
-sometimes continuous dose for tolerant ppl - cancer
-PCA byproxy is bad, but sometimes a patient who can’t push button has AACA (authorized agent-control analgesia)
-usually 2 nurses should check the setting
topical products
NSAID = ketoprofen patch
capsaicin
local anesthetics: lidocaine, prilocaine, diclofenac
FEW SIDE EFFECTS
transdermal
systemic
work even if not right by site of pain
lidocaine = 12 hr on; 12 hr off
don’t put on wounds, damaged skin, or face
skin irritation is common
application to vascular mucous membrane will speed absorption
use gloves and wash hands when applying or removing
local vs regional anesthesia
local = topical or injected to induce loss of sensation to a body part
regional = local anesthesia used to block a group of sensory nerve fibers to a larger area
if enough local anesthesia is used, motor and autonomic function is inhibited too
perineural infusion
catheter is placed by group of nerves and anesthesia is administered like an IV
used post surgically
usually 48 hrs
epidural
-example of regional anesthesia
-acute post op pain, delivery pain, cancer pain –> reduces overall opioid requirement
-risk of bleeding and/or hematoma –> don’t use anticoagulants
-monitor every 15 mins at first then move to every hour
-constipation, urinary retention, nausea, vomiting, hypotention, resp depression, and pruritis are side effects
-long term epidural exits through patient’s side
NO PRESERVATIVES OR ADDITIVES –> NEUROTOXIC
invasive interventions
FOR CHRONIC PAIN
intrathecal implantable pumps/injections
spinal cord and deep brain stimulation
neuroablative procedures
trigger point injections
cryoablation
intraspinal medications
cancer pain
can be chronic or acute
-often experience breakthrough pain
transdermal fentynal
100 times more potent than morphine
for opioid tolerant ppl with cancer or chronic pain
long acting –> not prn–> up to 72 hrs
do not use for anyone under 100 lbs (not enough subq)
do not use if hyperthermic (absorption is too fast) –> don’t exercise hard while wearing patch
flush patch down toilet when done
long term opioid use
need higher doses
-not the worst thing in the world bc they also become tolerant to resp depression
Sometimes (not usually) leads to hyperalgesia
make extra sure that noncancer patients aren’t getting addicted
transmucosal fentanyl unit
for breakthrough pain in opioid tollerant ppl
put bt cheeks and gum and let dissolve for 15 mins without chewing or swallowing
1 at a time – no more than 2 per breakthrough episode
if 4+ breakthrough episodes in a day, contact HCP
pseudoaddiction
patients with real pain exhibit druggie behavior (like doctor shopping) to get relief
rectal administration of pain meds
for ppl who can’t swallow, have nausea/vomiting, or are near death
not for ppl with diarrhea or cancerous lesions in but area
morphine, hydromorphone, oxymorphone
physical dependence vs addiction vs drug tolerance
phys dependence = withdrawal when you don’t have it
drug tolerance = it takes more to have the same effect
addiction = neurobiological disease with genetic, psychosocial, and environmental factors –> includes impaired control over use, compulsive use, continued use despite harm, and craving
palliative care vs hospice
palliative care is for life limiting conditions
hospice is for end of life
