Pain

Question 1

Drugs for Pain

Answer 1

● Local anesthetics
● Opioid Analgesics
○ Agonists
○ Agonists-Antagonists
○ Antagonists
● Non-Opioid Analgesics
○ COX-inhibitors
■ NSAIDS
● ASA
■ Acetaminophen

Question 2

Local Anesthetics

Answer 2

● Dibucaine
● Lidocaine
● Benzocaine
● Cocaine
● Tetracaine

Question 3

Drug class: Local anesthetic

Lidocaine

Indication: Painful procedures, localized pain/discomfort

Action: Stop axonal conduction by blocking sodium channels in the axonal
membrane. No conduction = no sensation!

Answer 3

Nursing Considerations:
● Systemic absorption can result in palpitations, tachycardia, and hypertension.
● Sometimes used with a vasoconstrictor (like epi!) to limit the absorption of the drug to surrounding tissues.

Question 4

Opioid Analgesic

Answer 4

• Opioid Agonist
  ● Morphine
  ● Codeine
  ● Meperidine
  ● Fentanyl
  ● Oxycodone
  ● Hydrocodone
  ● Hydromorphone
  ● Oxymorphone
• Opioid Agonist-Antagonist
  ● Buprenorphine
  ● Butorphanol
  ● Nalbuphine
  ● Suboxone (buprenorphine and naloxone)
• Opioid Agonist
  ● Naloxone
  ● Naltrexone
  ● Methylnaltrexone

Question 5

Opioid Agonists

Answer 5

● Morphine
● Codeine
● Meperidine
● Fentanyl
● Oxycodone
● Hydrocodone
● Hydromorphone
● Oxymorphone

Question 6

Drug class: Opioid Analgesic - Opioid Agonist

Morphine

Indication: Pain (moderate to severe), analgesic

Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS.

Answer 6

Nursing Considerations:
● Common side effect: constipation
● CNS depressant
○ Decreased respiration, decreased heart rate, etc.
○ Monitor respiratory rate

Antidote = Naloxone

Question 7

Drug class: Opioid Analgesic - Opioid Agonist

Fentanyl

Indication: Severe pain, Pain and anxiety associated with CPAP

Action: Binds to opiate receptors in the CNS reducing stimuli from nerve endings

Answer 7

Nursing Considerations:
* Use caution with increased ICP, head trauma, adrenal insufficiency
* Avoid use with MAOIs
* May cause apnea, laryngospasm, decreased respirations, bradycardia,
hypotension
* Do not consume grapefruit while taking this medication
* Monitor hemodynamics during administration
* Assess patient pain scale frequently

Antidote: Naloxone

Question 8

Drug class: Opioid Analgesic - Opioid Agonist

Oxycodone

Indication: moderate to severe pain

Answer 8

Nursing Considerations:
* PO: peak 30–60 minutes, duration 4–6 hours
* Controlled-release: peak 3–4 minutes, duration 12 hours
* Do not give if respirations are less than 12 per minute
* Avoid use with alcohol, CNS depressants
* Withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
* Physical dependency may result from long-term use

Antidote: Naloxone

Question 9

Drug class: Opioid Analgesic - Opioid Agonist

Hydromorphone

Indication:

Answer 9

Nursing Considerations:
* PO: onset 15–30 minutes, peak 30–60 minutes, duration 4–6 hours
* IM: onset 15 minutes, peak 30–60 minutes, duration 4–5 hours
* IV: onset 10–15 minutes, peak 15–30 minutes, duration 2–3 hours
* subQ: onset 15 minutes, peak 30–90 minutes, duration 4 hours
* Rectal: duration 6–8 hours
* Do not give if respirations are less than 12 per minute
* Avoid use with alcohol, CNS depressants
* Withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
* Physical dependency may result from long-term use
* Elderly patients may require lower doses

Antidote: Naloxone

Question 10

Drug class: Opioid Analgesic - Opioid Agonist

Methadone

Indication: Pain, opioid withdrawal

Action: Binds to opiate receptors in the CNS and alters perception of pain does not cause euphoria

Answer 10

Nursing Considerations:
● Long half life
● Very slowly titrate down

Antidote: Naloxone??

Question 11

Opioid:

Side Effects

Answer 11

Miosis (pupil contraction), Mood changes
Out of it
Respiratory depression, Reduced salivation
Pruritus, Pneumonia (aspiration)
Hypotension, Hedache
Infrequent elimination (constipation, urinary retention)
Nauseas, Nervousness
Emesis

Question 12

Opioid Agonist-Antagonists

Answer 12

● Buprenorphine
● Butorphanol
● Nalbuphine
● Suboxone (buprenorphine and naloxone)

Question 13

Drug class: Opioid Analgesic - Opioid Agonist-Antagonist

Buprenorphine

Indication: Mild to moderate pain, opioid addiction

Action: Opioid receptor agonist-antagonist

Answer 13

Nursing Considerations:
● Lower potential for abuse and less powerful analgesic effects

Question 14

Opioid Antagonists

Answer 14

● Naloxone
● Naltrexone
● Methylnaltrexone

Question 15

Drug class: Opioid Analgesic - Opioid Antagonist

Naloxone

Indication: Treatment of opioid overdose, relief of opioid-induced c

Action: Blocks the effects of opioid agonists reversing analgesia, sedation,
euphoria, and respiratory depression

Answer 15

Nursing Considerations:
Will cause immediate withdrawal in someone physically dependent on
opioids

Question 16

Non-Opioid Analgesics

Answer 16

Cyclooxygenase inhibitors
1) Non-Steroidal Anti-Inflammatory Drugs
○ Naproxen
○ Ketoprofen
○ Indomethacin
○ Ibuprofen
○ Ketorolac
○ ASA
○ Celecoxib
2) Non-Opioids that DO NOT suppress inflammation
○ Acetaminophen

Question 17

Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs)

Answer 17

○ Naproxen
○ Ketoprofen
○ Indomethacin
○ Ibuprofen
○ Ketorolac
○ ASA
○ Celecoxib

Medications used in the management and treatment of chronic pain syndrom

Question 18

Drug class: Non-steroidal anti-inflammatory drugs (NSAIDs)

Ibuprofeno

Indication: Inflammation (RA, OA, bursitis), mild to moderate pain,

Action: Block prostaglandin which causes inflammation, pain, and fever

Answer 18

Nursing Considerations:
● Side effects:
* Gastric ulceration
* Bleeding
○ Typically avoided in trauma and surgical clients
* Renal impairment
○ Monitor BUN/Cr

Question 19

Drug class:

Indication:

Action:

Answer 19

Nursing Considerations: