Pain Management Flashcards
what is nociceptive pain?
pain from physical damage or potential damage to the body
somatic - tissue damage like surgery, injury, infection, or inflammation
visceral - related to internal organs
what is neuropathic pain?
damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles, and other parts of the body - diabetes, shingles, chemo, poor response to opioids
what is the management strategy for pain?
- ask about pain regularly
- believe the report of pain
- choose appropriate pain control
- deliver timely and logical interventions
- empower patients and pts
what is a nonverbal pain scale used for?
children and pts who can’t communicate
what kind of interventions are there for pain?
- physical/psychosocial interactions
- nonopioid analgesics
- adjuvant analgesics
- opioid analgesics
- nonopioid centrally acting analgesics
what are examples of physical interventions for pain?
- heat
- ice
- massage
- position
what are examples of psychosocial interventions for pain?
- distractions
- music
- yoga
what are two examples of nonopioid analgesics?
- non-steriodal anti-inflammatory drugs (NSAIDs - aspirin, ibuprofen)
- acetaminophen
what precautions should be known about acetaminophen?
- overdose - no more than 4000mg a day
- liver failure
what is Percocet made of? what teaching is needed?
oxycodone and Tylenol
- oxycodone doesn’t have a limit but Tylenol does
- watch for overdose, pt can’t take extra Tylenol or any other drug that contains acetaminophen
what are adjuvant analgesics?
drugs not designed for pain management but can be used for pain control
what are the three examples of adjuvant analgesics are used for neuropathic pain and what is their original use?
all three are used for neuropathic pain
- amitriptyline (Elavil) - tricyclic antidepressant
- Gabapentin - anti-seizure drug
- lidocaine - local anesthetics/antidysrhythmics
what is the purpose of a CNS stimulant as an adjuvant analgesic?
enhance opioid analgesia and counteract sedation
when are bisphosphonates used as an adjuvant analgesic?
when pain is caused by a tumor-induced bone resorption
why would aspirin not be used for pain management?
risk for bleeding
why would a patient be prescribed nonopioid analgesics on top of opioid use?
it will spread out the amount of time between opioid use
why are antihistamines used as adjuvant therapy? give an example of the drug name
- hydroxyzine (Vistaril) or Benadryl
- promotes drowsiness and reduces and anxiety
why would glucocorticoids be used as adjuvant therapy? give an example of the drug name
prednisone or hydrocortisone
- reduce cerebral and spinal edema
- improve general sense of wellbeing
- improve appetite
what is an analgesic?
a category of drugs that relieve pain without causing loss of consciousness
what is the most common group of analgesics?
opioids (most effective pain relievers)
what is an opioid defined as?
a general term defined as any drug, natural or synthetic, that has actions similar to those of MORPHINE
what are Mu receptors?
related to dependence
- when activated it causes analgesia, respiratory depression, euphoria, sedation and decreased GI motility
what are Kappa receptors?
when activated it causes analgesia, sedation, and “psychotomimetic” effects
- hallucinations
- anxiety
- nightmares
what receptor is associated with dependence?
Mu receptor
what are pure opioid agonists?
they active both Mu and Kappa to produce analgesia and sedation
- strong opioid agonists
what are agonist-antagonist opioids?
an agonist to one receptor (usually kappa) and an antagonist to one receptor (usually mu)
what are pure opioid ANTAGONIST?
- blocks the agonist
- reversal effect of pure opioids
- naloxone (Narcan)
what are examples of pure opioid agonists?
- morphine
- codeine
- meperidine
- fentanyl
- dilaudid
- methadone
when would you use pure opioid agonists?
- postoperative pain
- obstetric analgesia
- myocardial infarction
- head injury (use with caution due to respiratory depression)
- cancer-related pain
- chronic non-cancer pain
where does morphine come from?
poppy plant
what does opium contain?
morphine and codeine
which receptors does morphine work on? what does it do?
mu and kappa
- blocks transmission of pain
what do endorphins relate to?
euphoria
what are the routes for morphine?
oral, IM, IV, subcutaneous, epidural, rectal, and intrathecal
how is morphine absorbed?
depends on the route
- need a much larger dose of morphine to be effective when PO
- IV morphine would need a much smaller dose to be effective
what does “first pass” mean when referring to morphine?
it is inactivated by the hepatic metabolism
- the first pass through the liver inactivates much of the orally ingested drug on its way to the systemic circulation
- PO could be like 30mg
- IV could be like 4mg
what is a serious adverse effect of morphine?
respiratory depression
what could cause an increase of respiratory depression with a patient on morphine?
on patients using/taking other CNS depressants
- alcohol
- barbiturates
- benzodiazepines
- or patients with preexisting respiratory conditions
what are the adverse effects of morphine? (more than just respiratory depression)
- euphoria/dysphoria
- sedation
- miosis (constriction of the pupil)
- neurotoxicity
- adverse effects from prolonged use is CONSTIPATION (would need a laxative and doesn’t get better with time)
what are the problems with the long-term use of morphine?
tolerance and physical dependence
- side effects will begin to decrease
what is the most common bothersome side effect of morphine
constipation - would require a laxative daily if a patient is on morphine for a prolonged period of time, doesn’t get better with time
what happens if a pt is dependent on morphine and stops taking them suddenly?
withdrawal symptoms
- unpleasant
what are the signs and symptoms of morphine toxicity?
classic triad
- coma (decreased level of consciousness)
- respiratory depression
- pinpoint pupils
what is the classic triad?
signs and symptoms of morphine toxicity
- coma (decreased level of consciousness)
- respiratory depression (less than 12)
- pinpoint pupils
what is the treatment for morphine toxicity?
- ventilatory support
- antagonist - naloxone (Narcan)
what types of people require a lower dose of morphine?
children and elderly
what is naloxone (Narcan) used for?
- used for overdoses of narcotics
- injected as IV push
- given for respiratory depression
before administering morphine, the nurse must…
check heart rate, respiration rate, and blood pressure
what teaching is needed with a patient-controlled anesthesia pump?
- know how to use and have it reachable
what is the nurse’s role with a patient-controlled anesthesia pump?
check vital signs more frequently
education needed for a pt discharge going home on a narcotic?
- taper down dose at home
- signs and symptoms of overdose
- manage constipation with prescriptions of high fiber diet
what is fentanyl?
an opioid 100 times more potent than morphine
what are the routes for fentanyl?
- intranasal
- parenteral IM/IV sublimaze
- transdermal (duragesic)
- transmucosal (Actiq - narcotic on a lollipop)
what is the most common form of fentanyl? what it used for?
transdermal (duragesic)
- it is patch that manages baseline pain and takes hours to work
- heat accelerates use
what is meperidine (Demerol)?
a rarely used strong opioid agonist
- doesn’t work well in everyone (tends to be a genetic predisposition)
what is methadone? what is an adverse effect?
a treatment pain and opioid addicts
- prevents withdrawals
- prolongs QT interval: risk for dysrhythmias
what advocation is needed by nurses in relation to pain management?
nurses should advocate for different medications for their patients if the medication is not working
what is the name of two moderate to strong opioid agonists?
codeine and oxycodone
how are codeine and oxycodone similar to morphine?
produce analgesia and sedation
how are codeine and oxycodone different from morphine?
produce less analgesia and less respiration depression
- a little bit lower risk for abuse
what are the side effects of codeine and oxycodone?
- respiration depression
- constipation
- urinary retention
- cough suppression
what is the antagonist for codeine and oxycodone?
Narcan
what route is codeine given?
only PO
what is the action of codeine?
- 10% of the dose converts to morphine in the liver
- mild to moderate pain and cough
- lower dose helps cough suppression
what drugs are combination drugs containing oxycodone?
- percodan
- percocet
- combunox
what is the immediate release form of oxycodone?
oxycodone
what is the controlled release (long-acting) form of oxycodone?
OxyCotonin
what are the side effects of oxycodone?
- valvular heart injury
- tissue necrosis
- pulmonary granulomas
what is hydrocodone used for?
used for pain and cough suppression
- often combined with nonopioid drugs
what is one problem with hydrocodone?
wide spread abuse
when should naloxone (Narcan) be administrated?
give immediately for decreased respirations to reverse opioid effects
what are two nonopioid centrally acting analgesics?
- tramadol
- clonidine
what is the action of tramadol?
combination of opioid and nonopioid mechanisms
what are the uses for tramadol?
- pain
- restless leg syndrome
what are the adverse effects of tramadol?
- sedation
- dizziness
- dry mouth
- constipation
what drugs should not be taken with tramadol?
- CNS depressants
- no alcohol
- no benzodiazepines
what is the abuse like with tramadol?
relatively low, doesn’t cause euphoria
what form does tramadol come in?
immediate and extended release
what is the mechanism of action for clonidine?
- decreased norepinephrine
- alpha 2 adrenergic agonist (blocks the nerve pathway)
what are the two approved uses for clonidine?
- used for pain in combination with opioid analgesics
- also used for hypertension (oral or patch)
what are the adverse effects of clonidine?
- severe hypotension
- rebound hypertension
- bradycardia
- nightmares
- psychodynamic effects
when shouldn’t clonidine be used?
in hemodynamically unstable patients
Clients diagnosed with chronic pain should be given what information regarding opioids’ effectiveness?
They should be given on a regular schedule, around the clock.
What would occur if you stop the administration of an opioid antagonist in a client who is physically dependent on opioids?
withdrawal symptoms
