Pain Management Flashcards
define acute pain
abrupt onset, short duration
subsides once healing is complete or pain stimulus ceases
most likely assoc. w/ injury or surgery
define chronic pain
persists longer than 6 mo
interfers w/ ADLs
may lead to depression physical/psychological dependence (especially with a chronic disease)
Mu opioid agonists info
opioids bind to opiate receptors in CNS
Mu and kappa major receptor sites
activation alters perception of pain
resp. and CNS depression and constipation
why do opioids cause constipation?
we have Mu recptors along the enteric tract causing:
dysmotility,
dysfunction of fluid secretion/absorption
dysfunction of gut sphincters
what is naloxegol (movantik) and methylnatrexone (relistor)?
opioid-induced constipation medication
does morphine have a ceiling?
no
an opioid naive pt. should have ________ medication, like __________
short acting
vicodin, diladid
morphine info
acute, chronic pain
(PRN typically)
PO, parenteral, and PR
tolerance can develop
short-acting vs. long-acting
morphine ER info
chronic pain management (routine typically)
short-acting given for breakthrough pain
opioid-tolerant pts
doses scheduled daily, BID or TID
must be swallowed whole
hydromorphone info
severe, acute and chronic pain
PO, PO-ER, parenteral, PR
less nausea than morphine
↑ risk for orthostatic hypotension and urinary retention
6.7 times greater potency than morphine
↑ resp. depression
codeine info
mild to moderate pain
cold/cough: antitussive action combo / guaifenesin
has a “ceiling effect”
↑ dose has ↑ adverse effects
for pain: used w/ acetaminophen or aspirin
hydrocodone info
semi-synthetic opioid
stronger than codeine
combined w/ acetaminophen
moderate to severe pain (sx, trauma)
fentanyl (reg) info
IV anesthetic for perioperative anesthesia
also avail PO, buccal, SL, transmucosal
opioid-tolerant pts
management of breakthrough cancer pain
chronic persistent pain
100 times more potent than morphine
fentanyl (transdermal patch) info
wear gloves
mod. to severe pain
opioid-tolerant pts
long term chronic analgesic therapy
6-12 hr to reach steady state
duration of action 72 hours
patch changed every 72 hrs
oxycodone info
mod. to severe pain
available in controlled release (oxyCONTIN)
short-acting doses for breakthrough pain (oxycodone)
combo w/ acetaminophen→ percocet
combo w/ aspirin→ percodan
methadone info
mod to severe pain in opioid tolerant; ATC long-term tx
used in tx to reduce or quit heroin/opiates (higher doses)
lessens withdrawal sx
long term methadone maintenance
does not cure dependence
what is ATC
around the clock
opioid AE on CNS
sedation, confusion, drowsiness, dizziness, floating feeling, and possible euphoria
opioid AE on Respiration
resp. depression
opioid AE on cadiovascular
hypotension, bradycardia
opioid AE on GI
constipation, nausea, vomiting
opioid AE on GU
urinary retention
how do we recognize oversedation?
assess RR (<12 breaths/min= hold opioid)
(<10 breathes/min = resp depression)
level of sedation (respond to verbal cues? requires painful stimuli?)
when should we give naloxone?
resp dep <10 breathes/ min
does not respond to verbal cues
requires painful stimuli
also need rapid response
what is an opioid antagonist? and what does it do?
naloxone
reverses opioid-induced CNS and respiratory depression
reverses analgesia effects
blocks receptor sites
in a pt. with RR of 11 in pain what do we do?
can give pain med but must think about using non-opioid kind and check in on them often
acetaminophen has anti-inflammatory properties: true or false
false
acetaminophen is commonly paired with?
opioid
what is the max dose of acetaminophen? what happens if you take too much?
4000mg/day
hepatotoxicity or renal failure
acetaminophen is good for? what forms?
mild pain and fever
or mod to severe pain w/ opioids
PR PO and IV w/ opioid
aspirin is an _________ and is good for what?
NSAID
mild to mod pain
anti-pyretic
↓platelet aggregation
infammatory disorders
how does aspirin work?
inhibits COX-1 and COX-2 which are responsible for the formation of prostaglandins
what are D-D interactions with aspirin?
↑ risk of bleeding with anticoagulants
Cox-1 does what?
what do COX-1 inhibitors do?
inhibits acid secretion and generates thromboxane A2
COX-1 inhibitors can cause ↑risk stomach ulcer formation and bleeding (GIB)
what can be given to help prevent GIB with aspirin?
PPIs
what do COX-2 INHIBITORS do?
↓ pain and inflammation
celecoxib is what?
selective COX-2 inhibitor
only decreases pain and inflammation and does not cause excessive GI acid
what is celecoxib used for?
OA
RA
acute pain
dysmenorrhea
what are the things to worry about with celecoxib?
BBW ↑ risk of thrombotic events such as MI and stroke
↑risk of GIB with concurrent use of anticaogulents, chronic NSAID therapy
ibuprofen is used for treating what?
mild to mod pain
anti-pyretic
inflammatory disorders
dysmenorrhea
how does ibuprofen work?
COX-1 and COX-2 inhibitors
what are the potential AE for ibuprofen?
↑ stomach acid
↑risk GIB with concurrent use of NSAIDs, warfarin and clopidogrel (either effects the clotting cascade or the platelet)
what are NSAID adverse neurological effects?
assess for stroke symptoms (except ASA)
aspirin and NSAIDs may cause tinnitus
what are NSAIDs adverse cardiovascular effects?
assess for MI symptoms (except aspirin)
what are the NSAIDs adverse GI effects?
assess for GI bleeding symptoms and symptoms r/t loss of blood
look at labs
look at symptoms
what is the nursing role for managing pain?
assess:
for PAIN
discuss pain medication orders
previous experiences?
anticipate and administer before activities
effectiveness?
teach importance of managing pain
manage AE
safety precautions
lower doses for opioid naive and geriatric
