Pain Management Flashcards
What are 6 major adverse effects of NSAIDs ?
G.I discomfort ( abdominal pain, heartburn, dyspepsia, and nausea)
G.I Bleed ( dark colored stool, hematemesis, )
Renal dysfunction: NSAIDs are nephrotoxic( increase BUN & Creatinine, decrease urine output and weight gain)
Salicysm: from taking aspirin.
S/S : THD SR
: tinnitus ( ear ringing); Headache, Dizziness, Sweating; Respiratory Alkalosis
Reye syndrome
Aspirin toxicity
What causes Reye syndrome and who is at risk?
Reye syndrome is cause by giving aspirin to children who have a viral illness such as chickenpox or flu.
What are s/ s of aspirin toxicity ?
Sweating, hyperthermia( fever), respiratory depression, respiratory acidosis, dehydration
What are two major classes that you should avoid giving NSAIDs with and why?
Warfarin & Stetoids because they both increase the risk for bleeding?
- check PT & INR!!! & report s/s of bleeding.
How should patient take NSAIDs to decrease G.I discomfort ?
With food, fluids or milk to prevent G. I discomfort.
Why Nsaids discontinued before surgery and when should it be discontinued?
NSAIDs just like warfarin increased the risk for bleeding during surgery. NSAIDs should be discontinued 1 week before surgery.
What is the 1 major adverse effect of acetaminophen and how can it be prevented?
Hint: dose!!!!
Liver toxicity( abdominal pain, jaundice, N/VD) It can be prevented by not drinking alcohol with acetaminophen and not to exceed the dose greater than 4g/ day.
What is the antidote for acetaminophen?
Acetylceistine ( mucomyst)
What one drug interacts with acetaminophen and how?
Warfarin. Acetaminophen slow the metabolism of warfarin and increased the risk of bleeding
What are two major nonopiod classes?
Acetaminophen ( Tylenol)
NSAIDS.
- aspirin
- keterolac
- ibuprofen( Motrin/ Advil)
- Celecoxib (Celebrex )
- Naproxen
- indomerhacin ( Indocin)
- Diclofenac
- Meloxicam
What are the Opiod agonist?
Morphine Fentanyl (sublimaze ) Oxycodone Hydromorphone Meperidine( Demerol) Methadone( Dolophine)
Opioids are indicated for what kind of pain?
Moderate to severe pain such as post-operative pain, cancer pain, and myocardial infarction
What are adverse effects of Opiod agonist? What are some intervention for each ?
Respiratory depression:
- assess for 12 RP/ min
- have Narcan & Oxygen available
Constipation
- increase fiber and fluid
- administer laxative & stool softeners
- give methylnaltrexone for people with constipation not reverse with laxative
Urinary Retention
- encourage patient to void every 4 hrs
- monitor I&O
Cough suppression ( oxycodone) - encourage cough
Sedation
- avoid driving cars at night / hazard activities
Biliary colic
- do not give morphine to patients with biliary tract disease/ surgery
Nausea/ vomiting
- give antiemetics
Pinpoint pupils
What is a major adverse effect of Meperidine ( Demerol) ?
Seizures !!! Due to repeated doses or renal failure.
How should morphine be given IV
Morphine is given IV push slowly over 4-5 min. With Narcan and oxygen available.
How should Opiod agonist be discontinued for people with physical dependence & why?
Opiod agonist should be tapered slowly over 3 days to prevent abstinence syndrome
What are s/ S of abstinence syndrome ?
Cramping, fever, vomiting, anxiety, and hypertension.
What are the 4 Opiod agonist & antoginst ? What are their advantages over Opiod agonist?
Butorphanol( stadol)
Nalbuphine ( Nubain)
Buprenorphine ( buprenex)
Pentazocine( talwin)
They cause less addiction & adverse effects
What are the main side effects of opioid- agonist / antagonist?
Abstinence withdrawal symptom: / pt. should discontinue opiod agonist before taking them
Headache
Respiratory depression
Sedation
Dizziness
What the are the 3 opiod antagonist ?
Narcan
Naltrexone
Methylnaltrexone
What is the specific indication for methylnaltrexone?
To reverse constipation that are caused opiod but can not relieved with laxatives etc.
How should morphine be administered to cancer patients?
On a fixed schedule
Ex: every 3-4hrs instead of PRN
How long does it take for Fentanyl patch to take action? When should it be replaced or changed
Up to 24hrs to take therapeutic effects.
Changed every 72hrs ( 3dys)
Adverse effects of opiod antagonist?
Tachycardia, tachyapnea, abstinence withdrawal syndrome
