Pain Medications Flashcards
Ketorolac (Toradol)
acetic acid derivatives (non-opioid analgesic)
Indomethacin
Acetic acid derivative (non-opioid analgesic)
ASA
non-opioid analgesic
celecoxib (Celebrex)
COX2 Inhibitors (Non-opioid analgesic)
meloxicam (Mobic)
enolic acid derivative (non-opioid analgesic)
Non-opioid analgesics work by:
blocking peripheral pain impulses causing an analgesic response
Drug types in the category of non-opioid analgesics include (4)
salicylates
NSAIDs
acetaminophen
Cox2 inhibitors
Do not take acetaminophen in what type of disease process?
severe liver disease
What are contraindications to taking salicylates?
bleeding risks
allergy
do not use in children
What are the signs of salicylate toxicity?
tinnitus, hearing loss, metabolic acidosis, respiratory alkalosis, CNS depression, hypoglycemia
What are the GI side effects of non-opioid analgesics?
dyspepsia, heartburn, nausea (common), vomiting, anorexia, GI bleeding (less common)
What is a renal side effect of NSAIDs?
renal failure
What is a hematologic side effect of non-opioids? (not acetaminophen)
bleeding, decreased platelet aggregation
What are the nursing care actions for non-opioids?
pain assessment and monitoring for side/adverse effects
What should the nurse teach about non-opioid analgesia?
administration guidelines
effective pain control strategies
non-pharmacologic options
side effect management
Morphine
opioid analgesic
MSIR, MS Contin
opioid analgesic
hydromorphone (Dilaudid)
opioid analgesic
fentanyl citrate
opioid analgesic
codeine
opioid analgesic
oxycodone
opioid analgesic
oxycontin/oxyIR/combinations (e.g. Percocet)
opioid analgesic
hydrocodone combinations (Vicodin, Lortab)
opioid analgesic
meperidine
opioid analgesic
Morphine is used for:
severe pain
What is important to know about Morphine? (3)
It has a high abuse potential
It comes in many dosage forms
It has extended release options
Hydromorphone (Dilaudid) 1 mg is equal to how many mg of morphine sulfate?
8 mg of Morphine Sulfate
0.1 mg of fentanyl citrate is equal to how many mg of morphine sulfate?
10 mg morphine sulfate IVP
What is important to know about Codiene? (3)
It is less effective than morphine
it has a dose ceiling
it often causes GI upset
Oxycodone is structurally similar to ______ _______.
Morphine sulfate
Hydrocodone is a stronger/weaker opioid?
weaker
Meperidine has toxic effects on what?
the CNS
What are contraindications of opioid therapy? (7)
- allergy
- severe asthma
- respiratory insufficiency
- elevated ICP
- morbid obesity and/or OSA
- myasthenia gravis
- paralytic ileus
What are possible side effects of opioids? (6)
- itching (most common)
- nausea/vomiting
- respiratory depression
- constipation
- urinary retention
- overdose
What are important nursing actions related to opioid analgesics?
pain assessment
monitor for side/adverse effects
careful dose titration
monitor for breakthrough pain
What patient teaching is important for opioids?
administration guidelines (take as soon as you start to feel pain)
effective pain control strategies
non-pharmacologic options
side effect management
Tricyclic antidepressants can be used as:
adjuvant pain therapy
SSNRIs can be used as
adjuvant pain therapy
anticonvulsants can be used as:
adjuvant pain therapy
amitriptyline (Elavil)
TCA used as adjuvant pain therapy
imipramine (tofranil)
TCA used as adjuvant pain therapy
Venlafexine (Effexor)
SSNRI used as adjuvant pain therapy
duloxetine (Cymbalta)
SSNRI used as adjuvant pain therapy
bupropion (Wellbutrin)
SSNRI used as adjuvant pain therapy
carbamazapine (Tegretol)
Anticonvulsant used as adjuvant pain therapy
phenytoin (Dilantin)
Anticonvulsant used as adjuvant pain therapy
gabapentin (Neurontin)
Anticonvulsant used as adjuvant pain therapy
pregabalin (Lyrica)
Anticonvulsant used as adjuvant pain therapy
lamotrigine (Lamictal)
Anticonvulsant used as adjuvant pain therapy
Adjuvant pain therapy mostly consists of:
anticonvulsant drugs
How do anticonvulsants help with pain therapy?
Decreases CNS transmission resulting in decreased nerve pain
How do antidepressants help with pain therapy?
increase serotonin decreasing pain sensation
What kind of pain is adjuvant pain therapy used to treat?
neuropathic pain, migraines, adjuvant to muscle pain
what are contraindications of adjuvant pain therapy?
These drugs will increase CNS depression from other meds?
What side effects could TCAs have?
ACH triad (blurred vision, dry mouth, urinary retention) orthostatic hypotension sedation
What side effects could anticonvulsant medications have?
dizziness, drowsiness, sedated, confusion, diplopia, poor coordination
SSNRIs have what possible side effects?
ACH triad (blurred vision, dry mouth, urinary retention)
insomnia/sedation
headache
nausea
Nursing care associated with adjuvant pain therapy
pain assessment
monitor for side/adverse effects
What patient teaching is important for adjuvant pain therapy?
Administration guidelines
effective pain control strategies
non-pharmacologic options
effects will take time to manifest
What is a contraindication of COX2 inhibitors?
cardiac history or risks
Opioids work by:
binding to pain receptors in the brain causing an analgesic response
What would be a contraindication for COX2 inhibitors?
cardiac history or risks
What are contraindications of NSAIDs?
bleeding risks
severe renal or hepatic disease
do not use in last trimester of pregnancy
celecoxib (Celebrex) is usually used for what type of pain if it is not helped by other analgesics?
joint pain
Non-Opioids work best for what type of pain?
mild to moderate, primarily work locally
How would a nurse assess for severe side effect of NSAIDs?
Renal failure can be assessed by urine output, BUN, creatinine, GFR
How should codeine be taken?
with food due to high incidence of GI upset
Oxycontin and MS Contin should be given how often?
q24h
MSIR and oxyIR should be given how often?
Immediate release, give every 4-6 hours as directed
