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Pharm 2 > pain meds > Flashcards

pain meds Flashcards

1
Q

what is pain

A
  • a sensory and emotional experience associated with actual or potential tissue damage
  • most common symptom to seek health care
  • the fifth vital sign
  • acute or chronic
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2
Q

name two types of pain

A
  • nociceptive
  • neuropathic
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3
Q

describe nociceptive pain

A

r/t tissue injury
- somatic (bones, muscle, and joints)
- visceral (organs)

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4
Q

describe neuropathic pain

A

produced by nerves
- peripheral
- central

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5
Q

describe the pathphysiology of pain

A
  1. tissue damage activates pain receptors (heat, cold, pressure, ischemia, chemical): slow and fast fibers
  2. nociceptors transmit to spinal cord
  3. signal then goes to brain stem and cerebrum
  4. endorphins and enkephalins released from pituitary (short term blockage of pain signals)
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6
Q

is pain subjective or objective

A

subjective

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7
Q

name some of the many factors that may influence pain

A
  • mood
  • sleep disturbances
  • medications
  • age
  • gender
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8
Q

what are some pain measurement tools

A
  • numeric scales
  • visual scales
  • observational scales
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9
Q

what are some nonpharmacologic treatments of pain and how do they work

A
  • massage
  • heat/cold therapy
  • physical therapy
  • cognitive therapy
  • guided imagery

kinda distract from the pain and make you think about other shit

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10
Q

how do opioid analgesics work

A
  • relieve moderate-severe pain
  • block pain signal from getting to the brain
  • inhibit prostaglandins (inflammatory cascade)
  • schedule II (high risk for abuse)
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11
Q

describe multimodal therapy for pain

A
  • drugs from different classes to change pain
  • reduced opioid use
  • improved outcomes
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12
Q

give an example of an opioid agonist

A

morphine sulfate

also codeine, fentanyl, hydromorphone, all the good stuff

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13
Q

describe the action of opioid agonists

A

binds to pain receptors in the brain, blocks pain impulse

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14
Q

what are opioid agonists used for

A
  • prevent or relieve moderate to severe pain (acute or chronic)

also:
- antitussive (codeine)
- heart failre/pulmonary edema (relaxes the heart)
- adjuncts to anesthesia

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15
Q

describe the pharmacokinetics of opioid agonists

A
  • IV: 10-20 minute onset
  • PO: 60 minute onset

start with a low dose and use caution in old people

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16
Q

what are some adverse effects of opioid agonists

A
  • resp depression
  • CNS depression
  • constipation

black box warning: resp failure is used in combo with benzos or other CNS depressants and risk for abuse and dependence

17
Q

what are some contraindications of opioid agonists

A
  • resp compromise
  • liver/kidney disease (bad metabolism and excretion)
  • increased ICP/head injury (increased confusion)
18
Q

describe administration of opioid agonists

A
  • reversal agent: naloxone
  • PO can be given with/without food
  • IV: dilute and push slow (5ml/5min)
  • pre/post pain assessment (based on route and onset)
  • closely monitor resp status (RR<8 and lethargy = bad)
19
Q

what are some nursing implications of opioid agonists

A
  • use caution with combination of opioids and other CNS depressants: antidepressants, sedatives, antihistamines, alcohol
  • use caution with long acting vs short acting onset (maintenance vs breakthrough)
  • utilize nonpharmacologic options
  • wean to oral medication
20
Q

describe patient education for opioid agonists

A
  • chronic pain - take around the clock (avoid peaks and valleys)
  • take only as prescribed
  • high fiber diet
  • encourage fluids (2-3L/day)
  • stoll softeners PRN
  • do not crush or chew pills
  • dispose properly
  • do not drive
21
Q

give an example of an opioid agonist/antagonist

A

butorphanol

22
Q

describe the action of opioid agonist/antagonists

A

activate some receptors and block some receptors, blocking pain sensation with lower risk for abuse

23
Q

what are opioid agonist/antagonists used for

A
  • second line moderate - severe pain
  • pain during labor
  • perioperatively
24
Q

what are some adverse effects of opioid agonist/antagonists

A
  • CNS depression
  • resp depression
  • risk for abuse and dependence
25
Q

whats a contraindication of opioid agonist/antagonists

A

use of opioid agonist

26
Q

what are some nursing implications of opioid agonist/antagonists

A
  • avoid combination with other CNS depressants
  • pre/post pain assessment
  • is used during labor monitor for fetal effects
  • monitor for s/sx opioid agonist withdrawal
27
Q

describe patient education for opioid agonist/antagonists

A
  • do not stop abruptly
  • avoid driving
  • change position slowly
28
Q

give an example of an opioid antagonist

A

naloxone

29
Q

describe the action of opioid antagonists

A

reverses analgesia, displaces opioids at receptor sites

30
Q

what are opioid antagonists used for

A
  • treat opioid overdose - antidote
  • reverses CNS and resp depression
31
Q

what are some adverse effects of opioid antagonists

A

immediate withdrawal symptoms:
- tremors
- sweating
- hypertension and tachycardia
- agitation

32
Q

what are some nursing considerations for opioid antagonists

A
  • only reverses opioid agonists
  • short half life ad may need multiple doses
  • available in several routes: IV (2min onset) and intranasal (8min onset)
  • available with and without Rx
  • naltrexone (vivitrol) long acting effects to treat opioid abuse
33
Q

when caring for a patient receiving morphine it is most important that the nurse regularly assess which of the following?

  1. respirations
  2. bowel sounds
  3. urination
  4. mental status
A
  1. respirations

while others are important, remember ABCs. airway is always the most important assessment

34
Q

a man is difficult to arouse after receiving IV morphine sulfate. he has a resp rate of 7. which of the following is your priority nursing action?

  1. place a nasal cannula
  2. administer naloxone
  3. increase IV fluid rate
  4. place patient in semi fowlers
A
  1. administer naloxone

nothing else matters if theyre not breathing

Pharm 2 (34 decks)

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