Pain pt 2 Flashcards
what are some barriers to pain management
age
communication
cognitive impairment
mental health conditions
injury associated w/ pain
conditions associated w/pain
what are some factors that affect pain
culture, ethnicity
family, sex, gender, age
religious beliefs
environment, support people
anxiety, other stressors
past pain experience
what are some nursing interventions for pain
Establishing trusting nurse–patient relationship
Manipulating factors affecting pain experience
Initiating nonpharmacologic pain relief measures
Managing pharmacologic interventions
Complementary and alternative relief measures
Considering ethical and legal responsibility to relieve pain
Teaching patient about pain
what are some non-pharmacologic pain relief measures
distraction
humor
music
imagery
relaxation
cutaneous stimulation
acupuncture
hypnosis
biofeedback
therapeutic touch
animal-facilitated therapy
what are the 3 opioid receptors
mu
kappa
delta
what are mu opioid receptors
stimulated by opioid drugs causing analgesia
also causes respiratory depression, euphoria, sedation, and physical dependance
what are kappa opioid receptors
stimulated by opioid drugs causing analgesia
also causes sedation and psychotomimetic effects such as hallucinations and delusion
what are delta opioid receptors
no pharmacology effects when stimulated
what is inflammation
Response to cellular damage and release of bradykinins, histamine, prostaglandins,
leukotrienes resulting in pain, inflammation, edema and the systemic response
what is suppression of inflammation
The hypothalamus stimulates the pituitary gland to release ACTH which stimulates the
adrenal glands to produce cortisol which plays a role in suppressing inflammation and the
release of aldosterone which affects fluid balance
what are the 2 nonopioid analgesics
acetaminophen and NSAIDS
what are some characteristics of nonopioid analgesics
can be used for acute or chronic pain
lack of dependence
less side effects
decreases inflammation
what are opioid/narcotic analgesics considered
controlled substaces
what are some characteristics of opioids/narcotics
used for visceral pain
drowsiness
respiratory depression
gi issues
constipation
high dependency rate
what are 2 examples of controlled substances
morphine and codiene
what are the 2 inflammatory drugs
antihyperuricemics/uricosurics/urate lowering therapy
glucocorticoids
what class are 1st gen NSAIDS
COX-1 inhibitors and COX-2 inhibitors
what are 2nd gen NSAIDS
COX-2 inhibitors and acetaminophen
what is a centrally acting NSAID
tramadol
what are examples of 1st gen NSAIDS
aspirin and ibuprofen
what is the 2nd gen NSAID
celecoxib
what is the pharmacologic action of aspirin and ibuprofen
inhibit the action of COX-1 and COX-2 which stimulates the release of prostaglandins
what are the adverse reactions w/ aspirin and ibuprofen
gastric upset
heartburn
nausea
gastric ulceration
bleeding tendencies
renal dysfunction
increased thromboembolic events
aspirin toxicity
Reye’s syndrome
what are the interventions for aspirin and ibuprofen
Monitor for signs of bleeding, such as dark stool, hematemesis, bruising
excessive bleeding from minor injuries such as shaving
Monitor I/O, BUN, Creatinine
Assess for signs of toxicity such as tinnitus, dizziness, headache.
Use acetaminophen instead of aspirin for children under 18 years old
how do you administer aspirin and ibuprofen
swallow do not crush or chew enteric coated or sustained release, avoid alcohol, take with food, milk or water
what are some contraindications of aspirin and ibuprofen
pregnancy
peptic ulcer disease
hemophilia
current diagnosis of chicken pox or flu
Older adults, smokers
alcohol use disorders
impaired kidney function
heart failure
hypertension
Helicobacter pylori
what is a precaution of aspirin and ibuprofen
discontinue a week before surgery
what are some interactions of aspirin and ibuprofen
use of aspirin with anticoagulants, glucocorticoids and alcohol increase risk for bleeding
Use with ACE inhibitors and angiotensin receptor blockers increase the risk of renal failure
Toxicity of lithium carbonate and methotrexate
what is the class of celecoxib
COX-2 inhibitors
what is the pharmacologic action of celecoxib
inhibit the action of COX-2 which stimulates the release of prostaglandins
what are the adverse reactions w/ celecoxib
renal dysfunction and increased risk of clots
what are the interventions for celecoxib
Monitor for signs of bleeding, such as dark stool, hematemesis, bruising
excessive bleeding from minor injuries such as shaving
Monitor I/O, BUN, Creatinine
Assess for signs of MI or stroke
how do you administer celecoxib
2 hours before or after magnesium or aluminum- based antacids, take with food, milk or water
what are some contraindications w/ celecoxib
pregnancy
children under the age of 18
alcohol use disorders
impaired kidney or liver function
heart failure
hypertension
Helicobacter pylori
allergic to sulfonamides
what are the precautions w/ celecoxib
changes in weight gain, signs of fluid retention, such as edema and bloating
what are the interactions w/ celecoxib
furosemide and antihypertensive less effective.
warfarin and lithium toxicity
Glucocorticoids and alcohol bleeding
what class is acetaminophen
nonopioid analgesic
what is the pharmacologic action for acetaminophen
inhibit the action of COX-1 and COX-2 but is limited to the CNS, therefore relieves pain and reduces fever but does have ant-inflammatory or anti-coagulant effects
what are the adverse reactions w/ acetaminophen
liver damage with toxic doses and hypertension when taken daily
what are the interventions w/ acetaminophen
Monitor for signs of overdose or poisoning such as abdominal discomfort, nausea, vomiting, sweating and diarrhea
Monitor blood pressure if taking on a regular basis.
how do you administer acetaminophen
do not take more than 4 g in 24 hours. Often is found in combination cold and flu products so be careful reading labels.
what is a contraindication for acetaminophen
alcoholism
what are the precautions w/ acetaminophen
anemia
immune suppression
liver/kidney disease
what are the interactions for acetaminophen
increases risk of bleeding when also taking warfarin, if reduced absorption when taking cholestyramine
what is the name of the centrally acting nonopioid
tramadol
what is the class of tramadol
centrally acting nonopioid
what is the pharmacologic action of tramadol
binds to selected opioid receptors and blocking
reuptake of norepinephrine and serotonin in the CNS
what are the adverse reactions for tramadol
rare but include sedation and dizziness, headache, nausea and constipation. Seizures
what are the interventions w/ tramadol
Monitor during ambulation, vital signs particularly respiratory rate, seizure activity and urinary retention.
how do you administer tramadol
effects typically not felt until an hour after
administration. Swallow extended release do not chew or crush.
what are the contraindications w/ tramadol
alcoholism
taking opioids or psychotropics
seizure disorders
respiratory depression
under the age of 12
liver or kidney disease
increased intracranial pressure
what are the precautions for tramadol
avoid taking before driving or performing activities
Change positions slowly
what are the interactions for tramadol
taking with MAOI’s increased risk for hypertensive crisis
increases effects of CNS depressant
taking with St. Johns wort increases its sedative effects.
what is the opioid agonist
morphine
what class is morphine
opioid agonist
what is the pharmacologic action of morphine
mimics naturally occurring opioids, endorphins and enkephalins by binding with the mu receptors
what are adverse reactions for morphine
respiratory depression and sedation
dizziness
lightheaded and drowsiness
Constipation
orthostatic hypotension
High potential for abuse
what are interventions w/ morphine
Monitor vital signs particularly respiratory rate and oxygen saturation, If RR less than 12 hold medication and consider administering
naloxone
Monitor for constipation, urinary retention and dependance
how do you administer morphine
orally
intramuscularly
intravenously
subcutaneously
rectally
epidurally
Have naloxone and resuscitation equipment readily available
what are contraindications for morphine
pregnant women because it can cause newborn respiratory depression or neonatal withdrawal syndrome
Renal failure
increased intracranial pressure
biliary surgery
what are the precautions for morphine
avoid taking before driving or performing activities. Change positions slowly
what are the interactions for morphine
interact with CNS suppressants causing increased CNS suppression
Anticholinergics- increases risk for constipation and urinary retention
taking with MAOI’s increased risk for hyperpyrexic syndrome
taking with St. Johns wort increases its sedative effects
what are the opioid agonist-antagonists
butorphanol and pentazocine
what is the class of butorphanol and pentazocine
opioid agonist-antagonist
what is the pharmacologic action of butorphanol and pentazocine
mu receptors antagonists and kappa receptor
agonists
what are adverse reactions for butorphanol and pentazocine
respiratory depression and sedation
dizziness
lightheaded and drowsiness
headache
nausea
Increased cardiac workload
what are interventions w/ butorphanol and pentazocine
ask if they are taking an opioid before administering as it can precipitate withdrawal symptoms
Monitor vital signs particularly respiratory rate and oxygen saturation. If RR less than 12 hold medication.
how do you administer butorphanol and pentazocine
IM
IV
intranasally
what are contraindications for butorphanol and pentazocine
Acute myocardial infarction
renal or liver disease
increased intracranial pressure
cardiac insufficiency
hypertension
what are the precautions for butorphanol and pentazocine
avoid taking before driving or performing activities.
Change positions slowly
what are the interactions for butorphanol and pentazocine
interact with CNS suppressants causing increased CNS suppression
If given with opioids will decease the effect of the opioid
what is an opioid antagonist
naloxone
what class is naloxone
opioid antagonist
what is the pharmacologic action of naloxone
block opioid receptors reversing or
antagonizing the effects of opioids
what are adverse reactions of naloxone
ventricular arrythmias and abstinence syndrome in opioid dependent including hypertension, vomiting and tremors
what are interventions w/ naloxone
closely monitor for dangerous elevations in blood pressure and abnormal heart rhythms
how do you administer naloxone
IM
IV
subcutaneous
what are contraindications w/ naloxone
Acute myocardial infarction
renal or liver disease
increased intracranial pressure
cardiac insufficiency
hypertension
what are precautions for naloxone
caution in use on cardiac irritability, head injury, with increased intracranial pressure, brain tumor, or seizures
what are interactions for naloxone
will decrease the effect of opioids
what drug is a antihyperuricemics/uricosurics/urate lowering therapy
allopurinol
what class is allopurinol in
anti/gout/antihyperuricemics
what is the pharmacologic action of allopurinol
inhibit the conversion of hypoxanthine and xanthine into uric acid and inhibit the reabsorption of uric acid by the kidneys promoting excretion
what are adverse reactions of allopurinol
generally tolerated well but some may experience hypersensitivity syndrome, liver and kidney dysfunction, GI disturbances and bone marrow depression and a metallic taste in their mouth. Cataracts if taken for extended period.
what are interventions of allopurinol
monitor for hypersensitivity syndrome if taking greater than 2-4 weeks
Monitor kidney and liver function and CBC. Give after meals if GI disturbances occur
Visit ophthalmologist regularly
how do you administer allopurinol
orally or intravenously. Tablets can be crushed and mixed with fluid or food. Drink at least 3 liters of fluid daily.
what are contraindications w/ allopurinol
bone marrow depression
liver or kidney disease
peptic ulcers
lower GI tract diseases
what are precautions of allopurinol
minimize exposure of eyes to bright sunlight
what are interactions of allopurinol
increases the anticoagulant effect of warfarin
increases risk of toxicity if taken with mercaptopurine, theophylline and azathioprine
Increases risk for rash if taken with ampicillin
what drug class is prednisone
glucocorticoids
what is the pharmacologic action of prednisone
mimic cortisol by suppressing inflammation
and the immune response resulting in decreasing pain and swelling
what are adverse reactions w/ prednisone
hyperglycemia
myopathy
peptic ulcer disease and GI distress
Bone loss
cataracts
increased risk for infection
what are interventions w/ prednisone
monitor hypotension and fatigue
monitor blood glucose levels
observe for sign of infection
I/O
edema
weight gain
how do you administer prednisone
orally
intramuscularly
intravenously
subcutaneously
topically
intranasally
inhalation
Start with larger doses and progressively decrease doses. Do not stop abruptly.
what are contraindications w/ prednisone
systemic fungal infection
cataracts
heart failure
peptic ulcer disease
diabetes
hypertension
renal dysfunction
myasthenia gravis
osteoporosis
what are precautions of prednisone
long term effects even if given for a short period of time
what are interactions of prednisone
prevent the body from responding appropriately to vaccines
Increased risk of hypokalemia if taking furosemide
Increased risk of dysrhythmias when taking digoxin
Increased risk of GI bleed and ulceration if also taking NSAIDs
effects of insulin and oral hypoglycemics decreased
what receptors do opioid agonists primarily bind to
mu receptors
what receptors do opioid agonist-antagonists primarily bind to
mu and kappa receptors
what is the pasero opioid-induced sedation scale
s=sleep, easy to arouse; no action necessary
i=awake & alert; no action necessary
3=frequently drowsy, drifts to sleep during
conversation; decrease the opioid
4=somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone
what is a uricosuric
Treat gout: an inflammatory disorder that occurs due to high levels of uric
acid in the blood. The uric acid crystalizes and deposits in joints. Primarily
small joints such as the big toe. Can also deposit in the skin and organs if
untreated.
what are corticosteroids
Treat inflammation and autoimmune diseases: wide variety of disorders of
the skin, respiratory system, allergic reactions, rheumatoid arthritis and to
prevent organ rejection and respiratory
what is drug diversion
any act that causes a drug to not reach the right person
