Pain Relief Flashcards
Examples of non-opioids:
— NSAIDS: ibuprofen, aspirin
— Acetaminophen (Tylenol)
What are risks with NSAIDS with children?
Aspirin: risk of Reye syndrome (neurological deficits)
— NSAIDS are approved for children 6+ mo.
* acetaminophen is the safest use for children
What is acetaminophen?
What is the max dose?
NOT AN NSAID
Max dose is 4g/day (4000mg/day)
What are the effects of cyclooxygenage-1? (Cox-1)
Do we want to block this enzyme pathway?
enzyme pathway for NSAIDS:
— promotes inflammation
— maintains renal function
— provides gastric mucosa integrity
— promotes vascular hemostasis
— assists in fever
* WE WANT TO BLOCK THIS PATHWAY = issues
* blocking this pathway leads to AE in our NSAIDS
AE:
— sodium retention
— edema
— HTN
— GI erosion
— bleeding
What are the effects of cyclooxygenage-2? (Cox-2)
— increase pain and inflammation
— vasodilation
— blocks platelet clumping
* pathway gets blocked resulting in AE
What are the indications of NSAIDS?
What is an NSAID?
— pain
— fever
— musculoskeletal disorders/inflammatory
Non-steroidal anti-inflammatory drug
What are the AE when taking NSAIDS?
— nausea
— vomiting
— gastritis
— epigastric pain
— peptic ulcers
— upper GI bleeding
* HARSH ON KIDNEYS
THINK RENAL
What are drug-drug interactions with NSAIDS?
— do not take other NSAIDS
— corticosteroids: hard on the stomach, GI problems
— anticoagulants: increased risk for bleeding
* NSAIDS help decrease clotting/inflammation
What is aspirin?
Risk for salicylate toxicity
Baby aspirin: 81 mg
Dark stools indicate upper GI bleeding
What is salicylate toxicity? Is it rare?
Yes, it is rare
— greater risk if taking 4g+/day
*monitor: tinnitus (ringing in ears); hearing loss
What is ibuprofen?
NSAIDS: toxic to the kidneys
What do you assess in your patients taking NSAIDS?
— baseline history + allergies
— focus on pain, fever, GI
— only monitor labs if bleeding + toxicity is expected
What are adjuvant drugs?
— often used for chronic pain
CAUTION: sedation
Examples:
— antidepressants
— anticonvulsants
— corticosteroids
— antihistamines
— sedatives
— benzodiazepines
— antispasmodics
— muscle relaxants
What is gabapentin?
Neuropathic pain
GABA = inhibitory neurotransmitter; slows brain activity (initially used for seizure disorders)
What is baclofen?
The nurse is reviewing a medication list for a client. The combination of which medications causes concern for the nurse?
A. Lispro and glargine
B. Loratadine and pseudoephedrine
C. Acetaminophen and aspirin
D. Ibuprofen and prednisone
D. Ibuprofen and prednisone
- taking an NSAID with prednisone increases the risk of GI irritation, GI ulcers and GI bleeding.
What type of medications do you need to waste if not taken by the patient?
Opioids/narcotics
— oxy
— morphine
— fentanyl
* requires a witness
What are opioids used for and what is the MOA?
Used for:
— mild to severe pain
— acute or chronic pain
— Antitussive effects
— adjuvant for anesthesia
MOA:
Interacts with opioid receptors to inhibit pain pathways in CNS
What are AE with taking opioids?
Urgent:
— SEDATION
— RESP DEPRESSION
Common:
— constipation
— urinary retention
— nausea/vomiting
— hypotension
— itching
Less likely to occur:
— euphoria (abuse)
— hallucinations
— bradycardia
What are opioid cautions?
What are contradictions?
Cautions:
— hypersensitivity
— opioid naive (someone that is not used to taking a lot of opioids)
— resp disease: asthma, COPD, PNA
— pregnancy: medication can cross placental barrier and affect baby
Contradictions:
— resp depression
— severe heart disease
— substance abuse
- some patients will ask you to push IV opioids faster = be aware patient may be abusing or have hx of opioid abuse
What are drug-drug interactions with opioid agonists?
CNS depressants — alcohol, sedatives, antipsychotics, skeletal muscle relaxants, benzodiazepines
- start with low dose if opioid naive
- discontinue gradually after long-term use to avoid withdraw
Your patient is prescribed opioids, after administering you go in to check on your patient and witness less than 10 breaths/minute. What are the next steps?
— assess VS, apply O2 if low saturation
— hold next dose
— consider antidote/antagonist
How will you manage constipation with your patient?
— plenty of fluids
— high fiber diet
— exercise
— stool softeners
How will the nurse manage nausea and vomiting with their patient?
— take medication with food
— medication to relieve n/v
How will the nurse manage itching with their patient?
— lotions, cool compresses
— medication to relieve itching: loratadine (Claritin)
What are the least to most potent opioids?
LEAST POTENT
Codeine: PO
Oxycodone: PO
Morphine: PO, IV, SL
Fentanyl: IV, SL, transdermal
MOST POTENT
What is important to know about PO opioid medications?
They are extended release - cannot crush or alter
Why is it important to know the doses of NSAIDS and acetaminophen?
— reduce overdose
— combination PO opioids are combined with a non-opioid component
Ex: oxycodone + acetaminophen
What is codeine?
What is oxycodone?
What is morphine?
What is fentanyl?
What is a PCA?
What are indications for PCA use and contraindications?
— allows patient some control of pain administration at need
— less sedation, less opioid consumptions, decrease post-op complication
*Indications:
— post-surgical pain
— trauma
— cancer pain
— sickle cell crisis
— burns
*Contraindications:
— cognitive problems
— hypoventilation syndromes
— extremes of age
What is naloxone?
The nurse would expect to administer morphine as the analgesia of choice for which clients? SATA
A. A client with severe post-op pain
B. A client with severe bronchitis
C. A client with cancer and severe bone pain
D. A client with chronic leg pain from peripheral neuropathy
E. A client with chronic pain unresponsive to NSAIDS and adjuvants
A. Severe post-op pain
C. Cancer and severe bone pain
E. Chronic pain unresponsive to other meds
The nurse knows that constipation could be caused by which medication?
A. Gabapentin
B. Acetaminophen
C. Oxycodone
D. Ibuprofen
C. Oxycodone
The nurse is caring for a client prescribed oxycodone and baclofen. The nurse should prioritize which assessment?
A. Bowel sounds
B. LOC
C. I&O
D. Range of motion
B. LOC
* combination of these drugs causes drowsiness; increased risk for falls
What is the mistake with the following?
Oxycodone/acetaminophen 5mg/325mg. Take 2 tabs PO every 3 hours.
Every 6 hours
Exceeds 24-hour acetaminophen limit
What is the mistake with the following?
Fentanyl 50mg. Administer via IVP q 2 hours PRN
Fentanyl should be mcg
What is the mistake with the following?
Oxycodone 60mg ER. Administer tablet via PEG tube every 12 hours.
Extended release - cannot crush
What is the mistake with the following?
Morphine 10mg. Administer via IVP 1 min every 3 hours PRN
Push slowly (4-5 min) to decrease damage to vein
