Pharm110 Chp 10 Analgesics and Antipyretics

Question 1

Analgesics Types and agents

Answer 1

Analgesics 2 types
Opioids:
Morphine, Codeine, Hydromorphone

Non-Opioids/Analgesic antipyretics:
Salicylates:
Asprin

Non-Salicylates:
Acetaminophen
NSAIDS e.g. Ibuprofen, Naproxen, Ketorolac

Analgesics relieve pain without causing a loss of consciousness

Question 2

Pain transmission

Answer 2

Tissue injury causes the release of inflammatory mediators that stimulate the nerve endings starting the pain process:
Bradykinin
Histamine
Prostaglandins
Serotonin

Question 3

Pain transmission in the spinal cord

Answer 3

A fibers

• Myelin sheath
• Large fiber size
• Conduct quickly
• Sharp and well localized pain

C fibers

• No myelin sheath
• Small fiber size
• Conduct slowly
• Dull and non localized pain

Question 4

Neurotransmitters

Answer 4

Body has endogenous neurotransmitters
-Endorphins
-Enkephalins
Produced by body to fight pain bind to opioid receptors and inhibit transmission of pain by closing the gate.

Question 5

Opioid analgesics

Answer 5

Natural substance from raw opium poppy plant, more than 20 different alkaloids (e.g. morphine, codeine) are obtained from unripe seeds of the opium poppy.

Question 6

Management of pain

Answer 6

Treat the cause
Select a safe analgesic
Psychological support due to depression
Nursing action: position change and back rub if not quite time to administer dose.
Do not undertreat pain out of fear of producing drug addiction.

Question 7

Morphine Sulfate

Answer 7

Most widely used opioid
Used to treat moderate to severe pain
Gold standard in pain management
CNS depressant
Effective treatment for ischemic chest pain
Agent of choice for postoperative visceral pain

Question 8

Uses for opioid analgesics

Answer 8

Couch suppression: codeine
Diarrhea: diphenoxylate (Lomotil)
Decrease anxiety and sedate before surgery
Conscious sedation

Question 9

Effects of opioid analgecis

Answer 9

Euphoria
Constipation: MOST common adverse effect
Urinary retention
Pupil constriction (miosis)
Respiratory depression: Most severe adverse effect.

Question 10

Opioid analgesics Nursing implications

Answer 10

Oral forms- take with food
Ensure safety measures to prevent fall risks
Children given opioids parenterally should not be discharged for at least 2 hours.

Question 11

Opioid physical dependance

Answer 11

Chronic use results in a high tolerance and withdrawal from discontinuation or dosage reduction

Tolerance forms more slowly from oral forms compared to parenteral forms.

Pain exists if the patient says it does

Nurses need to be more concerned with the adverse effects on the GI system.

Question 12

Respiratory depression

Answer 12

Opioid naïve patients are at a greater risk for respiratory depression than a regular opioid using patient.
Do not administer opioids if respirations are less than 12/min.
Warning signs
hypotension
constricted pupils
cold clammy skin

Opioid antagonist used Naloxone

Question 13

Storage laws

Answer 13

Opioids must be kept under a double lock

Question 14

Therapeutic effect of opioids

Answer 14

Monitor for
Increased comfort
Activities of daily living improved

Question 15

Adverse effects that should be reported to the Dr

Answer 15

Significant decrease in respiratory rate of 10 breaths/min or less
Significant increase in pulse rate or change in pulse quality (thready pulse)
Significant decrease in BP (systolic or diastolic) systolic pressure below 100 mmHg.

Question 16

Opiate antagonists

Answer 16

Naloxone (Narcan)
Bind to opiate receptors and prevent opiate response
Used for reversal of opioid-induced respiratory depression

Question 17

Opioid analgesic nursing implications

Answer 17

CHECK DOSAGES CAREFULLY
Prevent constipation
prevent respiratory depression
provide proper pt education
drug administration
position changes
Allergies
Possible interactions with other OTC or Rx meds

Question 18

Non-opioid analgesics/ Analgesic antipyretics

Answer 18

Acetylsalicylic acid (Aspirin)
peripherally interferes with synthesis of prostaglandins released from injured tissue
Treats mild to moderate pain
Anti-platelet effect

Question 19

Acetylsalicylic acid (Aspirin) adverse effects

Answer 19

GI irritation and bleeding (painless lowers hemoglobin)
Increases bleeding time
Tinnitus (ringing in the ears)
Children: Reyes’s syndrome

Question 20

Acetaminophen

Answer 20

Blocks pain impulses peripherally
Reduces fever (antipyretic)
Causes little if any GI irritation or upset
No anti-inflammatory action

Question 21

Acetaminophen adverse effects

Answer 21

Acute overdose causes hepatic necrosis
Doses of 150 mg/kg
Long term ingetion of large doses can result in nephropathy

Question 22

Acetaminophen overdose treatment

Answer 22

Antagonist Acetylcysteine

prevents the formation of hepatotoxic metabolites

Question 23

NSAIDS (Nonsteroidal anti-inflammatory Drugs)

Answer 23

Block pain impulses peripherally by inhibiting prostaglandins
May cause GI upset of bleeding
Should NOT be used with aspirin( aspirin diminishes their action and increases GI distress)

Question 24

Children’s pain scale

Answer 24

Pediatric nurses use the Oucher scale of the Wong-Baker Faces scale for pain assessment in children.

Question 25

Enteric coated Acetylsalicylic acid (Aspirin)

Answer 25

Help reduce the GI irritation caused by acetylsalicylic acid and should never be crushed up for administration
Instruct patient to never take antacids with enteric coated tablets.