Pharmacologic Treatment of Pain (Final Exam) Flashcards
Pharmacologic Treatment of Pain
Assess then assess after intervention
Start with least intense and gradually increase
3 Types of pain meds
-Non-opioids (NSAIDS)
-Opioids (Narcotics)
-Adjuvants (Gabapentin)
Non Opioids: Acetaminophen
-Safest/most tolerated
-MOA not clear
-Analgesic and anti-pyretic properties
-No anti-inflammatory
-Can cross blood brain barrier, good for patients after surgery, works quick
4gx24 hrs rule
HAVE CEILING EFFECTS
Non Opioids: NSAIDS
-Watch for gastro-intestinal bleeding, especially in elderly patients
Mild to moderate pain
HAVE CEILING EFFECTS
Opioids
-LOTS of side effects common
-Constipation and GI upset
-Memory/thought changes (CNS)
-Paired with Tylenol
-Start with lowest-dose possible (start low and go slow)
-NO CEILING EFFECT
Opioid: Respiratory Depression
-Serious effect
-Common in opioid naive patient or patients with around-the-clock dosing
-Often seen with patients who take benzodizepines
Opioid Induced Respiratory Depression Treatment
-Naloxone (narcan)
-Put on O2
-Maintain patient airway
-may need to give multiples doses of narcan because of short half life. Check every 15 min
Around the Clock Dosing
-Maximize pain relief and potentially decreasing opioid use
Percocet q 4 hrs @
Can then use non-opioids or adjuvant for breakthourgh pain (multimodal analgesia)
Range-Order Medications
Medication orders in which a does varies over. prescribed range to provide flexibility
-Nurses are responsible for assessing, administering, and following orders
-KNOW YOUR PATIENT
Patient Controlled Analgesia (PCA)
-Always IV
-Starts with loading dose
-Patient then BOLUS (push button when needed)
-There is a frequency
-And a limit (lock-out)
-If PCA then patient can only use the button and must have order for Narcan
-Watch the slide
Epidural Anesthesia
-form of regional anesthesia
-Must be preservative usually have sticker that identifies that
-Can be used in a PCA format, or just a continuous infucion
Epidural Anesthesia: SE
Hypotension, N/V, urinary retention, constipation, respiratory depression, pruritus
Dependence
-Also occurs after repeated exposure to opioid analgesic
-Withdrawal symptoms will occur if drug abruptly withdrawn
-Drug withdrawn by gradually decreasing the dosage
-Withdrawal symptoms not a sign of addiction
Tolerance
-Occurs after repeated exposure
-Does not occur with short-term use of opioids
-Associated with chronic opioids use, especially in malignancy
-Not a sign of addiction
Epidural Anesthesia: Nursing Care
Monitor Site placement
Monitor for infection/bleeding
Urinary retention–May need a catheter
Depending on location, may not be able to walk
-Monitor COAGS
