Sedative & Analgesic Medications Flashcards
Morphine
Pure agonist opioid analgesic
MOA: acts primarily on mu receptor to mimic endogenous opioid peptide actions
Indications:
- Severe pain relief
- Myocardial infarction
- Pre-op sedation
- Anxiety
Adverse Effects:
- Respiratory depression and cough suppression
- Constipation & emesis
- Sedation & increased ICP
- Orthostatic hypotension
- Physical dependence, euphoria, abuse potential
Nursing Considerations:
- Monitor for tolerance, physical dependence, and abuse
- Assess and reassess pain, respiratory status, and GI function
- More effective if administered ATC vs PRN
- Monitor use with other CNS depressants, anticholinergics, antihypertensives, etc.
- If OD, admin naloxone (Narcan)
Fentanyl
Pure agonist opioid analgesic
MOA: acts primarily on mu receptors to mimic endogenous opioid peptide actions
- Administered IM, IV, transdermal, transmucosal, & nasal spray
Indications:
- Chronic pain relief
- Surgical analgesia
- PRN breakthrough pain relief
Adverse Effects:
- Same as morphine
- Respiratory depression and cough suppression
- Constipation & emesis
- Sedation & increased ICP
- Orthostatic hypotension
- Physical dependence, euphoria, abuse potential
Nursing Considerations:
- Higher potency than morphine (100x)
- Transmucosal for breakthrough pain in patients with cancer and opioid tolerance only!
- Same as morphine
- Monitor for tolerance, physical dependence, and abuse
- Assess/reassess pain, respiratory function, and GI function
- Monitor use with other CNS depressants, anticholinergics, antihypertensives, etc.
- If OD, admin naloxone (Narcan)
Methadone
Pure agonist opioid analgesic
MOA: acts primarily on mu receptors to mimic endogenous opioid peptide actions
- Administered PO, IM, & IV
Indications:
- Pain relief
- Opioid addiction
Adverse Effects:
- Same as morphine & fentanyl plus:
- QT prolongation (fatal dysrhythmias)
- Respiratory depression and cough suppression
- Constipation & emesis
- Sedation & increased ICP
- Orthostatic hypotension
- Physical dependence, euphoria, abuse potential
Nursing Considerations:
- Same as morphine & fentanyl plus:
- Monitor heart rhythm on telemetry as well as s/s
- Establish baseline EKG
- Obtain thorough history and assessment of opioid abuse prior to use for addiction and ensure proper dosing
- Monitor for tolerance, physical dependence, and abuse
- Assess and reassess pain, respiratory status, and GI function
- More effective if administered ATC vs PRN
- Monitor use with other CNS depressants, anticholinergics, antihypertensives, etc.
- If OD, admin naloxone (Narcan)
Codeine
MOA: moderate to strong opioid that acts primarily on mu receptors to mimic endogenous opioid peptide actions but with less analgesic effects vs morphine
Indications:
- Mild-moderate pain (similar to 325mg ASA or 325mg acet.)
- Cough (not for children < 6 years)
Adverse Effects:
- Similar to morphine, but to slightly lesser degree
- Excessive sleepiness, breathing difficulties, lethargy, and poor feeding in infants from nursing mothers on codeine
Nursing Considerations:
- Same as morphine
- Monitor for tolerance, physical dependence, and abuse
- Assess and reassess pain, respiratory status, and GI function
- More effective if administered ATC vs PRN
- Monitor use with other CNS depressants, anticholinergics, antihypertensives, etc.
- If OD, admin naloxone (Narcan)
- Lower doses as antitussive, higher doses for analgesia
- Combination products have a lower abuse potential
Oxycodone & Hydrocodone
MOA: pure agonist that acts primarily on mu receptors to mimic endogenous opioid peptide actions
- Combination products include aspirin, acetaminophen or ibuprofen
- Increased street drug abuse potential
Indications:
- Mild-moderate pain
Adverse Effects:
- Similar to morphine plus adverse effects related to combination drug (aspirin, acetaminophen, ibuprofen)
- Respiratory depression and cough suppression
- Constipation & emesis
- Sedation & increased ICP
- Orthostatic hypotension
- Physical dependence, euphoria, abuse potential
Nursing Considerations:
- Same as morphine
- Monitor for tolerance, physical dependence, and abuse
- Assess and reassess pain, respiratory status, and GI function
- More effective if administered ATC vs PRN
- Monitor use with other CNS depressants, anticholinergics, antihypertensives, etc.
- If OD, admin naloxone (Narcan)
- CR and IR formulation for ATC and breakthrough pain tx respectively
Pentazocine
MOA: agonist-antagonist opioid analgesic with agonist action at kappa receptors and antagonist action at mu receptors
Indications:
- Mild-moderate pain
Adverse Effects:
- Similar to morphine but to lesser degrees especially with respiratory depression
- Little to no euphoria and lower abuse potential and with limited withdrawal symptoms
- High doses may produce anxiety, nightmares, hallucinations, etc.
Nursing Considerations:
- Same as morphine
- Withdrawal can be seen if used with patients who have a history of pure opioid agonist abuse
Naloxone
Competitive antagonist at opioid receptors that block opioid action via IV, IM, SQ, and intranasal
Indications:
- Opioid overdose
- Reversal of post-op opioid effects
- Reversal of neonatal respiratory depression
Nursing Considerations:
- Will not see reversal if depression is caused by another agent (benzodiazepines, EtOH, etc.)
- Due to short half life, may need to repeat doses during overdose
- Patient will experience analgesia again
- Other formulations can help with management of opioid-induced constipation and opioid addiction
Tramadol
MOA: non-opioid centrally acting analgesic with pain relief achieved through weak mu receptor agonist activity and blocking of NE and 5-HT reuptake.
Indications:
- Moderate-severe pain
Adverse Effects:
- Due to weak mu activity, risk for respiratory depression is low and rare
- Sedation, dizziness, headache, dry mouth, and constipation common
- Serotonin syndrome if co-administered with SSRI, SNRI, etc.
Nursing Considerations:
- Abuse potential low
- Utilized in suicide attempts in combination with other CNS depressants
- Closely monitor and educate patients on use with SSRI, SNRI, TCA, MAOI, and triptan meds
Aspirin
MOA: irreversible non-selective cyclooxygenase inhibitor with inhibition of COX-1 leading to protection against MI and ischemic stroke, and COX-2 leading to reduction in inflammation, pain, and fever
Indications:
- Suppressing inflammation, analgesia, and fever in adults only!
- Suppression of platelet aggregation, dysmenorrhea, and possible colorectal cancer prevention
Adverse Effects:
- GI effects (take with food)
- Bleeding
- Renal impairment
- Salicylism
- Reye’s syndrome & toxicity
Nursing Considerations:
- Patient education on bleeding and concurrent use with other blood thinners
- Stop high-dose 7-10 days prior to surgery
- Numerous medication interactions, many with OTCs
Ibuprofen
MOA: reversible non-selective cyclooxygenase inhibitor propionic acid class NSAID with inhibition of COX-1 but does not lead to protection against thrombotic events and COX-2 leading to reduction in inflammation, pain, and fever Indications: - RA & OA - Pain & Fever in adults (possibly IV) - Dysmenorrhea - Bursitis - Tendinitis Adverse Effects: - GI effects (take with food) - Bleeding - Renal impairment - Increased risk for thrombotic events - Very rarely, SJS Nursing Considerations: - Patient education on bleeding and concurrent use with other blood thinners - Education on the lowest possible effective dose for the shortest amount of time - No CV protection against MI/CVA - Caution with renal impairment, monitor renal function
Acetaminophen
Narcotic analgesic, antipyretic MOA: acts directly on the hypothalamus to increase vasodilation and sweating Indications: - Pain or fever in children - Mild-moderate musculoskeletal pain Adverse Effects: - Hepatotoxicity - Renal Failure - Hypersensitivity - Myocardial damage Nursing Considerations: - If overdose occurs, gastric lavage & activated charcoal within 4 hours; administer antidote Acetylcystine (PO/IV) if after 8-10 hours (does not reverse existing damage)
Ketorolac
MOA: reversible non-selective cyclooxyrgenase inhibitor with inhibition of COX-1 but does not lead to protection against thrombotic events and COX-2 leading to reduction in inflammation, pain, and fever.
Indications:
- Short-term management of acute moderate-severe pain particularly in post-op (similar to morphine pain relief)
Adverse Effects:
- GI effects (take with food)
- Bleeding
- Renal impairment
Nursing Considerations:
- Patient education on bleeding and concurrent use with other blood thinners
- Medication is only used up tp five days total regardless of route used
- No CV protection against MI/CVA
- Caution with renal impairment, monitor renal function
Celecoxib
MOA: second generation selective cyclooxyrgenase inhibitor with inhibition of COX-3 leading to reduction in inflammation & pain.
Indications:
- RA & OA
- Ankylosing Spondylitis
- Juvenile idiopathic arthritis
- Acute pain
- Dysmenorrhea
Adverse Effects:
- Increased risk for MI, CVA, and other CV related events from increased unimpeded platelet aggregation and increased vasoconstriction
- Possible cross-allergy with sulfa medications
- Renal impairment, although decreased risk with 2nd generation
Nursing Considerations:
- Decreased risk for GI related effects due to selectivity to COX-2 at therapeutic doses, but GI effects can still occur
- No CV protection against MI/CVA; monitor and educate patient on s/s
- Caution with renal impairment, monitor renal function
Adjuvant Analgesics
Used in combination with other analgesics Antidepressants: - TCA - SNRI Antiseizure: - Tegretol - Gabapentin - Pregabalin Anesthetics/Antidysrhythmics - Lidocaine CNS stimulants: - Dextroamphetamine - Methylphenidate Glucocorticoids: - Dexamethasone - Prednisone Biphosphates: - Pamidronate - Zoledronic acid
Benzodiazepines
Indications: - DOC for anxiety & insomnia - Seizure disorder - Muscle spasm - Alcohol withdrawal - Perioperative applications Adverse Effects: - CNS depression - Anterograde amnesia - Sleep driving - Paradoxical effects - Respiratory depression - Abuse - Teratogenicity Drug Interactions: - CNS depressants
