Surgical - Pharmacology

Question 1

Multimodal analgesia

Answer 1

Use of 2 or more classes of analgesics

• takes advantage of differing mechanism of action
• targets different mechanisms of pain
• superior pain relief at lower doses
• opioids + NSAIDs + simple analgesics

Question 2

Paracetamol
Brand: 
Class: 
Forms: 
Action: 
Indication:
Dose: 
Adverse Effects: 
Nursing Care:

Answer 2

Paracetamol
Brand: Panadol
Class: Analgesia
Forms: Tab, Suppose, Liquid, IV
Action: Analgesic, Antipyretic. 
- Prostaglandin synthesis inhibition
Indication: Mild to Mod pain, Fever
Dose: 1g 4-6/24. MAX 4g per day
Adverse Effects: Nausea, Dyspepsia (acid reflux), liver failure
Nursing Care: Metabolised by liver, caution in liver disease pts.

Question 3

Ibuprofen
Brand: 
Class: 
Forms: 
Action: 
Indication:
Dose: 
Adverse Effects: 
Nursing Care:

Answer 3

Ibuprofen
Brand: Nurofen
Class: NSAID
Forms: Tab, cap, liquid
Action: Analgesic, anti inflammatory, antipyretic.
Inhibits Cox - 1 non selectively and binds to Cox - 2, decreasing inflammation and pain
Indication: Mild to mod pain, Fever
Dose: 200-400mg 6/24. MAX 3.2g daily
Adverse Effects: Epigastric pain, nausea, vomitting, abdominal pain, rash
Nursing Care:
- Contraindicated with aspirin and other NSAIDs
- Caution with warfarin, increased risk of bleeding
- Antacids decrease absorption of ibuprofen

Question 4

Morphine
Brand: 
Class: 
Forms: 
Action: 
Indication:
Dose: 
Adverse Effects: 
Nursing Care:

Answer 4

Morphine
Brand: 
Class: Opiod analgesic
Forms: Oral solution, tab, XR tab, ampoule
Action: 
- CNS and smooth muscle
- binds to specific opiod receptors pre and post synaptically, thus decreasing pain and transmission in spinal cord 
- changes pain pathway to brain
Indication: Mod - severe pain
Dose: 2.5-5mg IV 1/24
Adverse Effects: 
- Rash, nausea, vomitting, dry mouth, constipation, headache
- Resp distress
- Urinary retention
- Drowsiness 
- Dependance
Nursing Care: 
- monitor for resp depression 
- Laxatives 
- FBC for urinary output 
- Caution in confused pts

Question 5

Fentanyl
Brand: 
Class: 
Forms: 
Action: 
Indication:
Dose: 
Adverse Effects: 
Nursing Care:

Answer 5

Fentanyl
Brand: 
Class: Opiod Analgesic
Forms: Patches, ampoules
Action: Morphine but more potent
- CNS and smooth muscle
- binds to specific opiod receptors pre and post synaptically, thus decreasing pain and transmission in spinal cord 
- changes pain pathway to brain
Indication: Mod - Severe Pain
Dose: 50 - 100mcg 1-2/24
Adverse Effects: 
- Bleeding gums
- Muscle Rigidity 
- Rash, nausea, vomitting, dry mouth, constipation, headache
- Resp distress
- Urinary retention
- Drowsiness 
- Dependance
Nursing Care: 
- monitor for resp depression 
- Laxatives 
- FBC for urinary output 
- Caution in confused pts

Question 6

Oxycodone
Brand: 
Class: 
Forms: 
Action: 
Indication:
Dose: 
Adverse Effects: 
Nursing Care:

Answer 6

Oxycodone
Brand: Endone, Oxycontin
Class: Opiod Analgesic
Forms: Tabs, caps, oral solution, ampoule
Action: Semi synthetic opiod
- similar to morphine but shorter acting
Indication: Mod - Severe pain
Dose: 5mg 4-6/24
Adverse Effects: Similar to morph, less severe
- Rash, nausea, vomitting, dry mouth, constipation, headache
- Resp distress
- Urinary retention
- Drowsiness 
- Dependance
Nursing Care: 
- monitor for resp depression 
- Laxatives 
- FBC for urinary output 
- Caution in confused pts

Question 7

Ondansetron
Brand: 
Class: 
Forms: 
Action: 
Indication:
Dose: 
Adverse Effects: 
Nursing Care:

Answer 7

Ondansetron
Brand: Zofran, Ondanz
Class: 5HT3 Receptor antagonist
Forms: Tab, wafer, ampoule, Syrup, Suppositories
Action: Blocks vagal afferents via 5HT3 receptors in brain
Indication: Nausea & Vomitting
Dose: 4-8mg
Adverse Effects: Headache, dizziness, fatigue, diarrhoea, constipation, tremors
Nursing Care:
- Given for most anaesthetics
- Considered safe post op
- Decreases analgesic affects of tramadol

Question 8

Metoclopramide
Brand: 
Class: 
Forms: 
Action: 
Indication:
Dose: 
Adverse Effects: 
Nursing Care:

Answer 8

Metoclopramide
Brand: Maxalon
Class: Antiemetic
Forms: Tabs, ampuoles
Action:
- Stimulates motility of upper GI tract w/o stimulating secretions
- increases tone of gastric contractions
- Accelerates gastric emptying and intestinal transit
Indication:
Dose: 10mg 8 hourly
Adverse Effects: Restlessness, drowsiness, headaches, constipation, tremors
Nursing Care:
- Rare intra-op, common post op
- not safe in kids under 15
- Contraindicated where gastric motility can be dangerous (obstruction, perforation, haemorrhage, pregnancy).

Question 9

PCA

• Advantages
• Pump Modes

Answer 9

• Avoids analgesic peaks and troughs
• Receive relief without delay
• Opiod blood concentration maintained in therapeutic range
• Pt empowerment

PCA = demand dose with lock out period
Continuous = Background infusion, pt receives constant dose, pt cannot alter
PCA + Cont = Set for continuous but pt. can self admin bolus

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