Week 11-Drugs to treat pain: Narcotics and Narcotic Agonists Flashcards
What is pain?
Sensory and emotional experience associated with actual or potential tissue damage
What is the gate-control theory of pain?
- transmission of these impulses are modulated or adjusted
- interneurons can act as “gates”
- several factors can activate the descending inhibitory nerves from the upper central nervous system including culture, learned experience, individual tolerance, placebo effect
What is acute pain?
sudden onset that usually subsides after treatment
What is nociceptive caused by?
direct stimulus to pain receptors (somatic and visceral pain)
What is chronic pain?
- persistent or recurrent pain
- 6 weeks or longer
- can be intermittent, occur in a pattern or persist (lasting more than 12h a day)
What is somatic pain?
nociceptive pain that includes skin/superficial/bone/connective tissue
What is visceral pain?
nociceptive pain that is of the internal organs
What are the 2 kinds of nociceptive pain?
somatic and visceral
What is neuropathic pain?
- pain from abnormal or damaged nerves
- central of peripheral
Why is pain management important?
helps you heal faster
What is most often the cause of visceral pain?
obstructions (often from tumours)
What are analgesics?
medication that relieve pains
- narcotic (moderate to severe pain)
- non-narcotic (mild to moderate pain)
What are ‘pain killers’?
analgesics
What are the general characteristics of narcotic/opioid analgesics?
- relieves moderate to severe pain
- react with opioid receptors throughout the body to cause analgesia, sedation or euphoria
Why did the narcotic safety and awareness act (2010) come about?
between 1991 and 2009 the number of prescriptions in Ontario for oxtcodone drugs rose by 900%
What does the narcotic safety and awareness act (2010) say?
- patients need to SHOW ID in order to be prescribed a narcotic or controlled substance medication
- implemented a MONITORING system to tract dispension of prescription narcotics
What are some of the common drugs being monitored?
- T3’s (acetaminophen compound with codeine and caffeine)
- Percocet (oxycodone HCl & acetaminophen)
- Oxycotin (Oxycodone HCl)
- dilaudid (hydromorphone hcl)
- statex, ms cotin (mophine sulfate)
-codeine, codeine contin
( codeine sulfate) - demerol (meperidine HCl)
What are the indications for narcotic use?
- prevent or relieve ACUTE or CHRONIC (moderate to severe pain)
- chronic pain ONLY when other measures and milder drugs are ineffective
- for SURGERY
- invasive DIAGNOSTIC procedures
Are opioids only used on their own or as an adjunct?
as an adjunct with pain relievers
- NSAIDS
- Antidepressants
- Anticonvulsants
- Corticosteroids
Why would antidepressants be used for pain relief and when would it be indicated??
neuropathic pain responds to antidepressants
Why would steroids be used for pain?
antiinflammatory action helps with pain
What are some opioid agonists?
Codeine
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Morphine
What dose the RNAO BPG on pain say about pharmacological interventions?
- multimodal analgesic approach
- changing of opioids (dose or route) when necessary
- Monitoring for safety and efficacy
- Prevention, assessment and management of adverse effects
- Prevention, assessment and management of opioid risk
Based on the RNAO BPG on Pain, how can the nurse ensure that the prescribed analgesic is appropriate for the client?
- Use most efficacious (able to effect something)
- Multimodal analgesic approach (combo of opioid and non-opioid)
- Effective dosing schedule
- Recognize potential contraindications
- Dose titration (adjusting dose based on different people)
- Anticipate and manage adverse effects
What are some things to consider when it comes to dose titration?
be careful with…
- children
- older adults
- people with complications of the liver or kidneys
How can the nurse optimize pain relief based on RNAO BPG on Pain?
- Use the form, route, dose and schedule that best meets individual’s needs
- To optimize pain management, opioid analgesics may need to be changed
What is equianalgesia?
a conversion chart for drug doses
What is the conversion chart for drug doses called?
equianalgesia
How can the nurse anticipate and prevent common adverse effects (Based on RNAO BPG on Pain)?
Recognize INDIVIDUAL VARIABILITY in response to opioids
- Constipation
- Respiratory depression (CNS depressant)
- Nausea and vomiting (most common at the beginning, usually improves
- Drowsiness, sedation
What will the nurse monitor for misuse of opioids (Based on RNAO BPG on Pain)?
- Inappropriate escalating doses
- Use of alternative routes
- Engagement in illegal activities
What is the action of a narcotic agonist?
- act at specific opioid receptor sites in the CNS
- produces analgesia, sedation, and sense of wellbeing
What are narcotic agonist indicated for?
- relief of severe acute or chronic pain
- analgesia during anesthesia
What are the pharmacokinetics of narcotic agonists?
- IV most reliable way to achieve therapeutic response
- IM or SC rate of absorption varies
- Hepatic metabolism and generally excreted in the urine and bile
What are the contraindications of narcotic agonists?
- Known allergy
- Pregnancy, labor, lactation
- Diarrhea caused by poisons
A client with a back injury has been prescribe T3’s
The client asks why only Tylenol, how will the nurse respond.
What health teaching will the RN provide for this client?
- T3’s have 300mg Tylenol and 30mg of codeine and 15mg of caffeine
(work well together and are not just tylenol) - Take with food if you get nausea
- Take prescribed amount
- May cause drowsiness (use safety precautions)
- Get up slowly because it can cause orthostatic hypotension
If you suspect that a patient is being dishonest about pain what can you do to check?
- When someone is being dishonest about the amount of pain they are in check if they can preform ADLS, etc
What are some cautions when taking narcotic agonists?
- RESP DEPRESSION
- GI or GU surgery
- acute abdomen or ulcerative colitis
What are some adverse effect of narcotic agonists?
- RESP DEPRESSION with apnea
- Cardiac arrest
- Shock
- ORTHOSTATIC HYPOTENSION
- N&V, CONSTIPATION
- Biliary spasm
- Dizziness, psychoses, anxiety, fear, hallucinations
What do narcotic agonist interact with?
- barbiturate general anesthetic
- phenothiazine
- MAOI’s
What is the the narcotic agonist prototype?
Morphine
What is morphine?
a narcotic agonist
What routes can you take morphine?
PO, PR, SC, IM, IV
How long does morphine last (what is its duration)?
5-6 or 7 h
What routes can you give morphine to a baby?
IM in bottom (1ml)
PR
What is the action of a narcotic antagonist?
- Drugs that bind strongly to opioid receptors, but they do not activate the receptors
- *Reverse effects of opioids
What are narcotic antagonists indicated for?
Reversal of the adverse effects of narcotics
- Treat narcotic and/or alcoholic dependence
What is naloxone (Narcan)?
narcotic antagonist
What are some non-pharmacological pain management techniques you could use?
- repositioning, sometimes heat and cold, massage, imagery, pet therapy, group therapy
- address emotional factors
What are the pharmacokinetics of narcotic antagonist?
- Well absorbed after injection and are widely distributed in the body
- Hepatic metabolism and excreted in the urine
- Enter breast milk
What are the contraindications?
allergy
What are some adverse effects of narcotic antagonists?
- Tachycardia (HR exceeding 100bpm)
- Blood pressure changes
- Dysrhythmias (abnormal rhythm in brain and heart)
What are some drug to drug interactions with Narcan?
Reverse Effects on: Buprenorphine Butorphanol Nalbuphine Pentazocine Propoxyphene
What routes can naloxone be given?
IV (onset 2 min, last 4-6h)
IM/SC (onset 3-5m, lasts 4-6h)
What kind of narcotic treatment may be given for a patient who had back surgery (for chronic pain)
Morphine 4mg to 8mg IV, q2-4h prn given over 5 minutes
After 24h, codeine 5mg with acetaminohphen 500mg PO q4-6 prn not to exceed 6 doses in 24hrs
