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Pharmacotherapeutics > Week 11-Drugs to treat pain: Narcotics and Narcotic Agonists > Flashcards

Week 11-Drugs to treat pain: Narcotics and Narcotic Agonists Flashcards

1
Q

What is pain?

A

Sensory and emotional experience associated with actual or potential tissue damage

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2
Q

What is the gate-control theory of pain?

A
  • 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
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3
Q

What is acute pain?

A

sudden onset that usually subsides after treatment

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4
Q

What is nociceptive caused by?

A

direct stimulus to pain receptors (somatic and visceral pain)

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5
Q

What is chronic pain?

A
  • persistent or recurrent pain
  • 6 weeks or longer
  • can be intermittent, occur in a pattern or persist (lasting more than 12h a day)
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6
Q

What is somatic pain?

A

nociceptive pain that includes skin/superficial/bone/connective tissue

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7
Q

What is visceral pain?

A

nociceptive pain that is of the internal organs

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8
Q

What are the 2 kinds of nociceptive pain?

A

somatic and visceral

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9
Q

What is neuropathic pain?

A
  • pain from abnormal or damaged nerves

- central of peripheral

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10
Q

Why is pain management important?

A

helps you heal faster

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11
Q

What is most often the cause of visceral pain?

A

obstructions (often from tumours)

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12
Q

What are analgesics?

A

medication that relieve pains

  • narcotic (moderate to severe pain)
  • non-narcotic (mild to moderate pain)
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13
Q

What are ‘pain killers’?

A

analgesics

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14
Q

What are the general characteristics of narcotic/opioid analgesics?

A
  • relieves moderate to severe pain

- react with opioid receptors throughout the body to cause analgesia, sedation or euphoria

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15
Q

Why did the narcotic safety and awareness act (2010) come about?

A

between 1991 and 2009 the number of prescriptions in Ontario for oxtcodone drugs rose by 900%

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16
Q

What does the narcotic safety and awareness act (2010) say?

A
  • 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
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17
Q

What are some of the common drugs being monitored?

A
  • 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)
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18
Q

What are the indications for narcotic use?

A
  • 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
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19
Q

Are opioids only used on their own or as an adjunct?

A

as an adjunct with pain relievers

  • NSAIDS
  • Antidepressants
  • Anticonvulsants
  • Corticosteroids
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20
Q

Why would antidepressants be used for pain relief and when would it be indicated??

A

neuropathic pain responds to antidepressants

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21
Q

Why would steroids be used for pain?

A

antiinflammatory action helps with pain

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22
Q

What are some opioid agonists?

A

Codeine
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Morphine

23
Q

What dose the RNAO BPG on pain say about pharmacological interventions?

A
  • 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
24
Q

Based on the RNAO BPG on Pain, how can the nurse ensure that the prescribed analgesic is appropriate for the client?

A
  • 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
25
Q

What are some things to consider when it comes to dose titration?

A

be careful with…

  • children
  • older adults
  • people with complications of the liver or kidneys
26
Q

How can the nurse optimize pain relief based on RNAO BPG on Pain?

A
  • Use the form, route, dose and schedule that best meets individual’s needs
  • To optimize pain management, opioid analgesics may need to be changed
27
Q

What is equianalgesia?

A

a conversion chart for drug doses

28
Q

What is the conversion chart for drug doses called?

A

equianalgesia

29
Q

How can the nurse anticipate and prevent common adverse effects (Based on RNAO BPG on Pain)?

A

Recognize INDIVIDUAL VARIABILITY in response to opioids

  • Constipation
  • Respiratory depression (CNS depressant)
  • Nausea and vomiting (most common at the beginning, usually improves
  • Drowsiness, sedation
30
Q

What will the nurse monitor for misuse of opioids (Based on RNAO BPG on Pain)?

A
  • Inappropriate escalating doses
  • Use of alternative routes
  • Engagement in illegal activities
31
Q

What is the action of a narcotic agonist?

A
  • act at specific opioid receptor sites in the CNS

- produces analgesia, sedation, and sense of wellbeing

32
Q

What are narcotic agonist indicated for?

A
  • relief of severe acute or chronic pain

- analgesia during anesthesia

33
Q

What are the pharmacokinetics of narcotic agonists?

A
  • 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
34
Q

What are the contraindications of narcotic agonists?

A
  • Known allergy
  • Pregnancy, labor, lactation
  • Diarrhea caused by poisons
35
Q

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?

A
  • 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
36
Q

If you suspect that a patient is being dishonest about pain what can you do to check?

A
  • When someone is being dishonest about the amount of pain they are in check if they can preform ADLS, etc
37
Q

What are some cautions when taking narcotic agonists?

A
  • RESP DEPRESSION
  • GI or GU surgery
  • acute abdomen or ulcerative colitis
38
Q

What are some adverse effect of narcotic agonists?

A
  • RESP DEPRESSION with apnea
  • Cardiac arrest
  • Shock
  • ORTHOSTATIC HYPOTENSION
  • N&V, CONSTIPATION
  • Biliary spasm
  • Dizziness, psychoses, anxiety, fear, hallucinations
39
Q

What do narcotic agonist interact with?

A
  • barbiturate general anesthetic
  • phenothiazine
  • MAOI’s
40
Q

What is the the narcotic agonist prototype?

A

Morphine

41
Q

What is morphine?

A

a narcotic agonist

42
Q

What routes can you take morphine?

A

PO, PR, SC, IM, IV

43
Q

How long does morphine last (what is its duration)?

A

5-6 or 7 h

44
Q

What routes can you give morphine to a baby?

A

IM in bottom (1ml)

PR

45
Q

What is the action of a narcotic antagonist?

A
  • Drugs that bind strongly to opioid receptors, but they do not activate the receptors
  • *Reverse effects of opioids
46
Q

What are narcotic antagonists indicated for?

A

Reversal of the adverse effects of narcotics

- Treat narcotic and/or alcoholic dependence

47
Q

What is naloxone (Narcan)?

A

narcotic antagonist

48
Q

What are some non-pharmacological pain management techniques you could use?

A
  • repositioning, sometimes heat and cold, massage, imagery, pet therapy, group therapy
  • address emotional factors
49
Q

What are the pharmacokinetics of narcotic antagonist?

A
  • Well absorbed after injection and are widely distributed in the body
  • Hepatic metabolism and excreted in the urine
  • Enter breast milk
50
Q

What are the contraindications?

A

allergy

51
Q

What are some adverse effects of narcotic antagonists?

A
  • Tachycardia (HR exceeding 100bpm)
  • Blood pressure changes
  • Dysrhythmias (abnormal rhythm in brain and heart)
52
Q

What are some drug to drug interactions with Narcan?

A 
Reverse Effects on:
Buprenorphine
Butorphanol
Nalbuphine
Pentazocine
Propoxyphene
53
Q

What routes can naloxone be given?

A

IV (onset 2 min, last 4-6h)

IM/SC (onset 3-5m, lasts 4-6h)

54
Q

What kind of narcotic treatment may be given for a patient who had back surgery (for chronic pain)

A

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

Pharmacotherapeutics (7 decks)

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