Week 2 Pharmacology Flashcards
pain
-subjective in nature
- acute or chronic
-somatic or visceral vs neuropathic
analgesics
meds that relieve pain
what are 2 main types of analgesics
opioids and non opiods
what are non opioid analgesics
nsaids
acetaminophen
antidepressants
anticovulsants
nsaids
block cox1 & 2 enzymes
for fever and pain
ex.
ibuprofen
naproxen
celecoxib
ketorolac
what happens when cox 1 enzymes blocked
less chemicals that promote
- gastric mucosal healing
- vasoconstriction
- platelet dumping
what happens when cox 2 enzymes blocked
less chemicals that cause
-vasodilation
-inflammation
- pain
- reduce platelet clumping
whats the definition of shunting
blocks one chemical and gets more production of another chemical
how much do nsaids decrease pain by
1-3pts
what are common adverse effects of nsaids
diarrhea
GI upset
what are serious adverse effects of Nsaids
renal failure/dysfunction
GI bleeding
what are nsaids contraindicated for?
hemorrhage
heart failure
recent MI
liver failure
GI ulceration/bleeding
what do cox 2 selective inhibitors have a higher risk of
cardiovascular issues
what drugs are commonly required when taking nsaids
stomach/ gastric protection drugs
acetaminophen (tylenol)
works for fever and pain
no side effect of bleeding
how much is acetaminophen likely to decrease pain by
0.5-2 pts
whats the antidote of tylenol
acetylcysteine
whats the MOA of antidepressants thought to be
NT modulation in brain
what type of pain are antidepressants used for
neuropathic
how long does it take to see effects of antidepressants
a month or longer
what are the 2 main classes of antidepressants used for pain management
TCAs
SNRIs
how can antidepressants help with pain management
alter NE and change the perception of pain
what side effects do opioids cause
urinary retention
blurred vision
dry mouth/throat
constipation
tachycardia
feeling hot/decreased sweating
sedation
confusion
dizziness
hallucinations
how do anticonvulsants work for pain
generally unknown act as a CNS depressant
when should anticonvulsants be administered
low doses at bedtime
what are adverse reactions to anticonvulsants
dizziness
somnolence
cerebellar toxicity
peripheral edema
what type of pain are anticonvulsants used for
neuropathic
cerebellar toxicity signs are…
ataxia
dysarthria
drunk walk
what are some examples of anticonvulsants
gabapentin (neurontin)
pregabalin
an opioid
any drug natural or synthetic that has actions similar to morphine
ex.
fentanyl
methadone
meperidine
hydromorphone
oxycodone
Opiates
specific to drugs isolated from opium poppies
ex.
morphine
codiene
heroin
what are opioids used for
moderate to severe
- pain
- sedation
- depression
- respiratory drive (palliative care)
whats the MOA of opioids
they bind to mu and kappa opioid receptors in CNS to reduce pain
what are narcotics
originally any drug that caused stupor or insensibility
any medically used controlled substances
legally: illicit or illegal substances
what are adverse rxns of opioids
- respiratory depression
- constipation
- miosis (pinpoint pupils)
- orthostatic hypotesnion
- urinary retention
-emesis
-euphoria
-sedation
what should be evaluated prior to opioid admin and after
assessment of
-pain
-HR
-RR
-BP
whos most likely to have an opioid overdose
opioid naive
when are lower doses of opioids required
elderly
hepatic impairment
whats the best way to avoid opioid withdrawl
taper dose slowly
whats a tolerance
- common physiological result of chronic treatment
- once occurs, larger dose needed to require same level of analgesia
whats is dependance
physiological adaptation of the body in the presence of an opioid
what does addiction refer to
pattern of compulsive drug use despite harmful consequences
what is potency referred to
term applied to drugs that all have the same MOA but need different does to reach same effects
whats a breakthrough dose
PRN dose - as needed
what determines when a med will take effect as well as when to reassess for efficacy
route
whas the bioavailibility of oral opioids usually
50%
signs of opioid overdose
- shallow/no breathing
- vomiting/gurgling
- skin is cold/pallor
- unresponsive/unconscious
how does naloxone work
competitive antagonism
whats suboxone
- sublingually/buccally administered alternative to methadone
- shown to improve patient lives, reduce risk of death, transmission of HIV/viral hepatitis, incarceration, crime
what are some nursing analgesic implications
- perform thorough history before beginning therapy
- obtain baseline vital signs
- assess for potential contraindications
- perform pain assessment
- withhold and contact physician if abnormal vital signs
- assess for constipation –> use laxatives liberally
- opioids considered high alert med. –> double checks used to reduce risk of harm/abuse
- DO NOT crush long acting/controlled release dosage forms
what is a MOA of triptans
binding serotonin 1B or 1D receptors
cause-vasoconstriction in intracranial blood vessels
what are adverse effects of triptans
dizziness
worsening nausea
transient heavy arms or chest pressure
what are some contraindications of triptans
coronary artery disease
cerebrovascular disease
periph vascular disease
hypertension
