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Exam 3 Review 110 > YES BOOK Pain meds > Flashcards

YES BOOK Pain meds Flashcards

1
Q

What are analgesics?

A

Medications that relieve pain.

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2
Q

What is the analgesic ladder?

A

Step 1: Nonopiods for mild pain
Step 2: Opioids for mild to moderate pain
Step 3: Opioids for moderate to severe pain

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3
Q

Nonopiod Analgesic

A

There is a ceiling affect to their analgesic properties, increasing the dose to the upper limit provides no greater analgesia

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4
Q

What are NSAIDS used for?

A

Commonly used to relieve pain and reduce inflammation.

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5
Q

How do NSAIDs work?

A

Work by inhibiting enzymes called cyclooxygenases, inhibit synthesis of prostaglandins.

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6
Q

What is responsible for many of the side effects of NSAIDs?

A

Cyclooxygenases enzyme inhibition

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7
Q

What are the two types of NSAIDs?

A

nonselective/selective

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8
Q

What are nonselective NSAIDS?

A

NSAIDS that inhibit both COX-1 and COX2

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9
Q

What are COX1 enzymes responsible for?

A

Normally found in stomach, blood platelets, blood vessels

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10
Q

What are COX2 enzymes reponsible for?

A

Found at sites of inflammation, less likely to cause gastrointestinal injury.

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11
Q

What do selective NSAIDS do?

A

Inhibit COX2 only

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12
Q

Who is not recommended to take NSAIDs?

A

Not recommended for people with kidney disease, heart failure, cirrohosis, those who take diuretics, allergic to aspirin. Nsaids may also cause worsening of asthma

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13
Q

What would patients with mild pain (No 1-3) Receive?

A

Nonselective NSAIDS

COX 1/2 inhibitors

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14
Q

What are the main things about NSAIDs the nurse should know?

A
  • Response varies to specific NSAIDs, if one is not effective try another.
  • Do not take a second NSAID at the same time because of increased risk of side effects.
  • Short Term use can cause stomach upset. (Dyspepsia)
  • Long term use, especially at high doses can cause peptic ulcer disease
  • Use of NSAIDs even for a short period can harm the kidneys.
  • They are commonly available without a prescription
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15
Q

What is the max dose of ibuprofen?

A

3,200 mg/day

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16
Q

What is the max dose of Naproxen?

A

1500 mg/day

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17
Q

What is the max dose of naproxen sodium?

A

Do not exceed 1650 mg/day

Available in immediate and delayed release formations

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18
Q

What does the nurse have to remember about ketorolac tromethamine?

A

It is injectable
It is an NSAID
Limit the treatment to 5 days, many adverse effects
contraindicated with renal impairment, aspirin allergy
Can cause renal insufficiency in dehydrated patients

19
Q

What does the nurse have to remember about COX2 inhibitors?

A

Sometimes recommended for patients with history of peptic ulcer, GI bleeding, GI upset.

  • Less potential to cause ulcers or GI bleeding
  • Should be avoided in patients with known coronary artery disease, history of stroke, narrowed arteries to the brain or those at high risk.
20
Q

What is the max dose of Celecoxib (COX2) inhibitor?

A

Maximum dose of 200 mg a day.

21
Q

What are the types of aspirin?

A

Acetylsalicyclic acid. (Aspirin, Ecotrin, Bayer)

Buffered aspirin products (Alka seltzer, bufferin, Ascriptin)

22
Q

What does the nurse need to remember about Salicyclates?

A
  • Inhibits both COX 1 and COX 2
  • The combination of low dose aspirin and an NSAID can increase the risk of bleeding. Aspirin should be taken at least two hours before the NSAID.
  • Can cause exacerbation of bronchospasm, rhinitis (With nasal polyps, asthma)
  • Has antiplatelet effects (Increased risk of bleeding)
  • Increased risk of bleeding when combined with oral anticoagulants, heparin)
  • Increased risk of GI ulceration with steroids, alcohol, NSAIDs.
  • Use cautiously with impaired renal functioning.
  • Maximum doses vary according to indications for use. Up to 4 g/day
23
Q

What is the nonaspirin pain reliever?

A

Acetaminophen

24
Q

What should the nurse remember about acetaminophen?

A

It does not affect platelets
Not an anti-inflammatory agent
Doses of greater then 4g/day can cause acute overdose.
Patients with alcoholism or liver disease are at risk for hepatotoxicity
Increased toxicity with long term excessive ethanol ingestion.

25
Q

What type of drugs would you expect to administer to a patient with mild to moderate pain? (4-7)

A

Opiod Agonists Analgesics - Codiene + acetaminophen, Hydrocodone + acetaminophen (Vicodin), Oxycodone + aspirin (Percodan), Codiene phosphate, Oxycodone, Hydrocodone
Opiod analgesic - Tramadol hydrochloride (Ultram, Ultram ER)

26
Q

What does the nurse need to remember about drugs in the opiod agonist class? (Codiene + acetaminophen, Hydrocodone + acetaminophen (Vicodin), Oxycodone + aspirin)

A

Binds to opioid receptors in the CNS to produce analgesia.
No defined maximum dose; Ceiling determined by the side effects
Use with caution respiratory depression may occur in the elderly, the very ill, or those with respiratory problems
- Codiene phosphate, Oxycodone, Hydrocodone
Usually prescribed with a nonopioid - reduces the opioid dose:
- Codiene + acetaminophen, Hydrocodone +
acetaminophen (Vicodin), Oxycodone + aspirin
(Percodan)

27
Q

What does the nurse need to remember about Tramadol hydrochloride?

A

Binds to mu-opioid receptors, inhibits the reuptake of norepinephrine and serotonin
Causes many similar effects to the opioids - dizziness, somnolence, nausea, constipation
Does not have the respiratory depressant effect
Less occurance of tolerance, physical dependency, addiction
Roughly the same efficiacy of tylenol #3
Also used for moderate to severe relief of chronic pain ATC

28
Q

What are the drugs that the nurse would expect to be prescribed for moderate to severe pain (8-10)?

A

Morphine sulfate, Fentanyl, Hydromorphone, meperidine, methadone.

29
Q

How is morphine sulfate delivered?

A

Timed release - Avinza, MS contin, Oramorph SR
Oral solution - Roxanol, MSIR
Rectal suppositories - RMS
Injection - Astramorph PF, Duramorph

30
Q

How is fentanyl delivered?

A

Transdermal System - Duragesic patch

Lozenge on a stick, buccal, sublingual, nasal spray(Actiq, Abstral, Fentora)

31
Q

What does the nurse need to know about meperidine?

A

Do not use for longer then 2 days because of risk of neurotoxicity.
IM route preferred for repeated injections.

32
Q

What does the nurse need to remember about the use of methadone?

A

Relief of severe pain not responsive to non-opioid analgesics.
Dextoxification and temporary maintenance (Treatment of opioid addiction)
Oral methadone is approximately 1/2 as potent as parenteral methadone.
Oxycodone + methadone (Percocet)

33
Q

What are the major side effects of opioids?

A

Constipation (Most common)
Nausea, vomiting, pruiritis.
Sedation, respiratory depression - at risk population (opioid naive, the elderly or those with underlying lung disease)
Less common: Urinary retention, myoclonus, dizziness, confusion, hallucinations.
Physical tolerance and dependence can occur - Addiction occurs in less than 1% of patients.

34
Q

How are adjuvant drugs used in the treatment of pain?

A

They enhance the effect of opiods, providing additional pain relief.

35
Q

How do adjuvant drugs enhance pain therapy/

A
  • Enhance the effects of opioids and non-opioids.
  • Possess analgesic properties
  • Counteract the side effects of other analgesics.
36
Q

How do anticonvulsants work to relieve pain?

A

Effective for neuropathic pain and prophylactic treatment of headaches.

37
Q

What is included in anticonvulsants used to treat pain?

A

Gabapentin (Neurontin) - idiosyncratic side effects - ankle swelling, ataxia
Carbamazepine (Tegretol)
Clonazepam (Klonopin) - Start with low doses and increase slowly. Baseline liver functions, renal functions, and blood counts needed.

38
Q

How do antidepressants work to relieve pain?

A

Thought to work by increasing the levels of certain chemicals (norephinephrine, serotonin) at nerve endings that help to inhibit pain signals. Neuropathic pain, migraines, fibromyalgia, rheumatoid arthritis.

39
Q

What is included in the antidepressants used to treat pain?

A

Amitriptyline (Elavil)
Doxepin (Sinequan)
Nortriptyline (Pamelor)
Imipramine (Tofranil - PM)

40
Q

What are the side effects of the antidepressants used to treat pain?

A

Dry mouth, urinary retention, constipation, drowsiness, confusion especially in the elderly.

41
Q

What are the indications for use of corticosteroids for pain

A
  • Acute and chronic cancer pain
  • Pain secondary to spinal cord compression
  • Some neuropathic pain syndromes
42
Q

What are the corticosteroids used to treat pain?

A
  • Dexamethasone

- Methylprednisone

43
Q

What are the side effects of corticosteroids used to treat pain?

A
  • Hyperglycemia, fluid retention, dyspepsia, GI bleeding
  • Impaired healing, muscle wasting, osteoporosis.
  • Susceptability to infection, mood swings, psychosis.

Exam 3 Review 110 (5 decks)

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