B. Analgesics

Question 1

Pain

Answer 1

• unpleasant sensory or emotional experience related to tissue injury - whatever the experiencing person says it is and when - fifth vital sign

Question 2

Pain experience

Answer 2

1. Perception of pain - ind. subjective 2. Pain threshold- intensity at which stimuli is judged as painful 3. Pain tolerance- max degree of pain intensity a person is will get to endure - variable

Question 3

Addiction vs. physical dependence

Answer 3

….

Question 4

Types of pain- duration

Answer 4

• acute - sudden -chronic - persistent ( not cancer)

Question 5

Types of pain - origin

Answer 5

• somatic ( superficial, visceral , vascular) - cancer - referred - phantom - neuropathic ( injury to peripheral nerve fibers)

Question 6

In tissue injury , body releases these substances that stimulate nerve endings

Answer 6

• bradykinin - histamine - potassium - prostaglandins - serotonin

Question 7

Endorphins and enkephalins

Answer 7

Produced by the body - considered the body’s painkillers “ runners high”

Question 8

Analgesics - non opioid

Answer 8

• acetaminophen - NSAIDS- aspirin, ibuprofen,naproxen

Question 9

Opioid analgesics

Answer 9

• morphine, hydromorphone, fentanyl - codeine, hydrocodone, oxycodone

Question 10

Nonopioid analgesics use and effects

Answer 10

• use for mild to moderate pain - antipyretic ( acetaminophen and NSAIDS) - anti- platelet (aspirin primarily) - anti- inflammatory ( NSAIDS only )

Question 11

Acetaminophen ( Tylenol)

Answer 11

• analgesic & antipyretic effects - no anti- inflammatory , no anti- platelet - less bleeding - less SE than opioid, avoid respiration depression

Question 12

Acetaminophen ( Tylenol) Indc/contraindications

Answer 12

Indications : mild to moderate pain , fever Contraindications: known drug allergy, severe liver disease, genetic disease ( G6PD- enzyme deficiency)

Question 13

Acetaminophen ( Tylenol) SE/AE

Answer 13

• generally well tolerated - may experience: rash, nausea & vomiting - less common: blood disorders ( anemia ) , ✨hepatic and nephroticities- esp. taken outside normal ranges ( + alcohol)

Question 14

Acetaminophen ( Tylenol) Toxicities/ management

Answer 14

-potentially lethal when overdosed (150 mg/kg+ at a time ) -✨hepatic necrosis- most serious - long term ingestion of high doses cause nephrotoxicity

Question 15

Treatment for Acetaminophen ( Tylenol) toxicity

Answer 15

Acetylcysteine

Question 16

Acetaminophen ( Tylenol) interactions

Answer 16

Alcohol, other hepatotoxic drugs

Question 17

Acetaminophen ( Tylenol) teaching

Answer 17

• take as directed - MAX DOSE: 4000 mg total in a day - geriatric and people with liver problems : 2000 mg per day or less -be aware of other meds that end with cet: darvocet, lorcet, dulcet … Vicodin, typically, wygesic

Question 18

Tramadol ( ultram ) -

Answer 18

moderate to severe pain -SE: N&V , constipation, HA, anxiety, seizures - schedule 4 - but risk of addiction - should be treated like codiene

Question 19

opioids

Answer 19

•pain relievers that contain opium, •or derived from the opium poppy •or chemically related to opium •Act primarily in the CNS

Question 20

Controlled substance act

Answer 20

“5” schedule categories- based on their potential for abuse

Question 21

addiction ( Psych & physical dependence)

Answer 21

A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

Question 22

opioid analgesics-

indication

Answer 22

Indications:

• relieve moderate to severe pain
• Codeine—mild to moderate pain
• cough suppression
• relieve diarrhea

**No Ceiling Effect**

Question 23

Common opioids

Answer 23

• Morphine Sulfate (Roxanol)—PO, IV, IM, SQ, SL,Rectal
• (MSContin)
• Hydromorphone (Dilaudid) PO, IV, SC, IM, Rectal
• Meperidine (Demerol)—PO, IM, IV
• Fentanyl (Duragesic)—PO, IV, IM, Transdermal, Lozenge (lollipop)-Duragesic Patch

Oxycodone—PO

• Oxycontin
• Percocet =Oxycodone+ Acetaminophen
• Percodan=Oxycodone+Aspirin
• Hydrocodone—PO
• Vicodin=Hydrocodone+ Acetaminophen
• Codeine Sulfate—PO, SQ, IM
• Tylenol #3 = Codeine + Acetaminophen

Question 24

opioid SE/AE

Answer 24

•

CNS depression **MOST SERIOUS**

• Respiratory depression
• Treatment—Opioid antagonists:

***Naloxone (Narcan)***

• Orthostatic hypotension
• Risk for???? Falls , “get up slowly!”
• Pupil constriction
• Urinary retention

Question 25

opioids: contraindications

Answer 25

* Drug allergy * Increased intracranial pressure * Severe asthma * Other respiratory insufficiency * Clients with very low BP (shock)

Question 26

opioid interactions

Answer 26

* CNS depressants * Alcohol * Sedative-hypnotics * Muscle relaxants * Major tranquilizers * Antipsychotic agents

Question 27

opioid physical dependence

Answer 27

if stopped , withdrawal symptoms may occur

Question 28

opioid tolerance

Answer 28

- common physiologic result - result-larger doses

Question 29

opioid analgesic: Nursing processes

Answer 29

\*\*Important for administration of any analgesic med\*\* * ASSESSMENT * Perform a thorough pain assessment, including nature and type of pain, precipitating and relieving factors, remedies, and other pain treatments. * “Fifth vital sign” * Critical assessments: Respirations, BP, Pain level/description/location; Last dose * DIAGNOSIS * Example: Acute pain related to disruption of tissue secondary to right hip arthroplasty •PLAN="which pain med to give?"

Question 30

opioid : Implement

Answer 30

* After assessment determine which pain med to administer * Patient teaching * Oral forms should be taken with food to minimize gastric upset * Ensure safety measures * Assess VS * Low BP and/or Respiratory depression --Hold dose and contact physician •May need to give Opioid antagonist -Monitor for other side effects * Constipation * Orthostatic Hypotension * Instruct patients to not take other meds or OTC preparations Follow proper administration guidelines for IM injections and IV administration \*\*CHECK DOSAGES CAREFULLY\*\* * Special populations * Adjuvant therapy * Addiction concerns

Question 31

opioid- evaluation

Answer 31

* Monitor for effects & SE * Follow up with pain assessment

Question 32

migraine patho

Answer 32

•Caused by inflammation and dilation of blood vessels •Imbalance of serotonin

Question 33

migraine treatment/prevention

Answer 33

triptans

Question 34

triptan use,action, SE

Answer 34

**•Use** •Treat migraine headaches **•Action** •Causes vasoconstriction of cranial arteries **•Side effects** •Hypertension, dysrhythmias, thromboembolus , MI, stroke •Dizziness, tingling, numbness, warm sensation, drowsiness, seizures •Muscle cramps, nausea, vomiting, diarrhea

Question 35

triptan - nurse implications

Answer 35

Teaching regarding: Dissolvable wafers, nasal spray, and self - injectable forms - Provide specific teaching about correct administration - Avoid food triggers - Patients should keep a journal to monitor response to therapy - May ↑ BP - Do not take other “triptans ” within 24º of sumatriptan

Question 36

cluster headache

Answer 36

severe , unilateral, non-throbbing pain around the eye