Ch. 26 - Nonopioid & Opioid Analgesics Flashcards Preview

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Flashcards in Ch. 26 - Nonopioid & Opioid Analgesics Deck (67):
1

Pain:

Stimulus applied to body = electrical impulses are initiated in the CNS

Impulses perceived in 2 ways (2 DIFFERENT things):
1.) Pain threshold
2.) Pain tolerance

2

Pain Threshold:

Level of stimulus results in perception of (how body) pain:
1.) Physiological
2.) About same for everyone

3

Pain Tolerance (1):

Amount of pain an indiv can withstand:
-Without disrupting normal functions
-Without needing analgesic tx

4

Pain Tolerance (2):

Varies by: 
1.) Client’s environment
2.) Culture
3.) personality, etc.

5

Gate Theory (1):

Pain sensations travel along a sensory nerve pathways (like a highway driving back and forth) to brain

-limited # of sensations can travel at one time

6

Gate Theory (2):

Certain cells regulate flow of impulses:
-Stops impulses from reaching brain

7

Gate Theory (3):

Learned response to pain:
= open the gate’ or ‘close the gate’
1.)To allow pain sensations to travel to the brain
2.) Emotions
3.) Distraction techniques (close the gate)

8

Ascertain Severity of Pain:

CRIES Scale:
-Crying
-Requires Ox (O2)
-Increased vital signs
-Expression
-Sleeplessness

9

Types of Pain (1):

Acute:
-Occurs suddenly
-Responds to tx
*Mild – moderate - severe

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Types of Pain (2):

Chronic:
-Lasts > 6 months
-Difficult to tx or control

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Undertreatment of Pain:

Undesirable Effects:
1.) Increased heart rate, resp rate, BP
2.) Increased stress response
3.) Lack of moving/ambulating

12

Analgesics:

Drugs that relieve pain without causing loss of consciousness

13

Nonopioid Analgesics:

1.) Less potent than opoid analgesics
2.) Tx: mild – moderate pain
3.) Usually over-the-counter- (OTC)

14

NSAIDs:

1.) ASA
2.)ibuprofen (Motrin, Advil)
3.) naproxen (Aleve)

15

NSAIDs – Action / Effect:

1.) Analgesic
2.) Antipyretic
3.) Antiinflammatory

-Inhibit synthesis of prostaglandin(released with inflammation & causes pain)

-Decreases platelet aggregation (clotting) -- ASA

16

NSAIDs Side Effects/Adverse Reactions:

1.) Gastric irritation
2.) Hypersensitivity ( tinnitis)

17

acetaminophen (Tylenol) (1):

Analgesic
Antipyretic
No antimflammatory effect
Does not
-STRICTLY FOR PAIN & FEVER

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acetaminophen (Tylenol) (2)

-Many products contain acetaminophen!
*Safe for children
-Po, rectal
-Dosage:
* 325(1 tablet)-650 mg every 4-6h PRN
-Based on age (for children)

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acetaminophen (Tylenol) (3):

Overdose (OD) = hepatotoxicity 
-deal d/t hepatic necrosis

*If OD suspected 
-Call poison control center IMMEDIATELY

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Other Nonopioid Analgesics:

-tramadol (Ultram)
*Mod – severe pain
Contraindicated --> Severe alcoholism, with use of opoids:
- n/v
- dizzy
-HA
-seizures

21

Opioid Analgesics (1):

“We’re not in Kansas anymore!”
- (opium comes from “Poppy Seads”)

22

Opioid Analgesics (2):

-Most potent analgesic
-Binds onto opioid receptors in CNS
*Inhibits transmission of pain impulses
*Alters perception of pain

23

Opioid Analgesics (3):

Variation in potency depends on affinity for opioid receptors
*Better fit* = *greater analgesic response*

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Opioid Analgesics (4):

Mod – severe pain from visceral (organs/GI system) sources
1.) Cough suppressant
2.) Suppresses GI motility (can be used to treat diarrehea)
3.) All types= dependence
*Controlled substance

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**Adverse Effects** (opiod):

1.) **Respiratory depression = most serious**
-Monitor closely: NOT to p/t with head injuries

2.)Tolerance & dependence:
-Abstinence syndrome = withdrawal symptoms
-Pruritis

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Morphine Sulfate:

Prototype drug:
-ALL OTHER OPIODS are measured in comparison to MORPHINE:

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Morphine Sulfate cont...

1.) Strong opioid analgesic
2.) Good for acute pain
-Myocardial infarction
-Cancer
-Drug of choice for mod-severe pain in children
3.) Po, SQ, IM, IV

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Nursing Process:

Acute pain r/t surgical tissue injury:
-AEB(as evidence by): subjective data

*Risk for ineffective breathing patterns r/t excess morphine dosage

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Nursing Interventions:

1.) Adm before pain is too severe
2.) Monitor VS (vital signs)
-Resp

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Nursing Interventions cont...

4.) Check bowel sounds
5.) Check pupil changes (very small = sign of overdose) & reaction
6.) Have naloxone ( Narca = life saver) avalible  used for respiratory depression

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Client Teaching:

1.) Do not use alcohol or other CNS depressants
2.) Teach nonpharmacologic pain relief measures
3.) Avoid activities requiring mental alertness
4.) Report = difficulty breathing, blurred vision, HA (headache)

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Evaluation:

Evaluate effectiveness of med 30-60min after administration & document

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Other Opioid Analgesics:

meperidine (Demerol) = first synthetic developed in 1950’s
-Shorter duration of action than morphine
-Po, SQ, IM, IV
*Check compatibility before mixing w/ other drugs in same syringe

34

meperidine (Demerol):

1.) No antitussive property
2.) Mod – severe pain
-Not for chronic pain
3.) Major SE = hypotension

35

fentanyl (Duragesic, Sublimaze):

1.) Potent opioid medication
2.) Breakthrough cancer pain
3.) Clients with a resistance for/tolerance to other pain medications
-50-100 times more potent than morphine! (but not necessarily effective due to mcg [fetninal] – mg [morphine])

36

fentanyl (Duragesic, Sublimaze) cont..

4.) IM, transdermal patch, lozenge, lollipop
5.) Epidural anesthesia
6.) Short surgical procedures

37

codeine:

1.) Po, SQ, IM, IV
2.)Smaller doses = antitussive (for cough)
-Pill = pain
-Liquid = cough

38

methadone:

1.) Po (usually liquid)
2.) Tx: opioid addiction
-Helps control withdrawal symptoms
-Adm in OJ or other citrus juice
-Suboxone (newer = dissolving tablet)

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Opioid Side Effects:

1.) Respiratory depression
-Resp

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Opioid Side Effects cont...

5.) Constipation***
6.) Urinary retention
7.) Tolerance
8.) Psychological/physical dependence with prolonged use

41

Opioid Contraindications (1):

1.) Head injuries:
-Opioids decrease resp = accumulation of CO2

2.) Increase in CO2 retention = vasodilation =increase intracranial pressure (ICP)

42

Opioid Contraindications (2):

3.) Respiratory disorders
-Intensifies resp distress
-Asthma = Decreases resp drive while increases airway resistance

43

Opioid Contraindications (3):

4.) Shock / very low BP
-If necessary to use  decrease dosage
5.) h/o (history) drug abuse

44

Combination Products:

1.) ASA or acetaminophen + opioid analgesics
-Decrease adverse effects
-Controlled substances

45

Combination Products cont...

2.) Percodan = oxycodone + ASA (asprin)

3.) Percocet = oxycodone + acetaminophen

-Tylenol w/ codeine No 1 (codeine 7.5 mg)
-Tylenol w/ codeine No 2 ( " 15 mg)
-Tylenol w/ codeine No 3 ( " 30 mg)
-Tylenol w/ codeine No 4 ( " 60 mg)

46

Patient Controlled Analgesia (PCA PUMP) (1):

1.) IV infusion pump (self-administered pain relief automatically thru IV)
-morphine**
-meperidine (Demerol)
-fentanyl (Sublimaze)

47

Patient Controlled Analgesia (2):

Pushes button to self medicate
Pre-set dosage = time interval --->
*Client cannot overdose

48

Opioid Antagonist:

1.) Compete with same receptor sites as opoiod (has higher affinity which makes good for opioids)

2.) Antidote for overdose of opioid analgesics

3.) To reverse resp depression

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Example: naloxone (Narcan):

1.) Pure opioid antagonist
2.) Little to no pharmacologic activitry
3.) IV = rpute preferred (fastest acting / route)

50

naloxone (Narcan):

***Drug is shorter acting than some opioid analgesics = resp depression may return!

-Pain will return!

51

Opioid Agonist-Antagonist:

-Opioid antagonist added to an opioid agonist

*Help prevent opioid abuse

52

Opioid Agonist-Antagonist --Examples:

1.) nalbuphine (Nubain)
2.) butorphanol (Stadol)
3.) pentazocine (Talwin)
^^^Scheduled drugs / controlled substances ^^^

53

Headaches:

1.) Migraine
2.) Cluster

54

Migraine HA (1):

1.) Classic
*Aura occurs minuted to 1 hr before onset

2.) Common migraine
*Not associated w/ aura

55

Symptoms = how it happens:

Dilation of one or more branches of carotid artery ------>

Increased sensitivity of nerve endings supplying artery ------>

Release of substances that increases severity of pain
-Vasodilation occuring

56

Migraine HA (2):

1.) Recurrent & severe
-n/v (nausea & vomiting), photophobia(very light sensitive)

2.) Aura

3.) Women = affected more often (than men)
-Lasts from several hrs - days

57

Precipitating Factors:

1.) Menstrual period
2.) Certain foods
-Red wine, aged cheese, chocolate
3.) Stress

58

Cluster HA:

1.) Occurs in clusters / attacks

2.) Not assoc w/ aura or n/v

3.) Men more often affected (than woman)

59

Migraine: Preventative Tx ...

Beta adrenergic blockers (block sympathetic NVS):
*propranolol (Inderal)
*atenolol (Tenormin)

60

Migraine: Treatment ....

**Ergotamine**

1.) Potent vasoconstrictor
2.) Decrease pulsations of cranial arteries
3.) Antagonizes action of serotonin

61

Ergotamine with Caffeine:

**Caffeine**

1.)Cranial vasoconstrictor
2.) Enhances vasoconstrictor properties of ergotamine

62

Ergotamine:

1.) To prevent or stop migrane attack

****NOT for prolonged use

63

Triptans (1) = most recent & common:

1.) sumatriptan (Imitrex)

2.) zolmitriptan (Zomig)

64

Triptans (2):

*Do not prevent migraine
*To treat migrane attack

65

Example: Sumatriptan (Imitrex) (1)...

1.) Po, SC, intranasal

2.) Adverse Reactions:
-Hypo/Hypertension
-Cardiac problems
-Stroke

66

Example: Sumatriptan (Imitrex) (2)...

Contraindications:
1.) Coronary Artery Disease (CAD)
2.) HTN, DM
3.) Obesity
4.) Smoking

67

Example: Sumatriptan (Imitrex) cont...

*Quiet, darkened room

*Bedrest x 1-2hrs