Ch. 26 - Nonopioid & Opioid Analgesics Flashcards
(67 cards)
1
Q
Pain:
A
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
Q
Pain Threshold:
A
Level of stimulus results in perception of (how body) pain:
1. ) Physiological
2. ) About same for everyone
3
Q
Pain Tolerance (1):
A
Amount of pain an indiv can withstand:
- Without disrupting normal functions - Without needing analgesic tx
4
Q
Pain Tolerance (2):
A
Varies by:
- ) Client’s environment
- ) Culture
- ) personality, etc.
5
Q
Gate Theory (1):
A
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
Q
Gate Theory (2):
A
Certain cells regulate flow of impulses:
-Stops impulses from reaching brain
7
Q
Gate Theory (3):
A
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
Q
Ascertain Severity of Pain:
A
CRIES Scale:
- Crying
- Requires Ox (O2)
- Increased vital signs
- Expression
- Sleeplessness
9
Q
Types of Pain (1):
A
Acute:
- Occurs suddenly
- Responds to tx
- Mild – moderate - severe
10
Q
Types of Pain (2):
A
Chronic:
- Lasts > 6 months
- Difficult to tx or control
11
Q
Undertreatment of Pain:
A
Undesirable Effects:
- ) Increased heart rate, resp rate, BP
- ) Increased stress response
- ) Lack of moving/ambulating
12
Q
Analgesics:
A
Drugs that relieve pain without causing loss of consciousness
13
Q
Nonopioid Analgesics:
A
- ) Less potent than opoid analgesics
- ) Tx: mild – moderate pain
- ) Usually over-the-counter- (OTC)
14
Q
NSAIDs:
A
- ) ASA
- )ibuprofen (Motrin, Advil)
- ) naproxen (Aleve)
15
Q
NSAIDs – Action / Effect:
A
- ) Analgesic
- ) Antipyretic
- ) Antiinflammatory
- Inhibit synthesis of prostaglandin(released with inflammation & causes pain)
- Decreases platelet aggregation (clotting) – ASA
16
Q
NSAIDs Side Effects/Adverse Reactions:
A
- ) Gastric irritation
2. ) Hypersensitivity ( tinnitis)
17
Q
acetaminophen (Tylenol) (1):
A
Analgesic Antipyretic No antimflammatory effect Does not -STRICTLY FOR PAIN & FEVER
18
Q
acetaminophen (Tylenol) (2)
A
- Many products contain acetaminophen!
- Safe for children
- Po, rectal
- Dosage:
* 325(1 tablet)-650 mg every 4-6h PRN
- Based on age (for children)
19
Q
acetaminophen (Tylenol) (3):
A
Overdose (OD) = hepatotoxicity
-deal d/t hepatic necrosis
- If OD suspected
- Call poison control center IMMEDIATELY
20
Q
Other Nonopioid Analgesics:
A
-tramadol (Ultram)
*Mod – severe pain
Contraindicated –> Severe alcoholism, with use of opoids:
- n/v
- dizzy
-HA
-seizures
21
Q
Opioid Analgesics (1):
A
“We’re not in Kansas anymore!”
- (opium comes from “Poppy Seads”)
22
Q
Opioid Analgesics (2):
A
- Most potent analgesic
- Binds onto opioid receptors in CNS
- Inhibits transmission of pain impulses
- Alters perception of pain
23
Q
Opioid Analgesics (3):
A
Variation in potency depends on affinity for opioid receptors
Better fit = greater analgesic response
24
Q
Opioid Analgesics (4):
A
Mod – severe pain from visceral (organs/GI system) sources
- ) Cough suppressant
- ) Suppresses GI motility (can be used to treat diarrehea)
- ) All types= dependence
- Controlled substance
25
**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
26
Morphine Sulfate:
Prototype drug:
| -ALL OTHER OPIODS are measured in comparison to MORPHINE:
27
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
28
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
29
Nursing Interventions:
1. ) Adm before pain is too severe
2. ) Monitor VS (vital signs)
- Resp
30
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
31
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)
32
Evaluation:
Evaluate effectiveness of med 30-60min after administration & document
33
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)
39
Opioid Side Effects:
1. ) Respiratory depression
| - Resp
40
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
49
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
