Chapter 10 Analgesic Drugs Flashcards Preview

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Flashcards in Chapter 10 Analgesic Drugs Deck (23):
1

Opioid Drugs

Synthetic drugs that bind to the opiate receptors to relieve pain

2

Opiod drug mild antagonists

codeine, hydrocodone

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Opiod drug strong antagonists

morphine, hydromorphone, oxycodone, oxymorphone, meperidine, fentanyl, and methadone

4

Meperidine

not recommended for long-term use because of the accumulation of a neurotoxic metabolite, normeperidine, which can cause seizures

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Opioid Ceiling Effect

-Drug reaches a maximum analgesic effect
-Analgesia does not improve, even with higher doses
Pentazocine
Nalbuphine

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Agonists

-Bind to an opioid pain receptor in the brain
-Cause an analgesic response (reduction of pain sensation)

7

Agonists-Antagonists

-Bind to a pain receptor
-Cause a weaker neurologic response than a full agonist
-Also called partial agonist or mixed agonist

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Antagonists

-Reverse the effects of these drugs on pain receptors
-Bind to a pain receptor and exert no response
-Also known as competitive antagonists

9

Opioid Analgesics Main Use

-to alleviate moderate to severe pain
-Often given with adjuvant analgesic drugs to assist primary drugs with pain relief

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Opiods are also used for

-Cough center suppression
-Treatment of diarrhea
-Balanced anesthesia

11

Opioid Analgesics: Contraindications
Use with extreme caution in patients with:

-Respiratory insufficiency
-Elevated intracranial pressure
-Morbid obesity or sleep apnea
-Paralytic ileus
-Pregnancy

12

Opioid Analgesics: Adverse Effects

CNS depression
Leads to respiratory depression
Most serious adverse effect
Nausea and vomiting
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
Constipation
Itching

13

Opioids: Opioid Tolerance

-A common physiologic result of chronic opioid treatment
-Result: larger dose is required to maintain the same level of analgesia

14

Opioids: Physical Dependence

-Physiologic adaptation of the body to the presence of an opioid
-Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with psychologic dependence (addiction)

15

Opioids: Psychologic Dependence

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

16

Opioid Analgesics: Interactions

-Alcohol
-Antihistamines
-Barbiturates
-Benzodiazepines
-Monoamine oxidase inhibitors
-Others

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Codeine Sulfate

-Natural opiate alkaloid (Schedule II) obtained from opium
-Less effective
-Ceiling effect
-More commonly used as an antitussive drug
-GI disturbance

18

Fentanyl

-Synthetic opioid (Schedule II) used to treat moderate to severe pain
-Fentanyl in a dose of 0.1 mg intravenously is roughly equivalent to 10 mg of morphine intravenously

19

Dilaudid

Hydromorphone (Dilaudid): very potent opioid analgesic; Schedule II drug
One milligram of IV or IM hydromorphone is equivalent to 7 mg of morphine

20

Methadone Hydrochloride (Dolophine)

-Synthetic opioid analgesic (Schedule II)
-Opioid of choice for the detoxification treatment of opioid addicts in methadone maintenance programs
-Renewed interest in the use of methadone for chronic (e.g., neuropathic) and cancer-related pain
-Prolonged half-life of the drug: cause of unintentional overdoses and deaths
-Cardiac dysrhythmias

21

Morphine Sulfate

-Naturally occurring alkaloid derived from the opium poppy
-Drug prototype for all opioid drugs; Schedule II controlled substance
-Indication: severe pain
-High abuse potential
-Oral, injectable, and rectal dosage forms; also extended-release forms

22

Naloxone Hydrochloride (Narcan)

-Pure opioid antagonist
-Drug of choice for the complete or partial reversal of opioid-induced respiratory depression
-Indicated in cases of suspected acute opioid overdose
-Failure of the drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose.

23

Opioid Analgesics:Nursing Implications

-Withhold dose and contact physician if there is a decline in the patient’s condition or if vital signs are abnormal, especially if respiratory rate is less than 10 to 12 breaths/min.
-Constipation is a common adverse effect and may be prevented with adequate fluid and fiber intake.