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488 > Class 10: Analgesics > Flashcards

Class 10: Analgesics Flashcards

(64 cards)

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1
Q

Somatic pain

A

Fibromyalgia, arthritis, tension headaches; from ligaments, joints and bone

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2
Q

Vascular pain

A

Leg cramps from; most migraines

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3
Q

Neuropathic pain

A

Also diabetic with nerve damage: diabetic with foot pain

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4
Q

Central pain

A

Tumors, inflammation and disease

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5
Q

Examples of acute pain

A

MI, appendicitis, kidney stones and surgical procedures

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6
Q

Examples of chronic/persistent pain

A

Arthritis, cancer, lower back pain, peripheral neuropathy

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7
Q

Opioids purpose

A

Purpose is to alleviate moderate to severe pain

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8
Q

Opioid MOA

A

-Agonist, partial agonist, antagonist & endorphins

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9
Q

Endorphins

A

Inhibitors communication of pain signals and produce a feeling of euphoria

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10
Q

Morphine-like drugs

A

Morphine, heroin, hydromorphone, codeine, hydrocodone & oxycodone

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11
Q

Meperidine-like drugs

A

Meperidine, fentanyl, remifentanil, sulfentanil and alfentanil

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12
Q

Methadone-like drugs

A

Methadone

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13
Q

Other opioids

A

Tramadol & tapentadol

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14
Q

Morphine indications & routes

A

-Post operative & chronic pain
-IV, suppository, PO (immediate release and sustained release)

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15
Q

Fentanyl indications, onset & routes

A

-Post operative and procedural pain
-Rapid onset and short duration
-IV, IM, transdermal

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16
Q

Methadone indications & routes

A

-Use in the detoxification of people addicted to opioids
-PO

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17
Q

Hydromorphone (dilaudid)

A

-More potent than morphine by 10x
-Common drug error

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18
Q

Meperidine (demerol) indications & routes

A

-Post operative pain
-IV and IM

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19
Q

Codeine indications & routes

A

-PO
-May be given alone or in combination
-Cough suppression

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20
Q

Adverse effects of opioids

A

-Stimulates the chemoreceptor trigger zone in the CNS, slows peristalsis, N/V & constipation
-Urinary retention & anaphylaxis

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21
Q

Opioid adverse effects on the CNS

A

Sedation, disorientation, euphoria, dysphoria, lightheadedness, tremors and lower seizure thresholds

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22
Q

Opioid CV adverse effects

A

Hypotension, palpitations & flushing

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23
Q

Opioid respiratory adverse effects

A

Depression & asthma

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24
Q

Opioid GI adverse effects

A

N/V, constipation & biliary tract spasm

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25
Opioid GU adverse effects
Urinary retention
26
Opioid integumentary adverse effects
Itching, rash & wheal formation
27
Opioid drug interctions
Alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine, demerol and MAO Inhibitors
28
Opioid lab values to monitor
ALT, Alk Phos, bilirubin, amylase, lipase & CK
29
Patient controlled analgesic typical ordered set
-PCA only hydromorphone 2mg/ml -PCA dose 1mg -PCA lockout 6 minute -4 hour dose limit (none)
30
PCA monitoring
Pain, RR, sedation: q1hx4, q2hx8, then q4h for the duration
31
PCA + end of shift
of attempts recorded, dose given over the shift. Log is reset for each shift on PCA
32
Acetaminophen MOA
-Blocks peripheral pain impulses by inhibiting prostaglandin synthesis -Antipyretic effects by acting on hypothalamus -Weaken anti-inflammatory response
33
Acetaminophen indications
-Mild to moderate pain -May be used in the place of aspirin with reduced side effects -Antipyretic effect for adults and children with the flu
34
Acetaminophen contraindications
-Severe liver disease -Glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency
35
Acetaminophen adverse effects
Rash, N/V, blood disorders or nephrotoxicities
36
Acetaminophen OD toxicity
-Life-threatening and potentially lethal -Maximum dose 4000 mg per 24 hr period -Acute ingestion results in liver toxicity -Long term ingestion results in nephrotoxicity
37
Tx of acetaminophen OD
Acetylcysteine
38
Acetaminophen interactions
-Alcohol, liver disease, hepatotoxic drugs -Phenytoin, barbiturates, isoniazid, rifampin, β-blockers and anticholinergic drugs
39
Adjuvant analgesic drugs
NSAIDS, antidepressants, anticonvulsants & corticosteriods
40
Benefits of adjuvant analgesic drugs
-Decreased opioid use and side effects -Provides an approach to the pain stimulus by another mechanism of drug action
41
Antidepressants in adjuvant analgesic therapy
Neuropathic pain (amitriptyline)
42
Antiseizure agents in adjuvant analgesic therapy
Neuropathic pain (gabapentin & pregabalin)
43
Corticosteroids in adjuvant analgesic therapy
Inflammation (prednisone)
44
Muscle relaxants in adjuvant analgesic therapy
Neuropathic pain/muscle spasms (benzodiazepine, baclofen & dantrolene)
45
Local anesthetics in adjuvant analgesic therapy
Lidocaine
46
NSAIDS in adjuvant analgesic therapy
Inflammation (ibuprofen, ketorolac (toradol), diclofenac (voltaren), indomethacin, COX-2 inhibitors (celecoxib (Celebrex), meloxicam))
47
Complementary & alternative therapy (CAM)
-Harmonious with many of the values of nursing: -Holistic, emphasis on healing, recognition that the provider-patient relationship is a partnership, focus on health promotion rather than illness prevention
48
Traditional chinese medicine (TCM)
Acupuncture, acupressure, Chinese herbology, massage, cupping, meditative exercise, nutrition & spiritual
49
Objective physical pain assessment + joints
-Joints; not size, contour, circumference, active & passive ROM
50
Objective physical pain assessment + muscle/skin
-Color/swelling -Masses/deformity -Sensation changes
51
Objective physical pain assessment + abdomen
-Countour/symmetry -Guarding/organ size
52
Objective physical pain assessment + pain behaviour
-Nonverbal cues -Acute pain behaviour -Persistent pain behaviour
53
Acute pain behaviours
Guarding, grimacing, vocalizations such as moaning/crying, agitation, restlessness, stillness, diaphoresis, changes in VS
54
Persistent (chronic) pain behaviours
Bracing, rubbing, diminished activity, sighing, change in appetite, being with other people, movement, exercise, prayer & sleeping
55
Slide 40
56
Pain involves 3 factors
Physical, pyschological & emotional factors
57
WHO 3 step analgesia ladder tx
-The use of non-opioids (with or without adjuvant medications) -The use of opioids with or without non-opioids and/or adjuvant medications -The use of opioids indicated for moderate to severe pain +/- nonopiods and/or adjuvant medications
58
Nursing interventions for pain
-Monitor response to medications by: -VS and identifying therapeutic or sub therapeutic response -Give medications with meals to eliminate GI upset -Monitor for adverse effects such as hallucinations and treat accordingly -May have increased effects of medication in the elderly and children (dose reduction)
59
Pyschological dependence
Taking opioids to deliberately acheive an aMental status
60
S&S of pyschological dependence
Impaired control over drug use, compulsive use & craving and continued despite harm
61
Physical dependence
State of physiological adaptation manifested by a drug-class-specific withdrawal syndrome -Can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and administration of an antagonist
62
S&S of physical dependence
Rebound pain, mental agitation, tachycardia, elevated BP and seizures
63
Opioid tolerance
A state of adaptation in which exposure to a drug for an extended period of time induces changes that result in the diminishing of one or more of the drug’s effects over time
64
S&S of opioid tolerance
Return of uncontrolled pain

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