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Pain Management Flashcards

(84 cards)

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1
Q

what is nociceptive pain?

A

pain from physical damage or potential damage to the body
somatic - tissue damage like surgery, injury, infection, or inflammation
visceral - related to internal organs

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2
Q

what is neuropathic pain?

A

damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles, and other parts of the body - diabetes, shingles, chemo, poor response to opioids

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3
Q

what is the management strategy for pain?

A
  • ask about pain regularly
  • believe the report of pain
  • choose appropriate pain control
  • deliver timely and logical interventions
  • empower patients and pts
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4
Q

what is a nonverbal pain scale used for?

A

children and pts who can’t communicate

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5
Q

what kind of interventions are there for pain?

A
  • physical/psychosocial interactions
  • nonopioid analgesics
  • adjuvant analgesics
  • opioid analgesics
  • nonopioid centrally acting analgesics
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6
Q

what are examples of physical interventions for pain?

A
  • heat
  • ice
  • massage
  • position
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7
Q

what are examples of psychosocial interventions for pain?

A
  • distractions
  • music
  • yoga
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8
Q

what are two examples of nonopioid analgesics?

A
  • non-steriodal anti-inflammatory drugs (NSAIDs - aspirin, ibuprofen)
  • acetaminophen
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9
Q

what precautions should be known about acetaminophen?

A
  • overdose - no more than 4000mg a day

- liver failure

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10
Q

what is Percocet made of? what teaching is needed?

A

oxycodone and Tylenol

  • oxycodone doesn’t have a limit but Tylenol does
  • watch for overdose, pt can’t take extra Tylenol or any other drug that contains acetaminophen
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11
Q

what are adjuvant analgesics?

A

drugs not designed for pain management but can be used for pain control

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12
Q

what are the three examples of adjuvant analgesics are used for neuropathic pain and what is their original use?

A

all three are used for neuropathic pain

  • amitriptyline (Elavil) - tricyclic antidepressant
  • Gabapentin - anti-seizure drug
  • lidocaine - local anesthetics/antidysrhythmics
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13
Q

what is the purpose of a CNS stimulant as an adjuvant analgesic?

A

enhance opioid analgesia and counteract sedation

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14
Q

when are bisphosphonates used as an adjuvant analgesic?

A

when pain is caused by a tumor-induced bone resorption

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15
Q

why would aspirin not be used for pain management?

A

risk for bleeding

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16
Q

why would a patient be prescribed nonopioid analgesics on top of opioid use?

A

it will spread out the amount of time between opioid use

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17
Q

why are antihistamines used as adjuvant therapy? give an example of the drug name

A
  • hydroxyzine (Vistaril) or Benadryl

- promotes drowsiness and reduces and anxiety

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18
Q

why would glucocorticoids be used as adjuvant therapy? give an example of the drug name

A

prednisone or hydrocortisone

  • reduce cerebral and spinal edema
  • improve general sense of wellbeing
  • improve appetite
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19
Q

what is an analgesic?

A

a category of drugs that relieve pain without causing loss of consciousness

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20
Q

what is the most common group of analgesics?

A

opioids (most effective pain relievers)

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21
Q

what is an opioid defined as?

A

a general term defined as any drug, natural or synthetic, that has actions similar to those of MORPHINE

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22
Q

what are Mu receptors?

A

related to dependence

- when activated it causes analgesia, respiratory depression, euphoria, sedation and decreased GI motility

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23
Q

what are Kappa receptors?

A

when activated it causes analgesia, sedation, and “psychotomimetic” effects

  • hallucinations
  • anxiety
  • nightmares
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24
Q

what receptor is associated with dependence?

A

Mu receptor

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25
what are pure opioid agonists?
they active both Mu and Kappa to produce analgesia and sedation - strong opioid agonists
26
what are agonist-antagonist opioids?
an agonist to one receptor (usually kappa) and an antagonist to one receptor (usually mu)
27
what are pure opioid ANTAGONIST?
- blocks the agonist - reversal effect of pure opioids - naloxone (Narcan)
28
what are examples of pure opioid agonists?
- morphine - codeine - meperidine - fentanyl - dilaudid - methadone
29
when would you use pure opioid agonists?
- postoperative pain - obstetric analgesia - myocardial infarction - head injury (use with caution due to respiratory depression) - cancer-related pain - chronic non-cancer pain
30
where does morphine come from?
poppy plant
31
what does opium contain?
morphine and codeine
32
which receptors does morphine work on? what does it do?
mu and kappa | - blocks transmission of pain
33
what do endorphins relate to?
euphoria
34
what are the routes for morphine?
oral, IM, IV, subcutaneous, epidural, rectal, and intrathecal
35
how is morphine absorbed?
depends on the route - need a much larger dose of morphine to be effective when PO - IV morphine would need a much smaller dose to be effective
36
what does "first pass" mean when referring to morphine?
it is inactivated by the hepatic metabolism - the first pass through the liver inactivates much of the orally ingested drug on its way to the systemic circulation - PO could be like 30mg - IV could be like 4mg
37
what is a serious adverse effect of morphine?
respiratory depression
38
what could cause an increase of respiratory depression with a patient on morphine?
on patients using/taking other CNS depressants - alcohol - barbiturates - benzodiazepines - or patients with preexisting respiratory conditions
39
what are the adverse effects of morphine? (more than just respiratory depression)
- euphoria/dysphoria - sedation - miosis (constriction of the pupil) - neurotoxicity - adverse effects from prolonged use is CONSTIPATION (would need a laxative and doesn't get better with time)
40
what are the problems with the long-term use of morphine?
tolerance and physical dependence | - side effects will begin to decrease
41
what is the most common bothersome side effect of morphine
constipation - would require a laxative daily if a patient is on morphine for a prolonged period of time, doesn't get better with time
42
what happens if a pt is dependent on morphine and stops taking them suddenly?
withdrawal symptoms | - unpleasant
43
what are the signs and symptoms of morphine toxicity?
classic triad - coma (decreased level of consciousness) - respiratory depression - pinpoint pupils
44
what is the classic triad?
signs and symptoms of morphine toxicity - coma (decreased level of consciousness) - respiratory depression (less than 12) - pinpoint pupils
45
what is the treatment for morphine toxicity?
- ventilatory support | - antagonist - naloxone (Narcan)
46
what types of people require a lower dose of morphine?
children and elderly
47
what is naloxone (Narcan) used for?
- used for overdoses of narcotics - injected as IV push - given for respiratory depression
48
before administering morphine, the nurse must...
check heart rate, respiration rate, and blood pressure
49
what teaching is needed with a patient-controlled anesthesia pump?
- know how to use and have it reachable
50
what is the nurse's role with a patient-controlled anesthesia pump?
check vital signs more frequently
51
education needed for a pt discharge going home on a narcotic?
- taper down dose at home - signs and symptoms of overdose - manage constipation with prescriptions of high fiber diet
52
what is fentanyl?
an opioid 100 times more potent than morphine
53
what are the routes for fentanyl?
- intranasal - parenteral IM/IV sublimaze - transdermal (duragesic) - transmucosal (Actiq - narcotic on a lollipop)
54
what is the most common form of fentanyl? what it used for?
transdermal (duragesic) - it is patch that manages baseline pain and takes hours to work - heat accelerates use
55
what is meperidine (Demerol)?
a rarely used strong opioid agonist | - doesn't work well in everyone (tends to be a genetic predisposition)
56
what is methadone? what is an adverse effect?
a treatment pain and opioid addicts - prevents withdrawals - prolongs QT interval: risk for dysrhythmias
57
what advocation is needed by nurses in relation to pain management?
nurses should advocate for different medications for their patients if the medication is not working
58
what is the name of two moderate to strong opioid agonists?
codeine and oxycodone
59
how are codeine and oxycodone similar to morphine?
produce analgesia and sedation
60
how are codeine and oxycodone different from morphine?
produce less analgesia and less respiration depression | - a little bit lower risk for abuse
61
what are the side effects of codeine and oxycodone?
- respiration depression - constipation - urinary retention - cough suppression
62
what is the antagonist for codeine and oxycodone?
Narcan
63
what route is codeine given?
only PO
64
what is the action of codeine?
- 10% of the dose converts to morphine in the liver - mild to moderate pain and cough - lower dose helps cough suppression
65
what drugs are combination drugs containing oxycodone?
- percodan - percocet - combunox
66
what is the immediate release form of oxycodone?
oxycodone
67
what is the controlled release (long-acting) form of oxycodone?
OxyCotonin
68
what are the side effects of oxycodone?
- valvular heart injury - tissue necrosis - pulmonary granulomas
69
what is hydrocodone used for?
used for pain and cough suppression | - often combined with nonopioid drugs
70
what is one problem with hydrocodone?
wide spread abuse
71
when should naloxone (Narcan) be administrated?
give immediately for decreased respirations to reverse opioid effects
72
what are two nonopioid centrally acting analgesics?
- tramadol | - clonidine
73
what is the action of tramadol?
combination of opioid and nonopioid mechanisms
74
what are the uses for tramadol?
- pain | - restless leg syndrome
75
what are the adverse effects of tramadol?
- sedation - dizziness - dry mouth - constipation
76
what drugs should not be taken with tramadol?
- CNS depressants - no alcohol - no benzodiazepines
77
what is the abuse like with tramadol?
relatively low, doesn't cause euphoria
78
what form does tramadol come in?
immediate and extended release
79
what is the mechanism of action for clonidine?
- decreased norepinephrine | - alpha 2 adrenergic agonist (blocks the nerve pathway)
80
what are the two approved uses for clonidine?
- used for pain in combination with opioid analgesics | - also used for hypertension (oral or patch)
81
what are the adverse effects of clonidine?
- severe hypotension - rebound hypertension - bradycardia - nightmares - psychodynamic effects
82
when shouldn't clonidine be used?
in hemodynamically unstable patients
83
Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness?
They should be given on a regular schedule, around the clock.
84
What would occur if you stop the administration of an opioid antagonist in a client who is physically dependent on opioids?
withdrawal symptoms

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