Drugs for Pain Management

studied byStudied by 19 people
5.0(3)
Get a hint
Hint
  1. culture

  2. past experiences

  3. meaning

  4. attention, anxiety

  5. suggestion and placebo

  6. feelings of control

1 / 73

encourage image

There's no tags or description

Looks like no one added any tags here yet for you.

74 Terms

1
  1. culture

  2. past experiences

  3. meaning

  4. attention, anxiety

  5. suggestion and placebo

  6. feelings of control

factors n fluencing pain experience [6]

New cards
2
  1. believe person’s self report

  2. establish cause of pain

  3. initiate appropriate treatment

principles of pain management [3]

New cards
3

Ask about pain regularly/assess pain systematically

believe the patient and family reports of pain and what relieves it

choose pain control options appropriate for the patient, family, and setting

deliver interventions in a timely manner

empower patients to control their treatment to the greater extent possible

Pain management strategy (ABCDE)

New cards
4

adjuvants

drugs that can be used for pain management but are not in anagelsic class

New cards
5

Pain pathway

always consider how pain management strategies work in relation to what?

New cards
6

nociceptors

small nerve endings of a-delta and c fibres

New cards
7
New cards
8
  1. histamine

  2. bradykinin

  3. prostaglandins

  4. substance P

  5. serotonin

  6. leukotrienes

tissue injuries release which chemical(s): [6]

New cards
9

dorsal hornw

relay station and sensory processing area in substantia gelatinosa

New cards
10

cerebral cortex

where muscle response is initiated in pain pathway

New cards
11

thromboxanes and prostaglandins

release of COX1 and COX2 results in the release of what? [2]

New cards
12

Cox-1

cyclo-oxygenase for house-keeping duties: protection of gastric mucosa, support renal function, and promotes platelet aggregation, stimulates uterine conractions

New cards
13

COX-2

cyclo-oxygenase for synthesis of prostaglandins associated with pain and inflammation

New cards
14

Acts by inhibiting COX-2 which blocks the synthesis of prostaglandins.

NSAID MOA:

New cards
15

Aspirin

First generation NSAID

New cards
16

first generation drug

NSAID that blocks both COX-1 and COX-2

New cards
17

Second generation

NSAID that targets cox-2

New cards
18

Celecoxib (Celebrex)

second generation NSAID prototype

New cards
19

Irreversible inhibition (3-5 days) of COX1 and 2

Acetylsalicylic acid (ASA) MOA:

New cards
20

7 days

stop taking aspirin how many days before surgery?

New cards
21
  1. absorbed rapidly in GI tract

  2. Highly bound to plasma protein

  3. excreted in kidneys

Aspirin pharmacokinetics: [3]

New cards
22
  1. GI upset

  2. bleeding

  3. renal dysfunction

ASA (aspirin blocks COX-1, so it will have which adverse effects?

New cards
23

Salicylism

Too much aspirin, causes tinnitus, sweating, and headache

New cards
24

warfarin is an antigoaculant

aspirin decreases platelet aggregation

risk of severe bleeding

Aspirin and warfarin drug interaction

New cards
25

Glucocorticoids act like cortisol. increases gastic secretions.

exaccerabates effects of aspirin

aspirin and glucocorticoids drug interaction

New cards
26

Alcohol increases bleeding risk

aspirin causes bleeding

Alcohol and aspirin drug interaction:

New cards
27
New cards
28
  1. hepatotoxicity

  2. renal toxicity

  3. visual changes

  4. alergic reactions

  5. bleeding

It is important patients taking aspirin be educated to report signs of what? [6]

New cards
29
  1. dark urine

  2. claycoloured stool

  3. yellow skin/sclera

  4. itching

  5. abdominal pain

Signs of hepatotoxicity[5]

New cards
30

Ibuprofen (advil, motrin)

First generation NSAID that is an anti-inflammatory, analgesic, antipyretic. Preferred drug now for inflammation over ASA, also has milder side effects

New cards
31

inhibits COX-1 and COX-2 but is reversible

Ibuprofen (Advil) MOA

New cards
32

Acetaminophen (Tylenol)

Drug for mild to moderate pain without anti-inflammatory properties

New cards
33

Inhibits prostaglandin synthesis in CNS to reduce pain and fever

Tyelenol MOA:

New cards
34

Competes for metabolism sites in the liver.

Tyelenol and alcohol drug interaction

New cards
35

causes warfarin to stay around longer

Tylenol and warfarin drug interaction

New cards
36
  1. easily distributed

  2. half-life of 2 hours

  3. excretion: metabolites in urine

Tylenol pharmacokinetics [3]

New cards
37

Opioid agonist

Drug that attaches to opioid receptor and causes something to happen

New cards
38

Opioid agonist/antagonist

Drug that attaches to opioid receptor and works as an agonist in some ways and an antagonist in others:

New cards
39

In the CNS, not an anti-inflammatoryM

where does tylenol work?

New cards
40

morphine

opioid agonist prototype

New cards
41
  1. binds to opioid receptors

  2. inhibits neurotransmitter release

  3. decreases firing rate and excitability

  4. decreases transmission of impulses

  5. decreased perception of pain and emotional response

  6. triggers histamine release from mast cells

Morphine MOA:

New cards
42

It causes histamine release from mast cells, causing itching

Why does morphine cause iching?

New cards
43
  1. well absorbed

  2. widel distributed

  3. half-life: 2-3 hours with significant (25%) hepatic first pass effect

  4. 90% appears in urine in 24 hours

Opioid pharmacokinetics: [4]

New cards
44

Mu receptors

opioid receptors in limbic system, thalamus, brainstem, dorsal horn, gut

New cards
45

Kappa

opioid receptors in cerebral cortex, spinal cord

New cards
46

Delta

Opioid receptors in the bowel, no much interaction

New cards
47
  1. analgesia

  2. euphoria

  3. sedation

  4. respirator depression

  5. nausea

  6. decreased GI motility

  7. restlessness, confusion

  8. pupil ocnstriction

  9. peripheral vasodilation

  10. itching

  11. cough suppression

effects of opioids [11]

New cards
48

less than 8 breaths per minute

respiratory depression rate

New cards
49
  1. patients with compromised respiratory system (ex: COPD)

  2. patients with head injuries, respiratory centre in medulla could be compromised

patients with what conditions should be cautioned about using opioids due to them causing respiratory depression [2]

New cards
50

always start a bowel regimen (laxatives) when giving opioids

Nursing care for opioids and constipation

New cards
51

offer anti-emetics to start; nausea will disappear in time unless sensitive

nursing care for opioids and nausea

New cards
52

observe for over-sedation; remove/be cautious with any other drugs with sedating effect

nursing care for opioids and sedation

New cards
53

Around the clock (ATC). Manage pain before it can “break through”

when should opioids be given? (schedule-wise)

New cards
54

Hydromorphone (Dilaudid)

Opioid 5X more potent than morphine

New cards
55

codeine

opioid that has the most constipation as a side effect

New cards
56

Meperidine (Demerol)

opioid that should only be given 600mg per day because it has a toxic metabolite that can build up with long term use. half life is 18 hours.

New cards
57

Percocet

combination opioid wit 5mg oxycodone and 325mg tylenol

New cards
58

Tylenol #3 or #4/Atasol 30 or 60

combination opioid with codeine, tylenol, and caffeine

New cards
59

patient-controlled analgesia (PCA)

pump that delivers opioid when patient pushes button

New cards
60
  1. a certain amount per hour maximum

  2. a lock-out period

Safety features of PCA:

New cards
61

Intrathecal morphine

“spinal” morphine, with or without anesthetic. Usually administered during a procedure in the OR. The effects can last up to 24 hours

New cards
62
  1. clocks access of opioid agonists to the opioid receptors

  2. reverses opioid actions and side effects

  3. bumps opioid molecules out of receptor

Naloxone (Narcan) MOA:

New cards
63

Naloxone (Narcan)

strucurally like morphine. is a competitive antagonist

New cards
64

0.4mg IV; repeat at 2-3 minute intervals

Narcan dosing:

New cards
65
  1. severe N+V with cheotherapy

  2. loss of appetite and weight with cancer and/or HIV/AIDS

  3. muscle spasms

  4. palliative/end of life care

when is medical cannabis prescribed? [4]

New cards
66

causes drowsiness

Cannabis and drugs that slow CNS interactions

New cards
67
  1. other anti-depressants

  2. certain heart meds

  3. certain antibiotics

  4. antiretroviral drugs (HIV)

  5. caution with psychoactive drugs

Medical cannabis should not interact with what? [5]

New cards
68

it is individualized and titrated to effect. Usually no more than 3 grams per day (dried)

Medical cannabis dosing:

New cards
69
  1. drowsiness

  2. lightheadedness

  3. disorientation

  4. confusion

side effects of medical cannabis [4]

New cards
70

responds poorly to opioids but much better with adjuvant analgesics

treatment for neuropathic pain:

New cards
71
  1. antidepressants (imipramine)

  2. Anti-convulsants (Carbomazepine)

  3. Local anaesthetics (lidocaine)

examples of adjuvant analgesics for opioids: [3]

New cards
72

the brain to support and augment endorphins

  1. opioids

  2. relaxation

  3. imagery

  4. distraction

  5. enhance control

  6. meditation

targeting the brain for pain relief for neuropathic pain and examples [6]

New cards
73
  1. opioids via epidural

  2. nerve blocks

  3. peripheral stimulation through massage / TENS

methods for pain relief that interrupt spinal cord messages: [3]

New cards
74

Use effective doses on a regular schedule

combine with alternative therapies

should not deter use if needed

Clinical implications for pain relief: [3]

New cards

Explore top notes

note Note
studied byStudied by 8 people
... ago
5.0(1)
note Note
studied byStudied by 21 people
... ago
5.0(3)
note Note
studied byStudied by 5 people
... ago
5.0(1)
note Note
studied byStudied by 64 people
... ago
5.0(2)
note Note
studied byStudied by 11 people
... ago
5.0(1)
note Note
studied byStudied by 9 people
... ago
5.0(1)
note Note
studied byStudied by 45 people
... ago
5.0(1)
note Note
studied byStudied by 1093 people
... ago
4.0(6)

Explore top flashcards

flashcards Flashcard (26)
studied byStudied by 8 people
... ago
5.0(1)
flashcards Flashcard (50)
studied byStudied by 5 people
... ago
5.0(1)
flashcards Flashcard (23)
studied byStudied by 16 people
... ago
5.0(1)
flashcards Flashcard (200)
studied byStudied by 1 person
... ago
5.0(1)
flashcards Flashcard (89)
studied byStudied by 13 people
... ago
5.0(1)
flashcards Flashcard (58)
studied byStudied by 55 people
... ago
5.0(1)
flashcards Flashcard (82)
studied byStudied by 3 people
... ago
5.0(1)
flashcards Flashcard (33)
studied byStudied by 80 people
... ago
5.0(2)
robot