Chapter 13-15: Pain

What is pain considered?

5th vital sign

Acute

short duration, sever initially, eases as it heals and goes away

Chronic

lasts longer than 6months

What drug is considered a salicylate

Aspirin

What drug is considered non-salicylates

Acetaminophen

What are the uses of Aspirin (ASA)?

Inflammation, pain, fever, decreases platelet clumping

What are the adverse drug reactions (ADRs) of Aspirin?

GI bleed, salicylism, Reye's syndrome in pediatrics

What are the contraindications for using Aspirin?

Children with viral illness, active peptic ulcer/GI bleed

What are some drug interactions with Aspirin?

Anticoagulants, glucocorticoids, alcohol, ibuprofen

What nursing considerations should be taken when administering Aspirin?

Discontinue 1 week before surgery, monitor for signs of GI bleeding, check bloodwork, monitor for signs of toxicity

What are the signs and symptoms of salicylate poisoning

tinnitus, fever, N/V, Hyperventilation, Lethargy/Excitability

What is Acetaminophen commonly known as?

Tylenol

What are the primary uses of Acetaminophen?

Pain, fever

What are the potential adverse drug reactions (ADRs) of Acetaminophen?

Overdose/toxicity, liver failure (jaundice)

What is a contraindication for using Acetaminophen?

Advanced Liver Disease

What precaution should be taken when using Acetaminophen?

Chronic alcohol use

What interaction should be noted with Acetaminophen?

Alcohol

What nursing consideration is important when administering Acetaminophen?

Monitor liver function

What is the maximum daily dose of Acetaminophen?

4g/day

What is the treatment for acetaminophen overdose and what may MD do to prevent aspiration and emesis

Acetylcysteine, and order duodenal tube

What is the treatment of an aspirin overdose?

Activated Charcoal

What should you stop 1 week prior to dental procedures or sx

aspirin

NSAIDS

Ibuprofen, Ketorolac, Celecoxib

Migraine Medications

Sumatriptan, Ergotamine

What are the uses of NSAIDs?

Pain, fever, inflammation

What are the adverse drug reactions (ADRs) of NSAIDs?

GI bleed, risk for heart attack/stroke, Stevens-Johnson syndrome, kidney damage

What are the contraindications for NSAIDs?

Active peptic ulcer/GI bleed

What precautions should be taken when using NSAIDs?

Peptic ulcer disease

What are some interactions with NSAIDs?

Anticoagulants, glucocorticoids, alcohol, other NSAIDs

What nursing considerations should be taken when administering NSAIDs?

Monitor for signs of GI bleeding, check bloodwork

Ketorolac (toradol)

Nursing Considerations: Monitor Kidney Function & I&O's

Contraindications: advanced kidney disease

ADRs: Kidney damage

Celecoxib (Celebrex)

ADRs: risk for heart attack/stroke

Contraindications: allergy to sulfa drugs, significant hx for heart attack/stroke/VTE

What is SumaTRIPTAN also known as?

Imitrex

What is the primary use of SumaTRIPTAN?

To treat and stop a migraine

What are some adverse reactions (ADRs) of SumaTRIPTAN?

Chest pressure, coronary artery vasospasm, angina

What are the contraindications for using SumaTRIPTAN?

Heart disease, uncontrolled hypertension, history of myocardial infarction (MI)

Which medications should not be used with SumaTRIPTAN?

Antidepressants, Ergotamine

When should SumaTRIPTAN be taken?

At the first sign of migraine onset

What is the maximum frequency of SumaTRIPTAN injections in 24 hours?

Should not be used more than 2 times

What is Ergotamine also known as?

Ergomar

What is the primary use of Ergotamine?

Treats and stops a migraine

What are common adverse drug reactions (ADRs) of Ergotamine?

Tingling/numbness in fingers & toes (toxicity), gangrene

What are the contraindications for using Ergotamine?

Pregnancy, hypertension (HTN), heart disease, history of myocardial infarction (MI)

What drug class should not be taken with Ergotamine?

Triptans

What is a nursing consideration when administering Ergotamine and triptans?

They should be taken 24 hours apart due to vasospasm risk

Melena

passage of black stools containing digested blood

What is ineffective for migraine pain

opioids

What are migraine medications used for?

treatment

What drugs are considered Opioid Agonists

Morphine, Oxycodone, Hydromorphone

What drug is considered an opioid agonist-antagonist?

Butorphanol

What drug is considered an opioid antagonist

Naloxone

What do opioid agonist cause?

analgesia, respiratory depression, euphoria, sedation, decreased GI movement,

What are the uses of opioid agonists?

Moderate to severe pain

What are the adverse drug reactions (ADRs) of opioid agonists?

Respiratory Depression, Constipation, opioid toxicity triad

What are the contraindications for opioid agonists?

Bradypnea, respiratory depression, head injury, paralytic ileus

What interactions should be considered with opioid agonists?

CNS depressants, alcohol, antidepressants

What nursing considerations are important for opioid agonists?

Must have antidote & resuscitation equipment, must wean slowly, hold for less than 12 RR

what is the opioid toxicity triad?

coma, respiratory depression, pinpoint pupils

What is another use for Morphine

cough suppressant

What opioid is not used for any biliary tract sx?

Morphine

How long should an opioid be given by IV push

2-5 minutes

What must you never do for an extended release pill?

crush or chew

What opioid agonists can be used for breakthrough pain

Oxycodone & Hydromorphone

Butorphanol (Stadol)

Uses; mild to moderate pain (including labor)

ADRs: Abstinence Syndrome (withdrawl)

Contraindications: opioid dependence,

Interactions: full opioid agonists

What is Naloxone commonly known as?

Narcan

What is the primary use of Naloxone?

Reverses effects of opioid overdose

What is a common adverse reaction (ADR) of Naloxone?

Abstinence syndrome (withdrawal)

Who should not receive Naloxone?

Fully opioid dependent patients

What is a key nursing consideration when administering Naloxone?

Give the lowest dose possible to achieve improved respiratory effort

How long must a patient be monitored after receiving Naloxone?

For 2 hours after dosing

What equipment must be available when administering Naloxone?

Resuscitation equipment

What should be prepared for when administering Naloxone?

Client's pain may return

What happens if Naloxone is given to someone who has not taken opioids?

Naloxone will have no effect

How long after administration of an opioid analgesics should you assess response?

30 minutes