NURS 2004 Pharmacology: Medication Therapy for Pain

the pain response is ______________

individualized

the pain response is _______________ to assess

difficult

does pain always respond well to management

no

does the client know their pain best

yes

what is pain threshold the level of

it is the level of stimulus needed to produce the perception of pain

what is pain threshold the measure of

the physiological response of the nervous system

what is pain tolerance the amount of

it is the amount of pain a person can endure without it interfering with normal function

does pain tolerance vary greatly from person to person

yes

what are analgesics

drugs to relieve pain

is there a loss of consciousness with using analgesics

no

what are the 2 major types of analgesics

1. non-narcotic (NSAIDs and acetaminophen)

2. narcotic

what is acetaminophen

it is a non-opioid, non-NSAID analgesics

what does acetaminophen block

pain impulses

what does acetaminophen inhibit

prostaglandin synthesis

what does acetaminophen lower

body temp by acting on the hypothalamus

what are the 2 indications to use acetaminophen

1. mild to moderate pain

2. fever (antipyretic)

what are the 2 contraindications to use acetaminophen

1. known allergy

2. liver disease

what is the one adverse effect of acetaminophen

hepatoxicity

what is the one interaction with acetaminophen

alcohol

what is the overdose treatment for acetaminophen

acetylcysteine

what is a herbal type of analgesic

feverfew

what property does feverfew have

anti-inflammatory

what 4 things is feverfew used to treat

1. migraine headaches

2. menstrual cramps

3. inflammation

4. fever

what are the 4 adverse effects of feverfew

1. GI distress

2. altered taste

3. muscle stiffness

4. joint pain

what 2 things may feverfew interact with

1. aspirin/other NSAIDs

2. anticoagulants

what are the 3 opioid classifications

1. agonists (mild and strong)

2. agonists - antagonists

3. antagonists

what are the 3 different types of opioid receptors

1. mu

2. kappa

3. delta

what is the prototypical agonist of opioid receptors type mu

morphine

what are the 4 effects of mu opioid receptors

1. supraspinal analgesia

2. respiratory depression

3. euphoria

4. sedation

what is the prototypical agonist of opioid receptors type kappa

butorphanol tartrate

what are the 3 effects of opioid receptor type kappa

1. spinal analgesia

2. sedation

3. miosis

what is the prototypical agonist of opioid receptors type delta

enkephalins

what is the effect of opioid receptor types enkephalins

analgesia

what are the 4 indications to use opioids

1. moderate to severe pain

2. used with anesthetics during surgical procedures (balanced anesthesia)

3. cough suppression

4. diarrhea

what are the 2 contraindications of using opioids

1. known drug allergy

2. severe asthma

what 6 things should you use opioids with extreme caution with

1. respiratory insufficiency

2. elevated intracranial pressure

3. morbid obesity

4. sleep apnea

5. paralytic ileus

6. pregnancy

what are the 3 adverse effects of using opioids

1. euphoria

2. histamine release

3. CNS depression

what 5 things come with the CNS depression from using opioids

1. respiratory depression

2. nausea

3. vomiting

4. constipation

5. urinary retention

what 2 things are really rare when taking opioids

1. severe hypersensitivity

2. anaphylactic reaction is rare

what is opioid toxicity treated with

opioid antagonists

what will opioid antagonists remove once they are at the receptor sites

they will remove the already bound drug and block the receptor site, reversing opioid effects

the effects of opioid toxicity are almost ________________

immediate

what interaction will opioids have with CNS depressants

additive respiratory effects

what interaction will opioids have with alcohol

additive respiratory effects

what interaction will opioids have with monoamine oxidase inhibitors (3)

1. seizures

2. hypotension

3. respiratory depression

what is morphine sulphate

an opioid agonist

what is the prototype drug for all opioids

morphine sulfate

what is morphine sulfate used to treat

severe pain

there is high _____________ potential when take morphine sulfate

abuse

what 4 routes can morphine sulfate be taken

1. orally

2. injected

3. rectal

4. extended release

(MS-contin)

what is hydromorphone

it is an opioid agonist

what is a common name for hydromorphone

dilaudid

hydromorphone is a very _____________ opioid

potent

1 mg of hydromorphone is equivalent to 7 mg of _______________

morphine

what are the 3 routes hydromorphone can be taken

1. intravenously

2. intramuscularly

3. subcutaneously

what is codeine sulfate

an opioid agonist

codeine sulfate has a ______________ effect

ceiling. this means it has no effect on pain after a certain dose. there will be no therapeutic effects

what is the main therapeutic use of codeine sulfate

an antitussive (relieves cough)

what is codeine sulfate often combined with acetaminophen for

analgesic uses

what is the main adverse event of codeine sulfate

GI issues - often mistaken for allergic reactions (nausea and upset stomach)

what is fentanyl

an opioid agonist

when fentanyl is mixed with a recreational drug, what does it lead to

overdose

what can fentanyl be used to manage

cancer pain with opioid tolerance (surgery and increased pain)

what are the 3 routes of administering fentanyl

1. parenteral

2. patch (most common)

3. sublingual

what is 0.1 mg of fentanyl IV equal

10 mg of morphine IV

fentanyl has a high potential for what

abuse

what methadone hydrochloride

an opioid agonist (stimulates opioid receptors)

do you get high or experience euphoria from methadone hydrochloride

no

what is methadone hydrochloride mainly used in the treatment of

opioid addiction (detox). also used for chronic and cancer related pain

methadone hydrochloride has a _______________ half life

prolonged, meaning it can be abused

what is the major adverse effect of methadone hydrochloride

cardiac dysrhythmias

what are opioid agonist - antagonists associated with

the ceiling effect

what do opioid agonist - antagonists exert

either no action or a limited action at the receptors

what do opioid agonist - antagonists have a lower risk of

misuse and addiction

what can opioid agonist - antagonists cause in opioid-dependent clients

withdrawal symptoms

what is naloxone hydrochloride

an opioid antagonist

naloxone hydrochloride has a very short _____________

half-life

what is naloxone hydrochloride the drug of choice for

complete or partial reversal of opioid-induced respiratory depression

what are the 2 methods of administration of naloxone hydrochloride

1. injectable

2. nasal spray

with an increased opioid tolerance, why are larger opioid doses required

maintain the same level of anesthesia

what is opioid tolerance seen with

long-term opioid treatment

when is physical dependence on opioids seen

when the opioid is abruptly discontinued or when an opioid antagonist is administered

what are the 11 symptoms of opioid withdrawal

1. anxiety

2. irritability

3. chills

4. hot flashes

5. lacrimation

6. rhinorrhea

7. diaphoresis

8. nausea

9. vomiting

10. abd cramps

11. diarrhea

what are the 2 treatments for opioid withdrawal

1. clonidine (bottoms out BP)

2. methadone

with a malignancy, what is the main concern

the patient's comfort, not prevention of a drug addiction

what are 2 jobs of analgesic adjuvant drugs

1. assist primary drugs in relieving pain

2. neuropathic pain

what 4 analgesic adjuvant drugs assist primary drugs in relieving pain

1. nonsteroidal anti-inflammatory drugs

2. antidepressants

3. anticonvulsants

4. corticosteroids

what 2 analgesic adjuvant drugs help with neuropathic pain

1. amitriptyline (antidepressant)

2. gabapentin/pregabalin (anticonvulsants)

how do anesthetics reduce pain

by depressing nerve function in the CNS and/or the PNS

what do anesthetics result in a state of

neurologic function

what are the 2 main types of anesthetics

1. general anesthesia

2. local anesthesia

what is there a complete loss of when using general anesthesia

consciousness and a loss of body reflexes, including paralysis of respiratory muscles (need respiratory support)

is there paralysis of respiratory function with local anesthesia

no

what is there an elimination of with local anesthesia

pain sensation in the tissues innervated by anaesthetized nerves

what are 2 types of local anesthetics

1. benzocaine

2. lidocaine

what are the 2 types procedural sedation

1. conscious sedation

2. moderate sedation

does procedural sedation cause a loss of consciousness

no, and it does not cause respiratory arrest

what 2 things does procedural sedation decrease

1. anxiety

2. sensitivity to pain

where do skeletal muscle relaxants

the CNS

what do skeletal muscle relaxants depress

nerve transmission in the spinal cord by enhancing the effects of GABA