Pharmacology T2

medications that relieve pain without causing loss of consciousness.

What is an analgesic?

Opioid analgesic and adjuvant analgesic

Pain Killers

sudden onset and short duration, has an end

Acute pain

Peripheral nervous system, headache

Vascular pain

Persistent or recurring pain that is often difficult to treat. Includes any pain lasting longer than 3 to 6 months

Chronic pain

pain or discomfort felt in an amputated limb

phantom pain

chronic pain that has been present for 3 months or longer

persistent pain

level of stimulus needed to produce the perception of pain. A measure of the physiological response of the nervous system

What is pain threshold?

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

What is pain tolerance?

subjective phenomenon of pain, how it felt, complex psychological and emotional factors

What is pain perception?

patient controlled analgesia pump

What is a PCA

No, giving it to your pt is lying and could lead to consequences

Are placebos recommended? why or why not?

They would require a higher dose

signs someone may be opioid tolerant

Comes on suddenly, lasts for short periods, and is not relieved by the patient's normal pain management

What is breakthrough pain?

drugs that work together to increase drug effectiveness

What does synergistic mean?

Drug that are added for combined therapy with a primary drug and may have additive or independent analgesic properties

What is an adjuvant?

In combination to be able to use lower doses of other drugs

Why do we use adjuvant drugs when it comes to analgesia?

1. non opioid +/- adjuvant
2. opioid for mild to moderate pain +/- non opioid +/- adjuvant
3. opioid for moderate to severe pain +/- non opioid +/- adjuvant

What is the three step ladder for analgesia

Narcotics: synthetic drug bind to opiate receptors to relieve pain.

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What are opioids?

codeine or hydrocodone

class of drugs that provide pain relief are…

relieve pain, reduce cough, relieve diarrhea, induce anesthesia

what do we use opioids for?

Because of the accumulation of a neurotoxic metabolite normeperidine

Why don't we use meperidine anymore?

* morphine
* hydrochloride
* oxycodone
* fentanyl

What is an example of a strong opioid agonist?

Occurs when the **therapeutic response cannot be increased with a higher dose of drug**

What is the ceiling effect?

Codeine & Pentazocine

What's an example of a drug that has a ceiling effect?

Binds to a pain receptor, causes weaker pain response than full agonist also called partial agonist/ mixed agonist

What's an opioid agonist-antagonist?

reverse effects of opioids

What does an opioid antagonist do?

Respiratory insufficiency, Elevated intracranial pressure, morbid obesity, or sleep apnea, paralytic ileus, pregnancy

Who should we be careful with when administering opioids?

Respirations

What **vital sign is the greatest concern** when administering pain meds?

CNS depression, Nausea and Vomitting, Constipation, and Urinary retention.

What are some other adverse effects of opioids?

Yes, they are treated with different methods of drugs.

Should we believe every patient's pain? Yes or No

yes we treat them according to pain

Should we treat everyone who says they have pain? Why or why not?

Naloxone Hydrochloride

What medication will be administered for opioid overdose?

altered consciousness and decreased respiration (apnea)

What are the symptoms of opioid overdose?

Natural opiate alkaloid obtained from opium, less effective, has ceiling effect. antitussive drug, GI disturbances

What do you know about codeine sulphate?

Synthetic opioid used to treat moderate to severe pain, parenteral injection, trans dermal patches, sublingual

What do you know about fentanyl?

Hydromorphone, very potent opioid analgesic

\-1mg IV/IM = to 7mg of morphine

What do you know about dilaudid?

Naturally occurring Alkaloid from poppy, prototype for all opioid drugs, it is a controlled substance for severe pain.

What do you know about morphine sulphate?

Methadone hydrochloride

What can we do for opioid treatment?

Cancer related pain

What can we use methadone for other than opioid treatment?

Non - opioid Analgesics

What classification is Tylenol?

analgesic, antipyretic effects, little to no anti inflammatory effect. blocks pain impulses, inhibits prostaglandin synthesis

What is Tylenol used for?

4g/day \= 4000mg

What is the maximum dosing for Tylenol

2g/day = 2000 mg

If they have a liver disease, what is the maximum dosing for Tylenol?

Liver Damage

Drug allergy

Liver dysfunction

Possible liver failure 

Glucose-6-phosphate dehydrogenase deficiency (G6PD)

What is an adverse effect of Tylenol? Who should we be cautious with in using Tylenol?

Acetylcysteine

What is the antidote for a Tylenol overdose?

Herbal

What other drug classification may be giving for pain but that is not their primary use?

Alcohol consumption while on acetaminophen

What do you watch for if a patient is using acetaminophen for pain and has six beers over 2 days?

A spinal headache caused by the spinal drug 

A patient had a spinal anaesthetic during surgical procedure and is now complaining of headache what is the likely cause of his headache?

Could give Analgesics, and caffeine.

doctor = bedrest and blood patch

What action would be appropriate by the nurse?

* Condition: Malignant hyperthermia 
* Med: Dantrolene Sodium
* Teach: Family susceptibility and let team know if any future surgery

*Patient has fever during surgery, elevated HR of 128 and respiration of 32.*

What condition does the nurse suspect the patient is experiencing? What medication is given? What teaches to do after surgery?

To reduce the patients dosage gradually so that eventually the patient can live permanently drug free

What's the goal of methadone?

Brief rush followed by a few hours of relaxed, content state

What do opioids make people feel like?

it makes respirations stop

What happens when opioids are given in large doses?

Hypotension, Drowsiness, Diuresis, Convulsions, Nausea and vomiting 

What are the adverse effects of opioids?

1 - 3 days

What is the peak of opioid withdrawal?

5 - 7 Days

What is the duration of opioid withdrawal?

* Intense desire for drugs 
* Muscle Cramps
* Arthralgia 
* Anxiety
* nausea 
* malaise

What are some symptoms of withdrawal?

Block receptors, Naltrexone hydrochloride, opioid antagonist and Suboxone

What is the treatment for opioid addiction/withdrawal?

Elevation of mood, Reduction of fatigue, increased alertness, invigorated aggressiveness

What are stimulants?

Amphetamines, Cocaine, Methylphenidate hydrochloride, Dextroamphetamine sulphate and Bath salts

What are some examples of stimulants

wired - don't sleep

How do patients on stimulants present?

Restlessness, Syncope, Tremor, Insomnia, Fever and Euphoria

What are some adverse effects of stimulants?

Convulsions, Coma, Cerebral hemorrhage

What are the three things that cause death from stimulants?

1 - 3 days

how long does the peak period lasts? (Stimulant Withdrawal)

5 - 7 days

What is the duration for stimulant withdrawal? (Stimulant Withdrawal)

Benzodiazepines & Barbiturates

What are the two main classes of depressants?

Anxiety, induce sleep, to sedate, and to prevent seizures

Benzodiazepines:

Seadtives and anticonvulsants and to induce anaesthesia

Barbiturates:

Relieve Anxiety irritability and tension when used as intended. It may also treat seizure disorders and induce anesthesia

What are depressants used for?

Anesthetics

Drugs that reduce or eliminate pain by depressing the nerve function in the CNS are known as:

**Local**: no paralysis of respiratory function

**General**: loss of consciousness and reflexes

What are the two types of anesthesia?

A drug given at a dose to depress the CNS to a degree that causes a loss of consciousness (unarousable), as well as analgesia (cannot feel pain).

What is general anesthetic?

Inhalational & Parenteral (IV)

How can we administer general anesthesia?

Adjuvant anesthetic enhances clinical therapy when used simultaneously with other drugs, less adverse effects, Opioid + Benzodiazepine

What does balanced anesthesia mean?

Morphine or Fentanyl

What is an example of an adjuvant drug?

systematic reduction of sensory and motor CNS function progressive depression of cerebral and spinal cord function

What is the mechanism of general anesthesia?

Malignant hyperthermia

What is an adverse effect that is commonly seen in general anaesthesia?

A side effect of general anesthesia - tachycardia, hypertension, acid-base and electrolyte abnormalities, muscle rigidity, hyperthermia

What is malignant hyperthermia?

Sudden elevation in body temp, tachypnea, tachycardia muscle rigidity

What are the symptoms of Malignant hyperthermia

Dantrolene & cardiorespiratory supportive care

How is malignant hyperthermia treated?

Antihypertensives increased hypotensive effect.

B- Blockers

What are two drug classes that interact with general anesthetic?

Depressed muscles and patterns of respiration; altered gas exchange and reduced oxygenation; depressed airway-protective mechanisms; airway irritation and possible laryngospasm

Effects of Inhaled and Intravenous General Anesthetics - **Respiratory system**

Depressed myocardium; hypotension and tachycardia; bradycardia in response to vagal stimulation

Effects of Inhaled and Intravenous General Anesthetics - **Cardiovascular system**

CNS depression; blurred vision; nystagmus; progression of CNS depression to decreased alertness and sensorium as well as decreased level of consciousness

Effects of Inhaled and Intravenous General Anesthetics - **CNS**

Increased intracranial blood volume and increased intracranial pressure

Effects of Inhaled and Intravenous General Anesthetics - **Cerebrovascular system**

Reduced liver blood flow and thus reduced liver clearance

Effects of Inhaled and Intravenous General Anesthetics - **Gastrointestinal** (**GI)**

Decreased glomerular filtration

Effects of Inhaled and Intravenous General Anesthetics - **Renal system**

Skeletal muscle relaxation

Effects of Inhaled and Intravenous General Anesthetics - **Skeletal muscles**

Vasodilation

Effects of Inhaled and Intravenous General Anesthetics - **Cutaneous circulation**

General Aesthesia and moderate sedation

**Ketamine**: What is this used for?

Disturbing psychomimetic effects including hallucinations

**Ketamine**: What are some adverse effects?

Laughing gas

**Nitrous Oxide:** What is this also known as?

Dental procedures or supplemental more potent Anastasia

**Nitrous Oxide:** What is this primarily used for?

only inhaled currently used, weakest of all general anesthsia

**Nitrous Oxide:** What is another fact you know about this drug?

Induction and maintenance of general anesthesia

**Propofol**: What is this used for?

Sedative-hypotic for moderate sedation

**Propofol**: What can it be used for in lower doses?

oral

What route do we commonly use for children who need conscious sedation?

backwards:

Motor, sensory then autonomic are restored

When local drugs wear off - recovery occurs in which order?

Lidocaine

What is one medication that we could use for local anaesthetic?