Pharmacology for Nursing Practice - Analgesia and Anaesthetic Medications

Acknowledgement of Country

  • RMIT University acknowledges the Woi wurrung and Boon wurrung language groups of the eastern Kulin Nation and their ancestors and elders.

Learning Outcomes

  • Develop understanding of the clinical decision-making process in relation to medication safety.
  • Apply knowledge to online Perusall case studies and clinical classes as part of self-directed learning.
  • Review pharmacotherapeutics and clinical reasoning to apply elements of the clinical reasoning cycle.
    • Further reading and self-directed learning is expected for continuous professional development in pharmacology.

Pain and Pathways

  • Definition: Pain is a discomforting sensation and a symptom of underlying physical or emotional diseases and serves as a warning.
  • Description: Pain can be described qualitatively (e.g., burning, sharp, dull, throbbing).
  • Challenges in Pain Management: Determining effective pain management is difficult due to varying descriptions and perceptions of pain configurations.
  • Complications from Inadequate Pain Control: Can lead to infections, stress, psychological distress, longer hospital stays, and increased healthcare costs.
Major Types of Pain
  1. Acute Pain: Lasts from minutes to months.
  2. Chronic Pain: Persists for more than 6 months.
  3. Neuropathic Pain: Results from nerve damage.
  4. Nociceptive Pain: Caused by tissue damage.

Analgesia and Pain Control Medications

  • Various medications for pain control, including:
    • Non-opioid analgesics (e.g., NSAIDs, antipyretics)
    • Opioids (agonists and antagonists)
    • Anaesthetics.

Non-Opioid Analgesics, Antipyretics and NSAIDs

  • Characteristics:
    • Provide pain control, anti-inflammatory, and antipyretic effects.
    • Can be used alone or as adjuvants.
    • Exhibit a 'ceiling effect' – higher doses yield diminishing returns.
    • No physical dependence observed.
  • Drug Classes Include:
    • Salicylates (e.g., aspirin)
    • Para-Aminophenol derivatives (e.g., paracetamol)
    • NSAIDs (e.g., ibuprofen, naproxen).

Pharmacotherapeutics – Salicylates

  • Use Cases: Commonly used for pain relief, fever reduction, and inflammation.
  • Metabolism: Distributed in body tissues, metabolized in the liver, and excreted by kidneys.
  • Mechanism: Reduces fever by acting on the hypothalamus and causes vasodilation to promote heat loss.
  • Adverse Reactions: Include gastric upset, bleeding tendencies, confusion, tinnitus, and Reye’s syndrome among others.

Nursing Considerations- Salicylates

  • Pain Assessment: Assess pain levels pre-administration.
  • Administration Tips:
    • Use food/milk to minimize GI upset.
    • Monitor for adverse reactions and effectiveness post-administration.
    • Observe for signs of bleeding and monitor blood counts and kidney/liver functions.

Pharmacotherapeutics – Paracetamol

  • Common OTC medication for mild pain relief and fever reduction.
  • Attributes: Absorbed quickly, crosses placenta, hepatically metabolized.
  • Adverse Reactions: Rare GI upset can occur, risk of liver toxicity if dosage > 4g/24hrs.

Nursing Considerations- Paracetamol

  • Monitoring: Assess patient’s medication history to avoid exceeding daily limits.
  • Evaluate Effectiveness: Monitor for adverse reactions.

Pharmacotherapeutics – Selective & Non-Selective NSAIDs

  • Effective for treating inflammation with analgesic and antipyretic properties.
  • Mechanism: Non-selective NSAIDs inhibit COX-1 and COX-2 for pain relief.
  • Adverse Reactions: Potential for ulcers, liver toxicity, hypertension, etc.

Nursing Considerations- Selective & Non-Selective NSAIDs

  • Assess for underlying conditions and pain levels before therapy.
  • Monitor for signs of bleeding, adverse reactions, and effectiveness.

Pharmacotherapeutics – Opioid Agonists

  • Derived from opium or synthetic, they relieve pain via receptor response.
  • Common Drugs: Codeine, morphine, fentanyl.
  • Adverse Reactions: Include respiratory depression and other common side effects confirming the necessity of monitoring.

Nursing Considerations- Opioid Agonists

  • Vital Signs Monitoring: Focus on respiratory rate.
  • Monitor for adverse reactions and signs of tolerance or dependence.

Pharmacotherapeutics – Opioid Antagonists

  • Drugs like Naloxone can reverse opioid overdose effects.
  • Monitor for withdrawal symptoms and respiratory status after administration.

Nursing Considerations- Opioid Antagonists

  • Assess for prior opioid use and monitor effectiveness and respiratory rates.

Anaesthetics Overview

  • Categories: General (inhaled & intravenous) and local anaesthetics.
  • Inhaled Anaesthetics: Rapid CNS depression; contraindicated in specific conditions.
  • Adverse Reactions: Include confusion, n/v, cardiovascular issues.

Nursing Considerations- Anaesthetics

  • Perform baseline vital checks and monitor post-administration for drug reactions, consciousness, and vital signs.

Pharmacotherapeutics – Local Anaesthetics

  • Administered in specific body areas; effective in patients contraindicated for general anaesthesia.

Nursing Considerations- Local Anaesthetics

  • Monitor baseline vitals and assess for potential complications.

Pharmacotherapeutics – Topical Anaesthetics

  • Used directly on skin/mucous membranes; produce minimal systemic absorption. Used for minor burns, itching, and before injections.

Nursing Considerations- Topical Anaesthetics

  • Monitor for vital changes, pain level, and individual reactions post-application.

Comparison: Analgesia vs Anaesthesia

  • Analgesia: Relief from pain; can be taken orally and is often available OTC.
  • Anaesthesia: Removes feeling from the body, is more invasive, and requires physician administration, affecting the whole body.

Continued Professional Development

  • Engage actively with learning opportunities to expand knowledge in pharmacology and medication management.