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110 Cards in this Set
- Front
- Back
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goal of therapy for analgesics
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to treat/prevent/decrease pain
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afferent neurons (noiciceptors), dorsal horn, substance p, central nervous system, forebrain
PHYISCAL WAY |
sensory nature of pain
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EMOTIONS
anxiety, fear, apprehension, attention, motivation |
Affective nature of pain
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Fifth VS
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pain
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assessing pain...
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subjective experience
scale of 1-10 location, intensity, quality, character |
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If severe pain, consider routine rather than
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PRN
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Narcotics (opoids
Non-narcotic Nonpharmacolgic methods |
Analgesic meds
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NSAIDS
CNS depressants |
Non-narcotic
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used for post op and chronic pain..
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Morphine (analgesia)
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15-30 minute period of no meds to prevent from mashing button too much.
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lock out interval
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Patient edu.
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- discourage family from mashing morphine
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ex. of patient controlled analgesia
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Morphine
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mod to severe pain; derivative of opoids; high potential for abuse; all medications are compared to morphine
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Narcotic analgesics
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C2 and C3
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narcotics
(always locked up) |
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C1
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Heroin; no medical use=illegal.
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goal of therapy for analgesics
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to treat/prevent/decrease pain
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afferent neurons (noiciceptors), dorsal horn, substance p, central nervous system, forebrain
PHYISCAL WAY |
sensory nature of pain
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EMOTIONS
anxiety, fear, apprehension, attention, motivation |
Affective nature of pain
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Fifth VS
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pain
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assessing pain...
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subjective experience
scale of 1-10 location, intensity, quality, character |
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goal of therapy for analgesics
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to treat/prevent/decrease pain
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afferent neurons (noiciceptors), dorsal horn, substance p, central nervous system, forebrain
PHYISCAL WAY |
sensory nature of pain
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EMOTIONS
anxiety, fear, apprehension, attention, motivation |
Affective nature of pain
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Fifth VS
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pain
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assessing pain...
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subjective experience
scale of 1-10 location, intensity, quality, character |
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agonist at mu, kappa, delta receptors
prevent transmission of noiceptor pain decrease release of substance P peripheral vasodilation, CNS depression excretion- urine, breast milk, feces 6 hours for morphine to leave body |
morphine
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routes:
IV -IV push or infusion -PCA PO - can be crushed - immediate release (tablet-released immed) -sustained release (MS-contin) tablet released overtime -liquid EPIDURAL, RECTAL, TOPICALLY avoid routinely administering SC and IM. (damages tissues) |
Morphine
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CI:
- respiratory depression (RR) -incr. Intracranial pressure -CNS depressants -pregnancy |
Morphine
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AE of morphine
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Mild: dizziness, sedation, n/v, sweating, constipation
severe: resp. depression, hypotn, urinary retention |
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tolerance may develop.
how much alchohol? monitor Resp. status? bowel function? urinary output? safety- protect from potential injury; falls with sedation; get u slowly ; call button; no driving. |
Morphine
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more drug is needed to achieve pain control; overtime, is natural
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tolerance
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withdrawal or abstinence syndrome when discontinued; natural
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physical dependence
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inapp. use, compulsive use of drug for secondary gain; morphine for high instead of pain
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addiction
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mu, kappa, delta
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opiate receptors
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respiratory depression, euphoria, decreased GI motility
SUPRASPINAL ANALGESIA |
MU
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SPINAL ANALGESIA
miosis, sedation |
Kappa
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Dysphoria, hallucinations
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Delta
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narcotic agonists
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morphine; fentanyl (sublimaze); hydromorphone (dilaudid); meperidine (demerol); oxycodone
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can be given IM, IV, PO
more potent than morphine less respiratory depression and physical dependency ADR-hyperglycemia (monitory blood sugar) |
Hydromorphone (dilaudid)
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GIVEN PO
- regular release (Roxicodone) immediate -sustain release (oxycontin) overtime -rapid release (oxylR) similar to morphine may be given in combination with other medications -acetaminophen- (tylox, percocet, Roxicet) -Aspirin- (percodan, roxiprin) |
Oxycodone
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PO, IM, IV
less potent than morphine less sedation and constipation metabolized to an active metabolite that accumulates in body. ADR-CNS toxicity CII |
Meperidine (demerol)
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More potent than morphine
given: -parentally- sublimaze (IM/IV) -trandermally- Duragesic - sustained release (patch 72 hours) - PCA (patch with controller) CII |
Fentanyl
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CIII
milder actions than morphine mild to moderate pain-opiate receptors antitussive-medullary cough center may be a prodrug- must be metabolized to become active may be combined with acetaminophen -tylenol #3 ADR-hypersensitivity |
Codeine
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Narcotic antagonist
IV most likely -antagonizes effects of opoid medications. -IM IV SC half life about 20 minutes ADR-withdrawal symptoms, deccreased pain control |
Naloxone (Narcan)
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mildly stimulate opiate receptor
hydrocodone -Combined with acetm (lorcet, vicodin) propoxyphene (Darvon) -combined with acetamin. (parvocet) |
mild narcotic agonist.
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Narcotic agonist-antagonist
– Receptor specific |
Pentazocine (Talwin)
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Non-Narcotic Analgesics
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prostaglandins
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– Synthesizes prostaglandins
– COX 1 - COX 2 |
Cyclooxygenase (COX)
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• Regulation of normal cell activity
• Vasodilation, protection of gastric mucosa, support renal blood flow • Promote platelet aggregation (synthesis of thromboxane A2) |
COX 1
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• Sites of injury and brain
• Inflammation, swelling, and sensitizes receptors to pain • Stimulates hypothalamus to reset the temperature regulating mechanism |
COX 2
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Inhibition of COX
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– Gastric erosion and ulceration
– Renal impairment – Decreased platelet aggregation • Bleeding |
COX 1
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– Suppression of inflammation
– Alleviation of pain – Reduction of fever – Renal impairment |
COX 2
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inhibit COX 1 and COX 2
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First Generation
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selectively inhibit COX 2
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Second Generation
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– Inhibit COX – decrease synthesis of prostaglandin
– Decrease activation of peripheral pain sensors |
Prostaglandin synthetase inhibitors
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– Decrease platelet aggregation
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• Inhibit synthesis of thromboxane A2
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Aspirin
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how is asprin given
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PO or Rectally
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indications for asprin
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adverse effects for aspirin
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– Gastrointestinal
– Bleeding – Renal impairment – Toxicity – Salicylism • Tinitis, headache – Reye’s syndrome – Hypersensitivity reaction • Cross sensitivity with other NSAIDs |
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CI an for Asprin
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– Bleeding disorders
– Peptic ulcers – Renal impairment – Children under 16 with viral infections – Pregnancy • Fetal harm – premature closure of ductus arteriosus, fetal death • Postpartum hemorrhage – Other NSAIDs, anticoagulants, alcohol |
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– Ibuprophen (Advil, Motrin)
• Less inhibition of platelet aggregation and GI bleeding than aspirin – Naproxen (Aleve, Naproxyn) |
First Generation
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Stevens-Johnson syndrome (severe
hypersensitivity reaction) |
AE of aspirin
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Ketorolac (Toradol)
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– Celecoxib (Celebrex)
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Second Generation of NSAIDS
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Inhibition of prostaglandin synthesis in CNS
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Acetaminophen (Tylenol)
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Indications of Acetaminophen (Tylenol)
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– Analgesic - Mild to moderate pain
– Antipyretic – children and pregnancy |
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Acetaminophen (Tylenol)
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AE of Acetaminophen
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with high or long term use – anemia, GI
bleeding |
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routh of Acetaminophen
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mouth and rectally
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Migraine Headache meds
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– Serotonin – selective medications
– Sumatriptan (Imitrex) |
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actions of migraine headache meds
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• Decrease in vasodilation caused throbbing sensation
• Decreased vascular inflammation |
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Migraine Headache meds affect...
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Acute migraine headache, cluster headache
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Sumatriptan (Imitrex)
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given orally, intranasally
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AE of Sumatriptan (Imitrex)
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– Severe - arterial spasm (coronary, cerebral,
peripheral), dysrhythmias, cardiac arrest – Mild – weakness, dizziness, myalgias, nasal burning |
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– Vascular diseases, chronic diseases that increase
CVD risk – Seizure disorders, pregnancy |
CI of Sumatriptan (Imitrex)
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– Disease modifying antirheumatic drugs
• Used in combination with NSAIDs and glucocorticoids • Methotrexate (Rheumatrex) • Tissue necrosis factor (TNF) inhibitors • Monoclonal antibodies - Infliximab (Remicade) |
Rheumatoid arthritis
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– Uricosuric Medications are for
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gout
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Antineoplastic medication that has
immunosuppressive effects |
Methotrexate (Rheumatrex)
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– Inhibit replication of T lymphocytes,
• Decrease synthesis of inflammatory mediators such as interlukin (1,6, and 8), tissue necrosis factor (TNF) alpha – folate depletion • Inhibits purine synthesis • May be given with folic acid (Vitamin B) to decrease adverse effects |
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indications of Methotrexate (Rheumatrex)
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Rheumatioid arthritis, psoriasis
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Therapeutic effect may take three to six
weeks |
Methotrexate (Rheumatrex)
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Methotrexate (Rheumatrex)
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Etanercept (Enbrel)
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Etanercept (Enbrel)
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Etanercept (Enbrel)
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AE of Etanercept (Enbrel)
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– Mild – injection site reactions, headache, rhinitis
– Severe – fatal infections, induction of demylinating diseases, blood dyscrasias |
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CI of Etanercept (Enbrel)
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– Hypersensitivity, active infection, live vaccines
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high levels of serum uric acid
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Hyperuricemia
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Acute pain, swelling and tenderness of joints
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Gout
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Uricosuric Drugs
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– Decreases inflammatory response to uric acid
crystals in joint tissue through inhibition of leukocyte activity – No analgesic activity or effect on urinary excretion of uric acid |
Colchicine
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indications
– Prevention of acute gouty arthritis – Treatment of acute and chronic gouty arthritis |
Colchicine
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Colchicine metabolized and excreted where?
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SE of colchicine
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GI upset, alopecia
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AE of colchicine
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Hemorrhagic gastroenteritis, renal
failure, bone marrow depression |
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colchicine
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nursing care for colchicine
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actions of Allopurinol (Zyloprim)
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– Decrease production of uric acid
– Antioxidant |
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Allopurinol (Zyloprim)
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Allopurinol (Zyloprim)
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SE of Allopurinol (Zyloprim)
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Allopurinol (Zyloprim)
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increased excretion of uric acid into
the urine |
Probenecid (Benemid)
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indications of Probenecid (Benemid)
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– Treatment of hyperuricemia and chronic gouty
arthritis – Prevention of acute gouty arthritis – Adjunct to antibiotic therapy – inhibits excretion of antibiotics at distal renal tubules |
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Probenecid (Benemid)
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Probenecid (Benemid)
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Uricosuric Drugs
Nursing Care |
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