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213 Cards in this Set
- Front
- Back
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3 categories for pain mgmt
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1. opiates or narcotics
2. non-opiates 3. adjuvant analgesics |
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what pain level are opiates or narcotics used for? give prototype
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morphine
severe pain 7-10 |
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what are non-opiates used for pain level wise and give ex
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mild pain 1-3
-acetaminophen, salicylates (ASA) and NSAIDS |
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what are adjuvant analgesics used for and give an ex
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not known for pain relief, they relieve other symptoms assoc. with pain (insomnia, depression)
-benzodiazopines, TCA, corticosteroids |
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what do you do for mild-moderate pain (4-6 on scale)
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smaller dose of an opiate with a non-opiate
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types of pain
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acute
chronic superficial/somatic deep/visceral neuropathic |
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what are the vital signs
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BP
HR RR Temp Pain |
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acute pain time
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less than 6 months...some say 3
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chronic pain describe
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increased depression, personality change, change in functional ability.
-withdrawn, ex: arthritis |
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describe superficial or somatic pain
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skin, sharp, burning, localized readily
-tends to stimulate SNS (vital signs) |
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deep or visceral pain is assoc with
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decreased vital signs
-PSNS |
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neuropathic pain description
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nerve endings, diabetics (bottom of feet)
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PQRST of pain assessment
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-Precipitates, provocate
-Quality -Radiation -Severity -Timing |
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Agonists
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non-ceiling drug: tolerance develops
-morphine, demerol, codeine, dilaudid |
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agonists/antagonists
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history of drug abuse, can trigger withdrawl
-nubain, stadol, talwin |
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ex of agonist/antagonist
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oxycontin, crush and you won't feel anything or withdrawl as agonist
antagonist-swallow it |
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actions of narcotics
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-interferes with pain impulses
-depresses CNS -depresses GI -alters pyschological response to pain -euphoria -very significant 1st pass effect |
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how do narcotics depress CNS,,,prob
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RR, BP, reflexes
-cough reflexes with mucous and vomitting |
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how do narcotics depress the GI
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decreased motility
small muscle spasms nausea constipation |
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how do narcotics alter psych response to pain
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decrease fear and anxiety
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whats impt about the first pass effect with narcotics
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it's very signif, change to increase PO dosage'
-IV, PO, PCA (patient controlled analgesia) |
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clinical uses of narcotics
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-relieve moderate-severe pain
-pre-op sedation -labor and delivery -invasive diagnostic test -acute pulmonary edema -severe nonproductive cough |
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what do you use for acute pulmonary edema?
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morphine because it vaso and bronchodilates
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narcotic antagonists prototype
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narcan
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what do narcotic antagonists do
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counteract the effect, interact at the opiate site
-short duration of action -care of patient -very rapid |
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effects of narcotic abuse
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amenorrhea
euphoria constipation dry skin decreased gait pinpoint pupils slurred speech decreased vitals |
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what happens if you abuse narcotics during pregnancy
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increased miscarriage
premies still births LBW |
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tolerance and cross tolerance of narcotics
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tolerance develops quickly because of enzyme induction
-cross tolerance iwth other meds, anesthetics |
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withdrawl treatment for narcotics and what happens
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methadone
buprenorphrine (suboxane) -chills, deep muscle pain, anxiety, aggression, anorexia |
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withdrawl after pregnancy
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babies are worse for weeks than mom
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therapeutic narcotic withdrawl
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goal = abstinence
-substitute one drug for another Ex: methadone for heroin -Suboxane...can get 1 month prescription, low OD risk, no mild high |
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prostaglandins physiologic action
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GI
Renal Regulates smooth muscles and blood clottings |
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prostaglandins pathologic fxn
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inflammation
edema leukocytosis release of cytokines |
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what is aspirin -asa
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analgesic (1-3)
anti inflammatory |
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what can aspirin be taken for
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antipyretic (fever)
anti-thrombotic non-selective oxygenase inhibitor arthritis, bursitis |
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how does aspirin work as an anti-thrombotic
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inhibits platelets, binds irreversibly until the cell dies in 7-10 days
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ASA adverse drug effects
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tinnitus
reyes syndrome n/v GI system bleeding ulcers prolongs preg, lbw, labor asa sensitive asthma salisilate poisoning |
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reyes syndrome
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no kid less than 12 can have asa, viral infection...aspirin raises BP and you get brain damage maybe death
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salisilate poisoning
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accidental and intentional
need history, drowsy, restless, profuse sweating, hyperventilation...acidosis blowing out CO2 |
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dosage of asa
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325 mg
1-2 tablets every 4-6hrs |
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anti-thrombotic dosages
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81 mg or 1 tablet a day
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treatment with OD of asa
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within 1-3 hours
induce vomitting gastric levage oxygen, ventilator IV fluids |
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NSAID uses
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analgesic (1-3)
anti-inflammatory antipyretic anti-thrombotic |
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NSAID anti-thrombotics limitations
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binds platelet as long as NSAID is in circulation (4-6 hours)
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ADE of NSAIDS
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-CNS: dizzy, drowsy, tinnitus
-renal system -eyes: blurred vision -GI (same as aspirin, pain. bleed. ulcer) |
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drug interactions with NSAIDS
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steroids
oral anticoagulants lithium toxicity oral hypoglycemics alcohol heparin bleeding |
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acetaminophen uses
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analgesic (1-3)
antipyretic no anti-inflamm properties no GI probs little/no effect on platelets |
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what drug is the choice for fever/pain with kids
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acetaminophen
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large doses of acetaminophen cause
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liver necrosis
hepatotoxicity 2 every 4-6 hours with alochol will do it too |
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what can you combine acetaminophen with for moderate to severe pain
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opiate
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tips for OTCS
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read and follow pkg direction
take at onset of pain dont drink dont take if pregnant/nursing avoid drug interactions asthmatics elderly |
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cox 2 inhibitors
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analgesic and anti-inflamm
-selective, increases platelet activity -increased clot production -caution for CVA, MI etc... |
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hepatotoxicity with cox-2 acetaminophen 1st 24 hours
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1st 24 hours: nausea, vomit, sweat, use mucomyst to stabilize liver cells
-try to levage it before tabs dissolve |
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hepatotoxicity 24-48 hours
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decreased urine output
pain in right upper quadrant |
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2-6 days after hepatotoxicity
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liver enzymes increase
jaundice renal and liver failure (cns affected) increased bleeding |
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anti-anxiety and sedatives are used for
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relaxation
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hypnotics are used for
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sleep
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large doses of anti-anxiety and sedatives...gives you
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sleep!
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small dose of hypnotics causes
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sedation
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difference between anti-anxiety, hypnotics and sedatives is...
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dosage dependent
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anxiety
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a person perceives any situation to be threatening
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daytime anxiety can lead to
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insomnia
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two types of insomnia
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classic toss and turn
fall asleep and then wake up in the middle of the night |
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barbituates drug type
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sedative-hypnotic
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barbituates are used for
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anticonvulsant
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barbituates prototype
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seconal, phenobarbital
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barbituates effects last
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short, intermediate to long lasting
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barbituates interfere with
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REM sleep
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barbituates enzyme induction
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quick tolerance
cross tolerance |
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do benzodiazapines and barbituates have abuse potential
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yes
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abuse level of benzodiazapine
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4-psychological
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benzodiazapine affect on sleep
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no suppression of REM
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what are benzodiazapines given for
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anti anxiety
anoxiolytics |
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prototype of benzodiazapines
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diazepam (valium)
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advantages of benzodiazapines
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wider margin of safety between therapeutic and toxicity
-rarely fatal -minimal enzyme induction |
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prob with benzodiazapine
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CNS depressant so you may have impairment iwht respiratory depression
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anti anxiety with opiates/narcotics
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greater pain and anxiety
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hypnotic prototype
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dalmane
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benzodiazapine librium used for
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anti anxiety, ETOH withdrawl
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diazepam is used for
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anti anxiety
ETOH withdrawl anti-seizure |
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ativan uses
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anti axiety
ETOH withdrawl anti seizure |
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versed use
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pre op sedation
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barbituates, benzodiazapines and misc length of use
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2-4 weeks
short term use |
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actions of barbituates, benzodiazapines and misc
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depress CNS
skeletal muscle relaxation/spasm sedative effect anti-convulsant |
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uses of barbituates, benzodiazapines and misc
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promote sleep and rest
pre op diagnostic procedures anti anxiety anti convulsant ETOH withdrawl CP spasticity |
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contraindications of barbituates, benzodiazapines and misc
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-respiratory disorders (weigh risk)
-severe liver disease -severe kidney disease (metab and excretion here) -History of allergies or drug abuse |
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patient teaching for barbituates, benzodiazapines,
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-dont drink alcohol
-dont drive, operate machinery -take prescribed dose -increase fluids and fiber -bedridden, C&DB every 2 hours -store in a secure place |
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tolerance with benzodiazapines and barbituates
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-mental:faster than physiological
-biological/physical |
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alcohol effect with benzodiaz and barbituates
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synergistic effect
exponential effect |
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OD of barbituates and benzodiaz
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respiratory support (O2 intibate)
-nasogastric levage -IV fluids and diuretics -flumazenil(romazicon) |
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what does flumazenil or romazicon do for barb/benzo OD
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competes at receptor site
-can reverse a coma -shorter acting than benzodiaz |
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withdrawl treatment for barbs/benzodiaz
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give a dose or gradually taper
#1 symptom= anxiety, seizures etc -more die of acute withdrawl from valium |
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normal BP vital
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less than 120/80
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HTN value
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greater than 140/90
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normal HR
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60-100 per min
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bradycardia value
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less than 60
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tachycardia value
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greater than 100
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normal RR
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16-20 per min
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hypovent value
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12 or less per min
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hypervent value
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greater than 20/min
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fxn of sympathetic ns and neurotransmitter
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adrenergic- Nor Epi
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parasymp ns fxn and neurotransmitter
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cholinergic
acetylcholine |
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ans sympathomimetic do what
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adrenergic
alpha adrenergic agonists beta adrenergic agonists same as stimulating sns |
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ans parasympathomimetic drugs
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cholinergic
cholinomimetic -same effect as stimulation of PSNS |
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sympatholytic drugs type
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anti-adrenergic
alpha adrenergic blockers beta adrenergic blockers *same effect as blocking SNS |
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parasympatholytic types
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anti-cholinergic
cholinergic blockers blocks PSNS |
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adrenergic effects
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- increased HR
- bronchodilation - pupils dilate - increased blood sugar - increased FAs -increased blood coagulation - increased sweating -GI anorexia and constipation |
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alpha adrenergic specifically do what
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peripheral vasoconstrict in teh arms and legs
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beta 1 adrenergic are where and do what
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cardiac
- increase HR (chronotropic) - increase force of contraction (inotropic) |
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beta 1 adrenergic are where and do what
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lungs
bronchodilation |
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catecholamines have what type of response
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sympathomimetic
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when are catecholamines used
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emergency treatment:
-cardiac arrest, hypotension, shock, bronchial asthma, obstructive pulmonary disease |
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catecholamine prototype
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epinephrine
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signif with catecholamine metab
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metabolized so rapidly in stomach that you can't take it PO
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difference for non-catecholamines that are sympathomimetic from catecholamines
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similar but their effects last longer
-can take PO, OTC meds -ephedrine |
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adrenergic contraindications
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tacky arrythmia
angina HTN cerebral vascular disease narrows angle glaucoma allergy elderly psych probs |
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assessment for adrenergics
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diabetic?...peripheral circ probs
IV sites...through BV and goes necrotic -resp and CV |
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interventions for adrenergics
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promote sleep
frequent bathing small and frequent meals IV infusions to area of infiltration |
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patient teaching for adrenergics
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no relief of symptoms
-use as directed, -anxiety -chest pain -emergency self admin kits -check with PCP b4 other meds |
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anti-adrenergic effects
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BVs dilate and lower BP (ortho hypo)
-bronchoconstriction -decreased CO -weakness -less effective metab of gluc -neg chrono and inotropic |
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anti adrenergic alpha receptors do what
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dilation of peripheral arteries and veins
-extremities: arms and legs |
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anti adrenergic beta 1 receptors do what
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cardiac
negative chrono and inotropic |
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anti-adrenergic beta 2 receptors do what
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lungs
bronchoconstriction |
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alpha adrenergic blockers prototype
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regitine
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clinical use of alpha adrenergic blockers
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Tx of HTN
Tx of BPH Raynauds & frostbite Prevent necrosis 2nd from extravasation |
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how do alpha adrenergic blockers help with raynauds and frostbite
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vasoconstriction of peripheries
increase bloodflow |
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contraindications with alpha adrenergic blockers
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angina
MI stroke (CVA) |
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beta adrenergic blockers prototype
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propanolol (inderal)
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clinical use of beta adrenergic blockers
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Tx of HTN, angina, MI
palpitations glaucoma pheochromocytoma migraines |
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how do beta adrenergics helps with glaucoma
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they decrease interoptic pressure
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contraindications of beta adrenergic blockers
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bradycardia (brachy?)
heart block CHF asthma bronchoconstriction |
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intervention with adrenergic blockers
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-allergies
-wean -question order if they have CHF, MI, resp infection -monitor BP, HR, periph circ -PO w/ food and avoid alcohol -decrease ortho hypo -check w/ HC provider b4 other meds |
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PSNS cholinergic effects
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miosis-pupil constriction
-increased salivation -increased sweating -bladder sphincter relaxes - neg chrono and ino for heart -increased GI secretions -WET |
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vasovagal response with cholinergics
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75% PSNS fibers in vagus nerve
wet |
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nicotinic receptors cholinergics-where and do what
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in motor nerves and skeletal muscles
-muscle contraction |
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muscarinic receptors with cholinergies are where
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internal organs
secretions |
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cholinergics prototype
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neostimine or prostigmine
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cholinergic meds mimic
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action of acetylcholine
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cholinergic meds inhibit...by what
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acetylcholine destruction
-anticholinesterase |
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cholinergic meds clinical uses
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bladder atony
Dx and Tx MG GI tract atony Antidote Glaucoma Alzheimers |
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contraindications for cholinergics
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urinary or GI tract obstruction
asthma CAD peptic ulcer pregnancy |
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ADE of cholinergics
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generally serious
increased bradycardia decreased blood pressure nuisance: increased salivation, sweat, constip, diarrhea etc |
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cholinergic blockers prototype
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atropine
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cholinergic blockers fxn
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block action of acetylcholine
-block sns DRY |
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actions of cholinergic blockers
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DRY
-pre-op -CNS -dry eyes, increased ocular P -decreased salivation -CV -skin -GI -pulmonary, -urinary -parkinsons to decrease tremors |
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ADE of cholinergic blockers
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tachycardia
palpitations dry bronchial secretions GI: IBS, decreased motility constipation urinary retention |
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teaching plan for cholinergic blockers
|
expected ADE
protect eyes, tooth decay prevent constip with fiber avoid OTC, alcohol and overheating protect skin |
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drugs used to treat respiratory disorders (bronchodilators and antiasthmatic) characterized by
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bronchoconstriction/spasm
inflammation mucosal edema excessive mucus production |
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what affects respiratory disorders
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-quantity and quality of air
-lung ability, contraction and expansion -ability of O2 to cross alveoli -patency of airway -exercise -envt -emotions |
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bronchodilators and anitasthmatic meds for bronchoconstriction are what
|
beta blockers
cholinergics -effective at relieving symptoms but don't cure |
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classification of bronchodilators
|
1. adrenergic
2. anti-cholinergics 3. corticosteroids 4. leukotriene inhibitors 5. mast cell stabilizers 6. xanthines |
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types of adrenergic bronchodilators
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B1
B2 B2 selective |
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adrenergic b1 and b2 prototype
|
epinephrine
|
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adrenergic b2 selective prototype
|
proventil
(albuteral) |
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do b2 selective still have some effect on b1
|
yes so watch b1
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corticosteroids prototype
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prednisone
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corticosteroids stop cascade from making..
|
leukotrienes
cox 1 cox 2 |
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corticosteroids fxn
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suppress airway inflammation
increase patency decrease edema in airway |
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what makes corticosteroids more effective
|
given with a b2 adrenergic
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leukotriene inhibitors prototype
|
zyflo
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leukotriene inhibitors fxn
|
-stop leukotriene part of cascade
-useful on daily basis to prevent asthma, useless once attack happens - |
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why do you want to inhibit leukotrienes
|
in response to injury they are a strong signaler for inflammation and bronchoconstriction
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mast cell stabilizers prototype
|
intal, tilade
|
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mast cell stabilzers fxn
|
can prevent release or decrease the amount of histamine
-decreased inflammatory response -bronchoconstriction -good at preventing attacks but no use during acute attack |
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xanthines/ophyllines fxn
|
-bronchus: dilate, relax smooth muscle
-stim CNS: more alert, hyperaware, higher RR and reflexes -cardiac: increased HR, + chronotropic -GI: increase HCL, gi bleeds are probs |
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contraindications for xanthines
|
acute ulcers
peptic ulcer disease |
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ADE for xanthines
|
-precaution tachycardia
-palpations -CNS: nervous, restless, anxiety, tremors, headache, -GI bleeding, nausea, vomit |
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hallmarks of hypoxia
|
restless
increased RR increased HR *if not enough O2 to brain, you go unconscious |
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early signs of hypoxia
|
respiratory distress
mental confusion restless increased HR and RR |
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late signs of hypoxia
|
cyanotic (blue lips, nails)
-decreased HR -using accessory muscles to breathe -nasal flaring |
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xanthines prototype
|
aminophylline
|
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xanthine uses
|
asthma
chronic bronchitis emphysema neonatal apnea |
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assessment for patient on bronchodilators
|
-respiratory status: muscles used
-BP, cardiac rhythm -N/V -Insomnia -Allergies -Cardiac Disease -MI -O2 saturation,..does it improve? -arrythmias |
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if xanthine is given PO or IV rather than inhaler you need to
|
increase dosage
|
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interventions of bronchodilators
|
-monitor serum levels of Theophylline
-rectal admin -IV admin (infusion pump) -vomitting -give PO with full glass of water or food -increase fluids -no smoking |
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antihistamine fxn
|
blocks receptor site
histamine is still made |
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histamine release causes
|
-bronchoconstriction
-cough -increased capillary permeability and dilation -increased mucus production -stim of sensory peripheral nerve endings |
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histamines and bronchoconstriction
|
respiratory distress
stimulates vagus nerve increases constriction |
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histamines increased capillary permeability and dilation significance
|
fluid can seep into tissues and cause swelling, inflamm of airway
-lower BP and get flushed |
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what releases histamine
|
basophils in response to allergic rxn, cell injury or extreme cold
|
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types of allergic rxn
|
I
II III IV |
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type I allergic rxn
|
immediate hypersensitivity
-immune system: mild to anaphactic shock -can be envt issue, ingestion, meds, blood transfusion or organ transplant |
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type II allergic rxn
|
blood transfusions
|
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type III allergic rxn
|
complex formed
rheumatoid arthritis |
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type IV allergic rxn
|
delayed hypersensitivity
transplant rejection |
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antihistamine prototype
|
benadryl (diphenhydramine)
|
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antihistamine actions
|
-sedation
-paradoxical rxn -lower seizure threshold -dry mouth, nose, throat -blurred vision -UA retention, constipation -anorexia, N/V |
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indications for antihistamines
|
allergic rhinitis
anaphylaxis: no breathing needs epi -drug allergies -blood transfusion rxn -contact dermatitis |
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contraindications for antihistamines
|
allergies
benign prostatic hypertrophy |
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nasal decongestants
|
phenylephrine
sudafed |
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contraindications for nasal decongestants
|
CAD
HTN |
|
|
antitussives central acting...narcotic and non narcotic
|
narcotic-codeine
nonnarcotic-dextromethorphan |
|
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peripherally acting antitussives
|
glycerine
|
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expectorants
|
guaifenesin
-increase fluids |
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mucolytics
|
normal saline
acetylcysteine -mucomyst: tylenool OD to help liver |
|
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cold remedies
|
combo of antihistamines, nasal decongestant, and an analgesic
|
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inhalant abuse
|
organic solvents like nail polish remover etc
|
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inhalant abuse range of effect
|
temporary stimulation to depressed CNS
|
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what are teh symptoms with depressed CNS from inhalant abuse
|
dizzy
slurred speech cant walk right permanent brain, liver, kidney and LUNG damage -death from resp distress |
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drug
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substance that helps well being in a pos or neg way
|
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medication
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substance with a pos effect on patient
-vaccines etc |
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|
controlled drugs schedule, abuse potential scale and give ex of each
|
1. LSD, heroin
2. Narcotic analgesics 3. sedatives, anabolic steroids 4. sedative hypnotics 5. partially controlled -lomotil |
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prototype for narcotic analgesics
|
morphine
|
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generic v trade name
|
generic: chemically related, manufacturer doesn't matter
ex: acetaminophen trade: big, bolded, patented by manu. tylenol |
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normal temp
|
98.6
|
|
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drug effects on fetus A
|
studies done on pregnant women, no risk
|
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drug effects on fetus B
|
animal studies and no probs
|
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drug effects on fetus C
|
animal studies
-look at risk/benefit -some harm to fetus |
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drug effects on fetus D
|
evidence of human fetal risk
|
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drug effects on fetus X
|
risk outweighs any benefit
-acutane |
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OTC advantages
|
low cost
readily accessible immediate treatment directions on label and warnings no provider cost |
|
|
OTC disadvantages
|
may postpone tx
vulnerable to tampering serious drug interactions labels tiny print risk ODing or under dosing few people read warnings |
|
|
general assessment before giving drugs
|
allergies
OTC drugs age recreational drugs body size sex ethnicity dose |
