Analgesics

Front 1

Opioid Agonist

Back 1

Binds to the opioid pain receptors in the brain/CNS; causes an analgesic response and reduces the pain sensation

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Opioid Partial-Agonist

Back 2

Binds to pain receptor but causes a weaker neurologic response than a
full agonist. Also called Agonists-antagonists

--Sometimes useful in opioid-addicted patients and obstetrical patients

Front 3

Opioid Antagonist

Back 3

Binds to a pain receptor but does not reduce pain signals.

-- It functions as a competitive antagonist because it competes with and reverses the effects of agonist and agonist-antagonist drugs at the receptor sites.

Front 4

Analgesics

Back 4

Medications that relieve pain without causing loss of consciousness; sometimes referred to as painkillers

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Analgesic Ceiling Effect

Back 5

What occurs when a given pain drug no longer effectively controls a patient's pain despite the administration of the highest safe dosages.

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Nociception

Back 6

Processing of pain signals in the brain that gives rise to the feeling of pain.

Front 7

Nociceptors

Back 7

A subclass of sensory nerves (A and C fibers) that transmit pain signals to the central nervous center from other body parts

Front 8

Narcotics

Back 8

Originally applied to drugs that produce insensibility or stupor, especially opioids (ie: morphine, heroin). Currently used in clinical settings to refer to any medically used controlled substances but falling out of favor - now using OPIOID. In legal settings, applies to illicit/street drugs.

Front 9

Neuropathic Pain

Back 9

Pain that results from a disturbance of function or pathologic change in a nerve

Front 10

Nonsteroidal Antiinflammatory Drugs (NSAIDs)

Back 10

A large, chemically diverse group of drugs that are analgesics and also process antiinflammatory and antipyretic activity but are not steroids.

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Opioid analgesics

Back 11

Synthetic drugs that bind to opiate receptors to relieve pain but are not themselves derived from the opium plant

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Pain Threshold

Back 12

The level of stimulus that results in the sensation of pain.

Front 13

Pain Tolerance

Back 13

The amount of pain a patient can endure without its interfering with normal function.

Front 14

Referred Pain

Back 14

Pain occurring in an area away from the organ of origin.

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Adjuvant Analgesic Drugs

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Drugs that are added as a second drug for combined therapy with a primary drug and may have additive or independent analgesic properties, or both.

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Narcotic Antagonist - Name?

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Naloxone / NARCAN (Generic Name)

Stadal

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When to give a Narcotic Antagonist

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For severe respiratory depression as a side effect of a narcotic agonist

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Examples of Opioid Agonists

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Codeine
Morphine
Demerol
Darvon, Vicodine
Hydrocodone, Oxycodone
Tylenol
Dilaudid
Talwin
Sublimaze (Fentanyl – patch)

Front 19

Opioid Agonist: Prototype

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Morphine Sulfate

Front 20

Fenanyl

Back 20

IV form of Morphine Sulfate

- Very concentrated and rapid (within 10 min); used for anesthesia

- Given in very small increments, SUCH AS: 2-4 IV slowly, then wait 5 min, then, may give more if no relief nor adverse effects (such as rr<12 or hypotension)

Front 21

Morphine - Transdermal Patch

Back 21

Duragesic or Fentanyl: for cancer pain

Slow release

Front 22

PCA

Back 22

Patient Controlled Anesthesia

- Given in pre-measured syringe infusion pump
- Safety factor allows med to be delivered every X minutes; charted every 4 hours

Front 23

Duramorph

Back 23

Epideral form of Morphine.

Injected into epidural space once by anesthesiologist-12-24 hrs of pain relief; pt often cannot receive any other pain meds during this time.

Front 24

Morphine Contin

Back 24

Oral form of Morphine; 12 hour duration

Front 25

Codeine-Based p.o. Meds

Back 25

1. Hydrocone- Lortabs (has hydrocone and tylenol)
2. Oxycodone

Front 26

Morphine Sulfate: Therapeutic Uses

Back 26

Release moderate to severe pain; provides pre-op sedation

Alters pain perception, induces mental changes, promotes deep sleep, depresses respirations, constricts pupils, DEPRESSES GI MOTILITY

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Morphine Sulfate: Adverse Effects

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-Respiratory Depression
-Adverse CNS changes --> sedation, light-headedness, dizziness
-Orthostatic Hypotension
-Decreased LOC
-Constriction of pupils
-GI Effects: N&V, constipation
-Some cause hypotension and anti-cholingergic effects (dry mouth, urinary retention)
-Euphoria
-Allergic reactions- pruritis (itch), uticartia, laryngospasm

Front 28

Morphine Sulfate: Nursing Implications

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* Monitor & take RR prior to giving – hold drug if RR < 12/min --> Narcan (Naloxon) = antidote
* Safety precautions, siderails up
* May need laxative or fiber b/c constipation; may mask other pains; may cause bladder retention
* Post op pts--> encourage pts to cough and deep breaths q 1-2 hrs and turn (need to keep lungs clear of secretions)
* Use round the clock, don’t wait until pain severe
* Can become addictive, no problem with acute surgical pain; problem w/ chronic pain
* Interacts with alcohol and sedatives; Don’t drive!

Front 29

Morphine Sulfate: Contraindications

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Pts w/ head injury b/c need to stay alert; alters pupil resonse (constricts)

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Morphine Sulfate: Duration

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4-6 hrs for most w/ PO & IM; Fentanyl = shorter 1-2 hr duration

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Morphine Sulfate: Onset of Routes

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ONSET: IV --> rapid within 10 min ONSET: IM --> 5-20 min ONSET: ORAL --> 12-24 hr time released: Morphine Contin; OxyContin ONSET Patch: slow release

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Morphine - Epidural: Nursing Implications

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Assess EVERY HOUR to report pain, pain relief; respiratory rate, level of numbness, if catheter in right place, if leaking; encourage coughing/deep breathing to avoid atelectasis

Front 33

Meperidine: Generic Name

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Demerol

Front 34

Demerol: Use

Back 34

Synthetic opioid analgesic used for acute pain during post-op settings, as well as emergency settings for acute migraine headaches

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Demerol: Adverse Effects

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* Resp depression < 12/min
* Drowsiness, urine retention, constipation, MORE NAUSEA than Morphine
* Inj. – often mixed in syringe with Vistaril or Phenergen (relieve nausea & potentiates narcotics, lasts longer)

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Non-Narcotic Analgesics: Categories

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Salicylates and Non-Salicylates

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Salicylates: Prototype

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Aspirin (ASA)

Front 38

Aspirin: Dose

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325-600 mg, q 3-4 hrs

(Much higher with arthritis pts!)

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ASA: Oral Onset

Back 39

30-60 minutes

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ASA: Peak Levels

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2-3 Hours

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ASA: Duration

Back 41

4-6 Hours (except time released)

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ASA: Action

Back 42

1. Analgesia: blocks generation of pain impulses & inhibits prostaglandin synthesis
2. Antipyretic- Relieves fever by acting on hypothalamus

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ASA: Therapeutic Uses

Back 43

Relief of mild to moderate pain, alleviate inflammation of rheumatoid arthritis, reduce fever, inhibits platelet aggregation to prevent clots

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ASA: Adverse Effects

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GI (heart burn, N&V, dyspepsia, bleeding); affects bleeding times

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Chronic Salicylate Intoxication

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Salicylism (prolonged high doses) – tinnitus, hearing loss, HA, confusion, hyperventilation, coagulation (bleeding problems)

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ASA: Contraindications

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1. Children/Teens -- Causes Reye’s Syndrome (Neurologic damage, coma, liver damage)

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ASA: Nursing Implications

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1. Take ASA with meals/food/milk or use enteric-coated or buffered form
2. Teach pt NOT to chew or crush e-c form
(Liquid form or crush available if can’t swallow)
3. Therapeutic levels for Arthritis may be very large doses 2.6-5.4 g/day in divided doses
4. Inspect skin for bruising; check stools for occult (old) blood (appears black or tarry); watch if nosebleeds (called epistaxis)
5. Instruct pt. to speak with Dr. about stopping ASA 5-7 days before any surgery
6. Many OTC meds (ie pepto bismol) contain ASA → should not be taken with NSAIDs
7. Teach pt to use child proof containers and keep out of reach of children

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Non-Salicylates: Prototype

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Acetaminophen (Tylenol)

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Acetaminophen: Dosage

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Maximum daily dose for adults is 4,000 mg/day

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Acetaminophen: Action

Back 50

Blocks pain impulse by inhibiting prostaglandin synthesis

Acts on hypothalamus to relieve fever

Front 51

Acetaminophen: Therapeutic Uses

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1. Analgesic: Relieve mild to moderate pain
2. Antipyretic
3. Little to no anti-inflammatory effects***

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Acetaminophen: Adverse Effects

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1. Relatively few with low dose
2. GI Upset
3. HEPATIC TOXICITY with overdose
4. Nephropathy with long-term ingestion

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Acetaminophen: Contraindications

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Liver dysfunction or possible liver failure

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Acetaminophen: Interactions

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Do not take with alcohol or other hepatotoxic drugs

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Acetaminophen: Nursing Implications

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Hold if pt develops rash or uticartia
If pain or fever for several days --> see Dr.

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Examples of NSAIDs

Back 56

Ibuprofen, Toradol, Cox 2 Inhibitors

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Ibuprofen: Generic Names

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Advil, Motrin, Pamprin, Midol, Nuprin

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Ibuprofen: Dosage

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~200-800 mg

1200-3200 mg/day divided 3-4 times daily

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Ibuprofen: Therapeutic Uses

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1. Analgesic effects in management of rheumatoid arthritis, osteoarthritis, gout, dental pain, musculoskeletal disorders, menstrual pain, headaches
2. Antipyretic
3. Antiinflammatory

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Ibuprofen: Adverse Effects

Back 60

Same as ASA; may cause dizziness or drowsiness; GI, headache

Front 61

Cox-2 Inhibitors: Generic Names

Back 61

Celebrex, Bextra

Note: Vioxx is off the market as of 2004!

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Cox-2 Inhibitors: Action

Back 62

Inhibits prostaglandin synthesis by inhibiting Cox2 enzymes

Front 63

Cox-2 Inhibitors: Therapeutic Uses

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1. Pain, arthritis, dysmenorrhea (menstrual pain)
2. Antipyretic Effects

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Advantage of Cox-2 Inhibitors over other NSAIDs

Back 64

Don't disrupt platelets and have less GI Bleeding problems.

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Cox-2 Inhibitors: Contraindications

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Patients with hepatic disorders

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Toradol: Therapeutic Uses

Back 66

NSAID For post-op pts, w/ orthopedic surgeries; only 2 weeks b/c bleeding