exam 2- drugs used for pain management
Opioid considered anti antagonists
adverse effects
CNS depression and urinary retention
opioids
BIG CONSTIPATORS
When on opioids need a bowel protocol
tolerance of opioids
longer dose is required to maintain the same level of analgesia
-they can get a physical and psychological dependence
norphine sulfate
for severe pain
-watch in patients with renal insufficiency
codeine sulfate
most commonly used as an antitussive drug
-cough suppressor
fentanyl
used to treat moderate to severe pain.
-fentanyl patches get changed every 72 hours
-2 nurses MUST check the patch location at the beginning of each shift
Dilavdid
very potent opioid analgesic
oxycodone hydrochloride
combination of acetaminophen and oxycodone
-there are many different forms
opiate partial agonists
short term relief
-subject to ceiling effect
-check for prior use of opiate agonists
-(drugs) buprenorphine (buprenex, subutex) and butorphanol (stadol)
serious adverse effect of opiate partial agonoists
respiratory depression
methadone hydrochloride
renewed interest in use of methadone for chronic and cancer related pain
opiate antagonists drugs
action- reverse respiratory depression, sedation, hypotension associated with opiate agonists and opiate partial agonists
prostaglandin inhibitors (drug)
-3,000mg a day!
-someone with liver disease, older adults will get 2,000mg
salicylates
help turn pain and fever off.
-aspirin has unique property of inhibiting platelet aggregation and clotting.
serious adverse effects of salicylatess
GI bleeding, salicylism
-NOT recommended due to risk of Reyes syndrome
NSAIDs
relief of pain, arthritis, osteoarthritis, gout.
-can cause GI constipation and GI bleed (coffee grounds)
althroga
arthritis pain
adverse effects of NSAIDS
GI bleeding, mucosal lesions
misoprostel (cytotec)
can be used to reduce these dangerous effects (effects of NSAIDS- EX: gi bleeding, musical lesions)
misoprostol
they will give this with NSAIDS to prevent GI irritation
PCA
patient controls when they are getting their pain meds.
ONLY the patient can give this medication
patient stilll needs to be monitored
acetaminophen dangerous interactions
may occur if taken with alcohol or other drugs that are hepatotoxic
ibuprofen hurts GI system and kidneys
(T/F)
true
Gout
condition that results from inappropriate uric acid metabolism
gout drugs
allopurinol
give for chronic gout
colchicine
give for an acute gout attack
-may cause short term leukopenia and bleeding into the GI or urinary tracts
herbal products: feverfew
given to treat migraine headaches
glucosamine and chondrotia
used to treat pain and joint stiffness
patient has stage 4 lung cancer, taking anagelic and now its not working
opioid tolerance, they will need increase : eventually will hit ceiling effect
getting aspirin 81, what are you getting it for?
anticoag platelet (after surgery)
GOUT
overproduction of uric acid as well as underproduction
what medication do you give for acute gout
colchine
glucosamine and chrondrointin
joint pain stiffness
fentanyl
given for severe pain
-patch stays on for 72 hrs and need 2 nurses to verify
acute toxicity from Tylenol
liver damage
NSAIDS contraindications , are what conditions
gastric ulcers, peptic ulcer disease; will cause more ulcers if given. heart failure and pregnancy
what are NSAIDS given for?
antipiretic, anagesic, arthralgia
why do we give cytotec with NSAIDS
helps prevent bleeding / ulcers
what could we educate patient on for opioid
fluids and exercise
Tylenol is a antipyretic and agnostic
tylenol cannot sedate you
given elderly patient NSAIDS everyday, what will occur?
a GI bleed
which med do we give to decrease fever?
antipiretic
patient coughing alot, no pain. what do we give?
antitussive
antidote for Tylenol overdose?
acetycysteine
what do we give for opioid overdose?
narcane (antagonist)
PCA, who can give this????
PATIENT ONLY
salicylate overdose
tinitus or hearing loss
neuropathic pain stems from?
nerves
appendectomy pain is considered ?
visceral pain (deep organ pain)
systemic pain, is what kind of pain?
bone pain
indolognest neurotransmitters
enderfens
actual term for sensation of pain
no suseption
do anagelsics cause you to go unconscious ?
NO
teronal
given for severe pain (given instead of morphine)
opioid detoxation
suboxone and methadone
chronic pain considered
3-6 months with persistent pain
acute pain
sudden onset
with opioids after we administer we check the patient after and hour; what are we checking?
respirations
pain level
side effect for aspirin in children
reyes syndrome
with PCA pumps, what are we assessing ?
assess respirations!
remember: they'll use less of the medication cause they are in control
analgesic
antiflam
antipyretic