Pharm pain
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33 terms
Terms | Definitions |
|---|---|
 A pain fibers | -contain a myelin sheath, have a fast conduction speed -large |
| C pain fibers | -contain no myelin sheath -small -pain travels here mostly |
| Endogenous neurotransmitters | **enkephalins -found in thalamus in brain -bind to opioid receptors -inhibit transmission of pain by closing gate **endorphins -produced in cells of nervous system -binds with phetitive receptors, relieves common pain -very powerful, not addictive -control stress/frustration/addictions/eating disorders -inhibit transmission of pain by closing gate |
| Acute pain | -sudden in onset -sharp and localized -usually subsides once treated |
| Chronic pain | -slow onset -long duration (more than 6 weeks) -dull persistent aching (recurring) -often difficult to treat |
| Pain: somatic | -from skeletal muscles, ligaments, joints |
| Pain: visceral | -from organs, smooth muscles in abdomen |
| Pain: superficial | -from skin |
| Pain: vascular | -from inflammation of vasculature |
| Pain: referred | -from somewhere pain is not originating from -example is left arm pain during an MI and appendicitis |
| Pain: neuropathic | -from fingers/feet from decreased sensation of nerves |
| Pain: phantom | -from lost limbs |
| Pain: cancer | -from wherever the cancer is -bone cancer is most painful of all cancers |
| Pain: psychogenic | -from procedures or other traumas |
| Pain: central | -from CNS |
| Opioid receptors | 1. Mu1, Mu2, Kappa |
| Mu1 binding | -analgesia -causes greatest improvement and less consequences |
| Mu2 binding | -analgesia, respiratory depression, constipation, addiction |
| Kappa binding | -analgesia, dysphoria (depression) |
| Opioids (enhances receptors ability to produce natural response) 1. prototypes 2. route/duration 3. indications 4. MOA | 1. codeine sulfate, fentanyl citrate, morphine sulfate (and CR), oxycodone CR, meperidine HCL, methadone HCL 2. -morphine: IV and PO, lasts 5hr -codeine: PO, lasts 4-6hr -fentanyl: IV, transdermal, lasts 1 hr with IV, 13-40 with transdermal **transdermal fentanyl works well with bone cancer pain 3. to alleviate moderate-severe pain, cough center suppression, diarrhea 4. mimics actions of endogenous opioid peptides, primarily at Mu1 and Mu2 sites |
| Opioids 1. contraindications 2. ADR | 1. allergy, severe asthma/respiratory insufficiency, increased intracranial pressure, pregnancy 2. CNS depression, euphoria, pupil constriction, diaphoresis, flushing, hypotension, bradycardia, RESPIRATORY DEPRESSION, N/V, constipation, urinary retention, itching, wheal formation |
| Opiate Antagonists 1. prototypes/ route/duration 2. indications 3. MOA | 1.- naloxone (drug of choice). IV only. lasts 2hr -Good for reversing respiratory depression -naltrexone. PO only. Lasts 1-3 days 2. used for complete or partial reversal of opioid-induced respiratory depression 3. they bind to opiate receptors and prevent a response |
| Opioid tolerance | -result of chronic opioid treatment -larger and larger doses are needed to produce therapeutic response -receptors are down-regulated |
| Opioid physical dependence | -body's adaptation to opioid -once drug is withdrawn, body craves the drug and withdrawal symptoms present -most dangerous for patient |
| Opioid psychological dependence | -pattern of compulsive drug use -craving for drug for uses other than pain relief: euphoria -ADDICTION |
| Narcotic withdrawal opioid abstinence syndrome characteristics | -anxiety, irritability, chills/hot flashes, joint pain, excessive lacrimation, rhinorrhea, diaphoresis, N/V, abdominal cramps/pain, diarrhea -In infants whose mothers were dependent: don't eat, cry, rub limbs until raw. |
| Non-opioids/NSAID 1. prototypes 2. route/duration 3. indications 4. MOA 5. toxicity 6. antidote 7. interactions 8. contraindications | 1. acetominophen (tylenol) 2. PO. Lasts 3-4hr. Rectal suppositories for infants/elderly 3. mild-moderate pain, fever, alternative for those who can't take aspirin (people on anticoagulants) 4. blocks pain impulses peripherally by inhibiting prostaglandin synthesis 5. -lethal when overdosed: causes hepatic necrosis. -Long-term ingestion of large doses causes nephropathy, oxidative damage, inflammation -4,000mg/day=max dosage 6. acetylcysteine 7. -alcohol -other hepatotoxic drugs 8. liver dysfunction, and possible liver failure |
| Analgesics: Nursing Implications | 1. pain assessment: LOCSTAAM 2. medicate patient before pain is severe 3. pain management includes drug and non-drug measures (massage, distractions, music...) 4. instruct patient to tell doctor if signs of allergic reaction or ADR present 5. take vitals and I&O |
| Opioid Analgesics: Nursing Implications | 1. withhold dose and call doctor if there's a decline in condition/VS, especially if respiratory rate is less than 12 breaths/minute 2. check dosages carefully 3. fentanyl given IV quickly=chest wall rigidity. 4. can be taken with food 5. patients should re-position themselves slowly b/c of hypotension 6. Monitor for VS change, continuance of pain: call doctor 7. monitor for therapeutic effects: decreased severity and complaints of pain, decreased fever (acetaminophen) |
| Signs of respiratory depression | 1. respiratory rate of less than 12 per minute, dyspnea, diminished breath sounds, or shallow breathing |
| NSAIDS | 1. inhibit cyclooxygenase 1 and 2 2. treat inflammatory disorders: rheumatoid arthritis, osteoarthritis, bursitis 3. alleviate mild-moderate pain, and menstrual pain 4. suppress fever 5. suppress inflammation |
| NSAIDS: 1st generation 1. prototypes/indications 2. route/duration 4. MOA 5. toxicity 6. antidote 7. interactions 8. contraindications | 1. Propionic acid derivatives: ibuprofen (pain/fever), naproxen (inflammation of joints), indomethacin (arthritis), ketorolac (severe pain) 2. PO, lasts 4-6hr 3. |
| NSAIDS: 2nd generation 1. prototypes 2. route/duration 3. indications 4. MOA 5. ADR 6. contraindications 7. interactions | 1. cyclooxygenase inhibitors: celecoxib (Celebrex) 2. PO, lasts 4-8hr 3. -suppresses inflammation/pain -osteoarthritis/ rheumatoid arthritis -dysmenorrhea -familial adenomatous polyposis 4. -reversible inhibition of leukotriene and/or -prostaglandin pathway -blocks the action of cyclooxygenase2 5. -lower risk for GI side effects than other NSAIDS -impairs renal function, hypertension, edema -increases the risk for MI/stroke 6. sulfa allergy, pregnancy (NSAIDS close ductus arteriosis) 7. increase effects of warfarin, decreases diuretic effect of furosemide, decrease antihypertensive agents, may increase levels of lithium |
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