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Meds Test 4
Terms in this set (29)
Block production of prostaglandins
Decrease movement of ions across the cell membrane
Depletes accumulation of substance P and blocks transduction; may also inhibit transmission of pain signals
Opioids (narcotic analgesics)
block the release of neurotransmitters, particularly substance P, which stops the pain at the spinal level.
relieve pain by blocking the reuptake of norepinepherine and serotonin, making them more available to fight pain
N-methyl-d-aspartate (NMDA) antagonists (e.g. ketamine and dextromethorphan)
may be used to help diminish the pain signals.
NONOPIOID/ NSAIDS FOR MILD PAIN
* acetaminophen - Tylenol
* acetylsalicylic acid - aspirin
* choline magnesium trisalicylate - Trilisate
* ibuprofen - advil
* indomethacin sodium trihydrate - Indocin
* naproxen, naproxen sodium - Naprosyn, Anaprox
* ketorolac - Toradol
* Piroxicam - Feldene
* Meloxicam - Mobic
* celecoxib - Celebrex Cox II NSAID
OPIOID ANALGESICS FOR MODERATE PAIN
* hydrocodone - Lortab, Vicodin
* codeine - Tylenol 3
* tramadol - Ultram, Ultracet
* Pentazocine - Talwin
-generally 2 to 4 times more potent than nonopioids alone
-has ceiling effect due to nonopioids and max. daily dose limit
-have narrow therapeutic index
opioid analgesic for moderate pain
-doses of 30-60 mg produces dose-limiting GI distress
-enzymes CYP450 required to be effective. About 10% of the population lack this enzyme and may not get any pain relief
-nonspecific opioid with dual mechanism of action (weak opioid agonist and inhibits the reuptake of norepinepherine and epinepherine
-usual dose is 50-100 mg/day
SSRI's may inhibit metabolism
Admin. w/ monoamine oxidase inhibitors (MAOIs) could cause psychosis
Darvon and Darvocet
-used to be considered as opioid for moderate pain
-10,000 deaths associated w/ metabolite accumulation
-should be avoided for older adults
OPIOID ANALGESICS FOR SEVERE PAIN
* Fentanyl citrate - Sublimaze, transdermal patches
* Hydromorphone hydrochloride - Dilaudid
* Oxycodone - OxyContin
* Morphine sulfae - morphine
* oxymorphone - Opana
* methadone - Dolophine
for severe pain
avoided due to short half-life, toxic metabolite, and potential to induce tremors and seizures with repeated doses
Should not be used on infants,children, older adults, or clients w/ cancer pain or sickle cell disease
synthetic opioid used for pain
long half-life (15-60 hrs) there is increased risk for sedation and resp. depression esp. in older adults
* tricyclic antidepressants - nortriptyline, amitriptyline
* anticonvulsants - gabapentin, pregabalin
* topical local anesthetic - Lidoderm
-include acetaminophen and nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen
-useful for chronic or acute pain
-most common NSAID available OTC
-can prolong bleeding time so needs to be stopped 1 week prior to any surgical procedure.
-can cause excessive anticoagulation if a client is taking Warfarin
-should never be given to children under 12 due to possibility of Reye's syndrome.
-antipyretic and analgesic
-does not affect platelet func. and rarely causes GI distress
-hepatotoxicity and renal toxicity w/ high doses or long-term use
-even w/ recommended doses up to 4 g. /day, some clients may still be at risk for hepatotoxicity
-do not drink alcohol while taking
-Recommended that otherwise healthy and young people limit consumption to < 3 g./day
-Susceptible individuals (older adults, alcoholism hist., dehydration, or liver disease) limit to < 2 g./day
-often an ingredient in OTC remedies (ie. pain, fever, allergy, cough & cold preparations) so teach clients to read all ingredients of all OTC meds they take.
Common Prescription Pain Medications Containing Acetaminophen
Tylenol No. 3 (325 mg acetaminophen/30 mg codeine)
Percocet (325 mg/ 5 mg oxycodone)
Lortab (500 mg/ 5, 7.5, or 10 mg hydrocodone)
Vicodin (500 mg/ 5 mg hydrocodone)
Tylox (500 mg/ 5 mg oxycodone)
Darvocet-N 100 (650 mg/ 100 mg propoxyphene)
Vicodin ES (750 mg/ 7.5 mg hydrocodone)
-have anti-inflammatory, analgesic, and antipyretic effects
-relieves pain by inhibiting the enzyme cyclooxygenase (COX), a chemical that is activated by damaged tissue, resulting in decreased synthesis of prostaglandins.
-Side effects: GI bleed, diminished renal blood flow, and inhibited clotting.
-had less risk of GI bleeding but uncommon cardiovascular events and rare skin problems occur in susceptible individuals.
once max. analgesic effect is achieved, additional amounts of the drug will not produce more analgesia; however more toxicity can occur.
narrow therapeutic index
there is not much margin for safety between the dose that produces a desired effect and the dose that may produce a toxic, even lethal effect.
3 types: Full agonist, Mixed agonists-antagonists,Partial agonists
-Common side effects:
Respiratory depression (8 breaths/min. or <; occurs usually in early therapy with opioid-naive clients.)
Full Agonist Opioids
-pure opioids that bind tightly to mu receptor sites, producing max. pain inhibition, an agonist effect.
Morphine (gold standard)
Oxycodone (Percocet and OxyContin)
Fentanyl (Duragesic; Actiq)
-no ceiling on analgesia level; dose can be steadily increased to relieve pain
-no max. daily dose limit except when used with nonopioid analgesic
-can act like opioids and relieve pain (agonist effect) when given to client who has not taken pure opioids.
-blocks /inactivates other opioids when given to a client who has been taking pure opioids (antagonistic effect); therefore could cause immediate and severe withdrawal symptoms in client who is on pure opioids for > 2 wks.
-not recommended for terminally-ill clients
-opioid naive client with acute pain could have success with few side effects
pentazocine hydrochloride (Talwin)
butorphanol tartarate (Stadol)
nalbuphine hydrochloride (Nubain)
-have a ceiling effect in contrast to a full agonist
-has good analgesic potency and is emerging as an alternative to methadone for opioid maintenance and narcotic treatment programs
Opioid Side Effects
Common side effects:
Respiratory depression (8 breaths/min. or <; occurs usually in early therapy with opioid-naive clients, dose escalation, drug-drug/drug-disease interaction.)
Sedation (manifests BEFORE resp. rate and depth)
Percocet; Tylox (w/ acetaminophen)
Percodan (w/ aspirin)
-semisynthetic codeine derivative; narcotic; schedule II controlled substance
Assess pain prior & 60 mins. after admin.
Assess bowel func. to prevent constipation
Take w/ food to decrease GI upset
Avoid rushing ER tabs
Avoid alcohol or other CNS depressants
Max daily dose for Acetaminophen: 4,000 mg in healthy adult; 2,000 mg/day for elderly, malnourished, and risk for liver problems
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