34 terms

Pharm Chapter 18

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3 things that can increase the perception of pain
anxiety, fatigue, and depression
acute pain
intense pain occurring over a brief time, usually from time of injury until tissue repair
chronic pain
longer lasting pain that may persist for weeks, months, or years. Pain lasting longer then 6 months can interfere with ADLs and can contribute to feelings of helplessness or hopelessness
nociceptive pain
due to injury to issues
somatic
sharp, localized sensation
visceral
dull, throbbing, aching pain
neuropathic pain
due to injury to nerves (burning, shooting, numbing)
ex. carpal tunnel, sciatica, phantom limp pain and diabetic retinopathy
nonpharmacologic therapies to reduce pain
acupuncture
biofeedback
massage
heat or cold
meditation or prayer
relaxation therapy
art or music therapy
opioids
natural or synthetic morphine-like substance responsible for reducing moderate to severe pain
narcotic opioid agonists action
interact with specific receptors (mu and kappa)
adverse effects of narcotic opioid agnoists
respiratory depression, sedation, nausea and vomiting
used to reverse respiratory depresion and is an opioid antagonists
naloxone (Evzio, Narcan)
morphine (Astramorph PF, Duramorph, others)
Therapeutic Class: opioid analgesic
Pharm Class: Opioid receptor agnoist
Action: binds with both mu and kappa receptor sites to produce profound analgesia
Use: symptomatic relief of serious acute and chronic pain after nonnarcotic analgesics have failed, as preanesthetic medication, to relieve shortness of breath associated with heart failure and pulmonary edema, and for acute chest pain connected with MI
Adverse Effects: dysphoria, hallucinations, nausea, constipation, dizziness, and an itching sensation
Overdose: treat with naloxone
Interactions: avoid CNS depressants, MAOIs and TCAs (increase the risk of severe respiratory depression and death)
naloxone (Evzio, Narcan)
Therapeutic class: Drug for treatment of acute opioid overdose or misuse
Pharm Class: Opioid receptor antagonist
Action: interact with receptors
Use: to reverse respiratory depression and other acute symptoms of opioid addiction, toxicity, overdose
Adverse Effects: minimal toxicity; rapid loss of analgesia, increased BP, tremors, hyperventilation, nausea and vomiting, and drowsiness
Interactions: shouldn't be used for respiratory depression caused by nonopioid medications
Herbal/Food: echinacea
Administration: administer for a respiratory rate of fewer than 10 breaths/minute (resuscitation equipment accessible)
Black Box: may produce hepatic injury
ways to prevent opioid dependence
Switch from IV and inhalation forms to methadone, the oral form
methadone
doesn't cure but avoids withdrawal symptoms of opoid dependence
Treatment may be needed for many months or year
action of NSAID
inhibiting pain mediators at the nociceptor level
Inhibt cyclooxygenase (COX), an enzyme responsible for the formation of prsotaglandins
Difference between acetaminophen and NSAIDs
both reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can reduce inflammation
tension headache
most common HA; self-limiting annoyance rather than emergency
migraine
throbbing or pulsating pain, may be preceded by aura, often causes nausea and vomiting, and often have triggers that can be avoided
primary goal of therapy for migraines
stop migraines in progress
prevent migraines from occuring
sumatriptan (Imitrex)
Therapeutic Class: Antimigraine drug
Pharm Class: Triptan
Action: to act as serotonin agonists, constricting certain intracranial vessels
Use: abort migraines with or without auras
Adverse Effects: GI upset, some dizziness, drowsiness, or a warming sensation
Contraindicated: patients with recent MI, or with a history of angina pectoris, hypertension, or diabetes, serious renal or heaptic impairment
Interactions: MAOIs, SSRIs increase effect and ergot alkaloids and other riptans can further vasoconstriction
Overdose: drug therapy; symptoms include lack of coordination, watery eyes and mouth, tremors, seizures, or breathing problems
Herbal: ginkgo, ginseng, echinacea, and St. John's wort
endogenous opioids
group of neurostransmitters;
may modify sensory information, interrupting pain transmission
(endorphins, dynorphins, enkephlins)
opioid agonsit drugs
stimulate mu and kappa receptors
opioid antagonist drugs
block mu and kappa receptors
Reverse symptoms of addiction, toxicity and overdose
opioids with mixed agonist-antagonist acitvity
stimulate opioid receptor, thus causing analgesia
Withdrawal symptoms and side effects not as intense as those of opioid agonists
ex. pentazocine (Talwin)
nonopioid analgesics
used for fever, inflammation, analgesia, mild or moderate pain associated with inflammation
includes: NSAIDs, acetaminophen, and a few centrally acting drugs
aspirin (ASA)
Therapeutic Class: nonopioid analgesic; NSAID, antipyretic
Pharm Class: Salicylate; COX inhibitor
Action: as anticoagulant, antipyretic, anti-inflammatory, and analgesic
Use: Mild to moderate relief of fever, reduce the risk of mortality following MI, reduce incidence of strokes, reduce risk of colorectal cancer
Adverse Effects: with high doses may cause GI distress and bleeding
Administration: discontinue 1 week prior to sugry
contraindications: patients receiving anticoagulant therapy (wafarin and heparin) should avoid asprin
Herbal: feverfew, garlic, ginger, and ginkgo may increase the risk of bleeding
Overdose: acitvted charcoal, gastric lavage, laxative, or drug therapy; symptoms include dizziness, drowsiness, abdominal pain, or seizures
ibuprofen (Motrin)
Pharm Class: Nonsteroidal anti-inflammatory drugs (NSAIDs)
Action: inhibit cyclooxygenase and prevent formation of prostaglandins
Use: mild or moderate pain and reduce inflammation
Adverse Effects: GI upset, acute renal failure
celecoxib (Celebrex)
Phar class: selective Cox-2 inhibitors
Action: similar to the NSAIDs
Use: to relieve pain, fever, inflammation
Adverse Effects: mild and related to GI system
acetaminophen (Tylenol)
Pharm class: centrally acting nonopioid analgesics
Action: to treat fever at the level of the hypothalamus; causes dilation of peripheral blood vessels, enabling sweating and dissipation of heat
Use: treatment of fever and to relieve pain
Adverse Effects: uncommon with therapeutic doses
tramadol (Ultram)
Pharm class: centrally acting nonopioid analgesics
Action: weak opioid activity
Use: centrally acitng analgesic
Adverse Effect: CNS, GI, and CV effects
ergot alkaloids
Action: promote vasoconstriction
Use: terminate ongoing migraines
Adverse effects: GI upset, weakness in the legs, myalgia, numbness and tingling in fingers and toes, angina-like pain, tachycardia
other drugs for migraine prophylaxis
antiseizure drugs
beta-adrenergic blockers
calcium channel blockers
tricyclic antidepressants