19. Analgesics, Sedatives, and Hypnotics

Unit 2

Terms in this set (...)

-relieve pain
perceived by the individual, not observable by others
-endogenous analgesics produced within the body
-block the transmission of pain
-may be responsible for the placebo effect
produced or originating within a cell or organism
placebo effect
relief from pain as the result of suggestion without the administration of an analgesic
analgesics (classifications)
Opiods (classifications)
-full or pure agonists, partial agonists, or mixed agonist
-controlled substances
-include natural opium alkaloids (morphine & codeine) and synthetics (Demerol and Darvon)
-tend to cause tolerance and physiological dependence
-linked to death from overdoses
-weak opiate
-not classified as a controlled substance on the Federal level
-centrally acting synthetic analog of codeine
-less potential for abuse or respiratory depression
decreased response to a drug after repeated dosage; greater amounts of the drug are required for the same effect
acquired need for a drug after repeated use; may be psychological with craving and emotional changes or physical with body changes and withdrawal symptoms
Opiods (Side Effects)
-Sedation, Confusion, Euphoria, Restlessness, Agitation, Headache, Dizziness, Hypotension, Bradycardia, Urinary retention, sexual dysfunction, nausea, vomiting, constipation, respiratory depression, physical and or emotional dependence, tolerance, blurred vision, seizures with large doses, flushing, rash, pruritis
Opiods (Contraindications or extreme caution)
-Head injury;intracranial pressure, cardiac disease, hypotention, CNS depression, GI, Hepatic, renal, thyroid disease, Chronic obstructive pulmonary disease, asthma, pregnancy, lactation, pediatrics, older adults, patients, debilitated, driving or operating machinery, addiction prone, suicidal, alcoholic, opiate agonist hypersensitivity, abrupt drug discontinuation in patients taking opioids chronically
Opioids (Interactions)
(potentiation of effect of opiods with all CNS depressants)
-psychotropics , alcohol, sedatives/hypnotics, muscle relaxants, antimetics, antiarrhythmics/antihypertensives
tramadol (interactions)
-Monoamine oxidase inhibitors (MAOIs) or neuroleptics may increase seizure risk, Carbamazepine (Tegretol) antagonizes tramodol action, Selective serotonin reuptake inhibitors (SSRIs) may cause serotonin syndrome and increase sz risk
opiod antagonist
-Naloxine (Narcan) is used to treat opioid overdoses
Nonopiod Analgesics
-many available without prescription
-relieves mild-moderate pain, fever, anti-inflammatory conditions
nonopioid analgesic drugs that are combined with opioids for more effective analgesic action in relief of acute or chronic pain (e.g., NSAID or acetaminophen)
-most commonly used for their analgesic and antipyretic properties and anti-inflammatory action
medication to reduce fever
Salicylates and other NSAIDs (Side Effects)
-prolonged bleeding time, bleeding & frequent bruising, gastric distress, ulceration, bleeding, tinnitus, hepatic dysfunction, drowsiness, headahce, rash, coma, GI symptoms
Salicylates and other NSAIDs (Contraindications)
-GI ulcer & bleeding, asthma, Reyes Syndrome, Pregnancy, Lactation, Vit. K deficiency, Allergy to ASA
Salicylates and other NSAIDs (Caution)
-Anemia, Hepatic Disease, Renal Disease, Hodgkin's Disease, Pre/postoperatively (d/c 5 -7 days before elective sx)
Salicylates and other NSAIDs (Interactions)
-Alcohol, Anticoagulants, Corticosteroids, Antacids (high doses), NSAIDs, don't give salicylates and NSAIDs together, insulin, or oral antidiabetic agents, methotrexate, probenecid, Antichypertensives, Carbonic anhydrase inhibitors (toxic effects)
-Mild-moderate pain & fever
-Little effect on inflammation
-Fewer adverse effects than salicylates
Acetaminophen (Side Effects)
-Severe liver toxicity, renal insufficiency (decreased urine output), rash, blood dyscrascias
Acetaminophen (Caution)
-Must be used with frequent acetaminophen use and alcohol ingestion because of potential liver damage
-Pregnancy & Breastfeeding
Acetaminophen (Contraindicated)
-Hypersensitivity to acetaminophen or any component of the combination product
Adjuvant Analgesics
-originally intended for treatment of conditions other than pain
-enhance analgesic effect with opioids & nonopioids
-produce analgesia alone
-reduce side effects of analgesics
Adjuvant Analgesics (2 classes)
-Specified classes of antidepressants
Additions to the course of treatment to increase the efficacy
Tricyclic Antidepressants
-Nerve pain associated with herpes, arthritis, diabetes, migraine, tension headaches, insomnia, depression
TriCyclic Antidepressants (Side Effects)
Dry mouth, urinary retention, delirium, constipation, sedation, orthostatic hypotention, tachyarrhythmias, heart block in cardiac patients
Tricyclic Antidepressants (Caution)
If used with prostatic hypertrophy, urinary retention, increased intraocular pressue, and glaucoma
Tricyclic Antidepressants (Contraindications)
-Hypersensitivity and recovery phase of mycardial infarction
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
-Antidepressants that inhibit reuptake of both serotonin and norepinephrine
-Do not affect histamine or muscarinic receptors
-Treats diabetic neuropathy and fibromyalgia
SNRIs (Side Effects)
-Sleep disturbance, headache, nausea, stomach pain, diarrhea, constipation, dizziness, sweating
SNRIs (Contraindications/Precautions)
-Narrow angled glaucoma, hepatic or renal impairment, abrupt discontinuation, substantial alcohol use
SNRIs (Interactions)
-Serotonin Syndrome
Serotonin Syndrome
-Rapid development of hyperthermia, hypertension, rigidity, autonomic instability, and mental status changes that can include coma and delirium
-Management of nerve pain associated with neuralgia, herpes zoster (shingles), cancer
-Sharp, shooting pain
Anticonvulsants (Side Effects)
Sedation, dizziness, confusion, nausea, vomiting, constipation, anorexia, ataxia, hepatitis, rash, bone marrow suppression, blurred/double vision, gingivitis, weight gain
Anticonvulsants (Caution)
If used with allergies, hepatitis, cardiac disease and renal disease
Anticonvulsants (Contraindications)
Hypersensitivity, psychiatric conditions, pregnancy, Hemolytic disorders, Abrupt discontinuation
Anticonvulsants (Interactions)
-Alcohol (decreased effects), Antacids (decreased effects), Antineoplastics, CNS depressants, Folic Acid, Antiretovirals
Lidocaine Patch
-Approved for management of postherpetic neuralgia
Lidocaine Patch (Side Effects)
Erythema, edema, hives, allergic reactions
Lidocaine Patch (Precautions and Contraindications)
Sensitivity to local anesthetics, hepatic disease, nonintact skin, pregnancy, breast-feeding, pediatric use, handling & disposal to prevent access by children and pets
Lidocaine Patch (Drug Interactions)
Antiarrhythmic drugs such as mexiletene and local anesthetics
Antimigraine Agents
-migraine most common neurovascular headache
Serotonin Receptor Agonists (SRAs)
-developed based on the observation that serotonin levels decrease, while vasodilation and inflammation of blood vessels in the brain increase
-effective in treating nausea and vomiting associated with migraine
SRAs (Side Effects)
Malaise, fatigue, dizziness, drowsiness, nausea, vomiting, diarrhea, asthenia, tingling, parathesis, flushing, pain or pressure in the chest, neck, or jaw, arrhythmias, angina, palpitations, myocardial infarction, cardiac arrest
SRAs (Contraindications & Precautions)
-cerebrovascular/cardiovascular disease, uncontrolled hypertension, hepatic/renal disease, pregnancy, lactation, use in children
SRAs (Drug Interactions)
Ergot alkaloids, MAOIs, Antidepressants, Macrolide antibiotics
Controlled substances used to promote sedation in smaller doses and to promote sleep in larger doses
Drug that promotes sleep
Sedative-Hypnotics (Side Effects)
daytime sedation, confusion, headache, risk of falls, dependence, withdrawals, amnesia, sleep walking
Sedative-Hypnotic (Contraindications & Warnings)
Hypersensitivity, Severe liver impairment, renal impairment, porphyria, pregnancy, lactation, children, COPD, sleep apnea...
Sedative-Hypnotics (Interactions)
-psychotropic drugs, alcohol, muscle relaxants, antiemetics, antihistamines, anagesics
Ramelteon (Rozerem)
-1st FDA approved prescription medication that acts on melatonin receptors, mimicking the actions of melatonin to trigger sleep
-not classified as a controlled substance
-works quickly
opposite effect from that expected