NR 293 Week 2 Concepts; Pain

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Contributor

Robin Williams

Category

Nursing

Course

NR 293 Pharmacology

Institute

Chamberlain

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50

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Week 2 Concepts: Pain Prepare: Analgesic Drugs Analgesic Drugs Analgesic drugs are medications that relieve pain, but do not cause loss of consciousness. Pain Sudden onset that subsides with treatment. Acute pain Skeletal muscle, ligament and joint pain. Somatic pain Level of stimulus needed to produce a sensation of pain. Pain threshold Organ and smooth muscle pain. Visceral pain Amount of pain a person can endure without impeding on normal daily function. Pain tolerance Persistent and/or recurring lasting over 3 months. Chronic pain Match the terms with the appropriate description. Opioids can be classified as mild agonists and strong agonists. Mild agonists include codeine and hydrocodone and strong agonists include fentanyl, hydromorphone, meperidine, methadone, morphine and oxycodone. Self Check: Therapeutic Use and Pharmacologic Action Treating Pain Opioid drugs are used to treat moderate to severe pain. Nonopioid drugs are normally prescribed for mild to moderate pain. Classifications The three classifications of opioid drugs are agonist, agonist-antagonists and antagonists. Nonopioid Medications The most widely used nonopioid medication is acetaminophen. This medication also works as an antipyretic by acting on the hypothalamus, the section of the brain that regulates temperature. Self Check: Adverse Effects of Acetaminophen Which of the following is the most serious adverse effect of acetaminophen? Hepatotoxicity Nausea Vomiting Constipation Self Check: Nonopioid Analgesics Do not use nonopioid analgesics with which of the following conditions? Select all that apply. Pregnancy Asthma Allergy to the medication Severe liver disease Glucose-6-phosphate dehydrogenase (G6PD) deficiency Reflect: Analgesic Drugs Pharmacological Action What is the pharmacological action of opioid antagonists? Bind to pain receptors and cause a weaker pain response than does a full agonist Bind to a pain receptor but do not reduce pain signals Bind to opioid pain receptors in the brain to reduce the sensation of pain Creates a weak bond to the mu opioid receptors which alters the perception of pain Adverse Effects Which of the following are adverse effects of nonopioid analgesic drugs? Select all that apply. Dysphoria Anemia Constipation Hepatotoxicity Nephrotoxicity Respiratory depression Contraindications of Opioids Which of the following is a contraindication for opioid analgesic use? Select all that apply. Constipation Vomiting Nausea Allergy to the medication Severe asthma Mild Opioid Agonists Which of the following are considered mild opioid agonists? Select all that apply. Oxycodone Hydrocodone Meperidine Fentanyl Codeine Hydromorphone Strong Opioid Agonists Which of the following are considered strong opioid agonists? Select all that apply. Methadone Meperidine Morphine Codeine Hydromorphone Oxycodone Hydrocodone Fentanyl Pharmacological Action What is the pharmacological action of opioid agonist-antagonists? Bind to a pain receptor but do not reduce pain signals Creates a weak bond to the mu opioid receptors which alters the perception of pain Bind to opioid pain receptors in the brain to reduce the sensation of pain Bind to pain receptors and cause a weaker pain response than does a full agonist Adverse Effects Which of the following are adverse effects of opioid analgesic drugs? Select all that apply. Dysphoria Urinary retention Tachypnea Constipation Bradycardia Diarrhea Respiratory depression Tachycardia Pharmacological Action What is the pharmacological action of opioid agonists? Bind to a pain receptor but do not reduce pain signals Creates a weak bond to the mu opioid receptors which alters the perception of pain Bind to opioid pain receptors in the brain to reduce the sensation of pain Bind to pain receptors and cause a weaker pain response than does a full agonist Opioid Analgesics (meperidine, fentanyl, methadone, morphine, oxycodone) Prepare: Opioid Analgesics Classification of Opioids Opioids are classified under which of the following related to their mechanism of action? Anti-infectives Immunosuppressants Antagonists Agonists Therapeutic Effect The therapeutic effect of opioid analgesics is which of the following? Antidiarrheal Anti-inflammatory Analgesia Antipyretic Opioid Overdose When an opioid overdose occurs, what medication should be administered? Aspirin Naloxone Activated charcoal Atropine Self Check: Mechanism of Action Mechanism of Action Opioid analgesics are further classified by their mechanism of action of agonists, which bind to opioid pain receptors in the CNS to alter and reduce the sensation of pain. Self Check: Naloxone Naloxone When patients experience respiratory depression or overdose from opioid agonist, an opioid antagonist needs to be administrated, which include naloxone and naltrexone. Self Check: Drug-to-Drug Interaction Drug-to-Drug Interaction May cause paradoxical reactions, particularly with Meperidine. MAO inhibitors and procarbazine May cause opioid withdrawal for dependent patients. Partial-antagonist opioid analgesics May cause an increase in CNS depressant properties. Alcohol, antihistamines, antidepressants, sedative/hypnotics, phenothiazines and MAO inhibitors May decrease the analgesic effects of the opioid analgesic. Nalbuphine Please match the correct drug to drug interaction with the resulting possible outcome. Self Check: Tolerance, Dependence, and Addiction Physical Dependence, Addiction, and Tolerance Tolerance of/to opioids occurs when larger doses are required to maintain the same drug effect. Physical Dependence, Addiction, and Tolerance #2 Physical dependence is when the body adapts to the presence of the opioid. Reflect: Opioid Analgesics Main Action What is the main action of opioids? Increasing heart rate Inhibiting prostaglandin synthesis Inhibiting protein synthesis Bind to opioid pain receptors in the CNS to alter and reduce the sensation of pain Patient Conditions Caution should be taken in giving opioids to which of the following patient conditions? (Select all that apply) Frequent migraines Elderly History of opioid addiction Anxiety Respiratory insufficiency Sleep apnea Chronic back pain Adverse Effects Which of the following are adverse effects of opioids? Select all that apply. CNS depression Diarrhea Constipation Respiratory depression Incontinence Indications for Use Indications of use for opioids include which of the following? Select all that apply. Diarrhea Paralytic ileus Treat moderate to severe pain Diabetes Cough center suppression Opioid Education Opioid education should include which of the following? Select all that apply. Change positions slowly to prevent orthostatic hypotension Maintain bedrest Maintain adequate fluid and fiber intake to prevent constipation Drink a full glass of water with each dose to prevent choking Keep a record of pain experience and treatment response Monitor respiratory rate and call prescriber immediately if it is less than 10 breaths per minute or with any difficulty breathing Contraindications Opioids are contraindicated with which of the following conditions? Select all that apply. Dysmenorrhea Severe back pain Rheumatoid arthritis Severe asthma Known drug allergy Physical Dependence, Addiction, and Tolerance When there is compulsive opioid use and continual craving and need for effects outside of pain relief, (psychologic dependence). Addiction When larger doses are required to maintain the same opioid effect. Tolerance When the body adapts to the presence of the opioid. Physical dependence Drag and drop to match the correct term to the definition. Facts About Opioids Drag and drop to match the correct facts under the related opioid. Meperidine – Synthetic opioid Typically used for migraines and post-operative shivering Active metabolite (normeperidine) can accumulate when it reaches toxic levels, therefore not recommended for long- term pain management Fentanyl - Synthetic opioid Used for long-term pain management Patches should not be used for acute post-operative pain management Used to supplement general anesthesia Methadone – Synthetic opioid Detoxifying patients addicted to methadone Used for neonate abstinence syndrome caused by mothers taking methamphetamine during pregnancy Morphine – Natural opioid derived form the opium poppy plant Used for pulmonary edema and pain from a myocardial infarction (MI) Oxycodone – Semi-synthetic opioid structurally related to morphine Weaker than other opioids and is often used in combination with acetaminophen for moderate to severe pain. Used for long-term pain management. Nonopioid Analgesics (acetaminophen) Prepare: Nonopioid Analgesics Classification of Acetaminophen To which class of medications does acetaminophen belong? Antiemetic Corticosteroid Nonsteroidal anti-inflammatory (NSAIDS) Analgesic Other Uses for Acetaminophen Acetaminophen is used as an analgesic, but additionally has antipyretic effects due to acting on the hypothalamus, the section of the brain that regulates temperature. Analgesia and Antipyretic The therapeutic effect of acetaminophen include analgesia and antipyretic. Self Check: Use, Effect, and Administration Therapeutic Effect The therapeutic effect of acetaminophen includes which of the following? Select all that apply. Analgesia Antipyretic Antidiarrheal Antacid Anti-inflammatory Routes of Administration What are the available routes of administration for acetaminophen? Select all that apply. Rectal Oral Intramuscular Intravenous Subcutaneous Self Check: Prostaglandin Synthesis Prostaglandin Synthesis Acetaminophen works by inhibiting prostaglandin synthesis, primarily in the CNS, to alleviate pain and fever. Self Check: Increased Risk and Chronic Use Increased Risk Acetaminophen-induced liver damage and hepatotoxicity are at increased risk when administered with alcohol, isoniazid, rifampin, rifabutin, phenytoin, barbiturates and carbamazepine. Chronic Use Chronic use of acetaminophen may increase bleeding risk when administered with warfarin. Reflect: Nonopioid Analgesics Half-Life Neonates 7 hours Children 3 – 4 hours Adults 1 – 3 hours Drag and drop the correct half-life for acetaminophen in neonates, children, and adults. Adverse Effects Which of the following are adverse effects of acetaminophen? Select all that apply. Stevens-Johnson syndrome Toxic epidermal necrolysis MI Hepatotoxicity GI bleeding Renal failure Similarity to NSAIDs Acetaminophen is similar to nonsteroidal anti-inflammatory drugs (NSAIDs) except for which of the following? Select all that apply. GI irritation Antipyretic Analgesic Anti-inflammatory Pharmacokinetics Onset Peak Duration PO 0.5 – 1 hour 1 – 3 hours 3 – 8 hours Rectal 0.5 – 1 hour 1 – 3 hours 3 – 4 hours IV 0 – 0.5 hours 0.5 hours 4 – 6 hours Drag and drop the items to complete the chart with the onset, peak and duration for acetaminophen po, rectal and IV routes. Contraindication Acetaminophen is contraindicated with which of the following conditions? Active GI bleed Dysmenorrhea Severe liver disease Ulcer Drug-to-Drug Interactions Acetaminophen-induced liver damage. Isoniazid, rifampin, rifabutin, phenytoin, barbiturates and carbamazepine Increased adverse renal effects. NSAIDs Please match the outcome of the drug to drug reactions with acetaminophen below. Increased bleeding risk. Chronic acetaminophen use plus warfarin Hepatotoxicity Alcohol Pharmacological Action What is the pharmacological action of acetaminophen? Increases prostaglandin synthesis Increases protein synthesis Inhibits inflammatory reactions Inhibits prostaglandin synthesis, primarily in the CNS, to alleviate pain and fever Acetaminophen Interactions Acetaminophen-induced liver damage and hepatotoxicity are at increased risk when administered with which of the following? Select all that apply. Antivirals Barbiturates Alcohol Phenytoin Rifampin Isoniazid Laxatives Miscellaneous Analgesics (tramadol) Prepare: Miscellaneous Analgesics Therapeutic Effect The therapeutic effect of Tramadol is analgesia. Class of Medications To which class of medications does tramadol belong? Corticosteroid Analgesic Antineoplastic Nonsteroidal anti-inflammatory (NSAID) Best Use Tramadol is best used for what condition? Severe pain Moderate to moderately severe pain Mild pain Fever Inflammation Self Check: Use, Effect, and Administration Routes of Administration What are the available routes of administration for tramadol? Select all that apply. Rectal IV Subcutaneous Oral Oral extended release Therapeutic Effect The therapeutic effect of Tramadol has been achieved when the patient has which of the following? Decreased inflammation Decreased temperature Decreased pain Increased temperature Self Check: Pharmacological Action Pharmacological Action #1 Tramadol weakly binds to mu opioid receptors and inhibits the reuptake of norepinephrine and serotonin in the CNS. Phamacological Action #2 Due to tramadol’s weak bond to opioid receptors, it is not classified as an opioid analgesic. Self Check: Contraindications Contraindications Do Not Use Use Caution Hypersensitivity Cross-sensitivity with opioids Respiratory depression Acute or severe asthma GI obstruction Use with MAO inhibitors Alcohol intoxication Use with Sedatives/hypnotics Use with Central acting analgesics Use with Opioid analgesics Use with Psychotropic agents Opioid analgesic dependent individuals Lactation Children less then 12 years old Children 12-18 postoperative Obstructive sleep apnea Obesity Severe pulmonary disease Neuromuscular disease Other medications causing respiratory depression Patients with a history of epilepsy or seizures Renal impairment Hepatic impairment Patients taking neuroleptics, SSRIs, TCAs or other CNS depressants Suicidal patients Patients prone to addiction Excessive use of alcohol Increased intracranial pressure or head trauma History of dependence Patients older than 75 years old Prolonged use during pregnancy can cause neonatal opioid withdrawal Below are two lists of contraindications, one for do not use and one for using caution with Tramadol administration. Drag and drop the correct answer (Do Not Use or Use Caution) above the listed information. Reflect: Miscellaneous Analgesics Conditions Which condition would be best treated with tramadol? Anxiety Mild headache Acute moderate back pain Diabetes Outcomes Carbamazepine Increased metabolism and decreased tramadol effectiveness Penicillin, cephalosporins, phenothiazines, opioid analgesics or antidepressants Increased risk of seizures St. John’s Wort Increased risk of serotonin syndrome MAO inhibitors Increased risk of adverse reactions Kava-kava, valerian and chamomile Increased CNS depression Drag and drop to match the outcome of the drug to drug reactions with Tramadol below. Adverse Effects Which of the following are adverse effects of tramadol? Select all that apply. GI bleeding Seizures Suicidal thoughts Visual disturbances Serotonin syndrome Physical dependence Contraindication Which of the following conditions would be a contraindication to administer Tramadol? Dysmenorrhea Rheumatoid arthritis Allergic rhinitis Lactating mother Half-Life PO 6 – 8 hours ER 7.9 hours Drag and drop the items to complete the table with the correct half-life for Tramadol. Pharmacological Action What is the pharmacological action of Tramadol? Bind to a pain receptor but do not reduce pain signals Bind to opioid pain receptors in the brain to reduce the sensation of pain Bind to pain receptors and cause a weaker pain response than does a full agonist Creates a weak bond to the mu opioid receptors which alters the perception of pain Half-Life and Specific Conditions Half life is increased when taking tramadol with which of the following conditions? Select all that apply. Renal impairment Visual impairment Anxiety Hepatic impairment Hypertension Pharmacokinetics Route Onset Peak Duration PO 1 hour 2 – 3 hours 4 – 6 hours ER Unknown 12 hours 24 hours Drag and drop the items to complete the table with the onset, peak and duration for Tramadol PO route and PO extended release. Nursing Application: Analgesics Prepare: Nursing Application of Analgesics Pain Assessment Techniques Which of the following is the most accurate pain assessment technique? The nurse watching the patient when the patient is alone to see if the patient is really experiencing pain The patient gives a pain scale rating and describes the pain to the nurse The nurse observes how the patient reacts during the assessment The nurse combines the pain scale rating from the patient with his or her own observations Opioids vs. Nonopioids Opioid Nonopioid Medications Fentanyl Morphine methadone Oxycodone Tramadol Acetaminophen Match the correct medication under the class of opioid or nonopioid analgesic below. Administration of Opioid Analgesics Respiratory Rate Pain level Bowel Function Pain description Which of the following should be assessed prior to administration of opioid analgesics? Select all that apply. Assessed Before Administration Self-Check: Pain Pain Scale – Infants The most appropriate pain scale for an infant is the FLACC pain scale. Pain Pain is whatever the patient sa

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