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66 Cards in this Set
- Front
- Back
Opioid Agonist
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Binds to the opioid pain receptors in the brain/CNS; causes an analgesic response and reduces the pain sensation
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Opioid Partial-Agonist
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Binds to pain receptor but causes a weaker neurologic response than a
full agonist. Also called Agonists-antagonists --Sometimes useful in opioid-addicted patients and obstetrical patients |
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Opioid Antagonist
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Binds to a pain receptor but does not reduce pain signals.
-- It functions as a competitive antagonist because it competes with and reverses the effects of agonist and agonist-antagonist drugs at the receptor sites. |
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Analgesics
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Medications that relieve pain without causing loss of consciousness; sometimes referred to as painkillers
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Analgesic Ceiling Effect
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What occurs when a given pain drug no longer effectively controls a patient's pain despite the administration of the highest safe dosages.
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Nociception
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Processing of pain signals in the brain that gives rise to the feeling of pain.
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Nociceptors
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A subclass of sensory nerves (A and C fibers) that transmit pain signals to the central nervous center from other body parts
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Narcotics
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Originally applied to drugs that produce insensibility or stupor, especially opioids (ie: morphine, heroin). Currently used in clinical settings to refer to any medically used controlled substances but falling out of favor - now using OPIOID. In legal settings, applies to illicit/street drugs.
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Neuropathic Pain
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Pain that results from a disturbance of function or pathologic change in a nerve
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Nonsteroidal Antiinflammatory Drugs (NSAIDs)
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A large, chemically diverse group of drugs that are analgesics and also process antiinflammatory and antipyretic activity but are not steroids.
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Opioid analgesics
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Synthetic drugs that bind to opiate receptors to relieve pain but are not themselves derived from the opium plant
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Pain Threshold
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The level of stimulus that results in the sensation of pain.
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Pain Tolerance
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The amount of pain a patient can endure without its interfering with normal function.
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Referred Pain
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Pain occurring in an area away from the organ of origin.
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Adjuvant Analgesic Drugs
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Drugs that are added as a second drug for combined therapy with a primary drug and may have additive or independent analgesic properties, or both.
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Narcotic Antagonist - Name?
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Naloxone / NARCAN (Generic Name)
Stadal |
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When to give a Narcotic Antagonist
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For severe respiratory depression as a side effect of a narcotic agonist
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Examples of Opioid Agonists
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Codeine
Morphine Demerol Darvon, Vicodine Hydrocodone, Oxycodone Tylenol Dilaudid Talwin Sublimaze (Fentanyl – patch) |
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Opioid Agonist: Prototype
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Morphine Sulfate
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Fenanyl
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IV form of Morphine Sulfate
- Very concentrated and rapid (within 10 min); used for anesthesia - Given in very small increments, SUCH AS: 2-4 IV slowly, then wait 5 min, then, may give more if no relief nor adverse effects (such as rr<12 or hypotension) |
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Morphine - Transdermal Patch
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Duragesic or Fentanyl: for cancer pain
Slow release |
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PCA
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Patient Controlled Anesthesia
- Given in pre-measured syringe infusion pump - Safety factor allows med to be delivered every X minutes; charted every 4 hours |
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Duramorph
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Epideral form of Morphine.
Injected into epidural space once by anesthesiologist-12-24 hrs of pain relief; pt often cannot receive any other pain meds during this time. |
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Morphine Contin
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Oral form of Morphine; 12 hour duration
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Codeine-Based p.o. Meds
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1. Hydrocone- Lortabs (has hydrocone and tylenol)
2. Oxycodone |
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Morphine Sulfate: Therapeutic Uses
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Release moderate to severe pain; provides pre-op sedation
Alters pain perception, induces mental changes, promotes deep sleep, depresses respirations, constricts pupils, DEPRESSES GI MOTILITY |
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Morphine Sulfate: Adverse Effects
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-Respiratory Depression
-Adverse CNS changes --> sedation, light-headedness, dizziness -Orthostatic Hypotension -Decreased LOC -Constriction of pupils -GI Effects: N&V, constipation -Some cause hypotension and anti-cholingergic effects (dry mouth, urinary retention) -Euphoria -Allergic reactions- pruritis (itch), uticartia, laryngospasm |
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Morphine Sulfate: Nursing Implications
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* Monitor & take RR prior to giving – hold drug if RR < 12/min --> Narcan (Naloxon) = antidote
* Safety precautions, siderails up * May need laxative or fiber b/c constipation; may mask other pains; may cause bladder retention * Post op pts--> encourage pts to cough and deep breaths q 1-2 hrs and turn (need to keep lungs clear of secretions) * Use round the clock, don’t wait until pain severe * Can become addictive, no problem with acute surgical pain; problem w/ chronic pain * Interacts with alcohol and sedatives; Don’t drive! |
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Morphine Sulfate: Contraindications
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Pts w/ head injury b/c need to stay alert; alters pupil resonse (constricts)
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Morphine Sulfate: Duration
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4-6 hrs for most w/ PO & IM; Fentanyl = shorter 1-2 hr duration
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Morphine Sulfate: Onset of Routes
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ONSET: IV --> rapid within 10 min ONSET: IM --> 5-20 min ONSET: ORAL --> 12-24 hr time released: Morphine Contin; OxyContin ONSET Patch: slow release
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Morphine - Epidural: Nursing Implications
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Assess EVERY HOUR to report pain, pain relief; respiratory rate, level of numbness, if catheter in right place, if leaking; encourage coughing/deep breathing to avoid atelectasis
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Meperidine: Generic Name
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Demerol
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Demerol: Use
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Synthetic opioid analgesic used for acute pain during post-op settings, as well as emergency settings for acute migraine headaches
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Demerol: Adverse Effects
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* Resp depression < 12/min
* Drowsiness, urine retention, constipation, MORE NAUSEA than Morphine * Inj. – often mixed in syringe with Vistaril or Phenergen (relieve nausea & potentiates narcotics, lasts longer) |
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Non-Narcotic Analgesics: Categories
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Salicylates and Non-Salicylates
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Salicylates: Prototype
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Aspirin (ASA)
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Aspirin: Dose
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325-600 mg, q 3-4 hrs
(Much higher with arthritis pts!) |
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ASA: Oral Onset
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30-60 minutes
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ASA: Peak Levels
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2-3 Hours
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ASA: Duration
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4-6 Hours (except time released)
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ASA: Action
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1. Analgesia: blocks generation of pain impulses & inhibits prostaglandin synthesis
2. Antipyretic- Relieves fever by acting on hypothalamus |
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ASA: Therapeutic Uses
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Relief of mild to moderate pain, alleviate inflammation of rheumatoid arthritis, reduce fever, inhibits platelet aggregation to prevent clots
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ASA: Adverse Effects
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GI (heart burn, N&V, dyspepsia, bleeding); affects bleeding times
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Chronic Salicylate Intoxication
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Salicylism (prolonged high doses) – tinnitus, hearing loss, HA, confusion, hyperventilation, coagulation (bleeding problems)
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ASA: Contraindications
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1. Children/Teens -- Causes Reye’s Syndrome (Neurologic damage, coma, liver damage)
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ASA: Nursing Implications
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1. Take ASA with meals/food/milk or use enteric-coated or buffered form
2. Teach pt NOT to chew or crush e-c form (Liquid form or crush available if can’t swallow) 3. Therapeutic levels for Arthritis may be very large doses 2.6-5.4 g/day in divided doses 4. Inspect skin for bruising; check stools for occult (old) blood (appears black or tarry); watch if nosebleeds (called epistaxis) 5. Instruct pt. to speak with Dr. about stopping ASA 5-7 days before any surgery 6. Many OTC meds (ie pepto bismol) contain ASA → should not be taken with NSAIDs 7. Teach pt to use child proof containers and keep out of reach of children |
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Non-Salicylates: Prototype
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Acetaminophen (Tylenol)
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Acetaminophen: Dosage
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Maximum daily dose for adults is 4,000 mg/day
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Acetaminophen: Action
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Blocks pain impulse by inhibiting prostaglandin synthesis
Acts on hypothalamus to relieve fever |
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Acetaminophen: Therapeutic Uses
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1. Analgesic: Relieve mild to moderate pain
2. Antipyretic 3. Little to no anti-inflammatory effects*** |
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Acetaminophen: Adverse Effects
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1. Relatively few with low dose
2. GI Upset 3. HEPATIC TOXICITY with overdose 4. Nephropathy with long-term ingestion |
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Acetaminophen: Contraindications
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Liver dysfunction or possible liver failure
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Acetaminophen: Interactions
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Do not take with alcohol or other hepatotoxic drugs
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Acetaminophen: Nursing Implications
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Hold if pt develops rash or uticartia
If pain or fever for several days --> see Dr. |
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Examples of NSAIDs
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Ibuprofen, Toradol, Cox 2 Inhibitors
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Ibuprofen: Generic Names
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Advil, Motrin, Pamprin, Midol, Nuprin
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Ibuprofen: Dosage
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~200-800 mg
1200-3200 mg/day divided 3-4 times daily |
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Ibuprofen: Therapeutic Uses
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1. Analgesic effects in management of rheumatoid arthritis, osteoarthritis, gout, dental pain, musculoskeletal disorders, menstrual pain, headaches
2. Antipyretic 3. Antiinflammatory |
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Ibuprofen: Adverse Effects
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Same as ASA; may cause dizziness or drowsiness; GI, headache
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Cox-2 Inhibitors: Generic Names
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Celebrex, Bextra
Note: Vioxx is off the market as of 2004! |
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Cox-2 Inhibitors: Action
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Inhibits prostaglandin synthesis by inhibiting Cox2 enzymes
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Cox-2 Inhibitors: Therapeutic Uses
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1. Pain, arthritis, dysmenorrhea (menstrual pain)
2. Antipyretic Effects |
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Advantage of Cox-2 Inhibitors over other NSAIDs
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Don't disrupt platelets and have less GI Bleeding problems.
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Cox-2 Inhibitors: Contraindications
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Patients with hepatic disorders
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Toradol: Therapeutic Uses
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NSAID For post-op pts, w/ orthopedic surgeries; only 2 weeks b/c bleeding
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