Test 1 IV/Pharm Analgesics

Schedule of Controlled Substances

• Schedule 1: High potential for abuse, no currently accepted medical use in the US, lack of accepted safety for use under medical supervision. Examples include ecstasy, heroin, LSD, marijuana.
• Schedule 2: High potential for abuse, may lead to severe dependence (psychological and physical), currently accepted medical use with severe restrictions. Examples include Demerol, oxycodone, codeine.
• Schedule 3: Less potential for abuse than Schedule 1 and 2, moderate to low physical dependence, high psychological dependence. Examples include Vicodin, Tylenol with codeine, ketamine.
• Schedule 4: Low potential for abuse relative to other substances. Examples include Valium (diazepam).
• Schedule 5: Low potential for abuse. Examples include cough medicines containing codeine such as Robitussin AC and NyQuil.

Pain Management

• Acute mild pain: Aspirin or acetaminophen, pain due to inflammation responds well to NSAIDs.
• Moderate pain: Moderate-potency opiates, example is Tylenol with codeine.
• Severe acute pain: Opiate partial agonist or opiate agonist.

Pain Medication Types

• Salicylates (Aspirin)
  • Inhibits prostaglandins.
  • Mild to moderate pain.
  • Antipyretic (fever reducer).
  • Contraindicated in children under 12 due to risk of Reye's Syndrome.
  • Antiplatelet agent (inhibits platelet aggregation, can increase risk of bleeding).
  • Common side effects: GI upset, heartburn, nausea, vomiting, anorexia, GI bleeding, ototoxic (can cause hearing loss, tinnitus).
• Non-Salicylates (Acetaminophen)
  • Mechanism of action not fully understood.
  • Mild to moderate pain.
  • Antipyretic.
  • Helps manage pain for arthritic disorders.
  • Common side effects: Allergic reactions (hives), hepatic toxicity (liver damage).
• NSAIDs (Non-Steroidal Anti-inflammatory Drugs)
  • Mild to moderate chronic pain.
  • Anti-inflammatory.
  • Antipyretic.
  • Can be used for primary dysmenorrhea.
  • Common side effects: Increased risk of bleeding, GI upset, GI bleed, thrombocytopenia (low platelet count), anemia.
• Opiates (Narcotics)
  • Severe pain.
  • Can be used to reduce anxiety.
  • Can cause opiate dependency.
  • Common side effects: Sedation, respiratory depression, urinary retention.

Contraindications and Interactions

• Salicylates (Aspirin)
  • Contraindicated in: Bleeding disorders, patients undergoing surgery (within 7 days), children under 12 (due to risk of Reye's Syndrome).
  • Interactions: Anticoagulants (increased risk of bleeding), carbonic anhydrase inhibitors (increased risk of salicylism), alcohol (increased risk of bleeding).
• Non-Salicylates (Acetaminophen)
  • Contraindicated in: Patients with hepatic disease, alcoholics.
  • Interactions: Barbiturates (increased risk of barbiturate toxicity, decreased effect of acetaminophen), rifampin (increased risk of acetaminophen toxicity), loop diuretics (decreased effect of acetaminophen).
• NSAIDs
  • Contraindicated in: Third trimester of pregnancy, lactation, patients allergic to sulfa drugs, history of cardiovascular disease or stroke, bleeding disorders, allergy to aspirin.
  • Interactions: Anticoagulants (increased risk of bleeding), diuretics (decreased effectiveness of diuretics), antihypertensives (decreased effectiveness of antihypertensives), alcohol (increased risk of bleeding).
• Opiates
  • Contraindicated in: Children with bronchial asthma, emphysema, or upper airway obstruction (can depress respiration), patients with head injuries or increased intracranial pressure (can worsen condition), patients with convulsive disorders, severe renal or hepatic dysfunction.
  • Interactions: Alcohol (CNS depressant, increased risk of respiratory depression), sedatives, barbiturates (CNS depressants, increased risk of respiratory depression).

Adverse Reactions

• Salicylates (Aspirin)
  • GI bleed, ulceration, perforation.
• Non-Salicylates (Acetaminophen)
  • Hepatic toxicity, jaundice, abdominal pain, hemolytic anemia, pancytopenia (low blood cell count), hypoglycemia.
• NSAIDs
  • GI bleed, ulceration, perforation, thrombocytopenia, anemia.
• Opiates
  • Sedation, respiratory depression, urinary retention.

Nursing Interventions

• General
  • Administer analgesics with food to minimize GI upset.
  • Assess for history of GI problems or bleeding tendencies.
  • Discontinue analgesics at least one week prior to surgery.
  • Monitor for signs and symptoms of adverse reactions.
  • Monitor pain levels before and after administration of analgesics (use pain scale) and document.
• Acetaminophen (Tylenol)
  • Not indicated in patients with hepatic disease.
• Salicylates (Aspirin)
  • Not indicated in children under 12 with viral illnesses (due to risk of Reye's Syndrome). Monitor for signs and symptoms of Reye's Syndrome: vomiting, lethargy, coma, permanent brain damage, death.
• Opiates
  • Monitor for signs and symptoms of respiratory depression.
  • Protect patient safety (monitor sedation levels, closely supervise).
  • Taper patients off of opiates gradually after prolonged use.
  • Do not administer opiates with other depressants.

Antagonists (Naloxone)

• Action: Prevents or reverses effects of opiates.
• Uses: Post-operative respiratory depression, suspected opiate overdose (including emergency situations).
• Common side effects: Sweating, nausea, vomiting, tachycardia, tremors, increased blood pressure.
• Nursing Considerations: Monitor for rebound effects of opiates after administration.

This quiz covers the characteristics and classifications of controlled substances as well as their use in pain management. It includes information about different schedules of substances, their potential for abuse, and appropriate medications for varying levels of pain. Test your knowledge on this critical topic in pharmacology.