Pain Management: Acute vs Chronic Pain

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Questions and Answers

What is the primary use of opioid drugs?

To treat diarrhea

To alleviate moderate to severe pain (correct)

To suppress cough center

To alleviate mild pain

What is the maximum analgesic effect achieved by a drug called?

Adjuvant analgesic effect

Opioid tolerance

Opioid ceiling effect (correct)

Physical dependence

What is an example of an adjuvant drug for neuropathic pain?

Pentazocine

Corticosteroids

Amitriptyline (correct)

NSAIDs

What is a serious adverse effect of opioid drugs?

CNS depression Signup and view all the answers

When should an opioid antagonist be given to a patient?

When a patient experiences severe respiratory depression Signup and view all the answers

What is chronic pain characterized by?

Persistent or recurring and lasts 3 to 6 months Signup and view all the answers

What is the main difference between acute and chronic pain?

Duration of pain Signup and view all the answers

What is a contraindication for opioid use?

Known drug allergy Signup and view all the answers

What is the effect of opioid drugs on the CNS?

Depression Signup and view all the answers

What is an example of an opioid drug used to treat diarrhea?

Loperamide Signup and view all the answers

What is the primary mechanism by which opioids produce analgesia?

Stimulation of opioid receptors in the brain and spinal cord Signup and view all the answers

What is the main difference between opioid tolerance and physical dependence?

Tolerance is a physical phenomenon, whereas physical dependence is psychological Signup and view all the answers

Which of the following opioids has a ceiling effect?

Codeine Signup and view all the answers

What is the primary indication for methadone maintenance programs?

Detoxification from opioid addiction Signup and view all the answers

What is the primary mechanism of action of acetaminophen?

Inhibition of prostaglandin synthesis Signup and view all the answers

Which of the following opioids is often combined with acetaminophen?

Oxycodone Signup and view all the answers

What is the primary use of naloxone?

Reversal of opioid-induced respiratory depression Signup and view all the answers

Which of the following is a common adverse effect of codeine?

GI disturbance Signup and view all the answers

What is the equivalent dose of fentanyl to 10 mg of morphine?

0.1 mg Signup and view all the answers

What is the primary indication for oxycodone?

Severe pain Signup and view all the answers

What is a key instruction to patients to prevent orthostatic hypotension?

Change positions slowly Signup and view all the answers

What is a manifestation of respiratory depression?

Dyspnea and diminished breath sounds Signup and view all the answers

What is a therapeutic effect of medication?

Decreased fever Signup and view all the answers

What is Feverfew related to?

The marigold family Signup and view all the answers

What is a possible interaction of Feverfew?

With anticoagulants Signup and view all the answers

What should patients do if they experience a decline in their condition?

Contact a physician immediately Signup and view all the answers

What is a common adverse effect of medication?

Constipation Signup and view all the answers

What is a property of Feverfew?

Anti-inflammatory Signup and view all the answers

What is a therapeutic effect of medication on activities of daily living?

Increased ability Signup and view all the answers

What is a possible side effect of Feverfew?

Altered taste Signup and view all the answers

What is a possible contraindication for taking acetaminophen?

G6PD deficiency Signup and view all the answers

What is the recommended antidote for acetaminophen overdose?

Acetylcysteine Signup and view all the answers

What is the primary mechanism of action of tramadol?

Inhibits the reuptake of norepinephrine and serotonin Signup and view all the answers

What is the primary indication for lidocaine?

Postherpetic neuralgia Signup and view all the answers

What is a key component of the nursing process assessment for pain management?

All of the above Signup and view all the answers

Why should patients be instructed to take oral forms of pain medication with food?

To minimize gastric upset Signup and view all the answers

What should the nurse do if a patient's vital signs are abnormal, especially if the respiratory rate is less than 10 to 12 breaths/min?

Withhold the dose and contact the physician Signup and view all the answers

What is a key consideration for nurses when administering IM injections?

Rotating the injection site Signup and view all the answers

Why should patients be instructed to notify their physician about signs of allergic reaction or adverse effects?

To identify potential complications and take prompt action Signup and view all the answers

What is the purpose of pain management in nursing?

To provide adequate analgesia and pain control Signup and view all the answers

Study Notes

Acute vs Chronic Pain

Acute pain has a sudden onset and usually subsides once treated
Chronic pain is persistent or recurring and lasts 3 to 6 months, often difficult to treat
Tolerance and physical dependence can occur in chronic pain management

Adjuvant Drugs

Assist primary drugs in relieving pain
Examples include NSAIDs, antidepressants, anticonvulsants, and corticosteroids
Adjuvant drugs can be used to treat neuropathic pain, such as amitriptyline and gabapentin or pregabalin

Opioid Ceiling Effect

A drug reaches a maximum analgesic effect, and further dose increases do not improve analgesia
Examples include pentazocine and nalbuphine

Opioid Drugs

Main use: to alleviate moderate to severe pain
Often given with adjuvant analgesic drugs to assist primary drugs with pain relief
Other uses include cough center suppression, treatment of diarrhea, and balanced anesthesia
Contraindications: known drug allergy, severe asthma, use with extreme caution in patients with respiratory insufficiency, elevated intracranial pressure, morbid obesity or sleep apnea, paralytic ileus, and pregnancy
Adverse effects: CNS depression, respiratory depression, nausea and vomiting, urinary retention, diaphoresis and flushing, pupil constriction, constipation, and itching
Management of overdose: naloxone (Narcan) and naltrexone (ReVia)
Withdrawal symptoms: anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, and confusion

Opioid Tolerance, Physical Dependence, and Psychologic Dependence

Opioid tolerance: a common physiologic result of chronic opioid treatment, requiring larger doses to maintain analgesia
Opioid physical dependence: a physiologic adaptation of the body to the presence of an opioid, leading to withdrawal symptoms when the drug is stopped
Opioid psychologic dependence: a pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

Opioid Analgesics: Interactions

Interactions with alcohol, antihistamines, barbiturates, benzodiazepines, monoamine oxidase inhibitors, and other drugs

Specific Opioid Analgesics

Codeine sulfate: opioid agonist, natural opiate alkaloid, often combined with acetaminophen, Schedule III, commonly used as an antitussive drug
Fentanyl: synthetic opioid, Schedule II, used to treat moderate to severe pain, available in various forms
Hydromorphone (Dilaudid): very potent opioid analgesic, Schedule II drug, equivalent to 7 mg of morphine
Methadone hydrochloride (Dolophine): synthetic opioid analgesic, Schedule II, used in methadone maintenance programs, prolonged half-life can cause unintentional overdoses and deaths
Morphine sulfate: naturally occurring alkaloid, Schedule II controlled substance, indication: severe pain, high abuse potential
Oxycodone hydrochloride: analgesic agent structurally related to morphine, Class II, comparable analgesic activity to morphine, often combined with acetaminophen or aspirin

Nonopioid Analgesics

Acetaminophen (Tylenol): analgesic and antipyretic effects, little to no antiinflammatory effects, available OTC and in combination products with opioids
Mechanism of action: blocks pain impulses peripherally by inhibiting prostaglandin synthesis
Indications: mild to moderate pain, fever, alternative for those who cannot take aspirin products
Dosage: maximum daily dose for healthy adults is being lowered to 3000 mg/day, 2000 mg for older adults and those with liver disease
Contraindications/interactions: drug allergy, liver dysfunction, possible liver failure, G6PD deficiency, hepatotoxic drugs, and alcohol
Overdose management: acetylcysteine regimen
Tramadol hydrochloride (Ultram): centrally acting analgesic with a dual mechanism of action, indicated for moderate to moderately severe pain, adverse effects similar to opioids
Lidocaine: topical anesthetic, indications: postherpetic neuralgia, minimal adverse effects, skin irritation may occur

Nursing Process Assessment

Obtain a thorough history regarding allergies, medications, health history, and medical history
Perform a thorough pain assessment including pain intensity, character, location, description, precipitating and relieving factors, and type of remedies and other pain treatments
Pain is considered a fifth vital sign
Assess for potential contraindications and drug interactions

Nursing Implications

Be sure to medicate patients before pain becomes severe to provide adequate analgesia and pain control
Include pharmacologic and nonpharmacologic approaches in pain management
Instruct patients to notify physicians about signs of allergic reaction or adverse effects
Ensure safety measures, such as keeping side rails up, to prevent injury
Monitor for adverse effects, including respiratory depression, and therapeutic effects, including decreased complaints of pain and improved activities of daily living

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Description

Understand the differences between acute and chronic pain, and how adjuvant drugs assist in relieving pain. Learn about the opioid ceiling effect and its implications.