Pain Management and Analgesics Overview

Study Notes

Pain management is most effective when analgesics are administered before pain becomes severe.
Opioids are categorized based on their potential for abuse.
Schedule 1 drugs, such as heroin, have a high potential for abuse.
Schedule 2-5 drugs are controlled substances under the Controlled Substance Act of 1970.
All controlled substances must be accounted for by licensed personnel.
Waste must be witnessed and co-signed by another licensed individual.

Aspirin has anti-inflammatory, anticoagulant, analgesic, and antipyretic properties.
It inhibits prostaglandin synthesis.
Aspirin can irritate the gastric mucosa.
Patients should take aspirin with milk or food.
Caution is advised for patients with peptic ulcers.
High risk of bleeding exists when taken with anticoagulants.
Tinnitus (ringing in the ears) is a sign of aspirin toxicity.

NSAIDs include Ibuprofen (Motrin), Naproxen (Naprosyn), Indocin (Indomethacin), and Ketorolac (Toradol).
NSAIDs have anti-inflammatory, analgesic, and antipyretic effects.
NSAIDs can irritate the gastric mucosa.
Patients should take NSAIDs with milk or food.
Use caution with patients with a history of peptic ulcers.
NSAIDs affect coagulation (platelet aggregation).
Use cautiously with the elderly.
Use the lowest effective dose for the shortest possible period in the elderly.
Avoid taking over-the-counter medications while taking NSAIDs.
Avoid taking NSAIDs with ACE Inhibitors.

Opioids include Codeine, morphine, opium, and various opium derivatives.
Respiratory depression can occur in elderly patients.
Codeine:
- Used for mild to moderate pain.
- Duration of action is 4-6 hours.
- Can cause constipation.
- Common side effects include dizziness and sedation.
Combination Dosage Forms (Tylenol #1-4):
- Contains acetaminophen and codeine phosphate in various strengths.
Morphine:
- Used for moderate to severe pain, both acute and chronic.
- Common side effects include nausea, vomiting, sedation, and dizziness.
- Morphine is versatile and can be administered via various routes.
- IV push should be administered slowly over 4-5 minutes per 15mg.
- Dilute morphine before IV administration.
- Do not mix morphine with other drug solutions as it can form a precipitate.
- Flush tubing thoroughly with 0.9% saline before and after IV administration.
- Do not use dextrose solutions.
- Use an inline filter to collect particulate matter.

Benzodiazepines include Lorazepam (Ativan), Diazepam (Valium), Alprazolam (Xanax), Triazolam (Halcion), Midazolam (Versed), and Temazepam (Restoril).
They are sedative/hypnotic medications.
Indications for benzodiazepines include:
- Anxiety.
- Sedation.
- Alcohol withdrawal treatment or prevention.
- Seizure or status epilepticus treatment.
- Nausea.
- Muscle spasm.
Benzodiazepines are available orally or as injections/infusions.
Adverse reactions include:
- Drowsiness.
- Confusion.
- Lethargy.
- Ataxia.
- Respiratory depression.
- Increased intraocular pressure.
Administer cautiously with other CNS depressants.
Monitor patients closely for effects.
Benzodiazepines have potential for abuse, misuse, and addiction.
Consider tapering the dose to prevent withdrawal symptoms.
Flumazenil is the antidote for benzodiazepines.

Tricyclic Antidepressants: Amitriptyline (Elavil), Trazodone (Desyrel).
Serotonin Reuptake Inhibitors: Fluoxetine (Prozac), Sertraline Hydrochloride (Zoloft).
Selective Serotonin Reuptake Inhibitors (SSRIs): Lexapro (Escitalopram), Paroxetine (Paxil), Venlafaxine (Effexor), Citalopram (Celexa).
Antidepressants take 3-4 weeks to achieve therapeutic effects.
Overdose symptoms include CNS signs (confusion, agitation), autonomic effects (dilated pupils, flushing, hyperpyrexia), and cardiovascular signs (tachycardia, arrhythmias, hypotension).
Common side effects include sedation, atropine-like reactions (dry mouth, blurred vision, tachycardia), rash, urticaria, and constipation.
Advise patients not to abruptly stop taking antidepressants.