Chapter 10: Analgesic Drugs

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Questions and Answers

What is a key factor in determining an effective pain management approach?

The cause of the pain (correct)

The patient's gender

The patient's age

The physician's preferences

What role do adjuvant analgesic drugs play in pain management?

They assist primary drugs in relieving pain. (correct)

They only focus on psychological treatment.

They are exclusively for chronic pain.

They are the primary medication for pain relief.

Which of the following is NOT considered a characteristic to assess in pain management?

The patient's color preferences (correct)

Psychological factors

Concurrent medical conditions

Cultural factors

What does the Gate Theory of Pain primarily explain?

How impulses from damaged tissues are sensed in the brain. Signup and view all the answers

Which of these drugs is classified as an adjuvant analgesic for neuropathic pain?

Amitriptyline Signup and view all the answers

What is one of the indications for the use of opioids?

Cough center suppression Signup and view all the answers

Which condition is considered a contraindication for the use of opioids?

Elevated intracranial pressure Signup and view all the answers

What is a common adverse effect associated with analgesics?

Urinary retention Signup and view all the answers

In cases of severe respiratory depression caused by opioids, which medication should be administered?

Naloxone (Narcan) Signup and view all the answers

Which of the following conditions requires extreme caution when using analgesics?

Respiratory insufficiency Signup and view all the answers

What is the primary function of opioid agonists?

To bind to opiate receptors and relieve pain Signup and view all the answers

Which of the following drugs is classified as a strong agonist?

Fentanyl Signup and view all the answers

What effect does opioid ceiling effect have on pain relief?

There is no further improvement in analgesia with increased doses Signup and view all the answers

Which classification of opioids causes a weaker response than a full agonist?

Agonists-Antagonists Signup and view all the answers

What is the role of Narcan in opioid treatment?

To reverse the effects of opioids on pain receptors Signup and view all the answers

How is equianalgesia defined?

Calculating dosages of different drugs for comparable analgesia Signup and view all the answers

Which opioid drug is noted to be seven times more potent than morphine?

Hydromorphone Signup and view all the answers

What characterizes an opioid antagonist?

It binds to pain receptors with no response Signup and view all the answers

What is NOT a symptom of opioid withdrawal?

High fever Signup and view all the answers

Which substance should be considered potentially interacting with analgesics?

Antihistamines Signup and view all the answers

What should be performed before beginning therapy with analgesics?

Perform a thorough history regarding allergies Signup and view all the answers

What is the purpose of the OLDCART acronym in pain assessment?

To identify pain characteristics Signup and view all the answers

What should patients be cautious about concerning OTC medications when on analgesics?

Not take medications without consulting a physician Signup and view all the answers

What is one potential side effect of using herbal products related to the marigold family?

Muscle stiffness Signup and view all the answers

What approach is encouraged for managing pain according to nursing implications?

Combining both pharmacologic and nonpharmacologic approaches Signup and view all the answers

What action should be taken if patients exhibit signs of a reaction to analgesics?

Alert the physician Signup and view all the answers

Study Notes

Pain

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage
Pain is a personal experience
Pain exists when the patient says it exists
Pain involves physical, psychological, and cultural factors

Pain Management

Pain management is an important aspect of nursing care.
Pain is one of the most common reasons people seek healthcare.
Pain can lead to suffering and economic burden.
There is no single approach to effective pain management.
Pain management is tailored to each patient's needs.
Consider the cause of pain, concurrent medical conditions, pain characteristics (psychological and cultural), and ongoing assessments.

Analgesics

Analgesics are “painkillers.”
Analgesic drugs include opioid analgesics and adjuvant analgesic drugs.
Adjuvant analgesic drugs assist primary drugs in relieving pain.
Examples of adjuvant analgesics include NSAIDs, antidepressants, anticonvulsants, and corticosteroids.
Adjuvant drugs for neuropathic pain include amitriptyline (antidepressant) and gabapentin (anticonvulsants).
NSAIDs and corticosteroids reduce inflammation.

Gate Theory of Pain Transmission

The gate theory of pain transmission is a common theory used to explain how impulses from damaged tissues are sensed in the brain.
Many current pain management strategies aim to alter this system.

Treatment of Pain in Special Situations

Pain management can involve balancing patient comfort with fear of drug addiction.
Treatment should address opioid tolerance.
Treatment may include the use of placebos.
Healthcare professionals should recognize patients who are opioid tolerant.

Patient-Controlled Analgesia (PCA)

PCA allows patients to self-administer pain medication.
PCA by Proxy allows another person to control the pain pump.

Opioid Drugs

Opioid drugs are synthetic drugs that bind to opiate receptors to relieve pain.
Mild agonists include codeine and hydrocodone.
Strong agonists include morphine, hydromorphone, oxycodone, meperidine, fentanyl, and methadone.

Opioid Ceiling Effect

Opioid ceiling effect occurs when a drug reaches a maximum analgesic effect.
Analgesia does not improve even with higher doses of the drug.
Pentazocine and nalbuphine are examples of drugs that exhibit a ceiling effect.

Mechanisms of Analgesic Action

Analgesics are classified into three groups based on their actions: agonists, agonists-antagonists, and antagonists.

Agonists

Agonists bind to an opioid pain receptor in the brain.
Agonists cause an analgesic response (reduction of pain sensation).

Agonists-Antagonists

Agonists-antagonists bind to a pain receptor.
Agonists-antagonists cause a weaker neurological response compared to a full agonist.
Agonists-antagonists are also called partial agonists or mixed agonists.

Antagonists

Reverse the effects of these drugs on pain receptors.
Bind to pain receptors and exert no response.
Also known as competitive antagonists.
Example: Narcan.

Equianalgesia

Equianalgesia is the ability to provide pain relief by calculating dosages of different drugs or routes of administration that provide comparable analgesia.
Example: Hydromorphone (Dilaudid) is seven times more potent than morphine.
Example: If a patient is given morphine 10mg, and 1 hour later hydromorphone 1mg, the patient would have received an equivalent of 17mg of morphine.

Analgesic Indications

Used to alleviate moderate to severe pain.
Often given with adjuvant analgesic drugs to assist primary drugs with pain relief.
Other uses: cough center suppression, treatment of diarrhea, and balanced anesthesia.

Analgesics: Contraindications

Known drug allergy.
Severe asthma.
Use with extreme caution in those with respiratory insufficiency, elevated intracranial pressure, morbid obesity or sleep apnea, paralytic ileus, and pregnancy.

Analgesics: Adverse Effects

CNS depression (which leads to respiratory depression).
Nausea and vomiting.
Urinary retention.
Diaphoresis and flushing.
Pupil constriction
Constipation.
Itching.

Analgesics: Toxicity and Management of Overdose

Toxicity is managed with Naloxone (Narcan) or Naltrexone (ReVia).
Even if a patient is experiencing withdrawal symptoms, an opioid antagonist should be administered if they have severe respiratory depression.
Opioid withdrawal or opioid abstinence syndrome is characterized by anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, and confusion.

Analgesics: Interactions

Alcohol, antihistamines, barbiturates, benzodiazepines, and monoamine oxidase inhibitors can interact with analgesics.

Herbal Products: Feverfew

Feverfew is related to the marigold family.
Feverfew has anti-inflammatory properties and is used to treat migraine headaches, menstrual cramps, inflammation, and fever.
Feverfew may cause GI distress, altered taste, and muscle stiffness.
Feverfew may interact with aspirin, other NSAIDs, and anticoagulants.

Analgesics: Nursing Process

Before beginning therapy, perform a thorough history regarding allergies and the use of other medications, including alcohol, health history, and medical history.
Obtain baseline vitals.
Assess for potential contraindications and drug interactions.
Perform a thorough pain assessment using the OLDCART acronym:
O-Onset
L-Location
D-Duration
C-Characteristics
A-Aggravating factors
R-Relieving factors
T-treatments tried
Medicate patients before pain becomes severe to provide adequate analgesia and pain control.
Pain management includes pharmacologic and nonpharmacologic approaches; include other interventions as indicated.
Patients should not take other medications or OTC preparations without checking with their physicians.
Alert the physician to any signs of a reaction or adverse effect.

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Description

This quiz explores the critical aspects of pain management in nursing care, including the nature of pain, its personal experience, and factors affecting it. It also discusses various analgesics and their roles in effective pain relief tailored to patient needs. Test your knowledge on pain management strategies and analgesic classifications.