Pain Management Medications PDF

1. Differentiate pain medication selection based on type of pain (somatic, visceral, neuropathic) *somatic pain: localized; pinprick, stabbing, or sharp; A-delta fiber activity located in the periphery; ex: periosteum, joints, muscles, sickle cell, laceration, burns, IM injections, venous access...

1. Differentiate pain medication selection based on type of pain (somatic, visceral, neuropathic) *somatic pain: localized; pinprick, stabbing, or sharp; A-delta fiber activity located in the periphery; ex: periosteum, joints, muscles, sickle cell, laceration, burns, IM injections, venous access, stomatitis, abrasion *visceral pain: generalized; aches, pressure, or sharp; C fiber activity involved deeper innervation; ex: colic spam pain, appendicitis, kidney stone, chronic pancreatiti, IBS, angina, menstrual cramps *neuropathic pain: (pain caused by a lesion or disease of the somatosnsory nervous system) radiating or specific; burning, prickling, tingling, electric sock-like, or lancinsting; dermatomal (periphery) or non-dermatomal (central); ex: trigeminal neuralgia, avulsion neuralgia, posttramatic neuralgia, peripheral neuropathy (diabetes, HIV), limb amputation, herpetic neuralgia *note: somatic and visceral pain are nociceptive pain (pain arising from actual or threatened damage to non-neural tissue and is d/t activation of nociceptors) 2. Ibuprofen contraindications, adverse reactions, pt teaching *contraindications: hypersensitivity (including aspirin), active GI bleed/ulcer, CABG surgery, hx of MI, severe HF, OB avoid after 30 weeks *adverse reactions: black box warning: GI bleed (less GI bleeding compared to asprin-still a risk!), CV events (HF, stroke, MI); SJS, constipation, dyspepsia, nausea, vomiting, headache, renal failure, intraventricular hemorrhage *pt teaching: adults- don’t exceed 3200 mgs/day, children- max dose 2.4 g/day, increased hypersensitivity w/ asthma, aspirin induced allergy, nasal polyps, assess GI bleeding s/s (high death risk w/ elderly), assess pain, fever, arthritis, PDA closure, monitor renal, K+, liver enzymes (AST, ALT), bleeding time, higher doses- hydrate well prior to administration, rapid effects- administer 30 min before or 2 hr after meal, decrease GI SE- adminidter w/ food/mild/antacid, may caue fetal harm prior to 20 weeka (oligohydramnios) & 30 week gestation (premature closure of FDA) 3. Opioid analgesics names *(strongest to weakest) fentanyl, buprenorphine, levorphanol, oxymorphone, hydromorphone, phenazocine, methadone, oxycodone, morphine, hydrocodone, tapentadol, dihydrocodeine, tramadol, codeine 4. DEA drug schedule definition and drugs associated with it *schedue 1: drugs w/ no currently accepted medical use and a high potential for abuse, ex. drugs- heroin, lysergic acid diethylamide (LSD), marijuana, 3,4-methylenedioxymethamphetamine (ecstacy), methaqualone, and peyote *schedule 2: drugs w/ a high potential for abuse, w/ use potentially leading to severe psychological or physical dependence, these are also considered dangerous, ex. drugs- combination products w/ less than 15 milligrams of hydrocodone per dosage unit (vicodin), cocaine, methamphetamine, methadone, hydromorphone (dilaudid), meperidine (demerol), oxycodone (oxycontin), fentanyl, dexedrine, adderall, and ritalin *schedule 3: drugs w/ a moderate to low potential for physical and psychological dependence, these drugs abuse potential is less than schedule 1 and 2 drugs but more than schedule 4, ex. drugs- products containing less than 90 miligrams of codeine per dosage unit (tylenol w/ codeine), ketamine, anabolic steroids, testosterone *schedule 4: drugs w/ a low potential for abuse and low risk of dependence, ex. drugs- xanax, soma, darvon, darvocet, valium, ativan, talwin, ambien, tramadol *schedule 5: drugs w/ lower potential fo abuse than schedule 4 and consist of preparations containing limited quantities of certain narcotics, generally used for antidiarrheal, antitussive, and analgesic purposes, ex. drugs- cough preparations w/ less than 200 milligrams of codeine per 100 milliliters (robitussin AC), lomotil, motofen, lyrica, parepectolin 5. Opioid adverse reaction, nursing considerations, education *morphine: adverse reactions- hypotension, constipation, sedation, flushing, itching, urinary retention, dizziness, miosis, cough suppression, RESPIRATORY DEPRESSION; considerations- opioid naïve pts: START LOW!, lager doses may be needed for chronic therapy, assess PQRST of pain prior and following peak of drug, may need breakthrough boluses as needed, assess LOC, BP, HR, RR, pulse ox before/duing therapy (consider holding for any abnormalities), prolonged use may lead to physical/psychological dependence & tolerance, assess r/f opioid addiction, abuse, med misuse, assess bowel fuction routinely-manage constipation, opioid antagonists is required for reversing respiratory depression/come (nalaxone 0.4 mg amp diluted in 10 mL NS), do not confuse MS Contin and Oxytocin, morphine and hydromorphone, administer IV over 5 min (rapid admin can cause circulatory collapse-death); education- proper storage & disposal (protect from theft & do not give to family/friends), may cause drowsiness (call don’t fall, avoid driving), call 911 for any respiratory depression, may want naloxone at home, aggressive constipation management, early mobilization, no use of CNS depressants or alcohol w/ concurrent use 6. Opioid antagonists *naloxone (Narcan), methylnaltrexone (Relistor), naltrexone (ReVia, Vivitrol), nalmefene *(naloxone) acts as antagonists at Mu & Kappa receptors, DOES NOT produce analgesics or other effects causes by opioid agonsits, principle use is the reversal of respiratory and CNS depression w/ opioid agonist overdose, (methylnaltrexone) is used to treat opioid induced constipation *note: opioid antagonists is required for reversing respiratory depression/coma (naloxone 0.4 mg amp diluted in 10 mL NS) 7. COX 1 vs COX 2 inhibitors indications, contraindications, drug interactions, adverse effects, nursing consideration, pt teaching *4 types of COX inhibitors: 1st gen NSAIDs- aspirin-review previous module- testable, first gen NSAIDs- all others, second gen NSAIDs- CoxibsCox, acetaminophen *COX 1: (aka “Good COX) found in all tissue, protects gastric mucosa, supports renal function, promotes platelet aggregation *COX 2: (aka “Bad COX”) mainly produced at the site of tissue injury (mediates inflammation, sesnitizes receptors to painful stimuli), in the brain mediates fever & pain perception, in the kidneys supports renail function, in the blood vessels promotes vasodilation, in the colon contributes to colon cancer *note: inhibiting COX 1= harmful events, inhibiting COX 2= largely beneficial effects (ex. Promotion of stroke/MI r/t vasoconstriction *1st gen NSAIDs: inhibits COX 1 & 2, BEERS drug, indications- fever, mild/mod pain, arthritis, dysmenorrhea (inhibition of uterine smooth muscle COX); contraindication- hypersensitivity (including aspirin), active GI bleed/ulcer, CABG surgery, hx MI, severe HF- OB avoid after 30 weeks; drug interaction- aspirin may decrease effectiveness of ibuprofen, additional GI effects w/ aspirin, oral K+, other NSAIDs, corticosteroids, alcohol, increased r/f bleeding w/ other NSAIDs and anticoags/antiplatelet; adverse reactions: black box warning: GI bleed (less GI bleeding compared to asprin-still a risk!), CV events (HF, stroke, MI); SJS, constipation, dyspepsia, nausea, vomiting, headache, renal failure, intraventricular hemorrhage; nursing considerations: adults- don’t exceed 3200 mgs/day, children- max dose 2.4 g/day, increased hypersensitivity w/ asthma, aspirin induced allergy, nasal polyps, assess GI bleeding s/s (high death risk w/ elderly), assess pain, fever, arthritis, PDA closure, monitor renal, K+, liver enzymes (AST, ALT), bleeding time, higher doses- hydrate well prior to administration, rapid effects- administer 30 min before or 2 hr after meal, decrease GI SE- adminidter w/ food/mild/antacid, may caue fetal harm prior to 20 weeka (oligohydramnios) & 30 week gestation (premature closure of FDA) *COX 2: indications- OA, RA, ankylosing spondylitis, juvenile idiopathic arthritis, acute pain, dysmenorrhea, off label familial adenomatous polyposis (FAP), considered last choice for chronic pain due to CV risk; contraindications- same as 1st gen NSAIDs PLUS-reaction to sulfonamides (drug contains sulfar molecules), severe renal/liver impairment; adverse effects- most common dyspepsis, abd pain, CV risk (HF, stroke, thrombosis, HTN), questionable gastric ulcer risk (does not inhibit COX 1)/GI bleed; considerations- may be administered w/o regard to meals, assess GI toxicity, assess renal.liver function prior to therapy *acetaminophen: inhibits prostaglandin synthesis. Indication- mild pain, fever, moderate/severe pain (IV only); contraindications- hypersensitivity to alcohol, aspartame, saccharin, sugar, tartazine (FDC yellow dye #5), severe haptic impairment/acute liver disease; adverse effects- SJS, constipation, hepatoxicity, renal failure, agitation (children); drug-drug interaction- other hepatoxic substances-additive effects, concurrent use of NSAIDs may increase renal effects (avoid concurrent use); consideration: assess liver, kidney, alcohol use & organ function, do not exceed maximum daily dose (consider all routes & combination products [opioids w/ tyn), do not take longer than 10 days (adults) and 5 days (children), avoid alcohol (3 or more glasses per day increases liver damage), may alter blood glucose monitoring (false low or high) First-Gener First-Generat Second-Genera Acetaminophen ation ion NSAIDS: tion NSAIDS: (lacks NSAIDS: All Others Coxibs (COX 2 antiinflammatory Aspirin (COX 1 & 2 inhibition-rever effects) COX 1 & 2 (COX 1 & 2 inhibition-rev sible) very Inhibition-i esible) selective-stays at rreversible peripheral ) sites-reversible Indications Inflammation Yes Yes Yes No Pain Yes Yes Yes Yes Fever Yes Yes No Yes MI/Stroke Yes No No No prevention Adverse Effects  Gastric ulceration Yes Yes Yes (maybe less No than other NSAIDS) Renal impairment Yes Yes Yes No Bleeding Yes Yes No No MI/Stroke No Yes Yes No Liver damage w/ No No No Yes overdose 8. Acetaminophen overdose antidote *N-acetycteine (Acetadoe)- most effective when given within 8 hrs