Analgesic Drugs PDF

Chapter 10 Analgesic Drugs  An unpleasant sensory and emotional experience associated with an actual or potential tissue damage A personal experience Pain Whatever the patient says it is Exists when the patient says it dose...

Chapter 10 Analgesic Drugs  An unpleasant sensory and emotional experience associated with an actual or potential tissue damage A personal experience Pain Whatever the patient says it is Exists when the patient says it dose Pain involves physical factors, psychological factors and cultural Pain Management Important aspect to nursing care Pain is one of the most common factors for people seeking healthcare Pain can lead to: Suffering Economic burden  No single approach to effective pain management Tailored to each patients needs Pain Consider: Cause of the pain Manageme Existence of concurrent medical conditions nt Characteristics of pain Psychological and cultural Approach characteristic Requires on going assessments.  What are they??? Analgesi “Painkillers” cs Opioid analgesics Adjuvant analgesic drugs  Assist primary drugs in relieving pain NSAIDS Antidepressants Anticonvulsants Corticosteroids Adjuvant Example Adjuvant drugs for neuropathic pain Amitriptyline (Antidepressant) Drugs Gabapentin (anticonvulsants) NSAIDS and Corticosteroids help in reducing inflammation  Most common theory Gate Theory of Uses the analogy of a gate to describe hoe Pain impulses from damaged tissues are sensed in the brain Transmission Many current pain management strategies are aimed at altering this system  Patient comfort vs. fear of drug addiction Treatment of Opioid tolerance Pain in Special Use of placebos Situations Recognizing patients who are opioid tolerant PCA PCA by Proxy- Patient- Someone else controlled controls pain analgesia pump  Synthetic drugs that bind to opiate receptors to relieve pain Opioid Mild Agonists: codeine, Drugs hydrocodone Strong agonists: morphine, hydromorphone, oxycodone, meperidine, fentanyl and methadone  Drug reaches a maximum analgesic effect. Analgesia does not improve, Opioid even with higher doses Ceiling Pentazocine Nalbuphine Effect  Three classifications based on Analgesi their actions Agonists cs: Agonists-Antagonists- bind to one receptor to activate Mechanis agonist activity, then binds to another receptor to m of produce no or low receptor activation. (Pentazocine, Action butorphanol) Antagonists  Bind to an opioid pain receptor in the brain Agonis ts Cause an analgesic response (reduction of pain sensation)  Bind to a pain receptor Agonists- Cause a weaker Antagoni neurologic response than a full agonist sts Also called partial agonist or mixed agonist  Reverse the effects of these drugs on pain receptors Bind to a pain receptor Antagoni and exert no response sts Also known as competitive antagonist Example: Narcan  Ability to provide pain relief by calculating dosages of different drugs or routes of administration that provide comparable analgesia Hydromorphone (Dilaudid): seven times more potent than morphine Equianalges ia See box 10.2 Example: if morphine 10 mg was given to a patient followed 1 hour later by hydromorphone 1mg, then the patient would have received an equivalent of 17 mg of morphpine.  Mai use: to alleviate moderate to severe pain Analgesi Often given with adjuvant analgesic drugs to assist c primary drugs with pain relief Indicatio Opioids are also used for: Cough center ns suppression Treatment of diarrhea Balanced anesthesia  Known drug allergy Severe asthma Use in extreme caution in patients with: Analgesics: Respiratory insufficiency Contraindicati Elevated intracranial ons pressure Morbid obesity or sleep apnea Paralytic ileus Pregnancy  CNS depression Analgesics: Leads to respiratory depression Adverse Nausea and vomiting Urinary retention Effects Diaphoresis and flushing Pupil constriction Constipation Itching Analgesics Naloxone (Narcan) : Toxicity Naltrexone (ReVia) Regardless of withdrawal and symptoms, when a patient Managem experiences severe respiratory depression, an ent of opioid antagonist should be Overdose given.  Opioid withdrawal or opioid Analgesics: abstinence syndrome Toxicity Manifested as Anxiety, irritability, chills and and hot flahes, joint pain, Manageme lacrimation, rhinorrhea, diaphoresis, nausea, nt of vomiting, abdominal cramps, diarrhea, Overdose confusion  Analgesi Alcohol Antihistamines cs: Barbiturates Interactio Benzodiazepines Monoamine oxidase ns inhbitors  Related to the marigold Herbal family Anti inflammatory properties Product Used to treat migraine headaches, menstrual cramps, inflammation and s: fever May cause GI distress, Feverfe altered taste and muscle stiffness May interact with aspirin and w other NSAIDS as well as anticoagulants  Before beginning therapy, perform a thorough history regarding allergies, and use of other medications including Analgesics: alcohol, health history and medical history Nursing Process Obtain baseline vitals Assess for potential contraindications and drug interactions Perform a thorough pain assessment OLDCART O- Onset L- Location D-Duration C-Characteristics A-Aggravating factors R-Relieving factors T-treatments tried  Be sure to medicate patients before the pain becomes severe so as to provide adequate analgesia and pain control. Analgesics Pain management includes pharmacologic and nonpharmacologic : Nursing approaches; be sure to include other interventions as indicated. Implicatio Patients should not take other medications or OTC preparations ns without checking with their physicians. Alert physician with signs of a reaction or adverse effect.  Oral forms should be taken with food to minize gastric upset Ensure safety measures, such as keeping side rails up to prevent injury Withhold dose and contact physician if there is a decline in the patients condition or if vital signs are abnormal  Check dosages carefully Follow proper administration guidelines for IM injections, including site rotation Follow proper guidelines for IV administration, including dilution, rate of administration  Constipation is a common adverse effect and may be prevent with proper fiber and fluid intake Instruct patients to change positions slowly to prevent orthostatic hypotension  Monitor for therapeutic effects, which are?? Decreased complaints of pain and severity Increased periods of comfort Improved ADL’s Decreased fever