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Chap - 19


experienced or perceived only by the individual subjective
observation of patient's reaction to pain in terms of vital signs, position, & emotional response objective
pain has both psychological and __ components physiological
analgesics produced within the brain as a reaction to severe pain or intense exercise endorphins
produced within the brain endogenous
endorphins __ the transmission of pain block
relief from pain as the result of suggestion without administration of an analgesic placebo effect
classified as opioid, nonopioid, & adjuvant analgesics
classified as full or pure agonist, partial agonist, or mixes agonist-antagonists depending on specific receptors they bind to & their activity at the receptor opioids
commonly used because action similar to that of opium in altering the perception of pain full agonists
medication level at which there is no enhanced analgesia is said to have no ceiling to analgesic effects
morphine, hydromorphone, meperidine, oxycodone, & fentanyl will not __ __ like other classes reverse analgesia
listed under controlled substance schedule and include both the natural alkaloids and synthetics opioid
opioids tend to cause tolerance
with chronic use opioids can also cause dependence
addiction or psychological dependence is not a problem for patient's who require opioids for pain management
dependence is irrelevant for __ __ and should not be a consideration dying patients
more effective pain control can be achieved by combining opioids with nonopioid & __ drugs adjuvant
around-the-clock dosing, for terminally ill patients, prevents pain from developing
sometimes in the management of chronic pain therapy there is the addition to the analgesic regimen of tricyclic antidepressants or anticonvulsants
adjuvant analgesics __ the analgesic effects enhance
sedation, confusion, euphoria, restlessness/agitation, headache/dizziness, hypotension/bradycardia, urinary retention, nausea/vomiting, constipation, resp. distress, blurred vision, flushing, rash, pruritis are all side effects of opioids
in large doses of opioids a side effect can be seizures
head injuries, cardiac disease, hypotension, CNS depression, hepatic/renal/thyroid disease, COPD, asthma, pregnancy, lactation, pediatrics, elderly suicidal, alcoholic are all contraindications/extreme caution for opioids
higher doses of opioids are ___ for opioid-naïve patients contraindicated
psychotropics, alcohol, sedatives/hypnotics, muscle relaxants, antihistamines, antiemetics, antiarrhythmics, antihypertensives are all CNS depressants that are interactions for opioids because of potentiation of effect of opioids
perioperatively an opioid is frequently combined in a syringe with __ to reduce # of injections given concurrently anticholinergics
preoperative meds are usually administered ___ 30-60 min. before start of anesthesia intramuscularly
Meperidine is frequently combined with Phenergan postoperatively to__ analgesic effect potentiate
available in various strengths, as concentrated oral solutions & in combination products opioid antagonists
combination of morphine, for potentiation of analgesic effect, postoperatively is better for older adults
used to treat opioid overdoses & in delivery room & newborn nursery for opiate-induced respiratory depression opioid antagonists
Trade name Narcan; used to treat opioid overdoses & in delivery room & newborn nursery for opiate-induced respiratory depression naloxone
Trade name ReVia; used to treat alcohol & opiate dependence; acts by robbing the drugs pleasurable effects naltrexone
naltrexone is only used after withdrawal from opiates, such as __ & __, to help avoid relapses morphine; heroin
if ReVia is given to someone currently dependent on opiates, it can send them into instant severe life-threatening withdrawal
given for purpose of mild to moderate pain, fever, & anti-inflammatory conditions nonopioids
nonopioids are also used as __ in severe acute or chronic pain requiring opioids coanalgesics
aspirin, salsalate, & choline magnesium trisalicylate are salicylates
salicylates are most commonly used for analgesic, __ & __ properties antipyretic; anti-inflammatory
used for analgesic & antipyretic properties, but little effect on inflammation acetaminophen
patient should be instructed to check the ingredients of all __ __ because of potentially serious side effects combination products
salicylate analgesic & anti-inflammatory actions are associated primarily with preventing the formation of prostaglandins
prolonged bleeding time, bleeding/frequent bruising, gastric distress, ulceration, & bleeding; tinnitus & hearing loss w/overdose; coma, resp. failure, or anaphylaxis; GI symptoms are all side effects of salicylates & NSAIDs
GI ulcer & bleeding, bleeding disorders in patients taking anticoagulants, asthma, pregnancy, lactation, Vit.K deficiency are all contraindications of salicylates & NSAIDs
anemia, hepatic disease, renal disease, Hodgkin's disease, pre/postoperatively are all cautions of salicylates & NSAIDs
alcohol, anticoagulants, corticosteroids, antacids in high doses, insulin/oral antidiabetic agents, methotrexate, Probenecid, antihypertensives are all listed for interactions with of salicylates & NSAIDs
severe liver toxicity, renal insufficiency, rash/uticaria, blood dyscrasias are rare, but all side effects of acetaminophen
caution must be used with frequent acetaminophen use & alcohol ingestion because of potential liver damage
centrally acting synthetic analgesic compound similar in effect to opioids, but chemically unrelated tramadol (Ultram)
dizziness, somnolence, malaise, headache, nausea, constipation, sweating & pruritus, orthostatic hypotension, anxiety, confusion, rash, allergic reaction are all side effects of tramadol
increased intracranial pressure/head injury, renal/hepatic disease, seizure disorders, pregnant/nursing, under 16 yr, abrupt discontinuation, opiate agonist hypersensitivity are all contraindications of tramadol
may impair mental/physical abilities, & in older adults or anyone operating machinery cautions of tramadol
MAOIs/neuroleptics (increase seizure risk), carbamazepine (antagonizes action), SSRIs (increase serotonin syndrome) are all interactions for tramadol
originally intended for treatment of conditions other than pain adjuvant analgesics
used in treatment of nerve pain associated w/herpes, arthritis, diabetes & cancer, migraines or tension headaches, insomnia, & depression tricyclic antidepressants
tricyclic antidepressants actions are associated w/increasing available __ & __, which block pain transmission norepinephrine; serotonin
Elavil, Pamelor, & Tofranil are common tricyclic antidepressants used for treating pain
dry mouth, urinary retention, delirium, constipation, sedation, orthostatic hypotension, tachyarrhythmias, heart block in cardiac patients are all side effects of tricyclic antidepressants
is used w/prostatic hypertrophy, urinary retention, increased intraocular pressure & glaucoma cautions for tricyclic antidepressants
commonly used for nerve pain associated w/neuralgia, shingles, & cancer; implemented when patient described the pain as sharp, shooting, shock-like, or lightening-like anticonvulsants
generally considered a first-line anticonvulsant or neuropathic pain therapy Neurontin
Neurontin, Tegretol & Lamictal are all anticonvulsant drugs
sedation, dizziness, & confusion; nausea, vomiting, constipation, & anorexia; hypotension & unsteadiness; bone marrow suppression; and hepatitis are all side effects of anticonvulsant drugs
if used w/allergies, hepatitis, cardiac disease, & renal disease cautions of anticonvulsant drugs
hypersensitivity, psychiatric conditions, pregnancy, SA & AV block, hemolytic disorders, & abrupt discontinuation are all cautions for anticonvulsant drugs
alcohol, antacids, antineoplastics, CNS depressants, folic acid, Dilantin w/ any drug in solution, antiretrovirals can cause interactions with anticonvulsant drugs
brand name for hydromorphone Dilaudid
brand name for SR oxycodone Oxycontin
brand name for hydrocodone w/acetaminophen Lortab, Vicodin, & Lorcet
brand name for oxycodone w/aspirin Percodan or Endodan
acetaminophen w/codeine 15mg Tylenol #2
acetaminophen w/codeine 30mg Tylenol #3
acetaminophen w/codeine 60mg Tylenol #4
Percodan is an opioid analgesic that contains aspirin
used only infrequently as sedative-hypnotics because they have many serious, potentially dangerous side effects barbiturates
adjuvant analgesic used in management of nerve pain associated w/neuralgia & other conditions carbamazepine (Tegretol)
tricyclic antidepressant used to treat nerve pain associated w/migraine or tension headaches amitripytyline (Elavil)
local anesthetic used for management of pain from postherpetic neuralgia Lidoderm
Imitrex (sumatriptan) is prescribed in order to treat __ migraine headaches in adults acute
abrupt withdrawal of hypnotics may results in rebound insomnia
most common neurovascular headache & may cause nausea, vomiting, & sensitivity to light/noise migraine
developed based on observation that serotonin levels decrease while vasodilation & inflammation of vessels in brain increase as migraine symptoms worsen Serotonin Receptor Agonists (SRAs)
Phenobarbital is still used in the treatment of seizure disorders
hypnotic benzodiazepine temazepam Restoril
nonbenzodiazepine hypnotics zolpidem & zaleplon Ambien, Sonata
daytime sedation, confusion & headache-hangover effect are side effects of benzodiazepines
when a patient is applying a lidocaine patch, it must only be applied to __ skin intact
drugs administered to calm, soothe, or produce sedation are called sedatives
benzodiazepines & non-benzodiazepines are classified as non-barbiturates
Benadryl is not desirable as sedative-hypnotics for use by older patients because it may have an extended half-life leaving the slower metabolism and impaired circulatory system of these patient particularly susceptible to the side effects
sedative-hypnotic agents should prescribed for short-term use only
codeine is considered ___ because it suppresses coughs antitussive