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Pain Medications

Narcotics and NSAIDs

In the brain, the __________ is a relay station for incoming sensory stimuli, including pain. thalamus
The ___________ nerve transmits pain signals to the ______ ____, and then to the ________. peripheral, dorsal horn, thalamus
Seizure meds are very effective at treating ___________ pain. neuropathic
______ analgesics are used to treat moderate to severe pain. Opioid
_________ analgesics are used to treat acute and chronic pain, and neuropathic or bone (somatic) pain. Nonopioid
Opioid analgesics relieve moderate to severe pain by __________ pain signal transmission from periphery to brain. inhibiting
Opioid analgesics are metabolized in the _____, and secreted in _____. liver, urine
Opioid analgesics are well absorbed __, __, and _____. PO, IM, SubQ
Opioids with highest potential for abuse, and risk of fatal overdose because of respiratory depression. fentanyl, hydromorphone, methadone, oxycodone, morphine
Morphine is most commonly given PO and IV (IVP, gtt, PCA)
Maximum analgesia with morphine occurs within _____ min. after IV, ___ min., after IM, __ min. after PO, _____ min. after SubQ. 10-20, 30, 60, 60-90
Impaired kidney or liver function may produce _________ ________. prolonged sedation
Codeine pro-drug (must be metabolized to be effective), weaker than morphine, PO route, up to 10% of ppl have problems with metabolizing.
Fentanyl 100x as potent as morphine, quick acting, transdermal patches for chronic/severe pain,
Hydrocodone (Vicodin, Lortab) combined with Tylenol (acetaminophen)-do not exceed dose limit!!! (4g), moderately potent
Hydromorphone (Dilaudid) 7-10x as potent as morphine, no active metabolites,
Meperidine (Demerol) problems with toxic metabolites-CNS stimulation, preferred in L&D for lowered effect on NB's respiratory system
Methadone longest duration of action (24h 1/2 life, used for severe pain and addiction treatment, prolonged QT syndrome
Oxycodone used for moderately-severe pain, can be combined with Tylenol (Percocet), short-acting (Percocet, OxyIR), long-acting (OxyContin)
Tramadol lowest potential for abuse (doesn't cross blood-brain barrier well – no euphoria, effective for fibromyalgia
half-life Morphine 2-3.5h
half-life Hydromorphone (Dilaudid) 2-3h
half-life Fentanyl 3-4h
half-life Oxycodone 2-3h
half-life Codeine 3h
half-life Methadone 24h
half-life Naloxone (Narcan) 2h
Equianalgesic Morphine to Hydromorphone (Dilaudid) 10mg to 1.5mg parenteral
Equianalgesic Morphine to Fentanyl 10mg to 0.1mg parenteral
Equianalgesic Morphine to Codeine 10mg to 130mg parenteral
Equianalgesic Morphine to Hydrocodone (Vicodin, Lortab) 30mg to 20mg oral
Equianalgesic Morphine to Oxycodone 30mg to 20mg oral
A patient is being switched from morphine 2-4mg IV to hydromorphone. What dosage do you anticipate the provider to prescribe? 0.3-0.6mg IV
Anti-prostaglandin drugs: NSAIDs Aspirin, Ibuprofen, Ketorolac, Indomethacin, Celecoxib
Prostaglandins are chemical mediators found in the body tissues, and exert all of the following: increased platelet aggregation, gastroprotection, increased body temperature, increased pain sensitivity
COX-1 inhibition: gastric erosion, platelet inhibition, renal toxicity
COX-2 inhibition: decreased inflammation, decreased pain, reduction of fever, protection against colorectal cancer, RENAL IMPAIRMENT, INCREASED RISK FOR CVA/MI, CONTRAINDICATED WITH SULFA ALLERGY
NSAIDs specific indications: inflammatory disorders (DJD, OA, RA), mild to moderate pain, fever, suppress platelet aggregation
NSAIDs contrainsications: peptic ulcer disease, GI or other bleeding disorders, impaired renal function, hypersensitivity to ASA, children, Pregnancy (ASA use with extreme caution, NEVER use Toradol)
NSAIDs adverse effects: GI: bleeding, n/v, ulceration, tinnitus (especially with ASA), nephrotoxicity, rash/itching, non-aspirin NSAIDs–increased risk of CVA/MI
NSAIDs nursing considerations: assess for allergies, assess for adverse effects: (bleeding [stool]) renal function), give with food to decrease GI irritation, ensure adequate fluid intake
NSAIDs Interactions: Decrease the effect of: antihypertensive drugs including diuretics, ACE inhibitors, Beta blockers; Increase the effect of anticoagulants; Garlic, Ginko, Ginseng increase risk of bleeding; Ibuprofen may limit cardioprotective effect of ASA
Platelet inhibition effect of aspirin lasts... 1 week
Acetaminophen :( no anti-inflammatory properties, metabolized in liver & small amount remains in body as toxic metabolite, dose limit: 4gm/24hrs DO NOT EXCEED!! Further dose limits for liver impairment or hx of ETOH abuse.
Acetaminophen toxicity may occur with: single large dose, chronic excessive doses, therapeutic doses in those who abuse alcohol
Acetaminophen toxicity: s/s are nonspecific, 24-48 hrs. after OD ALT & AST begin to increase, later manifistations: jaundice, vomiting, CNS, stimulation with excitement and delirium followed by coma and death.
Acetaminophen toxicity cont.: Gastric lavage & activated charcoal w/in 4 hrs, Acetylcystine (Mucomyst) w/in 10 hrs. may be helpful w/in 36 hrs., WILL NOT REVERSE DAMAGE ALREADY SUSTAINED
Created by: aek