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NRSG Pharm CH 18
Analgesics
| Question | Answer |
|---|---|
| Nociceptive pain | Results from stimulus |
| Somatic pain | Skin, bones, muscles |
| Visceral pain | Abdominal or thoracic areas |
| Neuropathic | Nerve injury, often stabbing or buring |
| Nociceptor stim A fibers | Sharp, well-defined pain |
| Nociceptor stim C fibers | dull, poorly localized pain |
| Substance P | neurotx that continues pain message. Activity of substance P influenced by other nerurotx - endogenous opioids. |
| Opioid Agonist (highly effective) | fentanyl, hydromorphone (Dilaudid), meperidine (Demerol), methadone, morphine |
| Opioid Agonist (moderately effective) | Codeine, hydrocodone, oxycodone (OxyContin), tramadol (Ultram) |
| Opioids w/ mixed agonist-antagonist effects | Buprenorphine (Buprenex) |
| Buprenorphine (Buprenex) considerations | Used to treat moderate pain, partial agonist = stim opioid receptors for analgesia, cause less resp depression, less risk for dependence. |
| Morphine (Duramorph) classes, action | Opioid receptor agonist, binds with both mu and kappa receptor sites for profound analgesia . Symptomatic relief of moderate to severe acute or chronic pain |
| Morphine (Duramorph) considerations | Sch 2, preg cat D, drug-drug- CNS depressants, alcohol, other opioids, gen anesthetics, sedatives, MAOIs, TCAs potentiate resp depression and death |
| Morphine (Duramorph) side/adverse | Nausea, constipation, dizziness, itching, ortho hypo euphoria, constriction of pupils, severe resp depression and cardiac arrest, tolerance, physical and physiological dep |
| Naloxone (Narcan) classes, mech | Drug for acute opioid OD, opioid receptor antagonist, blocking both mu and kappa receptors |
| Naloxone (Narcan) uses | reverse resp depression and other acute s/s of opioid addiction, tox, OD IV reverses CNS resp dep within minutes. Will immediately cause opioid withdrawal sx in pt with dependence. |
| Naloxone (Narcan) auto-injector | Evzio |
| Naloxone (Narcan) adverse | Minimal tox, however reversal of opioids may result in rapid loss of analgesia, inc BP, tremors, hyperventilation, N/V, drowsiness Monitor pt resp status |
| Tx for opioid dependence | Methadone maintenance (avoid withdrawal sx), months-years Buprenorphine (Buprenex) - mixed opioid agonist-antagonist Buprenorphine and naloxone (Suboxone) - unlikely to be abused because naloxone component will induce unpleasant withdrawal sx |
| Nonopioid Analgesics | analgesia, fever, inflammation, mild-moderate pain NSAIDS - ibuprofen, Salicylates - Aspirin Acetaminophen |
| Aspirin (Acetylsalicylic Acid, ASA) classes, mech | Nonopioid analgesic, NSAID, antipyretic. Salicylate, COX inhibitor Inhibits prostaglandin synthesis involved in pain and inflammation |
| Aspirin (Acetylsalicylic Acid, ASA) uses | analgesic, antipyretic, anti-platelet activity - reduce risk of mortality following MI |
| Aspirin (ASA) considerations | Platelet aggregation inhibitor, irreversible, should be D/C preg cat D, NOT in children r/t risk of Reye's syndrome |
| Aspirin (ASA) side/adverse | GI distress, GI bleeding, may inc action of oral hypoglycemic agents, inc bleed time, salicylism = tinnitus, dizziness, headache, excessive perspiration |
| COX1 and COX2 inhibitors | ibuprofen (Motrin, Advil) |
| COX2 inhibitors | celecoxib (Celebrex) |
| NSAIDS actions | Prostaglandin inhibitors, block COX1 and COX2, varying degrees of analgesic, antipyretic, anti-inflammatory |
| NSAIDS uses | Relief pain, inflammation, decrease fever (antipyretic) |
| NSAIDS common side effects | Gastric irritation, constipation, dizziness, drowsiness |
| NSAIDS serious adverse | GI bleeding, hepatotoxicity, nephrotoxicity, confusion, hypersensitivity reaction: hives, pruritus, rash, facial swelling |
| COX1 stimulation | Gastric mucosa - protected Platelet aggregation - enhanced Kidney - promotes perfusion |
| COX2 stimulation | Inflammation - promotes Pain - causes Temperature - increases |
| Non-opioid centrally acting analgesic | Acetaminophen (Tylenol) |
| Acetaminophen (Tylenol) actions | Prostaglandin inhibition, analgesic, antipyretic, NO anti-inflammatory |
| Acetaminophen (Tylenol) side effects | Minimal, hepatotoxicity in rare cases |
| Acetaminophen (Tylenol) considerations | Check labs for liver function, max daily dose = 4g. Check other meds for acetaminophen |
| Antidote for acetaminophen (Tylenol) OD | Acetylcysteine (Acetadote) |
| Tension headache | Most common |
| Migraine | Throbbing, poss aura, often N/V, often triggers can be avoided |
| Triptans | Serotonin agonists, vasoconstriction @ certain intercranial vessels |
| Ergot alkaloids | Serotonin agonist, interact with adrenergic and dopaminergic receptors. Act as vasoconstrictors, terminate ongoing migraines |
| sumatriptan (Imitrex) classes, mech | Antimigraine drug, triptan. Serotonin agonist, vasoconstriction of cranial arteries. |
| Sumatriptan (Imitrex) considerations | Oral, IN, subQ, should be admin as soon as possible after migraine is suspected or begun, not effective for long-term prophylaxis |
| Sumatriptan (Imitrex) side effects | Dizziness, drowsiness, tingling/warm, heaviness/tightness, May produce cardiac ischemia, hypertension, dysrhythmias, MI |
Created by:
kmulla
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