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CH 25 ANALGESICS (OPIOID ANALGESICS (Most potent (Action site (Act on CNS,…
CH 25 ANALGESICS
OPIOID ANALGESICS
Transdermal Opioid Analgesics
*
Up to 75% of patients have unrelieved pain.
Transdermal Route:
Provide continuous pain control
Helpful for chronic pain
Fentanyl
more potent than morphine
Available in various strengths
Most potent
Use
Moderate and severe pain
Many opioids possess antidiarrheal effects.
Action site
Act on CNS
Suppress pain impulses
Suppress respiration and coughing by acting on respiratory and cough centers in the medulla
Contraindication
Head injury
Morphine
side effects/adverse reactions
:warning: :!!:
Drowsiness, dizziness, euphoria
Confusion, depression, miosis, blurred vision
GI distress, flatulence, constipation
Orthostatic hypotension, weakness
Urinary retention
Respiratory depression
Nursing interventions
Administer morphine before pain reaches its peak to maximize drug effectiveness.
Monitor vital signs frequently to detect respiratory changes.
Check for pupil changes and reaction.
Have
naloxone (Narcan)
available as an antidote to reverse respiratory depression if morphine overdose occurs. :star:
Meperidine (demerol)
Use
Primarily effective in GI procedures
Preferred to morphine during pregnancy
:star:
Caution with large doses in older adults and patients with advanced cancer
Neurotoxicity
Nervousness, agitation, irritability, tremors, seizures
Hydromorphone (Dilaudid)
Use
Analgesic effect is approximately six times more potent than morphine
Side effects and adverse reactions
Drowsiness, dizziness, confusion
Weakness, constipation
Miosis, tolerance, dependence
Respiratory depression, urinary retention
Fewer hypnotic effects and less GI distress than morphine
NSAIDs
Ex. Aspirin, Ibuprofen, Naproxen
Action
Inhibits biosynthesis of prostaglandins
Inhibits COX-2 decreases inflammation and pain
Inhibits COX-1 decreases protection of the stomach lining
Use
Drug of choice for pain and arthritic inflammation
Analgesic, antipyretic, antiinflammatory
Decreases platelet aggregation
Side effects/adverse reactions
:!!: :warning:
Tinnitus, vertigo
GI distress
Excess bleeding
Metabolic acidosis, hyperventilation
Anaphylaxis, bronchospasm, dyspnea, urticaria
Reye syndrome (
Aspirin
)
ADJUVANT THERAPIES
Used along with a nonopioid and opioid
(
anything added
)
Adjuvant analgesics
Anticonvulsants
Antidepressants
Corticosteroids
Antidysrhythmics
Local anesthetics
Migraine and Cluster Headaches
Migraine Headaches
Triggers
Cheese, chocolate, red wine, aspartame, fatigue, stress, monosodium glutamate, missed meals, odors, light, hormone changes, drugs, weather, too much or too little sleep
Cluster Headaches
Characteristics
Severe unilateral nonthrobbing pain
Usually located around eye
Occur in a series of cluster attacks
Prevention
Beta-adrenergic blockers
Propranolol
Atenolol
Anticonvulsants
Valproic acid
Gabapentin
Tricyclic antidepressants
Amitriptyline
Imipramine
Management
Analgesics
Aspirin
with caffeine,
acetaminophen
NSAIDs:
ibuprofen, naproxen
Opioid analgesics
Meperidine, butorphanol
nasal spray
Ergot alkaloids
Dihydroergotamine mesylate
Selective serotonin1 receptor agonists
Sumatriptan, zolmitriptan
Causes vasoconstriction of cranial arteries
NONOPIOD ANALGESICS
Less potent than opioid analgesics :red_flag:
Use
Mild to moderate pain
Effective for dull, throbbing pain of:
Headaches, dysmenorrhea, minor abrasions
Inflammation, muscular aches, pain
Mild to moderate arthritis
Action site
Peripheral nervous system at pain receptor sites
Acetaminophen
Side effects
Rash, headache, insomnia
Low incidence of GI distress
Toxic effects/excess dosing
Hepatotoxicity, renal failure
Thrombocytopenia
Hemolytic anemia
Agranulocytosis
Leukopenia, neutropenia
MAX DOSE:
4g/day
If taken frequently 2 g/day
:warning: