Download class prep for chronic sept. 15

Class Preparation Study Questions for 9/15/14
1.
Describe the mechanism of action and the short-term and long-term side
effects associated with the use of narcotics. (pg. 227-229).
 Hydrophilic drug- drug is readily absorbed in aqueous solution; slower onset,
longer duration of action
 Lipophilic drug- readily absorbed into fatty tissues; faster onset, shorter
duration of action
 Intermediate drug- less hydrophilic than morphine but less lipophilic than
fentanyl; intermediate
Opioid
Morphine
Fentanyl
Hydromorphone
Onset (min)
30-60 PO
5-10 IV
5 OT
3-5 IV
15-30 PO
5 IV
Peak (min)
60-90 PO
15-30 IV
15 OT
15-30 IV
30-90 PO
10-20 IV
Duration (hours)
3-6 PO
3-4 IV
2-5 OT
2 IV
3-4 PO
3-4 IV
 Short term side effects of narcotics
o Constipation
o Nausea
o Vomiting
o Pruritis
o Sedation
o Respiratory distress
o Post operative ileus
o Delayed gastric emptying
o Slowed bowel motility
o Decreased peristalsis
 Long term side effects of narcotics
o Tolerance to opioid therapy
2.
Discuss the most commonly used nonopioid analgesic agents, including
their uses and most significant side effects. (pg. 222-223).
 Acetaminophen
o Approved for treatment of mild-moderate pain, fever
o May cause hepatotoxicity due to overdose
 NSAID’s
o Used for the treatment of mild-moderate acute pain
o Ibuprofen, naproxen, celecoxib, diclofenac, ketorolac
o May cause gastric toxicity, ulceration- higher dose and higher
duration= increased risk of gastric complications
o May cause adverse CV effects, renal failure less commonly, due
to prostaglandin inhibition
o may increase bleeding time
3.
Compare the advantages and disadvantages of analgesics that can be given
via different routes. How does this affect the onset, duration and dose
of various analgesics? (pg. 221-222).
 Oral route the preferred route
o Least expensive, easiest, best tolerated
o Can’t be used if pt. can’t swallow
o Need to have higher doses
 IV route used in post-op patients
o Fastest method of administration
 Rectal route used when oral, IV routes not an option
o Drug absorption can be unreliable
 Topical route
o Produces effects in tissues immediately under administration site
 Intraspinal
o Insert needle into subrarachnoid space or epidural space, provide meds
 Continuous peripheral spinal nerve block
o Uses indwelling catheter
o Infuse meds to targeted site of innervation
 Onset, duration, and dose depend on the route by which the med was
administered
4.
Explain what is meant by an “adjuvant” analgesic medication. List several
categories of adjuvant analgesics, including their use and mechanism of
action. (pg. 231).
 Adjuvant analgesics- a drug that has a primary indication other than pain
but is an analgesic agent for some painful conditions
 Local anesthetics
o Lidocaine patch 5%- approved for postherpetic neuralgia
(neuropathic pain syndrome), produces analgesia when placed
directly over a painful area for abs. into tissues directly below
 Anticonvulsants
o Gabapentin (Neurontin) and pregabalin (Lyrica) used against
neuropathic pain
 Antidepressants
o Tricyclic antidepressants (TCA’s) and serotonin-norepinephrine
reuptake inhibitors used for neuropathic pain treatment
 Ketamine
o Dissociative anesthetic, sedative
o Blocks the binding of glutamate at NMDA receptors, prevents the
transmission of pain to the brain