Download Chapter 17

Chapter 17
Medications for Pain
Management and Anesthesia
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
1
Learning Objectives
 Explain why there are so many rules about how narcotics and




2
related analgesic drugs may be given
Compare and contrast drug tolerance and drug addiction
Evaluate different forms of narcotic agonists and narcotic
agonist-antagonists in their ability to control pain
List medications commonly used for the treatment of
moderate to severe pain
List behaviors that would make you believe a patient is
addicted to a drug.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Opioids
Two Forms
 Natural: from opium
 Synthetic: man-made
Classifications:
Agonist
 Binds with the receptor(s) to activate and produce the maximum
response of the individual receptor
Partial agonist
 Produces a partial response
Agonist-antagonist
 Acts as an agonist at one type of receptor and as a competitive
antagonist at another type of receptor
3
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Opioids (cont.)
Morphine (****Gold Standard)
 Uses
 Acute care
 Hospice
Codeine, hydrocodone, oxycodone
 Uses
 Office or clinical setting
 Frequently used with acetaminophen
Hydromorphone (most potent)
 Uses
 Severe pain unrelieved by morphine
4
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Pain Measurement Scales
5
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Wong-Baker Faces Pain Rating Scale
6
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Terms for effects of pain meds
Tolerance
 The same amount of a drug produces a decreased effect over
time
Dependence
 A state in which the body will show withdrawal symptoms if the
drug is stopped or reduced
Addiction
 The uncontrollable need to have and use a drug for nonmedical
reasons
7
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Narcotic Agonist Analgesics
Action
 Prevent pain perception in the central nervous system
 Produce analgesia, sleepiness, euphoria, unclear thinking,
slow breathing, produce miosis, decreased peristalsis,
reduced cough reflex, and hypotension
Uses
 Treat moderate to severe pain
8
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Narcotic Agonist Analgesics (cont.)
Adverse Reactions
 Bradycardia, slowed breathing
 Hypotension, fainting
 Anorexia, constipation
 Confusion, euphoria
 Dry mouth, vomiting
 Pruritus, skin rash
9
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Narcotic Agonist Analgesics
 Codeine
 codeine
 Duragesic
 fentanyl
 Dilaudid
 hydromorphone
 Demerol
 meperidine
10
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
 Duramorph/ MS Contin
 morphine
 Paregoric
 opium tincture
 Oxycontin/ Oxycodone
 oxycodone
Narcotic Agonist-Antagonist
Analgesics
Action
 Act on chemicals at specific nerve sites in the CNS, possibly in
the limbic system
 Produce analgesia, euphoria, and respiratory and physical
depression
Uses
 Relief of moderate to severe pain
 Presurgical anesthesia
 Active labor
11
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Narcotic Agonist-Antagonist Analgesics
(cont.)
Adverse Reactions
 Bradycardia or tachycardia
 Hypertension or hypotension
 Changes in mood, confusion, nervousness
 Blurred vision, dizziness, headache
 Weakness, nystagmus, syncope, tingling
 Tinnitus, tremor, unusual dreams
 Nausea, vomiting, dry mouth, constipation
12
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Narcotic Agonist-Antagonist
Analgesics
 Stadol
 butorphanol
 Toradol
 Ketorolac tromethamine
 Talwin
 pentazocine
13
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Nonnarcotic Centrally Acting Analgesics
Action
 Act at the level of the brain to control mild or moderate pain
Uses
 Mild to moderate pain
 Used in combination products for pain alone or when pain
and fever are present
14
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Nonnarcotic Centrally Acting Analgesics
(cont.)
Adverse Reactions
 Postural hypotension, dizziness
 Disorientation, euphoria, headache
 Light-headedness, minor visual disturbances
 Sleepiness, slurring of speech, weakness
 Skin rashes, stomach or abdominal pain
 Dry mouth, nausea, vomiting, chills
 Difficulty urinating, stuffy nose
15
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Nonnarcotic Centrally Acting Analgesics
• Duraclon
– clonidine
• Darvon
– propoxyphene
• Ultram
– tramadol
• Questions?