Download Pharm Pain Meds

Chapter 20
Drugs Used for Pain Management
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Lesson 20.1
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Objectives


Differentiate among the properties of opiate
agonists, opiate partial agonists, and opiate
antagonists.
Describe the monitoring parameters
necessary for patients receiving opiate
agonists.
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Objectives (cont.)


Cite the common adverse effects of opiate
agonists.
Compare the analgesic effectiveness of
opiate partial agonists when they are
administered before or after opiate agonists.
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Pain


An unpleasant sensation that is part of a
larger situation is a pain experience
Three terms apply
 Pain perception—also called nociception
 Pain threshold—where pain is first perceived
 Pain tolerance—person’s ability to endure pain

Pain described in more than one way
 Acute pain—short-term, as from injury
 Chronic pain—slower onset, lasts longer than 3
months beyond the healing process
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Pain (cont.)

Pain classified by pathophysiology
 Nociceptive—dull and aching
 Somatic—originates from skin, bones, or muscles
 Visceral—originates from abdominal or thoracic
areas
 Neuropathic—results from nerve injury; stabbing
and burning
 Idiopathic—nonspecific and of unknown origin
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Pain Management

Analgesics relieve pain; can be classified
according to neurologic mechanisms
 Opiate agonists—for severe acute pain
 Opiate partial agonists—for unrelieved or
moderate acute pain
 Opiate antagonists—reverse adverse effects of
opiate agonists
 Salicylates—for mild acute pain
 Nonsteroidal antiinflammatory drugs (NSAIDs)—
for mild acute pain
 Miscellaneous
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Nonanalgesic Therapy
for Pain Management


When injury occurs, the body releases
chemicals that contribute to pain
Drugs used to block these chemicals include

Antihistamines
 Prostaglandin inhibitors (NSAIDs)
 Antidepressants (TCAs and SSRIs)
 Substance P antagonists (capsaicin)
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Pain Assessment



Considered fifth vital sign
To be assessed with vital signs and before
and after interventions
Pain assessment tools

Various tools for nonverbal patients, infants, and
children
 Scale of 0 to 10 (0 is no pain, 10 is intense)
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Pain Assessment (cont.)




Patient’s perception of pain
Believe pain experience
Note onset, location depth, quality, duration,
and severity
Nonverbal behavior
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Nonpharmacologic
Pain Management

Nonpharmacologic strategies enhance effects
of medications
 General comfort measures: backrubs,
repositioning, heat/cold applications
 Relaxation techniques
 Diversional activities
 Decreased environmental stimulation
 Visualization
 Biofeedback
 Meditation
 Transcutaneous electrical nerve stimulation
(TENS) unit
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Medication



Encourage patient to request pain medication
before pain escalates
Identify when last dose of pain medication
was administered
Pain scale assessment used with pain relief
range orders
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Patient-Controlled Analgesia (PCA)





Syringe pump contains opiate agonist
(usually morphine) connected to IV pump, IV
catheter
Patient self-administers small dose of
analgesic
Pump limits amount and frequency of dose
Provide patient/family teaching
Record amount used and degree of pain
relief
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Audience Response Question 1

The nurse is educating a postoperative patient about
the use of a patient-controlled analgesia (PCA)
pump. Which statement by the patient indicates a
need for further teaching?
A.
B.
C.
D.
“I’m afraid I’ll give myself too much medicine and become
addicted to it.”
“I can only receive the medication every 10 minutes.”
“I’ll let the nurse know if my pain doesn’t improve.”
“I’ll be sure to push the button to give myself pain medicine
before I get up into a chair.”
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Drug Class: Opiate Agonists

Actions
 Act on same sites in the brain as morphine to
stimulate analgesic effects
 Block the pain sensation

Uses
 Relieve acute or chronic moderate/severe pain
 Can be used preoperatively or to supplement
anesthesia
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Drug Class: Opiate Agonists (cont.)

Drugs
 Morphine and morphine-like derivatives; codeine,
hydrocodone, oxycodone, meperidine-like derivatives;
methadone-like derivatives; other opiate agonists

Common adverse effects
 Lightheadedness, dizziness, sedation, sweating, confusion,
disorientation; orthostatic hypotension, nausea, vomiting,
constipation

Serious adverse effects
 Respiratory depression; urinary retention; excessive use or
abuse, increased effect with CNS depressants
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Monitoring Parameters
for Opiate Agonists

Premedication assessment and planning
 Appropriate pain assessments

Therapeutic goals
 Pain at rest less than 3 on pain scale
 Pain with movement less than 5 on pain scale
 Able to have at least 6 hours of sleep without interruption by
pain
 Able to work at hobby for 1 hour

Observe for vital signs and mental status changes,
especially respiratory rate. Hold medication if
respirations are below 12/min for adult; consult with
health care provider
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Audience Response Question 2

Which common adverse effect may be seen
with use of opiate agonists?
A.
B.
C.
D.
Appetite stimulation
Orthostatic hypotension
Mood elevation
Increased respirations
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Drug Class:
Opiate Partial Agonists

Actions
 Effective analgesic without prior administration of
opiate agonists
 Pharmacologic action depends on whether an
opiate has been previously administered
 Subject to ceiling effect
 Prolonged use leads to tolerance

Uses
 Short-term relief (up to 3 weeks) of moderate to
severe pain associated with cancer, burns, renal
colic; preoperative analgesia, and obstetric and
surgical analgesia
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Drug Class:
Opiate Partial Agonists (cont.)

Drugs
 Buprenorphine (Buprenex, Subutex)
 Butorphanol (Stadol)
 Nalbuphine (Nubain)
 Pentazocine (Talwin)

Common adverse effects
 Clamminess, dizziness, sedation, sweating;
nausea, vomiting, dry mouth, constipation

Serious adverse effects
 Confusion, disorientation, hallucinations;
respiratory depression; excessive use or abuse
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Drug Class: Opiate Antagonists

Drugs
 Naloxone (Narcan)
 Naltrexone (Revia)

Action
 Reverse respiratory depression, sedation,
hypotension associated with opiate agonists and
opiate partial agonists

Uses
 Treat respiratory depression from excessive
doses of opiate agonists or opiate partial
agonists; drug of choice
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Audience Response Question 3

After receiving a dose of morphine for
postoperative pain, a patient becomes
unresponsive, with a respiratory rate of
10/minute, with shallow breathing. The nurse
should anticipate administering which
medication?
A.
B.
C.
D.
Naloxone
Nalbuphine
Meperidine
Pentazocine
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Education for Patients Discharged
with Analgesics

When to call health care provider
 Report poor pain control
 Adverse effects that occur

Common adverse effects
 Light-headedness, dizziness, sedation, nausea,
sweating; confusion, disorientation; orthostatic
hypotension; constipation

Encourage using the smallest dose that
relieves pain
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Lesson 20.2
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Objectives





Describe the three pharmacologic effects of
salicylates.
List the common and serious adverse effects and
drug interactions associated with salicylates.
Explain why synthetic nonopiate analgesics are not
used for inflammatory disorders.
Identify the substances listed in Table 20-4 that are
the active ingredients in commonly prescribed
analgesic combination products.
Identify products that contain aspirin and compare
the analgesic properties of agents available in
different strengths.
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Drug Class: Salicylates

Actions
 Inhibit prostaglandin synthesis
 Three pharmacologic effects: analgesic, antipyretic,
antiinflammatory
 Aspirin has unique property of inhibiting platelet aggregation
and clotting

Uses
 Discomfort, pain, inflammation, or fever associated with
bacterial and viral infections; drug of choice
 Headaches, muscle aches, rheumatoid arthritis
 Reduce risk of myocardial infarction, TIA, stroke
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Audience Response Question 4

Which classification does not describe a
property of salicylates?
Analgesic
B. Antipyretic
C. Antiplatelet
D. Sedative
E. Antiinflammatory
A.
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Drug Class: Salicylates (cont.)

Drugs
 Aspirin (ASA, Empirin), diflunisal (Dolobid), magnesium
salicylate (Doan’s, Novasal)

Common adverse effects
 GI irritation

Serious adverse effects
 GI bleeding; salicylism (tinnitus, impaired hearing, dimming
of vision, sweating, fever, lethargy, dizziness, mental
confusion, nausea and vomiting)

Use in children not recommended due to risk of
Reye’s syndrome
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Miscellaneous Analgesics


Drug: acetaminophen (Tylenol)
Actions
 Synthetic nonopiate; no antiinflammatory activity

Uses
 Fever and pain reduction, therapeutic effects
similar to aspirin

Common adverse effects
 Gastric irritation

Serious adverse effects
 Hepatotoxicity
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Acetaminophen (cont.)

Signs of toxicity: anorexia, nausea, vomiting,
low blood pressure, confusion, abdominal
pain



Later signs, jaundice, and increased AST/ALT
levels
Maximum daily adult dose: no more than 4
grams of acetaminophen daily
Antidote is acetylcysteine
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Analgesic Combination Products


Table 20-4
Examine products containing the following
and note dosages of each drug
 Aspirin and caffeine, aspirin and codeine
 Aspirin, acetaminophen, and caffeine
 Acetaminophen, caffeine, and butalbital
 Aspirin, caffeine, and butalbital
 Acetaminophen and hydrocodone, acetaminophen
and codeine
 Acetaminophen and oxycodone
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Drug Class: NSAIDs

Actions
 “Aspirin-like” but unrelated to salicylates
 Prostaglandin inhibitors
 Block cyclooxygenase (COX-1 and COX-2)
 Varying degrees of analgesic, antipyretic, and
antiinflammatory activity

Uses
 Relief of pain and inflammation from rheumatoid
arthritis, osteoarthritis, ankylosing spondylitis, gout
 Dysmenorrhea, minor aches and pains
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Drug Class: NSAIDs (cont.)

Drugs
 Diclofenac (Cataflam, Voltaren), etodolac,
fenoprofen (Nalfon), flurbiprofen (Ansaid),
ibuprofen (Motrin, Advil), others

Common adverse effects
 Gastric irritation, constipation; dizziness,
drowsiness

Serious adverse effects
 GI bleeding; hepatotoxicity; confusion; hives,
pruritus, rash, facial swelling; nephrotoxicity; blood
dyscrasias
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Audience Response Question 5

What is a common but serious adverse effect
of nonsteroidal antiinflammatory drugs
(NSAIDs)?
Increased upper GI bleeding
B. Excessive drowsiness
C. Antipyretic action
D. Diarrhea
A.
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