Download Chapter 7 Drugs for Pain and Sleep Problems Barriers to Good Pain

Chapter 7 Drugs for Pain and Sleep Problems
Barriers to Good Pain Management
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Patient’s and health care workers fear of addiction
Patient’s fear of meaning of pain, for example:
o Worsening of condition
o Threats to independence
o Impending death
Patient’s and health care worker’s belief that pain is an expected part of aging
Patient’s fear of testing
Health care workers fear of “drugging the older adult”
Health care provider’s fear of overdosing a patient
Acute Pain
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Sudden onset
Often has an identifiable cause
Limited duration
Triggers physiologic responses:
o Increased heart rate and breathing
o Increased blood pressure
o Sweating
Improves with time
Variable intensity
Relatively superficial
Described as sharp, stabbing, pricking, or electric
Chronic Pain
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Intermittent or persistent
Exact cause may or may not be known
Unlimited duration
Physiologic responses disappear with time
Does not improve and may even worsen
Intensity may increase over time
Deeper pain
Described as burning, aching, throbbing
Main Features of Cancer Pain
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The most distressing and most feared complication of cancer
Complex, with many emotional and physical issues
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More than one cause
Shares features with acute pain and chronic pain
Can be present in more than one body area at the same time
Usually occurs later in cancer progression
Can be managed by usually requires more than one drug type for adequate control
Type of pain in which nonopioid miscellaneous drugs play a major role
Common Opioids
morphine (Morphine Sulfate, Duramorph, Epimorph, Morphitec, Roxanol, MS Contin)
hydromorphone (Dilaudid, Hydrostat)
meperidine (Demerol)
codeine (Paveral)
fentanyl (Fentanyl, Actiq, Oralet)
fentanyl transdermal (Duragesic)
oxycodone (OxyContin, OxyFast, Supeudol)
oxycodone with acetaminophen (Endocet, Percocet, Tylox)
oxycodone with aspirin (Endodan, Oxycodan, Percodan)
oxymorphone (Opana, Numorphan)
hydrocodone (Lortab, Vicodin)
hydrocodone with acetaminophen (Dolacet, Polygesic, Vicodin)
tramadol (Ultram)
Common NSAIDs
Drug class: Acetic acid
Drug Examples: ketorolac (Toradol)
Drug class: Cox-2 selective
Drug Examples: celecoxib (Celebrex)
Causes of Sleep Problems
Acute Sleep Problems
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Stress (job loss, moving, ending a relationship)
Jet lag
Use of stimulants (caffeine, nicotine)
Use of alcohol
Noise, light, extreme temperatures
Minor illnesses (cold, flu)
Worries (work, school, finances, family)
Chronic Sleep Problems
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Medical conditions (chronic pain, obesity, head injury, cancer, asthma, arthritis, heartburn)
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Mood disorders (depression, anxiety)
Schedule changes (working nights)
Other sleep problems (sleep apnea)
Genetics (some sleep disorders run in families)
Common Drugs for Insomnia
Benzodiazepine Receptor Agonists
zolpidem (Ambien)
zaleplon (Sonata)
Benzodiazepines
flurazepam (Dalmane, Novoflupam, Somnol)
quazepam (Doral)
triazolam (Gen-Triazolam, Halcion, Novotriolam)
estazolam (ProSom)
temazepam (Restoril)
OTC Antihistamines
diphenhydramine (Allerdryl, Benadryl)
dimenhydrinate (Dramamine, Gravol, Nauseatol)
Sedating Antidepressants
trazodone (Desyrel)
amitriptyline (Apo-Amitriptyline, Elavil)
doxepin (Novo-Doxepin, Sinequan, Triadapin)
Drugs for Narcolepsy
methylphenidate (Riphenidate, Ritalin)
modafinil (Provigil)
sodium oxybate (Xyrem)
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Pain is whatever the patient says it is and exists whenever he or she says it does.
Assess the patient for pain whenever you check his or her vital signs
Check behaviors for pain in patients who cannot point or express pain in words
Pain perception occurs in the brain, not at the site of injury
Different types of nerve fibers are responsible for the types of pain felt and which type of pain
drug is most effective at relieving the pain
Nonmodifiable factors affecting pain perception are age and the presence of disease. These
factors cannot be changed.
Do not assume that a patient who is tolerating pain well is comfortable
Common physiologic changes with acute pain include elevated heart rate, blood pressure, and
respiratory rate, cool, clammy skin; dry mouth; restlessness; and inability to concentrate
The four most common sources of chronic pain are: Neck and back pain; Arthritis pain; Migraine
headaches; nerve pain
Do not rely on changes in vital signs to indicate the intensity of chronic pain
Do not rely on non-drug therapies alone for pain control
Analgesics include: Opioids; Nonsteroidal anti-inflammatory drugs (NSAIDs); nonopioid
miscellaneous drugs
Pain drugs have varying strengths and dosages to achieve the same level of pain relief
Drug dependence is a physical problem; drug addiction is a psychologic problem
Never substitute one opioid for another without an order from the prescriber that includes a
recalculation of the dose. Strengths vary.
What is painful for an adult is painful for a child
Check the patient’s pain level 30 minutes after giving a pain-control drug and then hourly
If a mother receives an opioid during labor, watch her newborn closely for the first 2 to 4 hours
after birth for any sign of respiratory depression
Avoid the use of meperidine in the older adult
Avoid giving NSAIDs with acetaminophen (Tylenol)
Teach the patient to avoid chewing or crushing an NSAID capsule or enteric-coated NSAID
tablet.
NSAIDs should never be taken with warfarin (Coumadin)
Most NSAIDs should not be given to women during the last 3 months of pregnancy
Most NSAIDs increase blood p0ressure and reduce the effects of antihypertensives, especially
ACE inhibitors
Acetaminophen can be toxic to the liver and kidneys and should not be taken by anyone with
health problems of these organs
Teach parents to read the label on liquid acetaminophen bottles for infants and small children
very carefully and ensure that the correct dose is given for the child’s size. Teach parents to
telephone the nearest pharmacy and talk with the pharmacist to ensure that the dose is correct
if they are not confident in their own calculations.
The three major symptoms of narcolepsy are cataplexy, vivid hallucinations, and total paralysis
at the beginning or end of the sleep episodes
Monitor patients for seizure activity when they also take CNS stimulants
29. Remind women taking modafinil (Provigil) to use an additional form of birth control to prevent
an unplanned pregnancy
30. To better monitor for side effects, assess the level of consciousness before giving a drug for
insomnia
31. Teach patients taking benzodiazepine receptor agonists to go to bed immediately after taking a
dose of these drugs
32. Teach patients to be sure that there is adequate time (4 to 8 hours) for sleep before taking a
drug for insomnia
33. Teach patients taking an insomnia drug to avoid alcohol and other CNS-depressing substances
because of the risk for oversedation