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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