Professional Documents
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Opioid Analgesics
Pain relievers that contain opium, derived
from the opium poppy or chemically related
to opium
Narcotics: strong pain relievers
Terminology
Analgesics: medication that relieves pain without causing a loss of conciousness Pain: whatever the patient says it is Pain threshold:level of stimulus that results in the perception of pain Pain tolerance: the amount of pain an individual can endure without interferinf with normal functionning
Terminology cont
Acute pain: sudden onset
Treatment of diarrhea
Balanced anaesthesia
insufficiency
Elevated intracranial pressure
Pregnancy
Opiate Antagonists
Naloxone, Narcan
Opiate antagonists Bind to opiate receptors and prevent a response
Used for complete or partial reversal of opioid-induced respiratory depression
Opiates
Opoid tolerance: a common physiological result of chronic opioid treatment. Larger dose of opioids is required to maintain the same level of analgesia Opoid physical dependance:The physiological adaptation of the body to the presence of an opioid Opoid phsychological dependance:A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief
Opiates
Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with psychological dependence (addiction) *Misunderstanding of these terms leads to ineffective pain management and contributes to the problem of under treatment
Nonopioid Analgesics
Acetaminophen
Analgesic and antipyretic effects
little anti-inflammatory effects Available OTC and in combination products
with opioids
Mechanism of Action
Similar to salicylates Blocks pain impulses peripherally by inhibiting prostaglandin synthesis
Indications: Mild to moderate pain fever Alternative for those who cannot take aspirin products
Acetaminophen Contraindications
Drug allergy Severe liver disease Genetic disease (G6PD)
Dosage
Maximum daily dose for healthy adults is 4000 mg per day Inadvertent excessive doses may occur when different combination drug products are taken together Be aware of the acetaminophen content of the medications taken by the client
Interactions
Dangerous interactions may occur if taken with alcohol Should not be taken in the presence of:
Liver dysfunction
Morphine
Codeine
Opiate analgesic Routes: PO, IM, SC Indications:
post op pain Chronic pain Palliative Antitussive Diarrhea
Codeine
Present in numerous combination drugs Tylenol #1 acetaminophen 300 mg caffeine 15 mg, in combination with codeine 8 mg Tylenol #2 acetaminophen 300 mg caffeine 15 mg, in combination with codeine 15 mg Tylenol#3 acetaminophen 300mg, caffeine 15mg, Codeine 30mg Codeine Contin
Others
Percocet: oxycodone and acetaminophen Percodan: oxycodone/Aspirin
Anaesthetics
Agents that depress the central nervous system (CNS)
Depression of consciousness Loss of responsiveness to sensory stimulation (including pain) Muscle relaxation
Anaesthesia
A state of depressed CNS activity Two types
General anaesthesia Local anaesthesia
Balanced anaesthesia
Types of anesthetics
General anesthetic: agents that induce global anesthesia with loss of conciousness Local anesthesia; agents that cause a specific area of the body to be insensitive to pain without affecting consciousness Topical anesthetic: local anesthetics directly applied to skin and mucous membranes.
General Anaesthetics
Agents that induce a state in which the CNS is altered to produce varying degrees of:
Pain relief Depression of consciousness Skeletal muscle relaxation Reflex reduction
Local Anaesthetics
Also called regional anaesthetics Used to render a specific portion of the body insensitive to pain Interfere with nerve impulse transmission to specific areas of the body Do not cause loss of consciousness
Nursing Implications
Always assess past history of surgeries and response to anaesthesia. Any known problems such as difficult intubation, N&V, malignant hyperthermia?
Assess past history, allergies, medications Assess use of alcohol, illicit drugs, opioids
Each phase has its own complex and specific nursing actions
CNS Depressants
Sedatives or Hypnotics
Sedatives: reduce nervousness, excitability and irritability without causing sleep
Sedative-Hypnotics
3 main categories:
1. Barbtuates
2. Benzodiazepine
3. Miscellaneous agents
Sedative-Hypnotics: Barbiturates
First introduced in 1903; standard agents for insomnia and sedation Habit forming Only a handful commonly used today due in part to the safety and efficacy of benzodiazepines Barbiturates have a narrow therapeutic index
Barbiturates: Indications
pentobarbital phenobarbital
Hypnotic
Respiratory
Benzodiazepines: Classification
Classified as either:
Sedative-hypnotic
Intermediate acting
alprazolam, clonazepam, lorazepam, oxazepam
Short acting
midazolam (IV), triazolam
Benzodiazepines: Indications
Sedation Sleep induction Skeletal muscle relaxation Anxiety relief Treatment of alcohol withdrawal Agitation Depression Epilepsy Balanced anaesthesia
Nursing Implications
Give 15 to 30 minutes before bedtime for maximum effectiveness in inducing sleep Most benzodiazepines (except flurazepam) cause REM rebound and a tired feeling the next day; use with caution in the elderly Clients should be instructed to avoid alcohol and other CNS depressants
Muscle Relaxants
Baclofen, Flexeril, Dantrolene
Act to relieve pain associated with skeletal muscle spasms Majority are central acting
CNS is the site of action Similar in structure and action to other CNS depressants
Direct acting
Acts directly on skeletal muscle Closely resembles GABA
CNS Stimulants
Drugs that stimulate a specific area of the brain or spinal cord. Analeptics (CNS stimulants) Appetite suppressants Treatment of
Attention-deficit/hyperactivity disorder (ADHD) Narcolepsy Migraine headache
Indications
Analeptics (CNS stimulants) Reversal of anaesthesia-
Side Effects
Wide range, dose related Tend to speed up body systems Common adverse effects include:
Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, increased urinary frequency