Term
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Definition
•an unpleasant sensory and emotional experience associated with actual or potential tissue damage
•a personal or individual experience
•whatever the patient states it is
•exists when the patient says it exist
•pain threshold (physiologic element) – the level of stimulus needed to produce a painful sensation
• pain tolerance (psychologic element)- amount of pain a patient can endure without it interfering with normal function |
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Term
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Definition
•Acute pain- sudden, onset, usually subsides when treated
•Chronic pain- persistent or reoccurring, lasts 3-6 months, difficult to treat
•Somatic- skeletal muscles, ligaments, joints
•Visceral- organs
•Superficial- skin & mucous membranes
•Deep- tissues below skin level
•Referred- somewhere else (moved)
•Neuropathic- nerve fibers (unexplained)
•Phantom- area of the body part that has been removed
•Cancer- tumor pushing against something
•Central- CNS, tumors, trauma |
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Term
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Definition
•Medications that relieve pain without loss of consciousness
•Opioid analgesics- used to manage moderate to severe pain
•Adjuvant analgesic drugs- are added for combined therapy and may have an additive or independent properties or both |
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Term
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Definition
•Often referred to as narcotics
•Came from the opium poppy plant
•Agonist- They bind to an opioid pain receptor in the brain and causes an analgesic response(the reduction of pain sensation)
•Two classifications of agonists- mild agonists(codeine, hydrocodone); strong agonists 9morphine, hydromorphone, oxymorphone, meperidine, fentanyl, and methadone) |
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Term
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Definition
•Binds to pain receptor and causes a weaker pain response than a full agonist
•Have an analgesic ceiling effect- means the drug reaches maximum analgesic effect, does not improve even with higher doses
•weaker pain response
•Lower dependency than agonist (pentazocine, nalbuphine) |
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Term
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Definition
| Binds to a pain receptor but does not reduce pain signals |
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Term
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Definition
•used to treat moderate to severe pin
•commonly used with anesthetics during surgery
•suppress the medullary cough center, which results in cough suppression
•helpful for treating diarrhea, because opioid drugs bind to intestinal opioid receptors |
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Term
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Definition
•drug allergy
•severe asthma
•pregnancy
•sleep apnea
•respiratory insufficiency
•paralytic ileus |
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Term
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Definition
•CNS depression may lead to respiratory depression
•constipation due to decreased GI tract mobility
•urinary retention
•diaphorseis and flushing
•pupil constriction
•itching
•nausea, vomiting (on empty stomach) |
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Term
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Definition
•alcohol
•antihistamines
•barbiturates
•benzodiazepines
•phenothiazine and other CNS depressant effects |
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Term
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Definition
•Codeine Sulfate
•Fentanyl
•Hydromorphone(Dilaudid)
•Meperidine hydrochloride (Demerol)
•Morphine Sulfate
•oxycodone hydrochloride
•Methadone hydrochloride(dolophine) |
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Term
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Definition
•Classified as a schedule II, HIGH ABUSE potential
•Causes GI tract upset
•Used for pain and cough (in cough syrup) |
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Term
| Opioid Agonists-Antagonists |
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Definition
•Opioids with mixed actions
•Bind to the mu receptor and compete with other substances for these sites(either competitive antagonists or are partial agonists)
•similar to the opioid agonists but have a lower risk for misuse and addiction
•can produce withdrawl symptoms in opioid dependent patients
•Used for short term pain control(obstetric procedures), history of opioid addiction
•buprenorphine(Buprenex), butorphanol(Stadol), nalbuphine(Nubain), pentazocine(Talwin) |
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Term
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Definition
•Treats moderate to severe pain
•Parenteral injections, transdermal, buccal lozenges, and buccal on a stick |
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Term
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Definition
•Very potent and HIGH ABUSE rate
•Equivalent to 7mg of morphine |
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Term
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Definition
•Classified as a schedule II substance, HIGH ABUSE potential
•naturally occurring alkaloid derived from opium poppy, drug prototype for all opioid drugs
•Used to treat severe pain
•oral, injectable(PCA cartridges), rectal, epidural
•Extended release forms include MS Contin and Kadin
•Has a potentially toxic metabolite(morphine-6-glucuronide);accumulation more likely to occur with renal impairment
•Embeda(morphine and naltrexone)is the newest morphine product |
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Term
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Definition
•structurally related to morphine and has comparable analgesic activity (schedule II)
•commonly combined in tablets with acetaminophen(percocet)and asprin(percodan)
•available in immediate release formulations(oxy IR) and sustained released formulations(OxyContin)
•hydrocodone- somewhat weaker, but commonly used(only available in tablets, most commonly used in combination with acetaminophen(Vicodin,Norco)(rescheduled as a CII drug) |
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Term
| Methadone hydrochloride(dolophine) |
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Definition
•Opioid of choice for detoxification treatment of opioid addicts in methadone maintenance programs
•Eliminated through the liver, makes it safer for patients with renal impairment
•Can cause dysrhythmias |
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Term
| Meperidine hydrochloride (Demerol) |
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Definition
| •Not recommended for long term use because of the accumulation of a neurotoxic metabolite, normeperdine which causes seizures |
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Term
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Definition
•Naloxone hydrochloride (Narcan)
•Naltrexone hydrochloride |
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Term
| Naloxone hydrochloride (Narcan) |
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Definition
•Used for toxicity and overdose
•Blocking drug for the opioid drug
•Does not produce analgesia or respiratory depression
•Adverse effect is opioid withdrawal syndrome, can occur with abrupt over reversal in opioid tolerant patients
•contraindicated in patients with hx of hypersensitivity to it |
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Term
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Definition
•used as an adjunct for the maintenance of an opioid-free state in former opioid addicts
•indicated as an adjunct to psychosocial treatments of alcoholism and reversal of postoperative opioid-induced respiratory depression
•most common adverse effects are nausea and tachycardia and are related to the reversal of the opioid effect
•contraindicated for known drug allergy and hepatitis patients or severe liver dysfunction
•only available for oral use |
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Term
| Nonopioid and miscellaneous analgesics |
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Definition
•all drugs in the NSAID class(aspirin, ibuprofen, naproxen, the cyclooxygenase-2 [COX-2] inhibitor celecocib)
•Used for pain management(pain associated with inflammatory conditions like arthritis) |
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Term
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Definition
•Blocks peripheral pain impulses by inhibition of prostaglandin sunthesis
•lowers body temps by acting on the hypothalamus
•lacks antiinflammation effects
•Contraindications- drug allergy, severe liver disease, and the genetic disease glicoes-6-phosphate dehydrogenase (G6PD)
•Side effects- skin disorders, nausea, vomiting, hepatotoxicity
•can only have 3000mg a day 2000 for older adults
•antidote-acetylcysteine |
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Term
| Traqmadol hydrochloride(Ultram) |
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Definition
•creates a weak bond to the mu opioid receptors and inhibits the reuptake of both norepinephrine and seratonin
•not currently classified as a controlled substance
•used to treat moderate to moderately severe pain
•rapidly absorbed(unaffected by food)
•metabolized in the liver to an active metabolite and eliminated via renal excretion
•Adverse effects- drowsiness, dizziness, headache, nausea, constipation, respiratory depression, seizures
•rescheduled as a class CIV narcotic
•contraindicated-drug allergy (may include opioid allergy)
•only available in oral dosage forms |
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Term
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Definition
| •Placed on painful areas of the skin |
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Term
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Definition
•Medicate patients before pain becomes severe
•pain assessment- onset, location character, description
•OTC drugs, drug allergies, safety measures
•Herbal products- (feverfew- may interact with aspirin, NAIDS as well as anticoagulants) |
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Term
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Definition
•Excitement (They "speed up" body systems)
•common adverse effects- anxiety, tachycardia, insomnia, GI distress, restlessness, angina, dysrhythmias |
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Term
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Definition
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Term
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Definition
•Diazepam(Valium)
•Midazolam(Versed)
•Temazepam(Restoril)
•Eszopiclone(Lunesta)
•Ramelteon(Rozerem)
•Zalepolon(Sonta)
•Zolpidem(Ambien) |
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Term
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Definition
•was the first available
•Treatment for anxiety, procedural sedation, and anesthesia adjunct, anticonvulsant therapy and skeletal muscle relaxation |
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Term
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Definition
•induces sleep within 20-40 min
•Take 1 hour before going to bed
•will be tired the next day("hangover effect") |
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Term
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Definition
•decreases anxiety
•Causes sedation
•causes amnesia |
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Term
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Definition
•Helps with insomnia
•provides full 8 hours of sleep |
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Term
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Definition
•contraindicated with liver disease
•Used to regulate day-night sleep cycles |
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Term
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Definition
•Induces sleep
•short acting
•Short half life, can take in the middle of night as long as its at least 4 hours before they must arise |
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Term
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Definition
•Short acting
•longer acting form with two separate drug reservoirs
•can cause somnambulation(sleepwalking) |
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Term
| When giving patients benzodiazepines, what should you educate them about? |
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Definition
| Patients should be educated about the REM interference and rebound insomnia that can occur with just a 3-4 week regimen of drug therapy. |
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Term
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Definition
•Physiologically habit forming and have low therapeutic index
•Side effects- drowsiness, lethargy, hangover, paradoxical restlessness or excitement
•deprive people of REM sleep, which causes agitation
•When stopped, rebound phenomenon may occur, when rebound occurs the proportion of REM sleep is increased, and nightmares can occur
•Pentobarbital(Nembutal), phenobarbital
•Classified in four categories-
Ultrashort acting- methohexital(Brevital), thiopental(Pentothal)
Short Acting- pentobarbital(Nembutal), secobarbital(Seconal)
Intermediate Acting- butabarbital(Butisol)
Long Acting- phenobarbital(Generic), mephobarbital(Mebaral) |
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Term
| How could a nurse manage safety for a patient taking a CNS depressant? |
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Definition
•Depending on the facility policies, safety precautions could include the use of side rails or bed alarms, and assistance when ambulating
•Educate the patient not to drive while taking the medication |
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Term
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Definition
•short-acting
•used preoperatively to relieve anxiety and provide sedation and occasionally used to control epilepticus, treat withdrawl symptoms in patients who are physicallydependent on barbiturates or nonbarbiturate hypnotics
•available in oral, injectable, and rectal dosage forms |
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Term
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Definition
•considered the prototypical barbiturate and classified as a long- acting drug
•used for the prevention of generalized tonic-clonic seizures and fever induced convulsions, also useful in treating hyperbilirubinemia in neonates
•Available in oral and injectable forms |
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Term
| Over-the-counter hypnotics |
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Definition
•Nonprescription sleeping aids often contain antihistamines (CNS depressant effect)
•most common antihistamines contained in otc sleeping aids are doxylamine(Unisom) and diphenhydramine(Sominex)
•concurrent use of alcohol can cause additive CNS depression |
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Term
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Definition
•Act with the CNS to relieve pain, caused by muscle spasms
•Are effective when used in conjunction with physical therapy
•Side effects- euphoria, lightheadedness, dizziness, drowsiness, fatigue, confusion, and muscle weakness
•dantrolene(Dantrium), baclofen(Lioresal), cyclobenzaprine(flexril)
•closely monitor level of consciousness, encourage cautious ambulation, change positions slowly, watch hypotension within 1 hour of dosing |
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Term
| Benzodiazepine overdose antidote |
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Definition
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Term
| Treatment of a barbiturate overdose |
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Definition
•maintain adequate airway, assisted ventilation, and oxygen administration along with fluid and pressor support
•Alkalization, along with forced diuresis using diuretics, can hasten elimination of the barbiturate |
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Term
| Treatment of a muscle relaxant overdose |
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Definition
•No specific antidote
•maintain adequate airway, means of artificial respiration available, EKG monitoring, large amounts of IV fluids to avoid crystalluria |
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Term
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Definition
| •Most common psychiatric disorder in children. Symptoms are developmentally inappropriate ability to maintain attention span and/or the presence of hyperactivity and impulsivity |
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Term
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Definition
| •An incurable neurologic condition in which patients unexpectedly fall asleep in the middle of normal daily activities |
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Term
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Definition
| •Is an associated symptom in at least 70% of narcolepsy cases. It involves sudden acute skeletal muscle weakness |
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Term
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Definition
| •A common type of recurring headache, usually lasting from 4-72 hours. Pulsatile quality with pain that worsens with each pulse. |
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Term
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Definition
| •The first line of choice for both ADHD and Narcolepsy |
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Term
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Definition
•Stimulate the areas of the brain associated with mental alertness, such as cerebral cortex and the thalamus
•CNS effects include: mood elevation and euphoria, increased mental alertness and capacity for work, decreased fatigue and drowsiness and prolonged wakefulness |
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