Term
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Definition
a common symptom
subjective experience
defense mechanism |
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Term
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Definition
| tissue damage activates the free nerve ending (pain receptors or nocieptors) of peripheral nerves |
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Term
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Definition
| lasts longer than 6 months |
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Term
| Pain is the _______ vital sign |
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Definition
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Term
| Joint Commission on the Accrediation of Healthcare Organizations (JCAHO) |
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Definition
| emphasizes importance of pain and it's management for all patients |
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Term
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Definition
Patient's own perception
numberical scale for uniformity |
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Term
| Use what to assess for pain? |
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Definition
quality
duration
onset
intensity |
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Term
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Definition
| usually from injury to recovery for a defined period of time, usually less than 6 months |
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Term
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Definition
| lasts longer than 6 months |
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Term
| Non-Pharmacological Pain Management |
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Definition
accupuncture
biofeedback
massage
heat/cold
relaxation
chiropractics
hypnosis
music therapy |
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Term
|
Definition
| medications to relieve pain |
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Term
| 2 main classes of medication |
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Definition
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Term
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Definition
| non-steroidal anti-inflammatory drugs aka non-opoids |
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Term
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Definition
| act at the peripheral level |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| or "Opium" milky extract of unripe sees of the poppy plant |
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Term
| How do opiates or opium work? |
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Definition
| act like morphine in the body |
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Term
| Natural "morphine-like" substance |
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Definition
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Term
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Definition
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Term
|
Definition
- morphine like drugs
- produces analgesia
- produces CNS depression
- can be Natural - morphine
- can be synthetic - meperidine (Demerol) |
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Term
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Definition
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Term
|
Definition
| produce numbness or stuporlike symptoms |
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Term
| Opioids interact with what? |
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Definition
| at least 6 receptor type cells |
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Term
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Definition
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Term
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Definition
|
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Term
| what is the desired response for opioids? |
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Definition
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Term
| Opioids are a scheduled ___ drug |
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Definition
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Term
| Opioids analgesics reduces |
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Definition
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Term
| Opioids produce what type of symptoms? |
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Definition
| numbness or stupor-like symptoms |
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Term
| How do opioids produce numbness? |
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Definition
| inhibits production of pain and inflammation by prostaglandins in peripheral tissues |
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Term
| Therapueutic actions of opioid analgesics |
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Definition
- widespread pharmacologic effects especially in CNS and GI systems
- Produces analgesia |
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Term
| Opioid Analgesics act mostly on ? |
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Definition
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Term
| Opioid Analgesics inhibits transmission of pain signals from... |
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Definition
| peripheral tissues to the brain |
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Term
| how does opioid anagesics produce analgesia |
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Definition
- reduces perception of pain
- causes CNS depression
- drowsiness-sleep-unconscious
- decreases physical and mental activity |
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Term
| Opioid Agents Mechanism of Action |
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Definition
Binds to opioid receptors in brain and spinal cord
- powerful CNA depressant |
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Term
|
Definition
- cause sedation
- euphoria
- intense relaxation
- highly abusive |
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Term
| Opioids Pharmacokinectics |
|
Definition
- IV administration most reliable to achieve therapeutic levels
100% bioavailability |
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Term
| opioid are better absorbed with what administration? |
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Definition
|
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Term
| opioids are absorbed faster in male or female? |
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Definition
|
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Term
|
Definition
| epidural, intrathecally (directly into spinal column) |
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Term
| oral drugs undergo significant |
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Definition
|
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Term
| which form of opioids require increased dosages? |
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Definition
|
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Term
| opioid metabolites are excreted in the |
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Definition
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Term
| Opioid is DOC for what symptom? |
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Definition
|
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Term
| morphine is the prototype drug for? |
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Definition
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Term
| Do opioids lower pain thresholds |
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Definition
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Term
| Do opioids block transmission of pain? |
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Definition
|
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Term
| what is the pharmocology of opioids? |
|
Definition
| alters the perception and emotional reponse to pain. |
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Term
| Reason opioids are abused? |
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Definition
| produces euphoria and intense relaxation |
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Term
| Clinical Indications for opioids |
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Definition
| Prevent or relieve acute or chronic pain |
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Term
| what are other uses for opioids other than pain relief? |
|
Definition
- suppresses cough reflex center (Codeine)
- slows motility of GI tract in severe diarrhea (Paragoric) |
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Term
| Adverse Reactions of Opioids |
|
Definition
- Potentially life threatening
- Respiratory Depression
- Sedation/Somulence
- Nausea/Vomiting/Constipation
- Orthostatic Hypotension |
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Term
| Respiratory Depression in opioids |
|
Definition
activation of the "mu" receptors in CNS
mu receptors are primarily pain blocking receptors
most serious adverse effect of this
class of drug |
|
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Term
| why do opioids have the potential for physical/psychological dependence? |
|
Definition
| more likely to occur with higher doses for extended periods |
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Term
| Who is more likely to undermedicate? |
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Definition
|
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Term
| what happens when patients under-medicate? |
|
Definition
energy expended in coping with pain
pain management = increased healing time |
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Term
| Opioids Contraindications & cautions |
|
Definition
respiratory depression
COPD
Liver disease
renal disease
BPH (urinary retention)
increased ICP
allergy |
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Term
|
Definition
|
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Term
|
Definition
naturally occuring opium alkaloid
produces profound analgesia
causes euphoria
produces sedation
constricts the pupils |
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Term
|
Definition
| relieves SOB in MI, cardiac failure, PE |
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Term
| Relieves chest pain associated with |
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Definition
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Term
|
Definition
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Term
|
Definition
pre-operative medication
smooth muscle relaxant |
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|
Term
| morphine causes peripheral vasodilation |
|
Definition
| by decreasing SVR, decreases MO2 demand |
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Term
|
Definition
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Term
| morphine pharmacokinetics |
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Definition
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Term
|
Definition
hallucinations
nausea
constipation
dizziness
itching sensation
urinary retention ** BPH exacerbated
physical/psychological dependence
- high doses long duration |
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Term
|
Definition
respiratory depression
cardiac arrest
increased ICP from CO2 retention
secondary to respiratory depression
seizures from increased ICP
cross tolerance with other opioids |
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Term
| Morphine contraindications |
|
Definition
may mask gallbladder disease pain
do not give in suspected GB disease or
pancreatic disease
causes biliary tract spasm
sphincter of Oddi
acute asthma, upper airway obstruction
GO obstruction, decreases persitalisis
severe hepatic or renal disease
respirations <12/min |
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Term
| Nursing Considerations Morphine |
|
Definition
Monitor clients health condition
educate pt on drug Tx |
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Term
| Nursing Considerations Initial Assessment Morphine |
|
Definition
Resp, BP, liver function
renal function
UOP
Allergy
CBC
Current Med usage, ETOH
safety; BR up, Bed-low |
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Term
| Nursing Interventions Morphine |
|
Definition
Assess LOC following medication administration
Monitor VS
Pain Levels
Respiratory rate and depth
monitor injection sites, IV sites |
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Term
| Nursing Interventions Morphine (Cont) |
|
Definition
Offer additional pain relief measures
massage, hot packs, ice packs
narcotic antagonist Narcon available if resp fall to 10 or less
may need to repeat doses |
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Term
| Nursing interventions morphine education |
|
Definition
Reassure risk of addition is minimal
provide thorough patient education
drug name
prescribed dose
S/S of adverse effects
when to call physician |
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Term
| Monitor client response to morphine |
|
Definition
pain levels
pain relief
cough suppressant
sedation
decreased GI motility |
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Term
|
Definition
Monitor for adverse effects
evaluate teaching effectiveness
monitor compliance with pain management |
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Term
|
Definition
Naturally occuring opium alkaloid
Schedule II
Analgesic/Antitussive(weaker than morphine)
Effective PO, subq, IM
strong antitussive effects
less likely to cause abuse & dependency |
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Term
| codiene is usually given with |
|
Definition
| acetaminophen for additive effects but causes nausea & vomiting |
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Term
|
Definition
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|
Term
| Demerol pharmacologic action |
|
Definition
|
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Term
|
Definition
|
|
Term
| Is Demerol natural or synthetic? |
|
Definition
|
|
Term
| What is the generic name for Demerol? |
|
Definition
|
|
Term
| What is the route for Demerol for children? |
|
Definition
|
|
Term
| What is the dosage of Demerol for children? |
|
Definition
| 50-150 mg q3-4h PRN, max: 100 mg q4h |
|
|
Term
| What is the route for Demerol for adults? |
|
Definition
|
|
Term
| What is the dosage of Demerol for adults? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Demerol produces what kind of sedation? |
|
Definition
|
|
Term
| Demerol has a _______ duration of action than morphine. |
|
Definition
|
|
Term
| Demerol requires more or less adm? |
|
Definition
|
|
Term
| Demerol has _____ antitussive effect |
|
Definition
|
|
Term
| demerol causes smooth muscle |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the preferred analgesic for clients with renal or biliary colic? |
|
Definition
|
|
Term
| what is used as a short term pain mangement in healthy clients? |
|
Definition
|
|
Term
| Demerol is contraindicated in |
|
Definition
| CA pain management, requires increased doses |
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|
Term
| Demerol is not recommended for pain control longer than |
|
Definition
|
|
Term
| Demerol is considered ______ line agent |
|
Definition
|
|
Term
| What does the active metabolite of Demerol cause? |
|
Definition
|
|
Term
| Is Demerol reversed by Narcan? |
|
Definition
|
|
Term
| Why is Demerol NOT recommended for PCA use? |
|
Definition
half life too short
frequent dosing required q3-4 hrs |
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|
Term
| How do opioid antagoinist work? |
|
Definition
competes with opioid receptors sites in the brain.
prevents opioid binding, deisplaces opioids already occupying receptor sites
neutralizes opiods |
|
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Term
|
Definition
| 0.4 - 2.0 mg, repeat q 2-3 minutes due to short half-life |
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Term
|
Definition
Natoxone (Narcan)
Reverses or blocks analgesia
reverses CNS depression
reverses resp depression |
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|
Term
| Nursing interventions of opioids antagonists |
|
Definition
administer small doses often repeated until client exhibits reversal of opiate effects
IV dose last 1 hr
maintain airway
resuscitation equipment immediately available |
|
|
Term
| Routes for opioids antagonists |
|
Definition
|
|
Term
| Pharmacokinetics of opioid antagonists |
|
Definition
Hepatic metabolism
renally excreted
hepatic metabolism
onset of action - IV 1-2 minutes
duration of action - IV, 1 hr
IM, up to 4 hrs |
|
|
Term
| Adverse effects of opioid antagonists |
|
Definition
| no common, but serious include lachycardia, dysrhythmias, HTN, N/V |
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