- Opioids act on the CNS by inhibiting the activity of the ascending nociceptive pathway. (for severe pain)

- NSAIDs decrease pain by inhibiting cycloxygenase (COX I & II),  an enzyme involved in the production of prostaglandin.

- "tissue pain", well localized, aching and throbbing

- Treatment: NSAIDs or maybe opioids

- "Nerve pain", injury or malfunction in the peripheral or CNS, not well localized, burning or "electrical"

- Treatment: pregabalin (Lyrica) or gabapentin (Neurontin) (seizure medications) (calms the NS down)

- seen in diabetic patients, MS injury that damages nerves

- Schedule II: has high potential for abuse

- pre and post counts, lock and key, watch wastes etc..

- Opioid

- Opioid

- Opioid

- Opioid

- Antidote for opioid overdose

- Morphine: Oral forms (tablets, elixir and IV forms)

- IR: PRN Q 4-6 HR (can crush)

- ER: Q 12 HR (cannot crush)

- are not interchangeable

- transdermal: gives sustained delivery

- epidural

- never intended for opiate niave patients (pt who never took opiate)

- active for 72 hours

- need a dose everyday

- don't cut them

- after done --> fold in half --> dispose safely (still active)

-Biliary tract (gallbladder)

–increase in the pressure in the biliary tract at the sphincter of Oddi (bile fluid cant get out)

Urinary bladder

–tone of detrusor muscle increased

–feel urinary urgency

–have urinary retention due to increased muscle tone where sphincter closed off

- urinary retention = pressure on sphincter --> spincter remains closed

- Cardiovascular

- Analgesia

- Respiratory Depression

- Euphoria

- Sedation

- Nausea

- Constipation

- Miosis (pupil constriction)

- Acute pulmonary edema

- Perioperative

- Cough (specifically phenergan/ codeine)

- CNS depressants potentiate opioids

- (no alcohol, other opiods, other pain medications or sedatives mixed with an opiod)

–Other drugs that cause sedation (benzodiazepines)

–Patients with poor respiratory reserve (COPD)

–Head injured patients

–Infants and elderly

- Obese patients: pressure on respiratory system = cannot breathe fully

- if RR is less than <8

- stop the medication,; disconnect the PCA pump and give antidote (Narcan)

- GI: opiods = decrease GI motility, make sure pt has BM, every pt gets morphine, miralax, prune juice, fiber, water etc..

- GU: urinary retention: palpate bladder size, percuss (dullness = full), bladder scan

- Tolerance: overtime, need to increase dose to acheive same pain relieft

- Dependence (physiological): without drug = withdrawl (s/s: diarrhea, shakes, goose bumps, BP fluctuates)

- Abuse (psychological): not using the medication as prescribed (example: selling instead of using)

- S/S: respiratory depression, coma, and high doses of many opiods can cause convulsions

- Treatment: ventilation (O₂) and Naloxone ( Narcan)

–Assess cognitive function (mental, developmental, level of consciousness)

–Vitals

–Pain

–Sedation

–Rate and respiratory

–When to alert nurse

- Local Anesthetic

–Weakness (motor nerve block)

–Numbness (sensory nerve block)

–Low blood pressure (autonomic nerve block)

–Local anesthetic toxicity (ringing in ears, metallic taste, lip and oral numbness, light headedness, and very rarely seizures, cardiac disturbances, coma and even death)

- Constipation

- Respiratory Depression

- N/V

- Itching

- Somnolence (sleepiness)

- Dysphoria (unpleasant feeling or experience)

- Zofran

- Benadryl

–Assessment: vitals, neurological exam, pain and sedation

–Label equipment to distinguish from other catheters

–Site care – aseptic technique

–Electronic infusion devices for continuous medication administration

- NSAID

- NSAID

-GI bleeding / irritation

–Advanced age, preexisting renal disease

–Hypovolemia, cirrhosis, heart failure

- PUD and bleeding disorders

–Warfarin – intensifies anticoagulant effects

–Gluccocorticoids – promote gastric ulceration

–Alcohol – increase risk of gastric bleeding

–Assess for therapeutic effect

–Overdose: may be asymptomatic or have mild GI upset (dyspepsia, nausea, vomiting, and abdominal pain)

–Higher doses may exhibit CNS symptoms, including drowsiness, lethargy, ataxia (altered gait), and nystagmus (twitching eyes)

- Selective NSAID

–Dyspepsia and abdominal pain

–Renal impairment – can impair renal function

–Sulfonamide allergy –

–Contraindicated in third trimester of pregnancy

–Drug Interactions:

–Does not provide anti-inflammatory effects

–Inhibits prostaglandin synthesis in CNS

- Acetaminophen

Acetaminophen Therapeutic Use

- Relief of pain and fever

- Alochol

-acetylcysteine (Mucomyst)

- Salicylate

- Gastric Ulcerations

- Ringing of the ears (tinnitius)

- N/V, sensitivity to light

- Ergot Alkaloids

- Triptans

–beta-blockers (propranolol (Inderal)

-calcium channel blockers (verapamil (Covera)

- Ergot Alkaloid

- Ergot Alkaloid

  and causes vasoconstriction

- Triptan

- Triptan

Oral tablets that “melt

–Not for pregnant women

–Uncontrolled diabetes

–Uncontrolled HTN

–Family history of CAD or heart attacks

–Risk factors for coronary artery disease

–History of stroke

–High cholesterol