Analgesic

• Analgesic


  Used to treat pain
• Indications for non-opioid analgesics

  • Headache, dysmenorrhea, abrasions, muscle aches and pains, mild to moderate arthritis
• Non-opioid analgesics


  Used to treat moderate pain (0-5)
• Non-opioid analgesic drugs


  • ASA, ibuprofen, naproxen (all OTC NSAIDs)
• Opioid analgesics


  Used to treat moderate to severe pain (6-10)
• Opioid analgesics


  • Antitussive and antidiarrheal effects, act on the CNS by attaching to receptors, suppress pain impulses
• Opioid analgesic drugs


  • Morphine, Fentanyl, Meperidine, Oxycodone, Hydromorphone, Methadone
• Common side effects of opioid analgesics

  • Cardiovascular: Orthostatic hypotension, Gastrointestinal: Constipation, Respiratory: Respiratory depression
• Morphine SE


  CV: orthostatic hypotension

  CNS: weakness

  GI: constipation, ilieus

  Urinary retention Psychological dependence, Respiratory depression
• Nursing process for morphine

  Administer IV, Monitor vital signs frequently to detect respiratory changes, Pulse oximetry, Administer opioids slowly over 4-5 minutes IV, Have naloxone available as an antidote to reverse respiratory depression
• Hydromorphone (Dilaudid)


  6 times more potent than morphine, Faster onset and shorter duration than morphine, Given PO, rectally, SC, IM, IV, Dilute with saline when giving IV push - slowly 2 mg over 2 minutes, Withdrawal symptoms are unpleasant but not as severe or life-threatening as sedative-hypnotics
• Common side effects of hydromorphone to monitor

  • Cardiovascular: Orthostatic hypotension, Gastrointestinal: Constipation, Renal: Urinary retention, Respiratory: Respiratory depression, Watch for withdrawal
• Aspirin therapeutic range


  15-30 mg/dL
• Aspirin uses


  • Anti-inflammatory, antiplatelet, antipyretic effects, analgesic effects
• Aspirin side effects


  • Central nervous system: Tinnitus, hearing loss, Gastrointestinal: GI distress, bleeding, ulceration, Hematologic: Thrombocytopenia, leukopenia, agranulocytosis, hemolytic anemia, Hepatic: Hepatotoxicity, Pediatric: Reye's syndrome
• Acetaminophen therapeutic range


  4g per day/2g if taking daily
• Acetaminophen uses


  • Muscular aches and pain, fever, Not an NSAID, No anti-inflammatory
• Acetaminophen side effects


  • Central nervous system: Anxiety, headache, insomnia, Gastrointestinal: Distress, Cardiovascular: Peripheral edema, Check liver enzymes for abnormalities (hepatotoxicity)
• Acetaminophen maximum dose is 4 grams per day, take only 2 grams per day
• Pathophysiology of migraine headaches

  Due to neurovascular events in cerebral cortex
• Migraine headache triggers


  • Cheese, chocolate, red wine, Fatigue, stress, too much/little sleep
• Medications used to treat migraine headaches in the ER


  • Ketorolac (NSAID), Diphenhydramine, Metoclopramide (antiemetic), Dexamethasone (corticosteroid), IV fluids
• Medications used to manage migraine and cluster headaches

  • Analgesics: Aspirin with caffeine,NSAIDs
  • Ergot alkaloids: Dihydroergotamine mesylate (nasal spray),
  • Selective serotonin1 receptor agonists: Sumatriptan, Zolmitriptan
• Sumatriptan


  MOA: Causes vasoconstriction of cranial arteries, Used to treat migraine and cluster headaches
• Sumatriptan SE:

  CNS: Dizziness, vertigo, headache, paresthesia, flushing, fatigue, drowsiness,

  GI: N/V

  Cardiac: Hypertension, hypotension, AV block, angina, bradycardia, dysrhythmias, thromboembolism, heart attack, stroke, cardiac arrest, Psychiatric: Suicidal ideation
• Cardiac monitoring is required when administering sumatriptan
• Pain assessment


  Fifth vital sign that is subjective, always check it, Use pain scale before administration and right after (30 minutes to an hour) and document, Reevaluate
• Pain assessment tools


  • Faces, FLACC, Numbers (Nonverbal pain scale for cognitively impaired individuals)

  
• Remember to ask details about the pain
• PCA pump


  Has a loading dose, with predetermined safety limits, Has a cap and will only deliver one dose and the patient cannot push it again (lock out mechanism), Timed, slow dose going in sometimes and sometimes it is just a bolus, set to parameters by the doctor, Provides better pain coverage and allows the patient to control it
• Patient education for PCA pump

  Educate patient and family, Double-nurse check when it is set up, Monitor vital signs
• Morphine SE

  CV: orthostatic hypotension

  CNS: weakness

  GI: constipation, ilieus

  Urinary: retention

  Respiratory depression

  Psychological dependence
• How slowly do you administer morphine

  4-5 minutes
• A patient on morphine should always be on?

  pulse ox
• long term affect of opioid?


  constipation
• When pushing dilaudid you should always

  Dilute it
• Acetaminophen can cause!!!

  Hepatotoxicity
• Antidote for Acetaminophen

  acetylcysteine
• Acetaminophen Postive


  absence of bleeding

  recommended for children
• "Suma" so bad for the

  heart : hypertension, AV block, Cardiac arrest