Analgesic Drugs - PowerPoint PPT Presentation

1 / 42
About This Presentation
Title:

Analgesic Drugs

Description:

Oxycodone. Semisynthetic derivative of codeine. Used to relieve ... Give opioid analgesic with short half-life (Oxycodone) Monitor for sedation or confusion ... – PowerPoint PPT presentation

Number of Views:404
Avg rating:3.0/5.0
Slides: 43
Provided by: Meli181
Category:

less

Transcript and Presenter's Notes

Title: Analgesic Drugs


1
  • Analgesic Drugs

2
Understanding Pain
  • Most common symptom prompting people to seek
    health care
  • Occurs when tissue damage activates free nerve
    endings of peripheral nerves
  • Cerebral cortex analyzes messages and determines
    actions
  • Activation of opiate receptors in CNS inhibits
    pain transmission

3
Understanding Pain
  • Pain is a subjective experience
  • People differ in their perceptions, behavior and
    tolerance of pain
  • Stressors increase pain
  • Diversionary activities tend to decrease pain-
  • deep breathing, listening to music, visual
    imagery, others?
  • Acute pain can be super-imposed on chronic pain

4
  • Try alternative measures for pain control in
    addition to drugs
  • Promote circulation and musculoskeletal function
  • Use heat or cold as ordered
  • Relieve pain ASAP
  • Administer analgesic before pain producing
    activities
  • Use the least amount of the mildest drug likely
    to be effective

5
Types of Pain
  • Acute pain
  • Chronic pain
  • Superficial pain
  • Deep pain

6
NARCOTICSOPIOIDS
  • Opioid-any derivative of opium plant or any
    synthetic drug that imitates natural narcotics
  • Opioid agonists-include opium derivatives and
    synthetic drugs w/similar properties (Kee p.332)
  • Decrease pain without losing consciousness
  • Opioid antagonists
  • Block effects of opioid agnoists
  • Used to reverse drug reactions-RD, CNS depression
  • Narcan (always keep antagonist nearby)

7
  • Opioid agonists
  • Any route
  • Inhalation uncommon
  • Absorbed from GI tract
  • Transmucosal / intrathecal fast acting
  • IV provides most rapid and almost immediate
  • Sub Q and IM delayed absorption
  • Poor circulation can cause further delay
  • Metabolized extensively in the liver
  • Administration of meperedine gt 48 hours increases
    risk of neurotoxicity and seizures from buildup

8
  • Pharmacodynamics
  • Reduce pain by binding to opiate receptors in
    PNS/CNS
  • Stimulation of opiate receptors-mimic effects of
    endorphins the bodys naturally occurring
    opiates
  • Cause dilation of blood vessels in head, neck,
    face could result in increased cranial pressure
  • With the exception of Demerol, suppress cough
    center to have antitussive effect
  • Adverse / Side effects include constipation,
    respiratory depression, nausea, vomiting, urinary
    retention, orthostatic hypotension
  • Morphine relieve dyspna r/t pulmonary edema

9
  • Nursing process
  • Assess pain before and after administration
  • Monitor for adverse reactions / side effects
  • Monitor for tolerance dependence
  • Shortened duration of effect
  • Evaluate respiratory status before each dose
  • Respiratory depression
  • Restlessness

10
Mechanisms by Which Opioid Analgesics Work
  • Reduce the perception of pain sensation
  • Produce sedation
  • Decrease emotional upsets associated with pain

11
Characteristics of Opioid Analgesics
  • Most are Schedule II or III drugs
  • Morphine (MSO4) is the prototype
  • May be given PO, IV, IM, SQ, or topically
  • Oral drugs undergo significant first-pass
    metabolism
  • Metabolized by liver and excreted in urine

12
  • Exert CNS effects
  • Use cautiously in clients with renal or hepatic
    disease, respiratory depression or increased
    intracranial pressure
  • Exert depressant effect on GI tract
  • Not recommended for prolonged periods of use
    except with chronic pain or malignant diseases

13
Morphine
  • Naturally occurring opium alkaloid
  • Used to relieve severe pain
  • Maximum analgesia occurs in 10-20 minutes with IV
    route
  • Controlled released tablets given for chronic
    pain
  • May be given intrathecally or epidurally
  • Route determines time interval or frequency of
    administration

14
Hydromorphone(Dilaudid)
  • Synthetic derivative of morphine
  • Same actions, uses, adverse effects as morphine
  • More potent on a mg per mg basis
  • More effective orally than morphine
  • Effects last longer than morphine

15
Meperidine(Demerol)
  • Synthetic drug similar to morphine
  • Dose of 100mg is equivalent to Morphine
    10mg
  • Has shorter duration
  • Has less respiratory depression and little
    antitussive effect
  • Causes less smooth muscle spasm

16
Codeine
  • Naturally occurring opium alkaloid
  • Used for milder pain
  • Acts as an antitussive (found in cough meds)
  • Often combined with acetaminophen
  • Preferred analgesic with head trauma

17
Oxycodone
  • Semisynthetic derivative of codeine
  • Used to relieve moderate pain
  • More potent and more likely to produce abuse than
    codeine
  • Available in combination with acetaminophen

18
Opioid Antagonists
  • Reverse or block analgesia, CNS and respiratory
    depression of opioid agonists
  • Compete with opioids for opioid receptor sites in
    brain
  • Do not relieve depressant effects of
    anti-anxiety drugs or antipsychotics
  • Naloxone - oldest, most commonly known
  • Nalmefene - newer with longer duration
  • Naltrexone - used in maintenance of opiate free
    states in opiate addicts

19
Client Teaching For Opioid Analgesics
  • Narcotics may be alternated with a
    non-narcotic analgesic
  • If pain relief not achieved notify physician
  • Do not drink alcohol or take other drugs that
    cause drowsiness
  • Do not smoke, cook, drive a car or operate
    machinery after taking

20
  • Constipation is a common adverse effect
  • Do not crush or chew long acting tablets
  • Decrease dose or omit if adverse effects occur

21
Use In Older Adults
  • Use cautiously if debilitated or hepatic, renal
    or respiratory impairment
  • Start with lower dose and increase gradually
  • Give less often?
  • Give opioid analgesic with short half-life
    (Oxycodone)
  • Monitor for sedation or confusion
  • Monitor urinary output
  • Assess ability to self-medicate

22
Characteristics of Withdrawal From Opiates
  • Generalized body aches
  • Insomnia
  • Lacrimation
  • Rhinorrhea
  • Perspiration
  • Pupil dilation
  • Piloerection
  • Anorexia
  • N/V/D
  • Increased vital signs
  • Abdominal and other muscle cramps

23
Treatment Of Withdrawal Syndrome
  • Gradually reduce the opioid over several days
  • Substitute methadone and slowly reduce dose over
    a longer time
  • Clonidine reduces withdrawal symptoms

24
NONNARCOTICSSALICYLATES
  • Salicylates-produce peripheral blood vessel
    dilation
  • Most common pain reliever
  • Control pain
  • Reduce fever-stimulate hypothalmus
  • Reduce inflammation
  • ASA is oldest nonnarcotic analgesic
  • Bonus effect-inhibits platelet aggregrate
  • Guideline
  • Use lowest dose that produces analgesia
  • Highly protein bound-can interfere w/other drugs
  • Heparin,methotrexate, oral antidiabetic meds,
    insulin

25
  • Adverse reactions
  • Hearing loss
  • Diarrhea
  • Thirst
  • Sweating
  • Tinnitus
  • Confusion
  • Dizziness
  • Impaired vision
  • Hyperventilation
  • Reyes syndrome-when given to children (do not
    use lt 12 yrs old)
  • Common side effects
  • Gastric distress
  • Bleeding tendencies
  • NVD

26
  • Give w/food
  • May crush except enteric coated
  • Hold and notify MD for bleeding
  • Stop ASA 5-7 days before elective surgery
  • Salicylate hypersensitivity
  • Tinnitus or hearing loss
  • Vertigo
  • Bronchospasm
  • Urticaria
  • Need to avoid prunes, raisins, paprika, licorice

27
ACETAMINOPHEN
  • Acetaminophen
  • Antipyretic and analgesic
  • IS NOT ANTI INFLAMMATORY
  • Drug of choice for children with flulike symptoms
  • Risk of liver disease
  • Phenytoin, barbituates, INH, ETOH
  • Rarely cause GI distress-may cause LIVER toxicity
  • Monitor total daily dose (adults 4g max.)

28
  • Phenazopyridine hydrochloride
  • Pyridium-now OTC
  • Dye used in commercial coloring-analgesic effect
    on urinary tract
  • Relieves pain, burning, itching, urgency,
  • Teach
  • Urine orange
  • Stains fabric-contact lenses
  • Notify in ineffective

29
  • Anti Inflammatory Drugs

30
  • Anti inflammatory agents
  • Reduce body temperature
  • Relief of pain
  • Anticoagulant (ASA)
  • Reduce inflammation
  • ASA oldest
  • NSAIDS- reduce inflammation pain for arthritic
    conditions
  • Inhibit enzyme COX

31
  • OTC
  • Ibuprofen, Motrin, Nuprin, Advil, Medipren
  • Naproxen (Aleve)
  • Motrin only available in 200 mg form
  • MD must prescribe higher dose

32
  • Second generation NSAIDS
  • COX-2 inhibitors
  • COX 1 inhibitor
  • Decreased protection of lining of stomach
  • Clotting time decreased-benefit cardiovascular
    patients

33
  • NSAIDS
  • Inhibit prostaglandin synthesis
  • Prostaglandins produced / released in
    inflammatory disorders
  • Ankylosing spondylitis
  • Moderate to severe arthritis
  • Osteoarthritis
  • Acute gouty arthritis
  • Dysmenorrhea
  • Migranes
  • Bursitis, tendonitis

34
  • Adverse reactions
  • Abdominal pain, bleeding
  • Anorexia
  • Diarrhea, nausea
  • Ulcers
  • Liver toxicity
  • Drowsiness
  • Headache
  • Tinnitus
  • Confusion
  • Vertigo
  • Depression
  • Blood in urine, bladder infection, kidney
    necrosis
  • Sodium water retention
  • Heart failure
  • Pedal edema

35
  • Nursing implications
  • CBC, platelet count, PT
  • Monitor hepatic / renal function
  • Bronchospasm
  • Monitor for s/s of bleeding
  • Take w/meals
  • Avoid alcohol

36
  • Corticosteroids
  • prednisone / prednisolone / dexamethasone
  • Suppresses components of inflammatory process at
    the injured site
  • NOT THE DRUG OF CHOICE FOR ARTHRITIC CONDITIONS
  • USED TO CONTROL FLARE UPS
  • Must taper dose when D/C

37
  • DMARDS-disease modifying antirheumatic drugs
  • Toxic
  • Alter disease process
  • Gold/Gold Salts
  • IM/PO
  • Used for relief of symptoms
  • Immunosuppressive agents-used when
    antiinflammatories do not work-cytoxan,
    methotexrate/cancer drugs
  • Antimalarials-when all other tx fails

38
  • Antiinflammatory Gout Drugs
  • gouty arthritis
  • Urinary calculi
  • Gouty nephrophaty
  • Increase fluid intake
  • Avoid foods rich in purine - organ meats,
    sardines, salmon, gravy, legumes
  • Avoid alcohol, caffeine, large doses of vitamin C
  • Zyloprim - inhibits final steps of uric acid
  • Colchicine - first drug, inhibits migration of
    leukocytes to the inflamed site

39
Propionic Acid Derivatives
  • Ibuprofen (Motrin) - prototype ketoprofen
    (Orudis), naproxen (Naprosyn)
  • Used as anti-inflammatory agents in gout,
    arthritis, tendonitis
  • Used as analgesic for dysmenorrhea, episiotomy,
    minor trauma
  • Used as antipyretic

40
  • Better tolerated than ASA but more expensive
  • Similar adverse affects as with ASA
  • May lead to renal impairment
  • Inhibits platelets only while drug molecules in
    bloodstream
  • Combined with other drugs

41
Acetic Acid Derivatives
  • Indomethacin (Indocin) - prototype Tolmetin
    (Tolectin), Sulindac (Clinoril)
  • Used to treat moderate to severe rheumatoid
    arthritis, osteo-arthritis, gouty arthritis,
    bursitis, pericarditis for anti-inflammatory
    effects
  • Prescription drug
  • Has increased incidence and severity of adverse
    effects

42
Client Teaching Guidelines
  • Take ASA and NSAIDS with full glass of water and
    food
  • Drink 2-3 quarts of fluid daily with NSAIDS
  • Report signs of bleeding
  • Avoid or minimize alcoholic beverages
  • Do not take more than prescribed amount
  • Do not take more that 3 days for fever or 10
    days for pain
  • Read labels of other OTC medications
Write a Comment
User Comments (0)
About PowerShow.com