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Chapter 17

Chapter 17. Medications for Pain Management. Chapter 17 Lesson 17.1. Learning Objectives. Explain why there are so many rules about how narcotics and related analgesic drugs may be given Compare and contrast drug tolerance and drug addiction

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Chapter 17

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  1. Chapter 17 Medications for Pain Management

  2. Chapter 17 Lesson 17.1

  3. Learning Objectives • Explain why there are so many rules about how narcotics and related analgesic drugs may be given • Compare and contrast drug tolerance and drug addiction • Evaluate different forms of narcotic agonists and narcotic agonist-antagonists in their ability to control pain

  4. Learning Objectives (cont.) • List medications commonly used for the treatment of moderate to severe pain • List behaviors that would make you believe a patient is addicted to a drug.

  5. Opioids Two Forms • Natural: from opium • Synthetic: man-made Classification of Action • Agonist • Partial agonist • Agonist-antagonist

  6. Opioids (cont.) Agonist • Binds with the receptor(s) to activate and produce the maximum response of the individual receptor Partial agonist • Produces a partial response Agonist-antagonist • Acts as an agonist at one type of receptor and as a competitive antagonist at another type of receptor

  7. Opioids (cont.) Morphine • Uses • Acute care • Hospice Codeine, hydrocodone, oxycodone • Uses • Office or clinical setting Hydromorphone • Uses • Severe pain unrelieved by morphine

  8. Pain “An unpleasant sensation or emotion that produces or might produce tissue damage.” - International Association for the Study of Pain (IASP) Two Types • Acute • Chronic

  9. Pain Measurement Scales

  10. Wong-Baker Faces Pain Rating Scale

  11. Pain (cont.) Factors That Produce Pain: • An unpleasant stimulus that affects nerve endings and sets off electrical activity • Electrical signals that pass the stimulus along nerve endings to the spine • Signals that are carried to the brain • Development of behavioral, psychologic, and emotional responses in the brain

  12. Pain (cont.) Tolerance • The same amount of a drug produces a decreased effect over time Dependence • A state in which the body will show withdrawal symptoms if the drug is stopped or reduced Addiction • The uncontrollable need to have and use a drug for nonmedical reasons

  13. Narcotic Agonist Analgesics Action • Prevent pain perception in the central nervous system • Produce analgesia, sleepiness, euphoria, unclear thinking, slow breathing, produce miosis, decreased peristalsis, reduced cough reflex, and hypotension Uses • Treat moderate to severe pain

  14. Narcotic Agonist Analgesics (cont.) Adverse Reactions • Bradycardia, slowed breathing • Hypotension, fainting • Anorexia, constipation • Confusion, euphoria • Dry mouth, vomiting • Pruritus, skin rash

  15. Patient-Controlled Analgesia • Used when a continuous infusion of opioids is required • Pump is calibrated to ordered dose and frequency • Patient is able to self-administer pain med by pushing control button • Pump can be programmed to deliver an hourly rate

  16. Patient-Controlled Analgesia

  17. Patient-Controlled Analgesia

  18. Narcotic Agonist Analgesics (cont.) Drug Interactions • Many drugs increase or decrease effects Nursing Implications Patient Teaching

  19. Narcotic Agonist-AntagonistAnalgesics Action • Act on chemicals at specific nerve sites in the CNS, possibly in the limbic system • Produce analgesia, euphoria, and respiratory and physical depression Uses • Relief of moderate to severe pain • Presurgical anesthesia • Active labor

  20. Narcotic Agonist-Antagonist Analgesics (cont.) Adverse Reactions • Bradycardia or tachycardia • Hypertension or hypotension • Changes in mood, confusion, nervousness • Blurred vision, dizziness, headache • Weakness, nystagmus, syncope, tingling • Tinnitus, tremor, unusual dreams • Nausea, vomiting, dry mouth, constipation

  21. Narcotic Agonist-Antagonist Analgesics (cont.) Drug Interactions • Caution with alcohol and CNS depressants • Nursing Implications • Patient Teaching

  22. Nonnarcotic Centrally Acting Analgesics Action • Act at the level of the brain to control mild or moderate pain Uses • Mild to moderate pain • Used in combination products for pain alone or when pain and fever are present

  23. Nonnarcotic Centrally Acting Analgesics (cont.) Adverse Reactions • Postural hypotension, dizziness • Disorientation, euphoria, headache • Light-headedness, minor visual disturbances • Sleepiness, slurring of speech, weakness • Skin rashes, stomach or abdominal pain • Dry mouth, nausea, vomiting, chills • Difficulty urinating, stuffy nose

  24. Nonnarcotic Centrally Acting Analgesics (cont.) • Drug Interactions • Nursing Implications • Patient Teaching

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