NSG 251 Pharmacology Exam 2 Study Guide)

 Describe the assessment of pain in a client o  Explain the use of nonopioids, nonsteroidal anti-inflammatory drugs, opioids, and miscellaneous drugs the management of pain  Briefly describe the mechanism of action, indications, dosages, routes of administration, adverse effects, toxicity, cautions, contraindications, and drug interactions of nonopioids, nonsteroidal anti-inflammatory drugs, opioids, and miscellaneous drugs  Explain the inflammatory process and the disease processes that are inflammatory in nature  Briefly describe the mechanisms of action, indications, dosages, routes of administration, adverse effects, toxicity, cautions, contraindications, and drug interactions of various anti-inflammatory and antigout drugs  Compare and contrast a COX-2 inhibitor and other NSAIDs  Describe the pathophysiology and the drug therapies commonly used to treat gout Perceptin of pain- definitions • Pain- is most commonly defined as an unpleasant sesnsory and emotional experience associated with either actual or potential tissue damage o It is stimulated by nociceptors • Perception of Pain- This is a personal and individual experience. It exists when the patient says it exists o It involves psychological, emotional, cultural aspects • Pain Threshold-the level of stimulus needed to produce a painful sensation o Cond that lower pain threshold: anger, anxiety, depression, discomfort, fear, chronic pain o Cond. That raise threshold: diversion, empathy, rest, sympathy, medication, analgesics, antianxiety drugs, antidepressants • Pain Tolerance- this is the amount of pain a patient can endure without its interfering with normal function o It is subjective and varies person to person. • Types of Pain o Acute- this is sudden and usually subsides when treated • After surgery, fracture, etc o Chronic- persistent or recurring, lasting 3 to 6 months • More difficult to treat because changes that occur in the nervous system that often require increase • Fibromyalgia, low back pain. IBS, arthritis • Classification of Pain • Somatic- originates from skeletal muscles, ligaments, and joints (bone pain) • Visceral- originates organs and smooth muscle • Superficial- originated from the skin and mucous membranes • Deep- occurs in tissues below skin level • Vascular- believed to originate from the vascular or perivascular or perivascular tissue (Mirgrain headaches) • Referred- visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subQ tissues in the body respond better to nonopioid analgesics such as nonsteroidal antiinflammatory drugs (NSAIDS) Responds to opiod drugs • Neuropathic- usually results from damage to peripheral or CNS nerve fibers by disease or injury but may also be idiopathic • Phantom- occurs in areas of a body part that has been removed surgically or traumatically and can occur in paraplegics as well • Cancer- acute or chronic pain or both; most often results from pressure of the tumor mass against nerves, organs, or tissues. • Other forms can by hypoxia from blockage of blood supply to an organ metastases, pathologic fractures, muscle spasms, and adverse effects of radiation, surgery, and chemotherapy • Central pain: occurs with tumors, trauma, inflammation, or disease. Affecting CNS tissues • o Gate Theory of Pain Transmission • Tissue injury causes the release of the following: • Bradykinin • Histamine • Potassium • Prostaglandins • Serotonin • Some pain medications manage pain by altering or increasing the level of these • These substances stimulate nerve endings, starting the pain process. • The nerve impulses enter the spinal cord and travel up to the brain. • The point of spinal cord entry or the “gate” is the dorsal horn. • This gate regulates the flow of sensory impulses to the brain. Closing the gate stops the impulses. • If no impulses are transmitted to higher centers in the brain, there is no pain perception. • Rubbing or applying a large sensory stimulus to the pain can reduce the sensation of pain. o Special Considerations when using pain management and opiods • Pt Addiction, family addiction, neonatal • Anelgesics- medications that reduce pain without causing a loss of consciousness (painkillers) • PCA and “PCA by proxy” (means the staff or family will push the button) • Patient-controlled analgesia is commonly use in the hospital setting • Patients are able to control their pain by having a button on a PCA infusion pump • This has been useful in reducing the total opiod dose used • Morphine and hydromorphone’s are commonly used with PCA • Patient comfort vs. fear of drug addiction • This is the main consideration for cancer patients. • You want to worry more about comfort than drug addiction • Use of placebos • Recognizing patients who are opioid tolerant- street opioid uses or patients with chronic pain have this tolerance and generally require a higher dose. • Breakthrough pain- this often occurs between doses of pain medications. This is because the analgesic effects wear off as the drug is metabolized and eliminated from the body • You can give doses of immediate release [IR] meds (i.e. oxycodone (IR)) in between