NURS 212 Unit 3 - Drugs for Pain, Inflammation, and Fever.

Unit 3 – Analgesic & Anti-inflammatory Drugs
Readings:
Pharmacology for Nurses: Chapter 18 – Drugs for Control of Pain
Pharmacology for Nurses: Chapter 33 – Drugs for Inflammation & Fever
Henke’s Med-Math: Chapter 5 – Liquids for Injection Pgs.: 135 – 140
Henke’s Med-Math: Chapter 7 – Special Types of IV Calculations Pgs.: 258 – 259
ATI: RN Pharmacology for Nursing: Pgs.: 459 – 474; 493 – 500????
- Learning Outcomes
1) Distinguish b/t opioid agonists, agonist-antagonists, & antagonists.
2) Discuss therapeutic uses for opioid agonists, agonists-antagonists, & antagonists.
3) List characteristics of opioid analgesics in terms of mechanism of action, indications for use, & major side
effects.
4) Apply nursing process, including client teaching for clients receiving narcotic analgesics.
5) Differentiate b/t aspirin & acetaminophen in terms of action, adverse effects, & therapeutic uses.
6) Discuss mechanism of action, therapeutic uses & adverse effects of nonsteroidal anti-inflammatory drugs
(NSAIDS).
7) Discuss mechanism of action, therapeutic uses, & adverse effects of serotonin receptor agonists.
8) Distinguish b/t traditional NSAIDS & newer cyclooxygenase inhibitors
9) Apply nursing process for clients receiving acetaminophen, NSAIDS, cyclooxygenase inhibitors,/serotonin
receptor agonists.
Treating Pain, Inflammation, Fever, & Headache
- Pain – #1 reason for care
o 1960’s – pain under treated & under reported but still common today.
 Fear of not tough, addiction,/drug seeking behavior
o Universal experience – pain is what pt. says it is when they say it happens
o Unpleasant feelings/sensations – based on past experiences; age, culture, LOC
o Trauma/disease
o Body’s defense mechanism – functional pain scale vs. effects on activities of daily activities
o Physical, psychological, emotional components
- Assessing Pain
o Reaction to pain is subjective
o Use of standardized tools for measuring pain & evaluating interventions
 Numeric Scales; Use of smiley faces for kids & ELL’s
 0 = no pain; 10 = worst pain ever.
 Try to use interpreters for ELL’s & not family b/c don’t want alterations; can call in interpreter
- Classifying Pain
o Acute – specific/trauma to tissues; quick onset; 3 months to heal; pain subsides over time; if not then worry
o Chronic – no adequate relief over time; longer than 3 months; affects quality of life
o Nociceptive – injury to tissues.
 Somatic Pain – sharp, localized
 Visceral Pain – generalized dull, throbbing/aching
o Neuropathic – injury to nerves; burning, shooting, numb
- Pain Management – Non-Drug Therapies
o Massage o Biofeedback
o Heat/cold o Manipulation
o Meditation/prayer o Physical therapy
o Relaxation o Chiropractic manipulation
o Art/music o Therapeutic/physical Touch
o Imagery o TENS – Transcutaneous electrical nerve
o Hypnosis stimulation
o Acupuncture

, - Neural Mechanisms of Pain
o Nociceptors – pain receptors stimulated; pain transmission
 Pain impulse to spinal cord via A-δ & C fibers
 A-δ fibers – thinly wrapped in myelin; signal sharp, well-defined pain
 C Fibers – unmyelinated; slower transmission to brain; dull, poorly localized pain.
 Transmission – 1st step; peripheral to CNS & sent back for reaction.
 Release of sensitizing chemicals
o Pain Perception – Conscious awareness of pain
o Body’s Reaction
 Physical/mental
 Substance P – neurotransmitter that continues pain message
 Reactions – body reacts before pain felt (long term is processing what happened)
 Endogenous Opioids – body mediates pain
 Endorphins, dynorphins, & enkephalins
- Treating Severe Pain
o Narcotic (Opioid) Analgesics
 Opioids – narcotic substances; produce numbness/stupor-like symptoms
 General term; natural/synthetic & interchangeable w/ opiate (opium milk from poppy plant)
 Very effective for pain management
 Level of pain dictates drug & route
 Routes & meds determined on reported pain; terms interchangeably
- Narcotic (Opioid) Analgesics
o Affects μ, κ (kappa), & A-δ receptors
o Narcotic – Result is alteration in perception of pain, general CNS depression
o Use of pharmacologic agents is ONE part of pain management
 A-δ fibers = more emotional response
 μ & κ – traditionally targeted
 Activate μ & κ receptors
 μ Receptor Activation
o Analgesia; Decreased GI Motility; Euphoria; Physical Dependence; Respiratory Depression; Sedation
 κ Receptors Activation
o Analgesia; Decreased GI Motility; Miosis; Sedation
- Prototype: Morphine (Astramorph PF, Duramorph, others)
o Therapeutic Effects/Uses
 Treat acute/chronic pain; treat moderate & severe pain
 Activate μ & κ receptors – produce profound analgesia
 Results in altered pain perception
o Pharmacokinetics/Administration
 Multiple routes – sustained & quick release
 Sublingual; rectal; subcutaneous; IV; PO
 Onset: < 60 min; Peak: 60min PO, 20-60 min rectal, 50-90 sub cu., 30-60min IM, 20min IV; Duration: 7 hrs.
 Pregnancy Category B (D = long term)
o Pharmacodynamics/Mode of Action
 Binds w/ opiate receptors in CNS; result is diminished transmission of pain impulses
o Adverse Effects
 CNS depression - hallucinations
 Respiratory Depression
 Cardiac depression
 GI distress
 GU issues – retention (keep track of output)
 Overdose – life threatening