NR-291 Pharmacology I Study Guide – Exam 4 LATEST UPDATE

NR-291 Pharmacology I Study Guide – Exam 4 Chapter 10: Analgesic Drugs o Know and apply basic pharmacology principles for pain management o Know WHO Analgesic Ladder and apply to acute pain and chronic pain management o Opioid Drugs: 1, 5, 6, 11, 12, 13 (addicts and non-addicts)  Nice to know: • Nursing Considerations: o Medicate pts before the pain becomes severe (Around the Clock, ATC) o Pharmacologic and nonpharmacologic approaches to pain o Oral forms should be taken with food to minimize gastric upset o Ensure safety measures such as keeping side rails up, to prevent injury • Drug Interactions: o Alcohol, antihistamines, barbiturates, benzodiazepines, monoamine oxidase inhibitors • 4 categories of opioids: o Endogenous – produced by the body o Opium alkaloids – morphine o Semi-synthetic opioids – oxycodone, hydrocodone, hydromorphone, heroin o Fully synthetic opioids – propoxyphene, tramadol, pentazocine • Heroin, oxycontin, and hydrocodone/acetaminophen (Vicodin) have similar effects • Opioid ceiling effect – codeine, nalbuphine, pentazocine • Clonidine o Alpha-2 adrenergic agonist o Central inhibition of the hyper-nonadrenergic state that occurs in opioid withdrawal o Decrease BP and stress in the first few days of withdrawal  Good to know: • Rapid-onset opioids (fentanyl) o Do not have to swallowed (injection, buccal lozenge, or stick/sucker) o Approved for treatment of cancer-related breakthrough pain o Patches change every 72 hours  Dispose by flushing down toilet or sharps container, avoid heat over patch because can increase absorption • Use with extreme caution in pts with: o Respiratory insufficiency, elevated intracranial pressure, morbid obesity and/or sleep apnea, paralytic ileus, pregnancy • Adv Eff: o CNS depression  Leads to respiratory depression, most serious adv eff  Decreased BP and HR  Sleepiness o GI  Nausea and vomiting  Paralytic ileus  Constipation (Opioid Induced Constipation/ OIC) – adequate fluid and fiber intake to prevent • Methlnaltrexone bromide (Relistor) • Lubiprostone (Amitiza) o GU  Urinary retention o Skin  Diaphoresis, flushing, and itching o Eyes  Pupil constriction (miosis) • Hydromorphone o 8 times more potent than morphine o Epidural route can lead to increased ICP  Got to know: • Opioid antagonist drug: naloxone o Given IV push o Reverse adv eff of opioid drugs  Withhold dose and contact physician if there is a decline in the pt’s condition or if vital signs are abnormal, especially if respiratory rate is less than 10-12 breaths/min  Regardless of symptoms, when a pt experiences severe respiratory depression (dyspnea, diminished breath sounds, or shallow/irregular breathing) give opioid antagonist o Reversal agent for opioid addicts: naltrexone • Opioid withdrawal/opioid abstinence syndrome o Peak 1-3 days; duration 5-7 days o Manifested as: increased BP and HR, anxiety, irritability, confusion, insomnia, chills, hot flashes, diaphoresis, joint pain (arthralgia), lacrimation, rhinorrhea, nausea, vomiting, abd cramps, diarrhea, mydriasis, piloerection • Medication treatment for withdrawal o Clonidine (Alpha 2 Agonist) o Methadone  Long half-life, may lead to overdose/death  Opioid so fills the same receptors of abused opioid, but block the effects of street drugs and decreases cravings • Meperidine HCl o Toxic CNS, may lead to seizures; not long-term therapy  adjuvant drugs: know classifications; amitriptyline: 2; gabapentin: 2 o Nonopioids: 1, 2, 3, 5