pain meds 2

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jean
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17006
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pain meds 2
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2010-05-03 10:48:05
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pain meds
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pain meds 2
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  1. Opioid agonists
    Morphine
  2. Opioid agonists
    • naturally occuring opium alkaloid
    • produces profound analgesia
    • causes euphoria produces sedation
    • constricts the pupils
  3. Morphine indications
    • relieves SOB in MI
    • cardiac failure
    • PE
  4. Relieves chest pain associated with
    Myocardial infarction
  5. relief of serious
    acute and chronic pain
  6. other indications
    pre-operative medication smooth muscle relaxant
  7. morphine causes peripheral vasodilation
    • by decreasing SVR
    • decreases MO2 demand
  8. morphine causes profound
    orthostatic hypotension
  9. morphine pharmacokinetics
  10. morphine adverse effects
    • hallucinations
    • nausea
    • constipation
    • dizziness
    • itching
    • sensation
    • urinary retention
    • ** BPH exacerbated physical/psychological dependence
    • high doses long duration
  11. Morphine overdose
    • respiratory depression
    • cardiac arrest
    • increased ICP from CO2 retention
    • secondary to respiratory depression
    • seizures from increased ICP
    • cross tolerance with other opioids
  12. Morphine contraindications
    • may mask gallbladder disease
    • pain
    • do not give in suspected
    • gall bladder disease or pancreatic disease
    • biliary tract spasm sphincter of Oddi acute asthma
    • upper airway obstruction
    • GO obstruction
    • decreases persitalisis
    • severe hepatic or renal disease
    • respirations <12/min
  13. Nursing Considerations Morphine
    • Monitor clients health condition
    • educate pt on drug Tx
  14. Nursing Considerations Initial Assessment Morphine
    • Resp
    • BP
    • liver function renal function
    • UOP
    • Allergy
    • CBC
    • Current Med usage
    • ETOH safety
    • BR up
    • Bed-low
  15. Nursing Interventions Morphine
    • Assess LOC following medication administration
    • Monitor VS Pain Levels
    • Respiratory rate and depth
    • monitor injection sites
    • IV sites
    • Offer additional pain relief measures
    • massage
    • hot packs
    • ice packs
  16. narcotic antagonist
    • Narcon available if resp fall to 10 or less
    • may need to repeat doses
  17. Nursing interventions morphine education
    • Reassure risk of addition is minimal
    • provide thorough patient education
    • drug name
    • prescribed dose
  18. S/S of adverse effects when to call physician
    • Monitor client response to morphine
    • pain levels
    • pain relief
    • cough suppressant
    • sedation decreased
    • GI motility
  19. Evaluation Morphine
    • Monitor for adverse effects
    • evaluate teaching effectiveness
    • monitor compliance with pain management
  20. Codeine
    Naturally occuring opium alkaloid
  21. Codeine is a Schedule ____ drug
    II
  22. Codeine is an
    Analgesic/Antitussive(weaker than morphine)
  23. What is mode of administration?
    Effective PO, subq, IM
  24. Codeine has a strong _________ effects antitussive
    less likely to cause abuse & dependency
  25. codiene is usually given with
    acetaminophen for additive effects but causes nausea & vomiting
  26. Demerol
    synthetic drug
  27. Demerol pharmacologic action
    is similar to MS04
  28. Demerol - 80-100 mgm =
    10 mg of morphine
  29. Is Demerol natural or synthetic?
    synthetic
  30. What is the generic name for Demerol?
    Meperidine
  31. What is the route for Demerol for children?
    PO/subQ/IM
  32. What is the dosage of Demerol for children?
    50-150 mg q3-4h PRN, max: 100 mg q4h
  33. What is the route for Demerol for adults?
    • PO
    • subQ
    • IM
    • IV
  34. What is the dosage of Demerol for adults?
    1-1.5 mg/kg q3-4hr PRN
  35. Demerol produces what kind of sedation?
    respiratory depression
  36. Demerol has a _______ duration of action than morphine.
    shorter
  37. Demerol requires more or less adm?
    more
  38. Demerol has _____ antitussive effect
    Less
  39. demerol causes smooth muscle
    spasms
  40. Demerol uses
    treatment of severe pain
  41. what is the preferred analgesic for clients with renal or biliary colic?
    Demerol
  42. what is used as a short term pain management in healthy clients?
    Demerol
  43. Demerol is contraindicated in
    • CA pain management
    • requires increased doses
  44. Demerol is not recommended for pain control longer than
    48 hrs
  45. Demerol is considered ______ line agent
    second
  46. What does the active metabolite of Demerol cause?
    tremors and seizures
  47. Is Demerol reversed by Narcan?
    no
  48. Why is Demerol NOT recommended for PCA use?
    half life too short frequent dosing required q3-4 hrs
  49. How do opioid antagoinist work?
    • competes with opioid receptors sites in the brain
    • prevents opioid binding
    • displaces opioids already occupying receptor sites
    • neutralizes opiods
  50. what is dose of Narcan?
    • 0.4 - 2.0 mg
    • repeat q 2-3 minutes due to short half-life
  51. Opioid Antagonists
    Natoxone (Narcan)
  52. Reverses or blocks analgesia
    • reverses CNS depression
    • reverses resp depression
  53. Nursing interventions of opioids antagonists
    • administer small doses often
    • repeated until client exhibits reversal of opiate effects
    • IV dose last 1 hr
    • maintain airway resuscitation
    • equipment immediately available
  54. Routes for opioids antagonists
    subq, IV, IM
  55. Pharmacokinetics of opioid antagonists
    • Hepatic metabolism renally excreted
    • hepatic metabolism onset of action - IV 1-2 minutes
    • duration of action - IV, 1 hr IM, up to 4 hrs
  56. Adverse effects of opioid antagonists
    • no common
    • but serious include tachycardia
    • dysrhythmias
    • HTN
    • N/V

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