1050: Pain Mgmt Exam 2

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Author:
xiongav
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285466
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1050: Pain Mgmt Exam 2
Updated:
2014-10-22 22:31:49
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NURS
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Description:
Pain management
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  1. What pt variables (side effects) must be assessed with the use of narcotics?
    • 1) respiratory distress
    • 2) cardiac distress
    • 3) baseline; severity of pain
  2. Morphine 

    Pain type?

    Apply ADME.

    Action:
    • 1) severe pain
    • 2) chronic pain
    • 3) post-op
    • Absorption: 30% oral; better w/ IV, subQ, rectal.
    • Distribution: Crosses placenta, found in breast milk.
    • Protein binding: 35% in adults.
    • Metabolism&Excretion: liver, kidneys

    Action: Binds with opioid receptors in CNS, altering perception and emotional response to pain.
  3. Morphine (continued)

    Onset & duration?
    Contraindications
    Side effects
    Adverse effects
    Interactions
    Onset&duration: 10-30 minutes; 4-5 hours

    Contra: hypersensitivity, head injuries, debilitated pts, pregnant/lactating, infants.

    Side FX: CNS-confusion, sedation, hypotension, constipation, urinary retention, N/V

    Adverse FX: RESPIRATORY DISTRESS

    Interactions: many drugs; natural products-valerian, chamomile--increases CNS depression.
  4. fentaNYL

    Routes
    What type of pain?
    ADME
    Routes: parenteral, transdermal, transmucosal.

    Pain type: moderate-severe pain requiring prolonged analgesic therapy.

    • Ab: well absorbed
    • Dist: crosses placenta, enters breast milk.
    • Metab/Excretion: liver and kidneys
  5. fentaNYL (continued)

    Onset & duration (transdermal)
    Contraindications
    Side effects
    Adverse effects
    Interactions
    Onset&duration: Onset-6 hrs; dur-72 hours

    Contra: hypersensitivity, acute pain, post-op, breast feeding, peds

    Sede FX: confusion, sedation, restlessness, bradycardia, constipation, N/V.

    Adverse FX: APNEA

    Interaction: drug-drug, MAO inhibitors, food-grapefruit juice.
  6. Codeine: mild opioid agonist.

    Pain type
    Purposes (2)
    ADME
    • Pain type: mild-moderate pain.
    • Purposes: 1) diarrhea 2) suppresses cough reflex.
    • Ab: 50% from GI tract
    • Dist: crosses placenta, breast milk, 7% protein-binding.
    • Met: liver
    • Excretion: kidneys
  7. Codeine (continued)

    Onset & duration
    Contraindications
    Side effects
    Adverse effects: none identified
    Interactions (similar to morphine)
    Onset: 30-45 minutes; duration: 4 hours

    Contra: head trauma, hypersensitivity, alcoholism.

    Side FX: confusion, sedation, hypotension, constipation, N/V.

    Interactions: drug-drug-many; natural products-valerian, chamomile, hops--increases CNS DEPRESSION
  8. HYDROmorphone

    Pain type: 
    ADME
    • Moderate - severe
    • A: well absorbed
    • D: Crosses placenta, enters breast milk.
    • M/E: liver, kidney
  9. HYDROmorphone (cont'd)

    Onset&duration:
    Contra/Cautions:
    Side FX:
    Adverse FX
    Interactions
    O&D: PO-30 min; 4-5 hours

    Contra: pregnancy, breast-feeding, GERIATRiCS, INCREASED CRANIAL PRESSURE.

    S FX: confusion, sedation, hypotension, blurred vision, constipation

    A FX: RESPIRATORY DEPRESSION, bronchospasm, bradycardia

    Interactions: anti-depressants, increase risk of CNS DEPRESSION

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