Ch 14 2 Pharm

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Author:
jld15
ID:
303865
Filename:
Ch 14 2 Pharm
Updated:
2015-06-09 16:36:35
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14 Pharm
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Description:
Ch 14 2 Pharm
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  1. Mechanism of Action Opioid
    • Located on CNS and possible in peripheral nerve tissue
    • ----CNS: responsible for transmitting nociceptive input to higher levels (pain transmission and interpretation)
    • 1. Inhibit synaptic pain transmission (bc substance P)
    • 2. Decrease neurotransmitter from the presynaptic terminal decreasing excitability of postsynaptic neuron
    • 3. G proteins
    • ---- activate G protein which inhibits opening of Ca channels on neuron, decreasing NT release for excitation
    • ---- increase release of K which causes hyperpolarization, decreasing likelihood of restimulation
    • ----Decreases synthesis cAMP (2nd messenger), decreases transmission of pain
  2. Peripheral Effects of Opioids
    • Decrease excitability of sensory neurons
    • ----Endogenous opioids (endorphins, Enkephalins) produced by leukocytes in peripheral tissues during painful inflammation and act locally on peripheral sensory terminals
    • Opioids that work at the peripheral level have decreased CNS mediated side effects
    • ----Bc don’t cross BBB
  3. Clinical Applications of Opioids
    • Pain management (post surgery/injury) by altering the perception
    • ----Moderate-to-severe
    • ----Acute pain
    • ----Surgery
    • ----Trauma
    • ----MI
    • ----Alter the perception of pain rather than eliminating sensation
    • ----Route of administration is important
  4. --------Parenteral more effective in chronic/severe pain
    • Dosing schedules
    • ----Oral
    • --------More effective when given at regularly scheduled intervals
    • Parenteral
    • ----Continuous infusions into epidural or Intrathecal space provides optimal pain relief but causes GI side effects
  5. Adverse Effects Opioids
    • Sedation
    • Mental slowness
    • Drowsiness
    • Respiratory depression
    • Orthostatic hypotension
    • GI distress
    • ----Nausea, constipation
    • Tolerance
    • Physical dependence
    • Withdrawal syndrome
  6. Withdrawal syndrome
  7. 6-10 hrs after last dose, peak 2-3 days after drug stopped, last 5 days
    • Body aches
    • Diarrhea
    • Fever
    • Goose flesh
    • Insomnia
    • Irritability
    • Loss of appetite
    • Nausea/vomiting
    • Runny nose
    • Shivering
    • Sneezing
    • Stomach cramps
    • Sweating
    • Tachycardia
    • Uncontrollable yawning
  8. Other Opioid Uses
    • Anesthesia premedication
    • Cough suppression
    • Decrease GI motility
    • Pulmonary edema
  9. Tolerance
    Greater dose needed for effect due to enzyme induction
  10. Dependence
    • Dependent on physiologic and psychologic need
    • Exhibit withdrawal symptoms
  11. Methadone
    Reduce addition from heroine
  12. Therapist concerns
    • Education pts about GI motility and constipation
    • ----Usually take laxative and GI stimulant
    • Pt can use physical agents (heat, electrotherapy) and manual techniques (massage, relaxation techniques) to aid in opioid withdrawal

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