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What is the 5th vital sign?
- Pain, should be accessed and monitored in all patients.
- an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
- Associated with surgery, other medical procedures or trauma
- Last only hours or a few days
- Treated primarily with analgesics, often narcotic analgesics
Chronic Malignant pain
- Associated with cancer or other progressive diseases
- May last months or years
- May be complicated by depression
- Treated with analgesics, often narcotic analgesics
Chronic Nonmalignant pain
- caused by ongoing disease that is not life-threatening, pain that has continued after the underlying cause is resolved or pain that has no identifiable cause
- Includes arthritis pain, headache pain, neuropathic pain and fibromyalgia
- May be complicated by depression, anxiety and other psychological disorders
- Treatment is complex involving use of analgesics as well as other therapies
- the immediate defensive action of tissue to any injury, which may be caused by infection, chemicals or physical agents.
- involves pain, heat, redness, swelling, and loss of function of the affected part.
What is opium? Where does it come from?
the poppy, papaver somniferum
How do narcotic analgesics work?
- produce most of their effects on the central nervous system (CNS) and the bowel.
- an agonist-receptor (lock and key) interaction.
- The relative potency of the different narcotic analgesics correlates well with their affinity for these receptors
What actions do narcotic analgesics have on various body functions?
- Pupil: cause constriction of the pupil, pinpoint pupils in a patient are said to be an indicator of narcotic use. Note: meperidine (Demerol�) can cause dilation of the pupils, good for shavering after surgery.
- Respiration system: all cause depression of respiration
- GI: Inhibit GI motility, and stimulate the CTZ. Mepergin can antagonist the vomiting after surgery , Opium was used for relief of diarrhea. Opiates decrease propulsive movements in the GI tract and increase muscle tone of the sphincters.
What is Lomotil� used for?
Narcotic analgesics agents
- Acetaminophen/Codeine (Tylenol #3�)
- Propoxyphene/Acetaminophen (Darvocet N 100�)
- Hydrocodone/Acetaminophen (Lortab�, Vicodin�)
- Hydrocodone/Ibuprofen (Vicoprofen�)
- Oxycodone (OxyContin�, Roxicodone�, M-Oxy�, Percolone�)
- Oxycodone/Acetaminophen (Percocet�, Tylox�, Roxicet�)
- Tramadol/Acetaminophen (Ultracet�)
- Tramadol (Ultram�) still addictive
- Tapentadol ( Nucynta�)
- Hydromorphone (Dilaudid�)
- Morphine (MS Contin�, Roxanol�) highest pain relief
- Propoxyphene (Darvon�) low in pain relive ability, high in
- that fits the lock of the narcotic receptor but doesn't turn the key.
- also blocks the receptor from getting stimulation from any narcotic agonist.
- Treat narcotic Addiction, reverse response of narcotic
- Naloxone (Narcan)
- Naltrexone (Trexan)
- Nalmefene (Revex)
Why are narcotic analgesics abused?
- Psychological Dependence: euphoria is responsible for a large part of the problem with drug abuse.
- Physical Dependence: When narcotic analgesics are used on a regular (usually daily) basis, the body tends to revolt if a scheduled dose is missed. This missing of a dose is very uncomfortable and is responsible for much of the "drug seeking behavior".
- Patients who regularly take narcotic analgesics will develop tolerance to the euphoria, analgesia, sedation and respiratory depression caused by these agents.
- However, they do not develop tolerance to the GI effects.
the "drying out" or "detox" period.
- Symptoms of withdrawal from narcotic analgesics begin shortly before the next scheduled dose (usually about 8 to 12 hours after the last dose).
- These symptoms will usually continue for 7 to 10 days.
What are some of the symptoms of narcotic withdrawal?
- Initial Period: Anxiety, restlessness, Insomnia, Perspiration, Yawning, Tremor
- Peak: Irritability, Nausea, vomiting, diarrhea, High blood pressure
- Others: Body aches, muscle cramps, Dilated pupils, Hot flashes, excessive sweating, Fever, chills, Abdominal cramps
What is Methadone used for?
- Narcotic withdrawal by a licensed detox center
- Maintenance of an addict while in the hospital for another reason
- Pain, long acting, one dose before leaving the hospital.
MOA of non-narcotic analgesics
- Cyclooxygenase is an important enzyme in the synthesis of prostaglandins.
- Inhibition of cyclooxygenase may result in analgesic, antipyretic and anti-inflammatory effects.
- Works by inhibiting prostaglandin synthesis both in the central nervous system and peripherally (COX-1 and COX-2)
- Also has antipyretic action
- Also has anti-inflammatory properties
- Works by inhibiting prostaglandin synthesis only in the central nervous system (COX-3)
- Also has antipyretic activity
- Has no anti-inflammatory properties
How do NSAID�s work?
- Work by inhibiting prostaglandin synthesis both in the central nervous system and peripherally (COX-1 and COX-2)
- Also have anti-inflammatory properties
- Also have antipyretic action
- Combination of NSAIDs with other drugs such as omperazole or misoprostol, can help prevent ulcer formation.
Uses of NSAID
- Menstrual cramps
- Aches and sprains of muscles
What is different about celecoxib?
selective COX-2 inhibitors. It is hoped that these agents will have a lower incidence of bleeding and other GI disturbances.
Identify all of the NSAID�s found on the Top 200.
- Ibuprofen (Motrin�, IBU�)
- Naproxen (Anaprox�, Naprosyn�)
- Meloxicam (Mobic�)
- Designed specifically for people on long-term NSAID therapy
- A synthetic prostaglandin that stimulates the GI tract to produce mucus
- Does not affect inflammatory response pathway
- Helps prevent ulcers without hindering the NSAIDs designated task
recurrent attacks of acute inflammatory arthritis�a red, tender, hot, swollen joint.
- Carisoprodol (Soma�)
- Cyclobenzaprine (Flexeril�)
Lortab, Vicodin, Lorcet
Tylox, Endocet, Percocet