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NR-291 Pharmacology I
Study Guide – Exam 4
Chapter 10: Analgesic Drugs
oKnow and apply basic pharmacology principles for pain management
oKnow WHO Analgesic Ladder and apply to acute pain and chronic pain management
oOpioid Drugs: 1, 5, 6, 11, 12, 13 (addicts and non-addicts)
▪ Nice to know:
• Nursing Considerations:
oMedicate pts before the pain becomes severe (Around the Clock,
ATC)
oPharmacologic and nonpharmacologic approaches to pain
oOral forms should be taken with food to minimize gastric upset
oEnsure safety measures such as keeping side rails up, to prevent
injury
• Drug Interactions:
oAlcohol, antihistamines, barbiturates, benzodiazepines,
monoamine oxidase inhibitors
• 4 categories of opioids:
oEndogenous – produced by the body
oOpium alkaloids – morphine
oSemi-synthetic opioids – oxycodone, hydrocodone,
hydromorphone, heroin
oFully synthetic opioids – propoxyphene, tramadol, pentazocine
• Heroin, oxycontin, and hydrocodone/acetaminophen (Vicodin)
have similar effects
• Opioid ceiling effect – codeine, nalbuphine, pentazocine
• Clonidine
oAlpha-2 adrenergic agonist
oCentral inhibition of the hyper-nonadrenergic state that occurs
in opioid withdrawal
oDecrease BP and stress in the first few days of withdrawal
▪ Good to know:
• Rapid-onset opioids (fentanyl)
oDo not have to swallowed (injection, buccal lozenge, or
stick/sucker)
oApproved for treatment of cancer-related breakthrough pain
oPatches 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:
oRespiratory insufficiency, elevated intracranial pressure,
morbid obesity and/or sleep apnea, paralytic ileus, pregnancy
• Adv Eff:
oCNS depression
▪ Leads to respiratory depression, most serious adv eff
▪ Decreased BP and HR
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▪ 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
oSkin
▪ Diaphoresis, flushing, and itching
oEyes
▪ Pupil constriction (miosis)
• Hydromorphone
o8 times more potent than morphine
oEpidural route can lead to increased ICP
▪ Got to know:
• Opioid antagonist drug: naloxone
oGiven IV push
oReverse 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
oReversal agent for opioid addicts: naltrexone
• Opioid withdrawal/opioid abstinence syndrome
oPeak 1-3 days; duration 5-7 days
oManifested 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
oClonidine (Alpha 2 Agonist)
oMethadone
▪ 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
oToxic CNS, may lead to seizures; not long-term therapy
▪ adjuvant drugs: know classifications; amitriptyline: 2; gabapentin: 2
oNonopioids: 1, 2, 3, 5
▪ Nice to know:
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