Introduction to Clinical Pharmacology Chapter 13 Nonopioid Analgesics: Salicylates and Nonsalicylates.

Introduction to Clinical Pharmacology Chapter 13 Nonopioid Analgesics: Salicylates and Nonsalicylates

Pain Pain is the unpleasant sensory and emotional perception associated with actual or potential tissue damage The sensation of pain is sent from the peripheral tissue to the brain where it is interpreted. Pain medications change the sensation in the tissues or modulate the signal in the brain Acute pain has a short duration of less than 3 to 6 months, whereas chronic pain lasts more than 6 months

Salicylates Drugs derived from salicylic acid
Useful in pain management due to analgesic, antipyretic, and anti-inflammatory effects

Salicylates: Actions and Uses
Lower body temperature Inhibit production of prostaglandins ( when prostaglandins are released sensitivity of pain receptors in the tissue increases) Aspirin: inhibits prostaglandin synthesis and has greater anti-inflammatory effects; prolongs bleeding time Used for mild to moderate pain; reducing elevated body temperature; treating inflammatory conditions; decreasing risk of myocardial infarction; reducing risk of transient ischemic attacks

Salicylates: Adverse Reactions
Gastrointestinal (GI) reactions: Gastric upset; heartburn; nausea; vomiting; anorexia; GI bleeding; allergy Significant blood loss Allergy to salicylates manifested by: Hives, rash, angioedema, bronchospasm, anaphylactoid reactions

Salicylates: Contraindications and Precautions
Contraindicated in clients with: Known hypersensitivity; bleeding disorders; Children or teenagers with chickenpox or influenza- Reye syndrome(life threatening by vomiting and lethargy progressing to coma) Used cautiously in clients: With hepatic and/or renal disease; during pregnancy and lactation; with pre-existing hypoprothrombinemia; with vitamin K deficiency; with GI irritation or peptic ulcer; with mild diabetes or gout

Salicylates: Interactions
Interactant drug Effect of interaction Anticoagulant Increased risk for bleeding NSAIDs Increased serum levels of the NSAID Activated charcoal Decreased absorption of the salicylates Antacids Decreased effects of the salicylates Carbonic anhydrase inhibitors Increased risk for salicylism

Nonsalicylates: Actions and Uses
Analgesic and antipyretic activity: same as salicylates No anti-inflammatory action Uses: Used to treat mild to moderate pain; reduce elevated body temperature; manage pain and discomfort—arthritic disorders

Nonsalicylates: Action and Uses
Useful for people: With aspirin allergy; bleeding disorders; receiving anticoagulant therapy; who had recent minor surgical procedures

Nonsalicylates: Adverse Reactions
Adverse reactions: skin eruptions; urticaria; hemolytic anemia; pancytopenia; hypoglycemia; jaundice; hepatotoxicity; hepatic failure ; ETOH abuse Overdose causes acute acetaminophen poisoning or toxicity

Nonsalicylates: Contraindications and Precautions
Contraindicated in patients with hypersensitivity Used cautiously in patients: With severe or recurrent pain or high or continued fever Acetaminophen used cautiously during pregnancy and lactation

Nonsalicylates: Interactions
Interactant drug Effect of interaction Barbiturates Increased possibility of toxicity and decreased effect of acetaminophen Hydantoins Isoniazid and rifampin Loop diuretics Decreased effectiveness of the diuretic

Nursing Process: Assessment
Preadministration assessment: Assess type, onset, intensity, and location of pain Evaluate ability to carry out activities of daily living Develop a care plan Evaluate the response to drug therapy

Nursing Process: Assessment (cont.)
Ongoing assessment: Monitor relief of pain; reassess pain rating 30 to 60 minutes following administration of the drug; monitor vital signs at least every 4 hours Assess and document severity, location, and intensity of pain Report any adverse reactions

Nursing Process: Nursing Diagnosis and Planning
Impaired Comfort related to fever of the disease process (e.g., infection or surgery) Chronic or Acute Pain related to peripheral nerve damage and/or tissue inflammation due to the disease process Impaired Physical Mobility related to muscle and joint stiffness Risk for Poisoning related to increased salicylate or acetaminophen use

Nursing Process: Implementation
Promoting an optimal response to therapy: Avoid salicylates 1 week before or after any surgery Observe for adverse drug reactions Observe for signs of salicylism

Nursing Process: Implementation (cont.)
Promoting an optimal response to therapy (cont.) Symptoms associated with salicylates: Levels greater than 150 mcg: result in mild salicylism Levels greater than 250 mcg: result in symptoms of mild salicylism Levels greater then 400 mcg: result in respiratory alkalosis; hemorrhage

Promoting an optimal response to therapy (cont.): Administer acetaminophen with full glass of water, with meals or on empty stomach Symptoms of overdosage: nausea; vomiting; diaphoresis; generalized malaise Acute overdosage treated with acetylcysteine to prevent liver damage

Monitoring and managing patient needs: Impaired comfort: Check temperature before and 45 to 60 minutes after administration Suppository form of drug used: check after 30 minutes for retention of suppository Notify primary health care provider if temperature not controlled

Monitoring and managing patient needs (cont.) Pain: Notify primary health care provider if no relief from pain or discomfort Check cause of new pain experienced; report to primary health care provider as other therapy may be needed Check the color of the stools

Monitoring and managing patient needs (cont.) Impaired physical mobility Acute pain or long-standing mild to moderate pain Determine degree of immobility Assist with ambulation

Monitoring and managing patient needs (cont.) Risk for poisoning Withhold drug and report any sensory alterations immediately if suspected Explain that hearing loss disappears when the drug therapy is discontinued

Educating the patient and family: Develop a teaching plan that includes: Take the drug exactly as prescribed by the primary health care provider Take the drug with food or a full glass of water Do not consistently use an OTC nonopioid analgesic to treat chronic pain

Educating the patient and family (cont.) Do not use these drugs on regular basis unless primary health care provider notified Teaching on salicylates includes: Salicylates deteriorate rapidly when exposed to air, moisture, and heat Consult pharmacist about the product’s ingredients if in doubt

Educating the patient and family (cont.) Discontinue use 1 week before surgery or dental procedure Teaching on acetaminophen includes: Acetaminophen lacks anti-inflammatory properties of aspirin Notify primary health care provider if any adverse reactions occur Avoid use of alcoholic beverages

Nursing Process: Evaluation
Relief from pain; body temperature normal Adverse reactions are identified, reported, and managed Patient verbalizes the importance of complying with the prescribed treatment regimen Patient demonstrates understanding of prescribed treatment regimen and adverse effects

Question Is the following statement true or false?
Respiratory distress is the primary adverse reaction of salicylates.

Answer False Gastric distress is the primary adverse reaction of salicylates. Long-term users should be monitored for potential bleeding from the GI tract. Ringing in the ears (tinnitus) can be an early sign of salicylism (toxic reaction). Children should refrain from aspirin use due to Reye syndrome.

Introduction to Clinical Pharmacology Chapter 14 Nonopioid Analgesics: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Migraine Headache Medications

A key component to good pain management is the pain assessment.

Answer True A key component to good pain management is the pain assessment. Location and intensity are the basic components of an assessment.

Pain Assessment A key component to good pain management is the pain assessment. Location and intensity are the basic components of an assessment. The sensation of pain is subjective—effort is taken with standardized pain measurement tools to help the patient relay information needed to provide pain relief

Assessment Guidelines
Patient’s subjective description of the pain (What does the pain feel like?) Location(s) of the pain Intensity, severity, and duration Any factors that influence the pain Quality of the pain Patterns of coping Effects of previous therapy (if applicable) Nurses’ observations of patient’s behavior

Sample Assessment Questions
Does the pain keep you awake at night? Prevent you from falling asleep or staying asleep? What makes your pain worse? What makes it better? Can you describe what your pain feels like? Sharp, stabbing, burning, or throbbing? Does the pain affect your mood? Are you depressed? Irritable? Anxious? What over-the-counter or herbal remedies have you used for the pain? Does the pain affect your activity level? Are you able to walk? Perform self-care activities?

Patients at risk for inadequate pain management are frequently those who are not assessed well.

Answer True Patients at risk for inadequate pain management are frequently those who are not assessed well. Consider using standardized visual analog tools to assess pain in these high-risk patient populations.

Populations at Higher Risk for Poor Pain Assessment
Infants and children Older adults, especially those cognitively impaired Developmentally disabled children and adults Those with communication problems such as limited English proficiency or limited health literacy Those unable to communicate due to the illness or treatment process

NSAIDs: Actions and Uses
Exact mechanism of action unknown; thought to work by inhibiting action of enzyme cyclooxygenase responsible for prostaglandin synthesis; NSAIDs inhibit two related enzymes Inhibit activity of cyclooxygenase-1 (COX-1): Enzyme helps to maintain the stomach lining Inhibit activity of cyclooxygenase-2 (COX-2): Enzyme triggers pain and inflammation

NSAIDs: Actions and Uses (cont.)
Ibuprofen and naproxen: block COX-2, produces pain relief; inhibit COX-1, causes adverse reactions including unwanted GI reactions such as stomach irritation and ulcers Celecoxib: inhibits only COX-2; less potential for GI adverse reactions Used for osteoarthritis, rheumatoid arthritis, and other musculoskeletal disorders; mild to moderate pain; primary dysmenorrhea; fever reduction

NSAIDs: Adverse Reactions
Gastrointestinal system reactions Nausea, vomiting, dyspepsia, diarrhea, constipation, epigastric pain, indigestion, abdominal distress or discomfort, intestinal ulceration, stomatitis, jaundice, bloating, anorexia, dry mouth

NSAIDs: Adverse Reactions (cont.)
Central nervous system reactions Anxiety, lightheadedness, vertigo, headache, drowsiness, somnolence, insomnia, confusion, depression, stroke, psychic disturbances Cardiovascular reactions Congestive heart failure, decrease or increase in blood pressure, cardiac arrhythmias, myocardial infarction

Renal reactions Hematuria, cystitis, elevated blood urea nitrogen, polyuria, dysuria, oliguria, acute renal failure in those with impaired renal function Sensory reactions Blurred or diminished vision, diplopia, swollen or irritated eyes, photophobia, reversible loss of color vision, tinnitus, taste change, rhinitis

Hematologic reactions Neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, aplastic anemia Skin reactions Rash, erythema, irritation, skin eruptions, exfoliative dermatitis, Stevens--Johnson syndrome, ecchymosis, purpura

Metabolic/endocrine reactions Decreased appetite, weight increase or decrease, hyperglycemia or hypoglycemia, flushing, sweating, menstrual disorders, vaginal bleeding Other Taste change, rhinitis, tinnitus, visual disturbances, thirst, fever, chills, vaginitis

NSAIDs: Contraindications
Cross-sensitivity, if allergic to one NSAID, there is increased risk of allergic reaction to others; hypersensitivity to aspirin; for post-operative pain following CABG; during third trimester of pregnancy and lactation Ibuprofen: hypertension, peptic ulceration, or GI bleeding Celecoxib: allergic to sulfonamides, or history of cardiac disease or stroke

NSAIDs: Precautions Cautious use: pregnancy (pregnancy category B); elderly patients; patients with bleeding disorders, renal disease, cardiovascular disease, hepatic impairment

NSAIDs: Interactions Anticoagulants: increased risk of bleeding
Lithium: increased effectiveness of and possible toxicity of lithium Cyclosporine: increased effectiveness of the cyclosporine Hydantoins: increased effectiveness of the anticonvulsant Diuretics: decreased effectiveness of the diuretic

NSAIDs: Interactions (cont.)
Antihypertensive drugs: decreased effectiveness of antihypertensive drug Acetaminophen in long-term use: increased risk of renal impairment

Drugs Used in the Treatment of Migraine Headaches
Pain associated with migraine headaches is believed to be caused by vascular spasms. Drugs used to treat migraine headaches are given: Prophylactically to prevent the spasms To treat the acute pain when a migraine occurs

Actions and Uses The symptoms of migraine headaches are believed to be caused by local cranial vasodilation and stimulation of trigeminal nerves Activation of the 5-HT receptors causes vasoconstriction and reduces the neurotransmission, which in turn produces pain relief Selective serotonin drugs are used for the relief of moderate to severe pain and inflammation related to migraine headaches

Adverse Reactions The most common are dizziness, nausea, fatigue, pain, dry mouth, and flushing Cardiovascular system Coronary artery vasospasm Cardiac arrhythmias and tachycardia Myocardial infarction

Contraindications and Precautions
These drugs are contraindicated in patients with a known hypersensitivity to selective serotonin agonists and should only be used when a clear diagnosis of migraine headache has been established 5-HT agonists should not be used in patients with ischemic heart disease (such as angina or myocardial infarction), transient ischemic attacks (TIAs), or uncontrolled hypertension or those patients taking monoamine oxidase inhibitor (MAOI) antidepressants These drugs should be used cautiously in patients with hepatic or renal function impairment, such as the elderly or patients requiring dialysis

Preadministration assessment: History: allergies, GI bleeding, cardiovascular disease, stroke, hypertension, peptic ulceration, or impaired hepatic or renal function; if present notify primary health care provider Assess and document type, onset, intensity, and location of pain Note if pain is different from previous episodes of pain

Arthritis; musculoskeletal disorder; soft tissue inflammation: examine the joints or areas involved for appearance and mobility Evaluate ability to carry out activities of daily living Important for plan of care and evaluation of response to drug

Ongoing assessment: Monitor pain relief; reassess pain rating 30 to 60 minutes following administration of the drug Persisting pain: assess and document severity, location, and intensity; monitor vital signs at least every 4 hours Assess for decrease in inflammation and mobility in joints Report any adverse reactions (dark stools, prolonged bleeding)

Nursing Process: Nursing Diagnoses
Acute or Chronic Pain related to peripheral tissue damage caused by the disease process or GI bleeding or inflammation from NSAID therapy Impaired Physical Mobility related to muscle and joint stiffness Risk for Injury related to adverse reaction of NSAID causing damage to optical field Impaired Skin Integrity related to photosensitivity when using 5-HT agonists

Nursing Process: Planning
Expected outcome: optimal response to drug therapy; management of adverse reactions; understanding of and compliance with prescribed treatment regimen

Promoting an optimal response to therapy: NSAID administered with food, milk, or antacids Several weeks of treatment: full therapeutic response

Monitoring and managing patient needs Pain Elderly more vulnerable to GI bleeding due to higher incidence of rheumatoid arthritis and osteoarthritis and use of NSAIDs on long-term basis Encourage to take drug with full glass of water and food

Monitoring and managing patient needs (cont.) Impaired physical mobility Provide comfort measures, support limbs, apply heat or cold, rest joint, avoid overuse Assistive mobility devices such as canes, crutches, walkers

Monitoring and managing patient needs (cont.) Assist patient using orthopedic and assistive devices Experience increased range of motion and reduced pain/tenderness/swelling Observe for adverse drug reactions, GI bleeding, and cardiovascular reactions

Monitoring and managing patient needs (cont.) Disturbed sensory perception: Visual Causes visual disturbances Report blurred, diminished vision or changes in color vision Visual changes are asymptomatic; patients on long-term therapy need periodic eye examinations

Educating the patient and family Patients may discontinue the drug, fail to take the drug, increase dose, decrease or increase time intervals when drug is to be taken; the patient and family need to understand the fact that the drug needs to be taken correctly even if symptoms are relieved Develop teaching plan: appropriate prolonged use of the drug

Educating the patient and family (cont.) Discuss points to be included in teaching plan for a patient receiving NSAIDs Take exactly as prescribed Notify dentist or primary health care provider if pain not relieved, fever not reduced Take drug with food and full glass water

Educating the patient and family (cont.) Inform all health care providers when drugs are taken Consult primary health care provider if fever and temperature remains elevated for more than 24 hours Notify primary health care provider if pain persists more than 10 days or fever more than 3 days Advise not to use aspirin

Educating the patient and family (cont.) Drug may take several days to produce effect; if not relieved in 2 weeks consult primary health care provider Causes dizziness/drowsiness/blurred vision; use caution while driving or with tasks requiring alertness Notify primary health care provider if adverse reactions occur

Relief from pain and discomfort; better mobility Body temperature: normal Adverse reactions: identified, reported, and managed Patient verbalizes understanding of treatment regimen and adverse effects of the drug

Introduction to Clinical Pharmacology Chapter 15 Opioid Analgesics

Introduction to Opioid Analgesics
Controlled substances Do not change tissues where pain originates Change patient’s perception of pain Treat pain centrally in the brain

Opioid Analgesics The opiates are natural substances –morphine sulfate, codeine, opium alkaloids, and tincture of opium. Synthetic opioids are those manufactured analgesics with properties and actions similar to the natural opioids. Examples -methadone, levorphanol, remifentanil, and meperidine. Morphine sulfate, when extracted from raw opium and treated chemically, yields the semisynthetic opioids- hydromorphone, oxymorphone, oxycodone, and heroin. Hydrocodone is a semisynthetic drug made from codeine.

Opioid Analgesics: Actions
Cells within central nervous system Mu and kappa receptors Agonist agents-Drugs that bind well to a receptor Opioid analgesic-may be classified as an agonist, partial agonist, or mixed agonist-antagonist. Agonist- binds to a receptor and causes a response. Partial agonist -A partial agonist binds to a receptor, but the response is limited Agonist-antagonist-have some agonist activity and some antagonist activity at the receptor sites. An antagonist can reverse the effects of the agonist. This reversal is possible because the antagonist competes with the agonist for a receptor site.

Opioid Analgesics: Actions
In addition to the pain-relieving effects, other nonintended responses occur when the opiate receptor sites are stimulated. -respiratory depression, decreased gastrointestinal (GI) motility, and miosis (pinpoint pupils). Slow GI motility and the resulting constipation are always a problem in opioid therapy.

Opioid Analgesics: Uses
Treat pain Manage opiate dependence Decrease anxiety -sedation Support anesthesia adjunct- post op pain Promote obstetric analgesia Administered intrathecally/epidurally Treats severe diarrhea; intestinal cramping; severe, persistent cough

Opioid Analgesics: Adverse Reactions
CNS: sedation, increased intracranial pressure Respiratory: depressed breathing rate/depth GI: constipation, anorexia, biliary tract spasms Cardiovascular: tachycardia, bradycardia Genitourinary: urinary retention/hesitancy Allergic reactions: pruritus, rash, urticaria Other reactions: sweating, pain at injection site, local tissue irritation

Opioid Analgesics: Contraindications
Patients with hypersensitivity to drugs Acute bronchial asthma, emphysema, or upper airway obstruction Patients with head injury or increased intracranial pressure Convulsive disorders; severe renal or hepatic dysfunction; acute ulcerative colitis Not recommended in pregnancy or labor

Opioid Analgesics: Precautions
Elderly patients Patients considered opioid naive Patients undergoing biliary surgery Lactating women Patients with undiagnosed abdominal pain, hypoxia, supraventricular tachycardia, prostatic hypertrophy, and renal/hepatic impairment

Opioid Analgesics: Interactions
Alcohol; antihistamines; antidepressants; sedatives; phenothiazines: increased risk for CNS depression Opioid agonist-antagonist: opioid withdrawal symptoms Barbiturates: respiratory depression, hypotension, and/or sedation

Preadministration assessment Assess and document description of pain Review patient’s health history, allergy history, and past and current drug therapies Data may be obtained during the initial history and physical assessment that require the nurse to contact the primary health care provider

Ongoing assessment Obtain blood pressure, pulse and respiratory rate, and pain rating Notify primary health care provider if analgesic is ineffective Inquire about details of pain Nursing judgment: when a change in pain/intensity or location needs to be reported Opioid-naive patient: risk for respiratory depression

Respiratory rate 10 or less needs frequent monitoring and notification Opiate as an antidiarrheal drug: Record each bowel movement: Appearance, color, and consistency Notify in case of blood, severe abdominal pain, or if diarrhea is not relieved or worsens

Nursing Process: Nursing Diagnosis
Ineffective Breathing Pattern related to pain and effects on breathing center by opioids Risk for Injury related to dizziness or lightheadedness from opioid administration Constipation related to the decreased GI motility caused by opioids Imbalanced Nutrition: Less Than Body Requirements related to anorexia caused by opioids

Opioid is a term used for drugs that change the pain sensation by attaching to receptor sites in the brain producing an analgesic, sedative, and euphoric effect.

Answer True Opioid is a term used for drugs that change the pain sensation by attaching to receptor sites in the brain producing an analgesic, sedative, and euphoric effect. Most of these are derived from opium or a synthetic substance like opium.

Nursing Process: Planning
Expected outcomes Relief of pain Supporting patient needs: management of adverse reactions Absence of injury Adequate nutrition intake Understanding of and compliance with prescribed treatment regimen

Relieving acute pain Self-administration system is under the control of the nurse Adds the drug to the infusion pump Sets the time interval (or lockout interval) between doses

Relieving chronic severe pain Morphine sulfate: should be scheduled around the clock Controlled-released forms: indicated for the management of pain when a continuous analgesic is needed for an extended time Long-acting forms: a fast-acting form may be given for breakthrough pain Drugs that combine a nonopioid and an opioid analgesic provide good pain relief

With tolerance, the body physically adapts to the drug, and greater amounts are needed to achieve the same effects. The rate at which tolerance develops varies according to the dosage, the route of administration, and the individual.

Nursing Process: Gerontologic Alert
Transdermal route: use with caution in the elderly Brompton’s mixture: mixture of an oral opioid and other drugs Monitor for the adverse reactions of each drug contained in the solution Fear of respiratory depression; adverse effects on GI system Decrease in motility causes constipation, nausea, acute abdominal pain, anorexia Provide a good, aggressive bowel program

Using epidural pain management Lower total dosages of the drug used; fewer adverse reactions; greater patient comfort Serious adverse reaction: respiratory depression Should be administered only by those specifically trained in the use of IV and epidural anesthetics Oxygen, resuscitative, and intubation equipment should be readily available

Monitoring and managing patient needs Report significant decrease in the respiratory rate or a respiratory rate of 10 breaths/min or below Report significant increase or decrease in the pulse rate or a change in the pulse quality Report significant decrease in blood pressure (systolic or diastolic) or a systolic pressure below 100 mm Hg

Ineffective Breathing Pattern: encourage coughing and breathing deeply every 2 hours Risk for Injury: provide assistance Constipation: record bowel movement daily Imbalanced Nutrition: assess food intake after each meal Opioid drug dependence: provide adequate pain relief to prevent returning to addictive behaviors

Management of opioid dependence Wait 48 hours after the last dose of levomethadyl before administering the first dose of methadone or other narcotic Maintenance therapy is designed to prevent desire Dose and length of time vary according to length of clients addiction Patients on methadone maintenance need to continue therapy when hospitalized

Educating patient and family Inform that drug is for pain relief Provide information on administration of drug and adverse effects Discuss appropriate use and care of PCA infusion pump, transdermal patch Give the family instruction in the parenteral administration of the drug or use of an IV pump

Introduction to Clinical Pharmacology Chapter 16 Opioid Antagonists

Opioid (Narcotic) Antagonists
Actions Antagonist: competes for opiate receptor sites Reverses all effects; pain will return No opioid: antagonist has no drug activity

Opioid (Narcotic) Antagonists (cont.)
Uses Postoperative acute respiratory depression, reversal of opioid adverse effects, suspected acute opioid overdosage Adverse reactions Nausea, vomiting, sweating, tachycardia, increased blood pressure, tremors

Opioid (Narcotic) Antagonists (cont.)
Contraindications, precautions, interactions Hypersensitivity, pregnancy category B, infants of opioid-dependent mothers, patients with opioid dependency, cardiovascular disease, and lactation Withdrawal symptoms: opioid dependent

Preadministration assessment: Long-term opioid therapy: tolerant to physical adverse effects Risk for respiratory depression Somnolence and pain relief: slows breathing pattern Coach breathing pattern

Obtain blood pressure, pulse, and respiratory rate Review record for drug suspected of causing respiratory depression symptoms Review initial health history, allergy history, treatment modalities

Ongoing assessment Monitor blood pressure, pulse, and respiratory rate at frequent intervals and vital signs every 5 to 15 minutes after patient responsive Adverse drug reactions: notify primary health care provider Continue to monitor vital signs until effects of opioid wear off

Nursing Alert Repeated dose needed if results from initial dose unsatisfactory Duration of close patient observation depends on response to opioid antagonist

Nursing Process: Planning and Implementation
Return to normal respiratory rate, rhythm, and depth; adequate ventilation of body; continued pain relief Implementation: promoting an optimal response to therapy Naloxone: used in postanesthesia recovery unit Balance pain relief

Nursing Process: Planning and Implementation (cont.)
Monitoring and managing patient needs Impaired spontaneous ventilation Naloxone: cardiac monitoring, artificial ventilation, suction equipment, maintain patent airway Naloxone by IV infusion: secondary line, IV piggyback, IV push

Nursing Process: Planning and Implementation (cont.)
Nursing Alert Slow IV push: somnolence abates Tremors Acute pain Assess pain and begin to treat pain again, review circumstances that led to use of antagonist, educate family, monitor fluid intake and output

The therapeutic effect is achieved The patient’s respiratory rate, rhythm, and depth are normal Pain relief is resumed

An opioid antagonist increases the effects of an opioid drug.

Answer False An opioid antagonist reverses the effects of an opioid drug. This is used when patients experience extreme adverse reactions such as respiratory depression.

Patients who seldom use opioid pain relievers are termed opioid naive, and they are at the greatest risk of experiencing respiratory depression when administered opioids.

Answer True Patients who seldom use opioid pain relievers are termed opioid naive, and they are at the greatest risk of experiencing respiratory depression when administered opioids.

Introduction to Clinical Pharmacology Chapter 17 Anesthetic Drugs

Introduction to Anesthesia and Types of Anesthesia
Induced by various drugs to bring about partial or complete loss of sensation Types of anesthesia: Local anesthesia General anesthesia Anesthesiologist Trained physician to administer anesthesia

Local Anesthesia and Types
Topical anesthesia: application of the anesthesia to surface of skin, open area, mucous membrane Local infiltration anesthesia: injection of anesthesia into tissue Dental procedures, suturing of small wounds, making an incision into a small area

Local Anesthesia and Types (cont.)
Local anesthesia (cont.): Regional anesthesia: injection of anesthesia around nerves to prevent sending pain signals Spinal anesthesia: injection of anesthesia into the subarachnoid space of the spinal cord Conduction blocks: injection of anesthesia into or near a nerve trunk

Preparing Patient for Local Anesthesia
Take patient’s allergy history Prepare the area to be anesthetized: Cleaning the area with antiseptic, shaving the area Requires fasting May administer intravenous sedative

Administering Local Anesthesia
Mixed with epinephrine to cause local vasoconstriction Epinephrine contraindicated when used on an extremity Be aware of when to and when not to use epinephrine

Nursing Responsibilities When Caring for Patient Receiving Local Anesthesia
Applying dressing to the appropriate surgical area Observe area for bleeding, oozing, other problems after administration

Preanesthetic Drugs Given before administration of anesthesia
May consist of one drug or a combination of drugs

Preanesthetic Drugs: Uses
Used to decrease anxiety and apprehension immediately before surgery Used to decrease secretions of the upper respiratory tract Used to lessen the incidence of nausea and vomiting during the immediate postoperative recovery period

Selection of Preanesthetic Drugs
May consist of one or more drugs Opioid or barbiturate may be given to relax the patient Cholinergic blocking drug is given to dry secretions in the upper respiratory tract Drug diazepam (valium) used for preoperative sedation

Nursing Responsibilities
Describe or explain the preparations for surgery ordered by the physician Describe or explain immediate postoperative care Demonstrate, describe, and explain postoperative patient activities Emphasize the importance of pain control using PCA pump

Introduction to Clinical Pharmacology Chapter 13 Nonopioid Analgesics: Salicylates and Nonsalicylates.

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Introduction to Clinical Pharmacology Chapter 13 Nonopioid Analgesics: Salicylates and Nonsalicylates.

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