1. Medications for Pain Management and Anesthesia Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. Chapter 17 1

2. Learning Objectives Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 2 Explain why there are so many rules about how narcotics and related analgesic drugs may be given Compare and contrast drug tolerance and drug addiction Evaluate different forms of narcotic agonists and narcotic agonist-antagonists in their ability to control pain List medications commonly used for the treatment of moderate to severe pain List behaviors that would make you believe a patient is addicted to a drug.

3. Opioids Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 3 Two Forms Natural: from opium Synthetic: man-made Classifications: Agonist Binds with the receptor(s) to activate and produce the maximum response of the individual receptor Partial agonist Produces a partial response Agonist-antagonist Acts as an agonist at one type of receptor and as a competitive antagonist at another type of receptor

4. Opioids (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 4 Morphine (****Gold Standard) Uses Acute care Hospice Codeine, hydrocodone, oxycodone Uses Office or clinical setting Frequently used with acetaminophen Hydromorphone (most potent) Uses Severe pain unrelieved by morphine

5. Pain Measurement Scales Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 5

6. Wong-Baker Faces Pain Rating Scale Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 6

7. Terms for effects of pain meds Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7 Tolerance The same amount of a drug produces a decreased effect over time Dependence A state in which the body will show withdrawal symptoms if the drug is stopped or reduced Addiction The uncontrollable need to have and use a drug for nonmedical reasons

8. Narcotic Agonist Analgesics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 8 Action Prevent pain perception in the central nervous system Produce analgesia, sleepiness, euphoria, unclear thinking, slow breathing, produce miosis, decreased peristalsis, reduced cough reflex, and hypotension Uses Treat moderate to severe pain

9. Narcotic Agonist Analgesics (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 9 Adverse Reactions Bradycardia, slowed breathing Hypotension, fainting Anorexia, constipation Confusion, euphoria Dry mouth, vomiting Pruritus, skin rash

10. Narcotic Agonist Analgesics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 10 Codeine codeine Duragesic fentanyl Dilaudid hydromorphone Demerol meperidine Duramorph/ MS Contin morphine Paregoric opium tincture Oxycontin/ Oxycodone oxycodone

11. Narcotic Agonist-Antagonist Analgesics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 11 Action Act on chemicals at specific nerve sites in the CNS, possibly in the limbic system Produce analgesia, euphoria, and respiratory and physical depression Uses Relief of moderate to severe pain Presurgical anesthesia Active labor

12. Narcotic Agonist-Antagonist Analgesics (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 12 Adverse Reactions Bradycardia or tachycardia Hypertension or hypotension Changes in mood, confusion, nervousness Blurred vision, dizziness, headache Weakness, nystagmus, syncope, tingling Tinnitus, tremor, unusual dreams Nausea, vomiting, dry mouth, constipation

13. Narcotic Agonist-Antagonist Analgesics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 13 Stadol butorphanol Toradol Ketorolac tromethamine Talwin pentazocine

14. Nonnarcotic Centrally Acting Analgesics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 14 Action Act at the level of the brain to control mild or moderate pain Uses Mild to moderate pain Used in combination products for pain alone or when pain and fever are present

15. Nonnarcotic Centrally Acting Analgesics (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 15 Adverse Reactions Postural hypotension, dizziness Disorientation, euphoria, headache Light-headedness, minor visual disturbances Sleepiness, slurring of speech, weakness Skin rashes, stomach or abdominal pain Dry mouth, nausea, vomiting, chills Difficulty urinating, stuffy nose

16. Nonnarcotic Centrally Acting Analgesics Duraclon – clonidine Darvon – propoxyphene Ultram – tramadol

17. Questions?