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Tuesday, September 16, 2008

Opioid Analgesics Updates (Online Continuing Education Nclex Pharmacology)

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Opioid Analgesics Updates (Online Continuing Education Pharmacology) Slideshow Transcript
Slide 1: Opioid Analgesic Agents Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 2: Analgesics • Medications that relieve pain without causing loss of consciousness • Painkillers Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 3: Classification of Pain By Onset and Duration • Acute pain – Sudden in onset – Usually subsides once treated • Chronic pain – Persistent or recurring – Often difficult to treat Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 4: Classification of Pain • Somatic • Visceral • Superficial • Vascular • Referred • Neuropathic • Phantom • Cancer • Psychogenic • Central Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 5: Classification of Pain By Source Vascular pain • Possibly originates from vascular or perivascular tissues Neuropathic pain • Results from injury to peripheral nerve fibers or damage to the CNS Superficial pain • Originates from skin or mucous membranes Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 6: Pain Transmission Gate Theory • Most common and well-described • Uses the analogy of a gate to describe how impulses from damaged tissues are sensed in the brain Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 7: Pain Transmission Tissue injury causes the release of: • Bradykinin • Histamine • Potassium • Prostaglandins • Serotonin These substances stimulate nerve endings, starting the pain process. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 8: Pain Transmission There are two types of nerves stimulated: • “A” fibers and • “C” fibers Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 9: Pain Transmission “A” Fibers “C” Fibers Myelin sheath No myelin sheath Large fiber size Small fiber size Conduct fast Conduct slowly Inhibit pain Facilitate pain transmission transmission Sharp and Dull and well-localized nonlocalized Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 10: Pain Transmission • Types of pain related to proportion of “A” to “C” fibers in the damaged areas Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 11: Pain Transmission • These pain fibers enter the spinal cord and travel up to the brain. • The point of spinal cord entry is the DORSAL HORN. • The DORSAL HORN is the location of the “GATE.” Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 12: Pain Transmission • This gate regulates the flow of sensory impulses to the brain. • Closing the gate stops the impulses. • If no impulses are transmitted to higher centers in the brain, there is NO pain perception. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 13: Instructors may want to use EIC Image #37: Gate Theory of Pain Transmission Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 14: Pain Transmission • Activation of large “A” fibers CLOSES gate • Inhibits transmission to brain – Limits perception of pain Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 15: Pain Transmission • Activation of small “B” fibers OPENS gate • Allows impulse transmission to brain – Pain perception Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 16: Pain Transmission • Gate innervated by nerve fibers from brain, allowing the brain some control over gate • Allows brain to: – Evaluate, identify, and localize the pain – Control the gate before the gate is open Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 17: Pain Transmission “T” cells • Cells that control the gate have a threshold • Impulses must overcome threshold to be sent to the brain Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 18: Pain Transmission • Body has endogenous neurotransmitters – Enkephalins – Endorphins • Produced by body to fight pain • Bind to opioid receptors • Inhibit transmission of pain by closing gate Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 19: Pain Transmission Rubbing a painful area with massage or liniment stimulates large sensory fibers • Result: – GATE closed, recognition of pain REDUCED – Same pathway used by opiates Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 20: Opioid Analgesics • Pain relievers that contain opium, derived from the opium poppy or • chemically related to opium Narcotics: very strong pain relievers Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 21: Opioid Analgesics • codeine sulfate • meperidine HCl (Demerol) • methadone HCl (Dolophine) • morphine sulfate • propoxyphene HCl Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 22: Opioid Analgesics Three classifications based on their actions: • Agonist • Agonist-antagonist • Partial agonist Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 23: Opioid Analgesics: Site of action • Large “A” fibers • Dorsal horn of spinal cord Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 24: Opioid Analgesics: Mechanism of Action • Bind to receptors on inhibitory fibers, stimulating them • Prevent stimulation of the GATE • Prevent pain impulse transmission to the brain Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 25: Opioid Analgesics: Mechanism of Action Three types of opioid receptors: • Mu • Kappa • Delta Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 26: Opioid Analgesics: Therapeutic Uses Main use: to alleviate moderate to severe pain • Opioids are also used for: – Cough center suppression – Treatment of constipation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 27: Opioid Analgesics: Side Effects • Euphoria • Nausea and vomiting • Respiratory depression • Urinary retention • Diaphoresis and flushing • Pupil constriction (miosis) • Constipation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 28: Opiate Antagonists naloxone (Narcan) naltrexone (Revia) • Opiate antagonists • Bind to opiate receptors and prevent a response Used for complete or partial reversal of opioid-induced respiratory depression Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 29: Opiates: Opioid Tolerance • A common physiologic result of chronic opioid treatment • Result: larger dose of opioids are required to maintain the same level of analgesia Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 30: Opiates: Physical Dependence • The physiologic adaptation of the body to the presence of an opioid Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 31: Opiates: Psychological Dependence (addiction) • A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 32: Opiates • Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with psychological dependence (addiction). Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 33: Opiates • Misunderstanding of these terms leads to ineffective pain management and contributes to the problem of undertreatment. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 34: Opiates • Physical dependence on opioids is seen when the opioid is abruptly discontinued or when an opioid antagonist is administered. – Narcotic withdrawal – Opioid abstinence syndrome Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 35: Opiates Narcotic Withdrawal Opioid Abstinence Syndrome • Manifested as: – anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 36: Opioid Analgesics: Nursing Implications • Before beginning therapy, perform a thorough history regarding allergies, use of other medications,health history, and medical history. • Obtain baseline vital signs and I & O. • Assess for potential contraindications and drug interactions. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 37: Opioid Analgesics: Nursing Implications • Perform a thorough pain assessment, including nature and type of pain, precipitating and relieving factors, remedies, and other pain treatments. – Assessment of pain is now being considered a “fifth vital sign.” Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 38: Opioid Analgesics: Nursing Implications • Be sure to medicate patients before the pain becomes severe as to provide adequate analgesia and pain control. • Pain management includes pharmacologic and nonpharmacologic approaches. Be sure to include other interventions as indicated. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 39: Opioid Analgesics: Nursing Implications • Oral forms should be taken with food to minimize gastric upset. • Ensure safety measures, such as keeping side rails up, to prevent injury. • Withhold dose and contact physician if there is a decline in the patient’s condition or if VS are abnormal—especially if respiratory rate is below 12 breaths/minute. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 40: Opioid Analgesics: Nursing Implications • Follow proper administration guidelines for IM injections, including site rotation. • Follow proper guidelines for IV administration, including dilution, rate of administration, and so forth. CHECK DOSAGES CAREFULLY Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 41: Opioid Analgesics: Nursing Implications • Constipation is a common side effect and may be prevented with adequate fluid and fiber intake. • Instruct patients to follow directions for administration carefully, and to keep a record of their pain experience and response to treatments. • Patients should be instructed to change positions slowly to prevent possible orthostatic hypotension. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 42: Opioid Analgesics: Nursing Implications • Patients should not take other medications or OTC preparations without checking with their physician. • Instruct patients to notify physician for signs of allergic reaction or adverse effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 43: Opioid Analgesics: Nursing Implications Monitor for side effects: • Should VS change, patient’s condition decline, or pain continue, contact physician immediately. • Respiratory depression may be manifested by respiratory rate of less than 12/min, dyspnea, diminished breath sounds, or shallow breathing. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 44: Opioid Analgesics: Nursing Implications Monitor for therapeutic effects: • Decreased complaints of pain • Increased periods of comfort • With improved activities of daily living, appetite, and sense of well-being Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.






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