Unit III: The Nervous System

1
Unit III The Nervous System

• Chapter 18
• Drugs for Control of Pain

2
Review Drug-Receptor Interactions

• What is a receptor?
• Drugs bind to receptor and cause specific
  activity of cell to be either enhances or
  inhibited.
• What is
• An Agonist
• A Partial Agonist
• An Antagonist

3
Pain Management

• What is essential to successfully manage pain?
• What does pain management therapy depend upon?
• Describe a comprehensive pain assessment.
• How is pain classified?

4
Compare and Contrast Nociceptor Pain and
Neuropathic Pain

• Nociceptor
• Injury to tissues
• Somatic sharp, localized sensations
• Visceral generalized, dull, throbbing or aching
• Responds well to conventional pain relief
  medications

• Neuropathic
• Injury to nerves
• Burning, shooting or numb
• Less therapeutic response to conventional pain
  relief medications

5
Nonpharmacologic Techniques

• May replace or be an adjunct to pharmacotherapy
• How does the concurrent use of nonpharmacologic
  therapies impact pharmacotherapy?

6
Neural Mechanism of Pain
7
Analgesics

• Classes of Pain Medications
• NSAIDs
• Opioids
• Action results from interaction with receptors
• Mu-1 and Mu-2
• Kappa
• Sigma
• Delta
• Epsilon

8
Compare and Contrast Responses

• Mu
• Analgesia
• Decreased GI motility
• Euphoria
• Physical dependence
• Respiratory depression
• Sedation

• Kappa
• Analgesia
• Decreased GI motility
• Miosis
• Sedation

9
Prototype Opioid Morphine

• See box on page 228
• Produces analgesia, cough suppression and
  decreased GI motility
• CNS depressant
• Adverse effects
• Respiratory depression
• Sedation
• Nausea and vomiting

10
Risk of Dependence

• All narcotic (opioid) analgesics have the
  potential to cause physical and psychological
  dependence.
• What factors increase the likelihood of
  developing dependence

11
Case Study

• Mr. J, a 56-year-old, had an inguinal hernia
  repair through ambulatory surgery. His discharge
  medications included Vicodin (hydrocodone 5 mg
  and acetaminophen 500 mg) one or two tablets
  every 4 hours prn.
• What is the drug classification for this
  medication?

12
Combination Drugs

• Opioid non-opioid (non-narcotic) analgesics
• What is the reason to combine these medications?
• What are the benefits of combined analgesics?

13
Nursing Considerations Opioids

• Carefully monitor clients condition
• Provide education as it relates to the prescribed
  drug treatment
• Assess current and past history
• Diagnostics
• Baseline and continuing VS
• Comprehensive pain assessment before
  administration

14
Nursing Considerations Opioids

• Have narcotic antagonist and resuscitative
  equipment available
• Ensure safety
• Monitor for urinary retention
• Can cause constipation and Nausea/Vomiting
• Do not administer in infectious diarrheal
  illnesses

15
Contraindications Opioids

• Hypersensitivity
• Do not administer if
• Acute asthma or upper respiratory obstruction
• Respiratory rate lt 12

16
Case Study

• Miss N, 86-years-old, weighs 96 lbs. They
  physician has ordered 10 mg of morphine sulfate
  IM for acute abdominal pain. Your are familiar
  with the drug and know that the ED50 is 10 mg.
  Miss Ns VS are 98.6- 80 22, 120/80. Thirty
  minutes after administering the medication you
  return to evaluate its effectiveness. You note
  that Miss N had a decrease in LOC and VS are
  98.6 - 68 8, 112/60.

17
Case Study Questions

• What will you do first?
• What other things must be done?
• Was a medication error made?
• What factors may have contributed to Miss Ns
  response?

18
Nursing Role Opioid Antagonist Therapy

• Carefully monitor patient condition
• Provide education as it relates to prescribed
  drug treatment
• Administer if RR lt 10
• Have resuscitative equipment immediately
  accessible
• Gather good medical history
• Underlying cardiovascular disease

19
Nursing Role Opioid Antagonist Therapy

• Use cautiously in patients physically dependent
  upon opioids
• Comprehensive pain assessment before
  administration and during treatment
• VS every 3-5 minutes
• ABGs, ECG
• Monitor for drowsiness, tremors,
  hyperventilation, VT and loss of analgesia

20
Opioid Antagonist Drugs

• Prototype naloxone hydrochloride (Narcan)
• See box p. 231
• Naltrexone
• Used for treatment of addiction
• Monitor for side effects during RX
• VS q 3 5 min
• Continuous assessment of respiratory and cardiac
  function

21

• Compare and Contrast Opioid Tolerance and Opioid
  Dependence
• How is opioid dependence treated?

22
Non-opioid Analgesics

• Acetaminophen
• NSAIDs
• Ibuprofen and ibuprofen type
• Salicylates ASA
• Centrally acting agents
• Clonidine (Catapres)
• Tramadol (Ultram)

23
Nursing Role Non-opioid Analgesics

• Thorough assessment
• Monitoring
• Diagnostics
• Baseline and continuing comprehensive pain
  assessment
• Give with food and plenty of fluids
• Do not crush enteric coated tablets
• Use extreme caution with ASA in children and
  teenagers

24
Headaches

• Two major types
• Tension
• Migraine
• Migraine treatment goals
• Stop migraine in progress
• Prevent migraine from occuring

25
Migraine Treatment

• Triptans
• Ergot alkaloids
• Ergot alkaloids are a Category X drug. What
  does that mean?

26
Migraine Prophylaxis

• Will be used if person has high incidence of
  migraines and is unresponsive to drugs to abort
  migraine.
• Beta blocker
• Propranolol (Inderal)
• Tricyclic antidepressant
• Amitriptyline hydrochloride (Elavil)

27
Role of Nurse Migraine Pharmacotherapy

• Carefully monitor clients condition
• Provide education as it related to prescribed
  drug treatment
• Gather data
• Assess
• Alter environment
• Monitor for possible side effects

28
Contraindications to Anti-migraine Therapy

• Hypertension
• Myocardial ischemia
• Coronary artery disease
• History of MI
• Dysrhythmias or heart failure
• High-risk CAD profile
• Diabetes