Chapter 31 Pharm

drugs that relieve pain without causing loss of consciousness
most effective pain relievers

general term defined as any drug, natrual or synthetic, that has action similar to those of morphine
very strong schedule 2 drug

applies only to compounds present in opium

mu receptors -> mainly these
Kappa receptors
delta receptors

seedpod of the poppy plant

pain relief
drowsiness
anxiety reduction

use: relief of pain or preoperative treatment of anxiety
adverse: respiratory depression -> tells receptors to turn off breathing and impaired pulmonary functioning ortho hypotension, urinary retention, miosis
does not cross BBB easily
tolerance = increase doses needed to obtain same response
physical dependence = abstinence syndrome with abrupt discontinuation

pregnancy, l & d = decreased respiratory rate for mother and baby
head injury = groggy, not responding right = don't give morphine = won't be able to figure out which is causing symptoms

CNS depressants, anticholinergic drugs

classic triad
- coma
- respiratory depression = less than 12 respirations
- pinpoint pupils
even if small dose they can still react with toxicity
treatment antagonist: naloxone (Narcan)

100 times the potency of morphine
parenteral = surgical anesthesia

short half-life
interacts adversely with several other drugs
toxic metabolic accumulation = don't use it over 48 hours = give something different
methadone = treatment for pain and opioid addicts

can cause respiratory depression, constipation urinary reten, cough suppression and miosis
can be reversed with naloxone

produce analgesia, sedatioin, euphoria
can cause respiratory depression, constipation

schedule 2
uses: pain and cough suppression
usually orally alone or with aspirin or acetaminophen

schedule 2
abuse: crushes and snorts or injects meds

mild to moderate pain = not very strong but can help some
people say they are allergic because not strong enough

pain location, characterisitcs and duration
things that improve/worsen pain
OLDCARTS?
Status before drug and 1 hour after = observe, ask to rate pain and document

controls own pain
certain amount of med at scheduled time
patient education
assess = check pt regularly, morphine can build up in system and not see triad if you don't go check on them
when PCA ordered, narcan is too

dr write too many prescription = go and check and be like holdup
these people evaluate through FDA

use: reversal of opioid overdose, reverse of postoperative opioid effects, reversal of neonatal respiratory depression

assess the pt
vital signs
if RR <12 = recommend hold meds
PRN pain med = 2-10mg Morphine q6h prn = do pain assessement, if 2mg works keep doing 2 but if still in severe pain give 8 mg instead