1. What is the 5th vital sign?
    • Pain, should be accessed and monitored in all patients.
    • an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
  2. Acute Pain
    • Associated with surgery, other medical procedures or trauma
    • Last only hours or a few days
    • Treated primarily with analgesics, often narcotic analgesics
  3. Chronic Malignant pain
    • Associated with cancer or other progressive diseases
    • May last months or years
    • May be complicated by depression
    • Treated with analgesics, often narcotic analgesics
  4. Chronic Nonmalignant pain
    • caused by ongoing disease that is not life-threatening, pain that has continued after the underlying cause is resolved or pain that has no identifiable cause
    • Includes arthritis pain, headache pain, neuropathic pain and fibromyalgia
    • May be complicated by depression, anxiety and other psychological disorders
    • Treatment is complex involving use of analgesics as well as other therapies
  5. Inflammation
    • the immediate defensive action of tissue to any injury, which may be caused by infection, chemicals or physical agents.
    • involves pain, heat, redness, swelling, and loss of function of the affected part.
  6. What is opium? Where does it come from?
    the poppy, papaver somniferum
  7. How do narcotic analgesics work?
    • produce most of their effects on the central nervous system (CNS) and the bowel.
    • an agonist-receptor (lock and key) interaction.
    • The relative potency of the different narcotic analgesics correlates well with their affinity for these receptors
  8. What actions do narcotic analgesics have on various body functions?
    • Pupil: cause constriction of the pupil, pinpoint pupils in a patient are said to be an indicator of narcotic use. Note: meperidine (Demerol�) can cause dilation of the pupils, good for shavering after surgery.
    • Respiration system: all cause depression of respiration
    • GI: Inhibit GI motility, and stimulate the CTZ. Mepergin can antagonist the vomiting after surgery , Opium was used for relief of diarrhea. Opiates decrease propulsive movements in the GI tract and increase muscle tone of the sphincters.
  9. What is Lomotil� used for?
  10. Narcotic analgesics agents
    • Acetaminophen/Codeine (Tylenol #3�)
    • Propoxyphene/Acetaminophen (Darvocet N 100�)
    • Hydrocodone/Acetaminophen (Lortab�, Vicodin�)
    • Hydrocodone/Ibuprofen (Vicoprofen�)
    • Oxycodone (OxyContin�, Roxicodone�, M-Oxy�, Percolone�)
    • Oxycodone/Acetaminophen (Percocet�, Tylox�, Roxicet�)
    • Tramadol/Acetaminophen (Ultracet�)
    • Tramadol (Ultram�) still addictive
    • Tapentadol ( Nucynta�)
    • Hydromorphone (Dilaudid�)
    • Morphine (MS Contin�, Roxanol�) highest pain relief
    • Propoxyphene (Darvon�) low in pain relive ability, high in
  11. Narcotic Antagonist
    • that fits the lock of the narcotic receptor but doesn't turn the key.
    • also blocks the receptor from getting stimulation from any narcotic agonist.
    • Treat narcotic Addiction, reverse response of narcotic
    • Naloxone (Narcan)
    • Naltrexone (Trexan)
    • Nalmefene (Revex)
  12. Why are narcotic analgesics abused?
    • Psychological Dependence: euphoria is responsible for a large part of the problem with drug abuse.
    • Physical Dependence: When narcotic analgesics are used on a regular (usually daily) basis, the body tends to revolt if a scheduled dose is missed. This missing of a dose is very uncomfortable and is responsible for much of the "drug seeking behavior".
  13. Tolerance
    • Patients who regularly take narcotic analgesics will develop tolerance to the euphoria, analgesia, sedation and respiratory depression caused by these agents.
    • However, they do not develop tolerance to the GI effects.
  14. the "drying out" or "detox" period.
    • Symptoms of withdrawal from narcotic analgesics begin shortly before the next scheduled dose (usually about 8 to 12 hours after the last dose).
    • These symptoms will usually continue for 7 to 10 days.
  15. What are some of the symptoms of narcotic withdrawal?
    • Initial Period: Anxiety, restlessness, Insomnia, Perspiration, Yawning, Tremor
    • Peak: Irritability, Nausea, vomiting, diarrhea, High blood pressure
    • Others: Body aches, muscle cramps, Dilated pupils, Hot flashes, excessive sweating, Fever, chills, Abdominal cramps
  16. What is Methadone used for?
    • Narcotic withdrawal by a licensed detox center
    • Maintenance of an addict while in the hospital for another reason
    • Pain, long acting, one dose before leaving the hospital.
  17. MOA of non-narcotic analgesics
    • Cyclooxygenase is an important enzyme in the synthesis of prostaglandins.
    • Inhibition of cyclooxygenase may result in analgesic, antipyretic and anti-inflammatory effects.
  18. Aspirin
    • Works by inhibiting prostaglandin synthesis both in the central nervous system and peripherally (COX-1 and COX-2)
    • Also has antipyretic action
    • Also has anti-inflammatory properties
  19. Acetaminophen
    • Works by inhibiting prostaglandin synthesis only in the central nervous system (COX-3)
    • Also has antipyretic activity
    • Has no anti-inflammatory properties
  20. How do NSAID�s work?
    • Work by inhibiting prostaglandin synthesis both in the central nervous system and peripherally (COX-1 and COX-2)
    • Also have anti-inflammatory properties
    • Also have antipyretic action
    • Combination of NSAIDs with other drugs such as omperazole or misoprostol, can help prevent ulcer formation.
  21. Uses of NSAID
    • Arthritis
    • Bursitis
    • Tendonitis
    • Gout
    • Headache
    • Menstrual cramps
    • Aches and sprains of muscles
  22. What is different about celecoxib?
    selective COX-2 inhibitors. It is hoped that these agents will have a lower incidence of bleeding and other GI disturbances.
  23. Identify all of the NSAID�s found on the Top 200.
    • Ibuprofen (Motrin�, IBU�)
    • Naproxen (Anaprox�, Naprosyn�)
    • Meloxicam (Mobic�)
  24. Cytotec�
    • Misoprostol
    • Designed specifically for people on long-term NSAID therapy
    • A synthetic prostaglandin that stimulates the GI tract to produce mucus
    • Does not affect inflammatory response pathway
    • Helps prevent ulcers without hindering the NSAIDs designated task
  25. Gout
    recurrent attacks of acute inflammatory arthritis�a red, tender, hot, swollen joint.
  26. Muscle Relaxants
    • Carisoprodol (Soma�)
    • Cyclobenzaprine (Flexeril�)
  27. Tylenol #3
  28. Darvocet N 100
  29. Lortab, Vicodin, Lorcet
  30. Tylox, Endocet, Percocet
  31. Ultram
  32. Vicoprofen
  33. OxyContin, oxycodone
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