Chronic Pain – Pharmacology Test

The key terms of Pharmacology Test include, Pain, Drug, Chronic, Therapy.

Before Administering Pain Medications

The nurse should:
-Assess for drug allergy
-Ask patient’s current medications
-Assess the patient’s current pain status
-Check vital signs

Drug Groups

-Non-Opioids
-Opioids
-Adjuvants

Pain Treatment

Mild (1-3)
-Non-opiods
Moderate (4-6)
-Weak opioids
Severe Pain (7-10)
-Strong opioids

Adjuvants: Can be used at every level of pain

Non-Opioid Analgesics

Most Common
-Acetylsalicylic acid (aspirin)
-Acetaminophen (Tylenol)
-Most are NSAIDs, including aspirin:
–Adverse effects: GI disturbances, bleeding
–COX-2 inhibitors for long-term use

Opioid Analgesics

-Used in management of all types of pain
-Work centrally to block release of neurotransmitters in spinal cord
-Bind to MU receptors to block release of substance P which prevents the transmission of pain
-Most opiods are similar in effect
-Response varies widely
-Can be administered in many different routes

American Geriatric Society Panel On Persistent Pain In Older Persons

Identified 6 common pain indicators
Facial expressions of grimacing, 1.crying
2.Verbalizations
3.Body movements
4.Changes in interpersonal interactions
5.Changes in activity or routines
6.Mental status changes

Psychosocial Aspects of Pain

-Meaning of pain to patient and family
-Past experiences with pain
Effect on:
-all aspects of all life
-daily activities
-relationship
-enjoyment
-family and financial
Spiritual & Cultural

Addiction

.Chronic
.Many factors influence addiction
.Occurs over time
Defined:
–Impaired control over drug
–Compulsive use
–Continued use despite harm and craving

Pseudoaddiction

– “Addictive Behaviors” because pain is under treated
-Anger/esculating demands for more meds
–Results in suspicion and avoidance by staff
-Common with chronic pain
-Behavior resolved when pain is adequately treated

Tolerance vs. Physical Dependence
Tolerance

Tolerance
Repeated use decreases the effect of drug over time
patient need increasing doses to achieve same pain relief.

Physical dependence

Physical Dependence
Results in physical withdrawal symptoms when drug abruptly discontinued, rapid dose reduction or reversal agent given

Occurs in everyone who takes opioids over long period of time

Withdrawal

-Important role of nurse is to assess for and prevent withdrawal
-Symptoms of opioid withdrawal:
-Nausea, vomiting
-Abdominal cramping
-Sweating
-Delirium
-Muscle twitching
-Convulsions

Substance Abusers

-Often result of traumatic injury or health problems that cause pain
-Patients with chronic pain medication use should not have medications stopped abruptly
-May require higher doses of conventional drugs
-Should be identified so appropriate therapy can be prescribed

Placebo Therapy

-Only indicated use is in research studies
-Need informed consent
-Is unethical to administer placebos to your patients