Opioid Analgesic Drug Effect – Pharmacology
This chapter of pharmacology is about different types of drug and also discuss Opioid analgesic drug effect .
Examples of Opioids
Hydromorphone, fentanyl, morphine sulfate, naloxone hydrochloride, methadone hydrochloride.
Morphine, hydromorphone, oxycodone Indications:
Moderate/severe pain
Post-op pain
Fentanyl, sufentanil, alfentanil Indications:
Balance sedation during surgery
drug tolerance
the tendency for larger doses of a drug to be required over time to achieve the same effect
Somatic Pain
Pain that originates from skeletal muscles, ligaments, or joints.
Visceral Pain
Pain that originates from organs or smooth muscles
Superficial Pain
Originates from the skin and mucous membranes
Deep pain
occurs in tissues below skin level
Vascular pain
Believed to originate from the vascular or perivascular tissues and is thought to account for a large percentage of migraine headaches
Referred Pain
When visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body.
Neuropathic Pain
Results form damage to peripheral or CNS nerve fibers by disease or injury but may also be idiopathic (unexplained)
Phantom Pain
Occurs in an area of the body that has been removed.
Cancer Pain
Can be acute or chronic or both.
Most often results from pressure of the tumor mass against nerves, organs, or tissues.
A patient’s emotional response to pain is molded by
Age, sex, culture, previous pain experience, and anxiety level.
drug tolerance A patient’s emotional response to pain is molded by
Age, sex, culture, previous pain experience, and anxiety level.
A patient’s emotional response to pain is molded by
Age, sex, culture, previous pain experience, and anxiety level.
Central Pain
Occurs with tumors, trauma, inflammation, or disease affecting CNS tissues.
Patient-controlled analgesia (PCA)
Drug delivery system that allows patients to self-administer analgesic medications on demand.
PCA by proxy
Family/friends controlling the PCA pump
Opioid tolerance
state of adaptation in which exposure to a drug causes changes in drug receptors that result in reduced drug effects over time
Breakthrough Pain
Pain that occurs between long-term doses of pain medication
When should you use Opioids?
For visceral and superficial pain; after surgery.
When should you use non-opioids?
Somatic pain and injuries with inflammation
Examples of mild opioids
Codeine and hydrocodone
Examples of strong opioids
Morphine, hydromorphone, levorphanol, oxycodone, oxymorphone, meperidine, fentanyl, and methadone
Acetaminophen Mechanism of action
Inhibits prostaglandin synthesis in CNS
Lowers fever by acting on the hypothalamus
Acetaminophen Indications (why give it?)
Pain and fever
Acetaminophen Contraindications (why not give it?)
Allergy
Severe liver disease
G6PD deficiency
Acetaminophen AE and SE
AE: anemia, nephrotoxicity, hepatotoxicity
SE: N/V and rash
Acetaminophen Interactions
alcohol, warfarin, phenytoin, barbiturates
Acetaminophen Assessment
Allergy, potential interactions, CNS depression, alcohol/substance use, pain assessment
What is the antidote for Acetaminophen overdose?
acetylcysteine
Fentanyl, sufentanil, alfentanil Indications:
Balance sedation during surgery
Codeine, hydrocodone Indications:
Cough suppressant
Opioid Adverse Effects
AE: CNS/respiratory depression, sedation, abuse, urinary retention, dec BP
SE: N/V/D, itching, dry mouth
Opioid Assessment
VS
age
allergy
resp function
head injury
neuro status/LOC
neuro disorders
GI/GU functioning
Opioid Contraindications
Known drug allergy
Severe asthma
Caution: resp insufficiency, elevated ICP, obesity/sleep apnea, Myasthenia Gravis, pregnancy
Opioid Interactions
Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Monoamine oxidase inhibitors
drug tolerance
the tendency for larger doses of a drug to be required over time to achieve the same effect
Somatic Pain
Pain that originates from skeletal muscles, ligaments, or joints.
Visceral Pain
Pain that originates from organs or smooth muscles
Superficial Pain
Originates from the skin and mucous membranes
Deep pain
occurs in tissues below skin level
Vascular pain
Believed to originate from the vascular or perivascular tissues and is thought to account for a large percentage of migraine headaches
Referred Pain
When visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body.
Neuropathic Pain
Results form damage to peripheral or CNS nerve fibers by disease or injury but may also be idiopathic (unexplained)
Phantom Pain
Occurs in an area of the body that has been removed.
Cancer Pain
Can be acute or chronic or both.
Most often results from pressure of the tumor mass against nerves, organs, or tissues.
Central Pain
Occurs with tumors, trauma, inflammation, or disease affecting CNS tissues.
Patient-controlled analgesia (PCA)
Drug delivery system that allows patients to self-administer analgesic medications on demand.
PCA by proxy
Family/friends controlling the PCA pump
Opioid tolerance
state of adaptation in which exposure to a drug causes changes in drug receptors that result in reduced drug effects over time
Breakthrough Pain
Pain that occurs between long-term doses of pain medication
When should you use Opioids?
For visceral and superficial pain; after surgery.
When should you use non-opioids?
Somatic pain and injuries with inflammation
Examples of mild opioids
Codeine and hydrocodone
Examples of strong opioids
Morphine, hydromorphone, levorphanol, oxycodone, oxymorphone, meperidine, fentanyl, and methadone
Acetaminophen Mechanism of action
Inhibits prostaglandin synthesis in CNS
Lowers fever by acting on the hypothalamus
Acetaminophen Indications (why give it?)
Pain and fever
Acetaminophen Contraindications (why not give it?)
Allergy
Severe liver disease
G6PD deficiency
Acetaminophen AE and SE
AE: anemia, nephrotoxicity, hepatotoxicity
SE: N/V and rash
Acetaminophen Interactions
alcohol, warfarin, phenytoin, barbiturates
Acetaminophen Assessment
Allergy, potential interactions, CNS depression, alcohol/substance use, pain assessment
What is the antidote for Acetaminophen overdose?
acetylcysteine
Examples of Opioids
Hydromorphone, fentanyl, morphine sulfate, naloxone hydrochloride, methadone hydrochloride.
Morphine, hydromorphone, oxycodone Indications:
Moderate/severe pain
Post-op pain
Codeine, hydrocodone Indications:
Cough suppressant
Opioid Adverse Effects
AE: CNS/respiratory depression, sedation, abuse, urinary retention, dec BP
SE: N/V/D, itching, dry mouth
Opioid Assessment
VS
age
allergy
resp function
head injury
neuro status/LOC
neuro disorders
GI/GU functioning
Opioid Contraindications
Known drug allergy
Severe asthma
Caution: resp insufficiency, elevated ICP, obesity/sleep apnea, Myasthenia Gravis, pregnancy
Opioid Interactions
Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Monoamine oxidase inhibitors
the tendency for larger doses of a drug to be required over time to achieve the same effect
Somatic Pain
Pain that originates from skeletal muscles, ligaments, or joints.
Visceral Pain
Pain that originates from organs or smooth muscles
Superficial Pain
Originates from the skin and mucous membranes
Deep pain
occurs in tissues below skin level
Vascular pain
Believed to originate from the vascular or perivascular tissues and is thought to account for a large percentage of migraine headaches
Referred Pain
When visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body.
Neuropathic Pain
Results form damage to peripheral or CNS nerve fibers by disease or injury but may also be idiopathic (unexplained)
Phantom Pain
Occurs in an area of the body that has been removed.
Cancer Pain
Can be acute or chronic or both.
Most often results from pressure of the tumor mass against nerves, organs, or tissues.
Central Pain
Occurs with tumors, trauma, inflammation, or disease affecting CNS tissues.
Patient-controlled analgesia (PCA)
Drug delivery system that allows patients to self-administer analgesic medications on demand.
PCA by proxy
Family/friends controlling the PCA pump
Opioid tolerance
state of adaptation in which exposure to a drug causes changes in drug receptors that result in reduced drug effects over time
Breakthrough Pain
Pain that occurs between long-term doses of pain medication
When should you use Opioids?
For visceral and superficial pain; after surgery.
When should you use non-opioids?
Somatic pain and injuries with inflammation
Examples of mild opioids
Codeine and hydrocodone
Examples of strong opioids
Morphine, hydromorphone, levorphanol, oxycodone, oxymorphone, meperidine, fentanyl, and methadone
Acetaminophen Mechanism of action
Inhibits prostaglandin synthesis in CNS
Lowers fever by acting on the hypothalamus
Acetaminophen Indications (why give it?)
Pain and fever
Acetaminophen Contraindications (why not give it?)
Allergy
Severe liver disease
G6PD deficiency
Acetaminophen AE and SE
AE: anemia, nephrotoxicity, hepatotoxicity
SE: N/V and rash
Acetaminophen Interactions
alcohol, warfarin, phenytoin, barbiturates
Acetaminophen Assessment
Allergy, potential interactions, CNS depression, alcohol/substance use, pain assessment
What is the antidote for Acetaminophen overdose?
acetylcysteine
Examples of Opioids
Hydromorphone, fentanyl, morphine sulfate, naloxone hydrochloride, methadone hydrochloride.
Morphine, hydromorphone, oxycodone Indications:
Moderate/severe pain
Post-op pain
Fentanyl, sufentanil, alfentanil Indications:
Balance sedation during surgery
Codeine, hydrocodone Indications:
Cough suppressant
Opioid Adverse Effects
AE: CNS/respiratory depression, sedation, abuse, urinary retention, dec BP
SE: N/V/D, itching, dry mouth
Opioid Assessment
VS
age
allergy
resp function
head injury
neuro status/LOC
neuro disorders
GI/GU functioning
Opioid Contraindications
Known drug allergy
Severe asthma
Caution: resp insufficiency, elevated ICP, obesity/sleep apnea, Myasthenia Gravis, pregnancy
Opioid Interactions
Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Monoamine oxidase inhibitors