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Slide 1
Medications for Pain Management and Anesthesia Copyright 2013,
2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier
Inc. Chapter 17 1
Slide 2
Learning Objectives Copyright 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc. 2 Explain why
there are so many rules about how narcotics and related analgesic
drugs may be given Compare and contrast drug tolerance and drug
addiction Evaluate different forms of narcotic agonists and
narcotic agonist-antagonists in their ability to control pain List
medications commonly used for the treatment of moderate to severe
pain List behaviors that would make you believe a patient is
addicted to a drug.
Slide 3
Opioids Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by
Mosby, an imprint of Elsevier Inc. 3 Two Forms Natural: from opium
Synthetic: man-made Classifications: Agonist Binds with the
receptor(s) to activate and produce the maximum response of the
individual receptor Partial agonist Produces a partial response
Agonist-antagonist Acts as an agonist at one type of receptor and
as a competitive antagonist at another type of receptor
Slide 4
Opioids (cont.) Copyright 2013, 2010, 2006, 2003, 2000, 1995,
1991 by Mosby, an imprint of Elsevier Inc. 4 Morphine (****Gold
Standard) Uses Acute care Hospice Codeine, hydrocodone, oxycodone
Uses Office or clinical setting Frequently used with acetaminophen
Hydromorphone (most potent) Uses Severe pain unrelieved by
morphine
Slide 5
Pain Measurement Scales Copyright 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc. 5
Slide 6
Wong-Baker Faces Pain Rating Scale Copyright 2013, 2010, 2006,
2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 6
Slide 7
Terms for effects of pain meds Copyright 2013, 2010, 2006,
2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7
Tolerance The same amount of a drug produces a decreased effect
over time Dependence A state in which the body will show withdrawal
symptoms if the drug is stopped or reduced Addiction The
uncontrollable need to have and use a drug for nonmedical
reasons
Slide 8
Narcotic Agonist Analgesics Copyright 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 8 Action
Prevent pain perception in the central nervous system Produce
analgesia, sleepiness, euphoria, unclear thinking, slow breathing,
produce miosis, decreased peristalsis, reduced cough reflex, and
hypotension Uses Treat moderate to severe pain
Slide 9
Narcotic Agonist Analgesics (cont.) Copyright 2013, 2010, 2006,
2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 9
Adverse Reactions Bradycardia, slowed breathing Hypotension,
fainting Anorexia, constipation Confusion, euphoria Dry mouth,
vomiting Pruritus, skin rash
Slide 10
Narcotic Agonist Analgesics Copyright 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 10 Codeine
codeine Duragesic fentanyl Dilaudid hydromorphone Demerol
meperidine Duramorph/ MS Contin morphine Paregoric opium tincture
Oxycontin/ Oxycodone oxycodone
Slide 11
Narcotic Agonist-Antagonist Analgesics Copyright 2013, 2010,
2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
11 Action Act on chemicals at specific nerve sites in the CNS,
possibly in the limbic system Produce analgesia, euphoria, and
respiratory and physical depression Uses Relief of moderate to
severe pain Presurgical anesthesia Active labor
Slide 12
Narcotic Agonist-Antagonist Analgesics (cont.) Copyright 2013,
2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier
Inc. 12 Adverse Reactions Bradycardia or tachycardia Hypertension
or hypotension Changes in mood, confusion, nervousness Blurred
vision, dizziness, headache Weakness, nystagmus, syncope, tingling
Tinnitus, tremor, unusual dreams Nausea, vomiting, dry mouth,
constipation
Slide 13
Narcotic Agonist-Antagonist Analgesics Copyright 2013, 2010,
2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
13 Stadol butorphanol Toradol Ketorolac tromethamine Talwin
pentazocine
Slide 14
Nonnarcotic Centrally Acting Analgesics Copyright 2013, 2010,
2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
14 Action Act at the level of the brain to control mild or moderate
pain Uses Mild to moderate pain Used in combination products for
pain alone or when pain and fever are present
Slide 15
Nonnarcotic Centrally Acting Analgesics (cont.) Copyright 2013,
2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier
Inc. 15 Adverse Reactions Postural hypotension, dizziness
Disorientation, euphoria, headache Light-headedness, minor visual
disturbances Sleepiness, slurring of speech, weakness Skin rashes,
stomach or abdominal pain Dry mouth, nausea, vomiting, chills
Difficulty urinating, stuffy nose