pharm - Analgesics Reading Assignment: Kee: Chapters 20...

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Analgesics Reading Assignment: Kee: Chapters 20 (anesthetics), 25; Lilley: Chapters 10, 11 Topic Objectives On completion of this topic, the student will: 1. Identify the key drugs, mechanism of action, therapeutic effects, side effects and patient care implications of: a. Opioids b. Opioid reversal agent c. Non-opioid analgesics d. Anesthetics e. NMB agents f. Local anesthetics 2. Understand the difference between tolerance, dependence, and addiction 3. Describe appropriate implementation of pharmacologic pain management Controlled Substances Controlled Substance Act, 1970 Unlawful to possess a controlled substance without a valid prescription Drug suppliers, agencies and personnel must control and account for substances Locked storage Records Supplies on hand Supplies added Each dose administered Schedule of Controlled Substances Schedule I: High abuse potential, no accepted medical use Approved protocol necessary Heroin, marijuana, LSD, mescaline, etc. Schedule II: High abuse potential, accepted medical uses Written prescription necessary, signed by provider, no refills, warning label Morphine, codeine, oxycodone, methadone, cocaine, short acting barbiturates, dextroamphetamine, etc., etc. Schedule III : Prescription required, expires in 6 months, no more than 5 refills in 6 months, warning label Limited opioids or combination of opioid and non-controlled substance, others such as paregoric, testosterone 199
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Schedule IV: Lower abuse potential, accepted medical uses Prescription required, expires in 6 months, no more than 5 refills in 6 months, warning label Benzodiazepines, psychotropics, long acting barbiturates, other hypnotics-sedatives Schedule V: Low abuse potential May or may not required prescription, limited quantities, 18 years old, written record Limited narcotic content, generally for coughs or diarrhea Analgesics Definition of an analgesic : “medications that relieve pain without causing loss of consciousness” Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Whatever the person experiencing the pain says it is, existing whenever the person says it does. Suffering is different than pain. Pain Transmission Gate theory Uses the analogy of a gate to describe how impulses from damaged tissues are sensed in the brain Builds on Gate theory Nociceptive Pain Activated by noxious stimuli (tissue damage) Bradykinin, serotinin, histamine, H + , K + Sensitized by facilitators Transduced by neural fibers Neuropathic Pain Damage to peripheral or CNS tissue Persistent noxious stimuli Unrelieved nociceptive pain can become neuropathic Hyperalgia
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pharm - Analgesics Reading Assignment: Kee: Chapters 20...

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