Drugs for Pain Opiods and Headaches-pharm

Accommodate dosing schedule as a rule opioids should

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Unformatted text preview: ration Nalbuphine (Nubain) Butorphanol (Stadol) Buprenorphine (Buprenex) Clinical Use of Opioids Clinical • Pain assessment – – – Essential component of management Based on patient’s description Evaluate: • Pain location, characteristics (sharp or dull pain), Pain duration (how long has it been going on), things that improve/worsen pain improve/worsen • Status prior to drug and 1 hour after Dosing Guidelines Dosing • Assessment of pain – Pain status should be evaluated prior to opioid Pain administration and about 1 hour after (orally) administration • Dosage determination – Opioid analgesics must be adjusted to Opioid accommodate individual variation. accommodate • Dosing schedule – As a rule, opioids should be administered on a As fixed schedule. fixed • Avoiding withdrawal Clinical Use of Opioids Clinical Physical Dependence A state in which an abstinence syndrome will occur if state the dependence-producing drug is abruptly withdrawn – NOT equated with addiction NOT Abuse Drug use that is inconsistent with medical or social Drug norms norms Addiction A behavior pattern characterized by continued use of behavior a psychoactive substance despite physical, psychologic, or social harm psychologic, Clinical Use of Opioids Clinical • Patient-controlled analgesia – PCA devices- when patient presses button, they PCA get a set amount (1 hour max- no more than 5 mg) mg) – Drug selection and dosage regulations – Comparison of PCA with traditional Comparison intramuscular therapy intramuscular – Patient education Clinical Use of Opioids Clinical • Using opioids in specific settings – – – – – – Postoperative pain Obstetric analgesia Myocardial infarction Head injury Cancer-related pain Chronic noncancer pain Fig. 28-3. Fluctuation in opioid blood levels seen with three dosing procedures. Note that with PRN dosing, opioid levels can fluctuate widely, going from subtherapeutic to excessive and back again. In contrast, when opioids are administered with a PCA device or on a fixed schedule, levels stay within the therapeutic range, allowing continuous pain relief with minimal adverse effects. Critical Thinking Question What drug should be available on the hospital unit when a patient may receives too much morphine? Narcan Opioid Antagonists Opioid • Drugs that block the effects of opioid Drugs agonists • Principal uses: – Treat opioid overdose, relief of opioid-induced Treat constipation constipation – Reversal of post-op opioid effects – Management of opioid addiction Opioid Antagonists Opioid Naloxone (Narcan) • Mechanism of action – Competitive antagonist • Pharmacologic effects – reversal of effects Pharmacologic (respiratory depression/coma/analgesia) (respiratory • Pharmacokinetics – IV, IM, subQ Naloxone Naloxone • Therapeutic uses – Reversal of opioid overdose • Drug of choice with pure opioid agonist overdose • Titrate cautiously with physical dependence – Reversal of postoperative opioid effects • Titrate to achieve adequate ventilation and maintain Titrate pain relief pain – Reversal of neonatal respiratory depression • Opioids given during labor and delivery may cause Opioids respiratory depression in neonate respiratory Nonopioid Centrally Acting Analgesics Analgesics • Relieve pain by mechanisms largely or Relieve completely unrelated to opioid receptors completely • Do not cause respiratory depression, Do physical dependence, or abu...
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This document was uploaded on 03/25/2014.

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