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Narcotic Analgesic Medications

Narcotic Analgesic Medications. Narcotic Analgesics. Opioids. Actions Analgesia Euphoria Sedation. Opioids. Primary Use Moderate Pain Severe Pain Acute Pain Chronic Pain Breakthrough Pain. Opioids. Other Uses Pre-Op Sedation Adjunct Anesthesia Anti Anxiety Diarrhea

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Narcotic Analgesic Medications

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  1. Narcotic AnalgesicMedications Narcotic Analgesics

  2. Opioids Actions • Analgesia • Euphoria • Sedation

  3. Opioids Primary Use • Moderate Pain • Severe Pain • Acute Pain • Chronic Pain • Breakthrough Pain

  4. Opioids Other Uses • Pre-Op Sedation • Adjunct Anesthesia • Anti Anxiety • Diarrhea • Opiate Dependence

  5. Opioids Common Opioids • Morphine sulfate • Codeine • meperidine HCl (Demerol) • hydromorphone (Dilaudid) • fentanyl (Duragesic) • oxycodone (OxyContin)

  6. Opioids Common Routes • IV • IM • Subcutaneous • Oral • Transdermal • Epidural

  7. Opioids Adverse Reactions Euphoria, dysphoria, confusion, sedation Respiratory depression, cough depression Nausea, vomiting, constipation Hypotension, bradycardia or tachycardia Urinary hesitancy, dysuria Allergic reactions, pruritis Pain, irritation at injection site

  8. Opioids Contraindications Opiate allergies Pulmonary diseases (asthma, COPD) Head injuries, increased intracranial pressure Convulsions Ulcerative colitis Renal or hepatic dysfunction

  9. Opioids Precautions Not recommended during labor Not recommended during lactation Use caution with elderly Not recommended for biliary surgery

  10. Opioids Precautions Opioid Naive Tolerance Addiction

  11. Opioids Precautions Opioids and Acetaminophen Daily acetaminophen intake should NOT EXCEED 4 grams

  12. Opioids Interactions CNS Depressants Use caution whenever two or more CNS depressants given

  13. Opioids Special Circumstances Opiates of Choice Morphine Myocardial Infarct Meperidine Biliary Surgery Codeine Persistent Cough

  14. Opioids Opiate Poisoning miosis hypoxia Respirations < 10 / min

  15. Opioids Opiate Antagonist

  16. Opioids Patient Controlled Analgesia (PCA)

  17. Opioids Epidural

  18. Opioids Transdermal

  19. Narcotic AnalgesicsNursing Process • Assessment • Pain assessment • Precipitating factors • Nonpharmacological medications • Time last medicated • Response to last pain medication • Allergies • Bowel history

  20. Narcotic AnalgesicsNursing Process • Planning • Adverse reactions • Expected pain relief • Route of administration

  21. Narcotic AnalgesicsNursing Process • Suggested Nursing Diagnoses • Pain, acute • Pain, chronic • Constipation r/t adverse drug effects

  22. Narcotic AnalgesicsNursing Process • Implementation • Identify patient • Observe 6 Rights

  23. Narcotic AnalgesicsNursing Process • Evaluation • Response to medication • Evidence of adverse reactions • Evidence of tolerance, addiction

  24. Narcotic AnalgesicsKey Points • Side Effects • Lethargy, Confusion • Constipation • Adverse Reactions • Respiratory Depression (Opiate Naïve) • Opiate Poisoning • Combination Drugs • Be mindful of acetaminophen toxicity

  25. Narcotic AnalgesicsKey Points • Addiction • Not likely to happen when purpose of drug is to relieve pain • Tolerance • Likely to occur, especially with morphine • PCA’s • PCA’s are PATIENT controlled, not nurse controlled

  26. Narcotic AnalgesicsKey Points • Opioids are drugs of choice for SOME pains • Not ALL pain should be managed with Opioids • Review: Thumbs Up? Thumbs Down?

  27. Narcotic AnalgesicsKey Points • Pain associated with Myocardial Infarction • Morphine is the drug of choice

  28. Narcotic AnalgesicsKey Points • Pain associated with Ulcerative Colitis • Opioids should be avoided

  29. Narcotic AnalgesicsKey Points • Pain associated with Gall Bladder surgery • Avoid morphine • Meperidine is drug of choice

  30. Narcotic AnalgesicsKey Points • Pain associated with Labor • May prolong labor • May cause respiratory depression in the newborn

  31. Narcotic AnalgesicsKey Points • Pain associated head injury • Opioids may increase intracranial pressure (ICP)

  32. Narcotic AnalgesicsKey Points • Pain in patients with COPD • Opioids cause respiratory depression

  33. Narcotic AnalgesicsKey Points • Pain in patients with seizure disorders • Opioids may precipitate seizures

  34. Anesthestic Medications

  35. Anesthetic Medications • Topical • Application to body surface • Cream, lotion, spray, gel, etc. • May be given prior to an injection

  36. Anesthetic Medications • Local Infiltration • Injection of anesthetic into tissue • Example: Novacaine

  37. Anesthetic Medications • Regional Anesthesia • Spinal Subarachnoid space • Conduction Near a nerve

  38. Anesthetic Medications • Regional Anesthesia - Spinal • Injected into subarachnoid space of spinal cord • Most commonly 2nd lumbar vertebra • Loss of feeling and movement • Lower abdomen • Perineum • Lower extremities

  39. Anesthetic Medications • Regional Anesthesia – Conduction Blocks • Epidural block • Caudal block • Brachial plexus block

  40. Anesthetic Medications • Preparing the patient for local or regional anesthetics • Positioning • Teaching • Emotional Support

  41. Anesthetic Medications • Providing care after local or regional anesthesia • Safety r/t lack of sensation • Loss of body functions • Hemorrhage • Infection

  42. Anesthetic Medications • Preanesthesia Medications • Opioids to decrease anxiety / apprehension • Fentanyl (Sublimaze) • Meperidine (Demerol) • Morphine

  43. Anesthetic Medications • Preanesthesia Medications • Barbiturates to decrease anxiety / apprehension • Pentobarbital (Nembutal) • Secobarbital (Seconal)

  44. Anesthetic Medications • Preanesthesia Medications • Benzodiazepines to decrease anxiety / apprehension • Chlordiazepoxide (Librium) • Diazepam (Valium) • Midazolam (Versed) • Lorazepam (Ativan)

  45. Anesthetic Medications • Antiemetic Medications • Decrease nausea / vomiting and side effect of drowsiness / antianxiety • Hydroxizine (Vistaril) • Promethazine (Phenergan)

  46. Anesthetic Medications • Antiemetic Medications • Cholinergic blocking agents to decrease respiratory secretions and mucous production • Atropine sulfate • Robinul • Scopolamine

  47. Anesthetic Medications • General Anesthesia • Cause loss of consciousness • Except for very short procedures, patient must be intubated • Profound analgesia

  48. Anesthetic Medications • Types of General Anesthesia • Barbiturates • Methotrexital (Brevital) • Propofol (Diprivan)

  49. Anesthetic Medications • Types of General Anesthesia • Benzodiazepines • Midazolam (Versed)

  50. Anesthetic Medications • Types of General Anesthesia • Ketamine (Ketalar) • Street Drug Special K

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