Describe the assessment of pain in a client
o
Explain the use of nonopioids, nonsteroidal anti-inflammatory drugs, opioids, and
miscellaneous drugs the management of pain
Briefly describe the mechanism of action, indications, dosages, routes of
administration, adverse effects, toxi...
describe the assessment of pain in a client o explain the use of nonopioids
nonsteroidal anti inflammatory drugs
and miscellaneous drugs the management
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NSG 251 Pharmacology
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Describe the assessment of pain in a client
o
Explain the use of nonopioids, nonsteroidal anti-inflammatory drugs, opioids, and
miscellaneous drugs the management of pain
Briefly describe the mechanism of action, indications, dosages, routes of
administration, adverse effects, toxicity, cautions, contraindications, and drug
interactions of nonopioids, nonsteroidal anti-inflammatory drugs, opioids, and
miscellaneous drugs
Explain the inflammatory process and the disease processes that are inflammatory
in nature
Briefly describe the mechanisms of action, indications, dosages, routes of
administration, adverse effects, toxicity, cautions, contraindications, and drug
interactions of various anti-inflammatory and antigout drugs
Compare and contrast a COX-2 inhibitor and other NSAIDs
Describe the pathophysiology and the drug therapies commonly used to treat gout
Perceptin of pain- definitions
• Pain- is most commonly defined as an unpleasant sesnsory and emotional experience associated with
either actual or potential tissue damage
o It is stimulated by nociceptors
• Perception of Pain- This is a personal and individual experience. It exists when the patient says it exists
o It involves psychological, emotional, cultural aspects
• Pain Threshold-the level of stimulus needed to produce a painful sensation
o Cond that lower pain threshold: anger, anxiety, depression, discomfort, fear, chronic pain
o Cond. That raise threshold: diversion, empathy, rest, sympathy, medication, analgesics,
antianxiety drugs, antidepressants
• Pain Tolerance- this is the amount of pain a patient can endure without its interfering with normal
function
o It is subjective and varies person to person.
• Types of Pain
o Acute- this is sudden and usually subsides when treated
• After surgery, fracture, etc
o Chronic- persistent or recurring, lasting 3 to 6 months
• More difficult to treat because changes that occur in the nervous system that often
require increase
• Fibromyalgia, low back pain. IBS, arthritis
respond better to • Classification of Pain
nonopioid • Somatic- originates from skeletal muscles, ligaments, and joints (bone pain)
analgesics such as • Visceral- originates organs and smooth muscle
nonsteroidal anti- • Superficial- originated from the skin and mucous membranes
inflammatory • Deep- occurs in tissues below skin level
drugs (NSAIDS) • Vascular- believed to originate from the vascular or perivascular or perivascular
tissue (Mirgrain headaches)
• Referred- visceral nerve fibers synapse at a level in the spinal cord close to fibers
that supply specific subQ tissues in the body
Responds to
opiod drugs
, • Neuropathic- usually results from damage to peripheral or CNS nerve fibers by
disease or injury but may also be idiopathic
• Phantom- occurs in areas of a body part that has been removed surgically or
traumatically and can occur in paraplegics as well
• Cancer- acute or chronic pain or both; most often results from pressure of the
tumor mass against nerves, organs, or tissues.
• Other forms can by hypoxia from blockage of blood supply to an organ
metastases, pathologic fractures, muscle spasms, and adverse effects of
radiation, surgery, and chemotherapy
• Central pain: occurs with tumors, trauma, inflammation, or disease. Affecting
CNS tissues
•
o Gate Theory of Pain Transmission
• Tissue injury causes the release of the following:
• Bradykinin
• Histamine
• Potassium
• Prostaglandins
• Serotonin
• Some pain medications manage pain by altering or increasing the level of
these
• These substances stimulate nerve endings,
starting the pain process.
• The nerve impulses enter the spinal cord
and travel up to the brain.
• The point of spinal cord entry or the “gate” is the dorsal horn.
• This gate regulates the flow of sensory impulses to the brain. Closing the gate stops the
impulses.
• If no impulses are transmitted to higher centers in the brain, there is no pain perception.
• Rubbing or applying a large sensory stimulus to the pain can reduce the
sensation of pain.
o Special Considerations when using pain management and opiods
• Pt Addiction, family addiction, neonatal
• Anelgesics- medications that reduce pain without causing a loss of consciousness
(painkillers)
• PCA and “PCA by proxy” (means the staff or family will push the button)
• Patient-controlled analgesia is commonly use in the hospital setting
• Patients are able to control their pain by having a button on a PCA
infusion pump
• This has been useful in reducing the total opiod dose used
• Morphine and hydromorphone’s are commonly used with PCA
• Patient comfort vs. fear of drug addiction
• This is the main consideration for cancer patients.
• You want to worry more about comfort than drug addiction
• Use of placebos
• Recognizing patients who are opioid tolerant- street opioid uses or patients with chronic
pain have this tolerance and generally require a higher dose.
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