PHARMA: NON-NARCOTIC& NARCOTIC ANALGESICS
taking for pain can contain acetaminophen or ibuprofen.
Read labels carefully to make sure you are not taking too high a
PAIN dose or getting any additives you do not want.
it is mostly a subjective experience of unpleasant sensation and Ask your doctor about any prescription pain medications that
emotional experience. People respond to pain differently may be used before, during, and after surgery to better
because of cultural differences, learned experiences, and understand how they work to control pain and reduce narcotic
environmental stimuli. requirements, as well as any potential side effects.
A-delta and -fibers are two sensory nerves that respond to
stimulation by generating nerve impulses that produce pain
sensations. NARCOTIC DRUGS
Narcotic drugs are drugs that react with different type of:
- opioid receptors
ACUTE VS. CHRONIC PAIN -, receptor sites that respond to naturally occurring peptides
Acute pain - enkephalins
is caused by tissue injury. It is the type of pain which makes the - and endorphins
person aware of the injury and leads him to seek for care and These are found in the CNS, peripheral nerves, and Gl tract cells.
education about the injury and how to take care of it In the spinal cord, they integrate and relate pain information.
Chronic pain Pain relief and side effects depend on the type of receptor sites.
is a constant or intermittent pain that keeps occurring long past
the time the area would be expected to heal.
This is the type that can interfere with activities of daily living. THE DIFFERENT TYPES OF OPIOIDS RECEPTORS ARE THE
FOLLOWING:
MU OPIOID RECEPTORS
PAIN CLASSIFICATION ACCORDING TO SOURCE: primarily pain-blocking receptors; also account for respiratory
Nociceptive pain depression, euphoria, and development of physical dependence
caused by direct pain receptor stimulus. BETA-RECEPTORS
Neuropathic pain modulate pain transmission by reacting with enkephalins in the
caused by nerve injury. periphery.
Psychogenic pain KAPPA-RECEPTORS
associated with emotional, psychological, or behavioral stimuli. associated with some analgesia, pupillary constriction, sedation,
and dysphoria
SIGMA-RECEPTORS
NON-NARCOTIC DRUGS
pupillary dilation, hallucinations, psychoses with narcotic use.
Non-narcotic analgesics are medications used to control pain and
inflammation.
They are available at drugstores without a prescription or by NARCOTIC DRUGS ARE DIVIDED INTO THREE CLASSES
prescription when given at higher doses. Some types of these NARCOTIC AGONISTS
medications can be given during surgery to reduce post-surgical - react with opioid receptors in the CNS; cause analgesia,
pain and lessen the need for narcotics. sedation, or euphoria. They are classified as controlled
Non-prescription options substances because they have potential for physical dependence.
-Tylenol (chemical name: acetaminophen) NARCOTIC AGONISTS-ANTAGONISTS
- NSAIDs such as aspirin, Motrin, or Advil (chemical name: - stimulate certain opioid receptors but block
ibuprofen) other such receptors. They exert similar analgesic effect with that
- Aleve or Naprosyn (chemical name: naproxen sodium) of morphine but they have less potential for abuse. However,
- Surgical options: Exparel (chemical name; bupivacaine liposome they are associated with more psychotic-like reactions.
injectable
NARCOTIC ANTAGONISTS
suspension)
bind strongly to opioid receptors without causing receptor
- IV Tylenol.
activation. They block opioid receptor effects as well as effects of
too much opioids in the system.
NON-NARCOTIC DRUGS
-Non-opioids are used to treat acute or persistent pain that is
NARCOTIC AGONISTS
mild to moderate.
Therapeutic action:
-They also may be used in combination with other medications or
act as agonist to specific opioid receptors in the CNS to produce
therapies to treat moderate to severe pain.
analgesia, euphoria, and sedation.
Acetaminophen and NSAID products
indications:
- sometimes contain additives such as caffeine, which acts as a
relief of moderate to severe acute pain or chronic pain;:
stimulant and can lessen pain
preoperative medication; component of combination therapy
ANTIHISTAMINES
fore severe chronic pain; intraspinal to reduce intractable pain.
to help with sleep and relaxation; and/or "buffering" ingredients
Naloxone is the antidote for narcotic overdose and reversal of
intended to decrease stomach upset.
narcotic effects
Also, other over-the-counter medications you may already be
Narcotics used in labor include morphine, meperidine, and
PHARMA: NON-NARCOTIC& NARCOTIC ANALGESICS
Perform baseline and periodic pain assessments with patient to
oxymorphone. monitor drug effectiveness and provide appropriate changes in
All narcotic agonists are pregnancy category B except oxycodone pain management protocol as needed.
(category C) so it might be the drug of choice if one is needed Have a narcotic antagonist and equipment or assisted ventilation
during pregnancy. readily available when administering this drug IV to provide
patient support in case of severe reaction.
Monitor timing of analgesic doses. Prompt administration may
CONTRAINDICATIONS AND CAUTIONS
provide a more acceptable level of analgesia and lead to a
Allergy to narcotic agonists. Prevent hypersensitivity reactions.
quicker resolution of the pain.
Diarrhea caused by toxic poisons. Drug depresses Gl activity and
this could lead to increased absorption and toxicity
Respiratory dysfunction. Exacerbated by respiratory depression NURSING RESPONSIBILITIES
caused by drugs. Provide non-pharmacological pain measures like breathing
Recent Gl/GU surgery, acute abdomen, ulcerative colitis. Can be exercises, back rubs, and stress reduction to increase drug
worsen by the Gl depressive effects of the narcotics. effectiveness and reduce pain.
Head injuries, alcoholism, delirium tremens, cerebral vascular Provide comfort measures (e.g. small, frequent meals for Gl
disease. Can be exacerbated by the CNS effects of the drug. upset) to help patient tolerate drug effects.
Liver, renal dysfunction. Can interfere with metabolism and Provide safety measures (e.g. adequate lighting, raised side rails,
excretion of the drug. etc.) to prevent injuries.
Pregnancy, lactation. Potential adverse effects to the fetus and Educate client on drug therapy to promote understanding and
the baby. compliance.
ADVERSE EFFECTS
CNS:
light-headedness, ditziness, psychoses, anxiety, fear, NARCOTIC ANTAGONISTS
hallucinations, pupil constriction, impaired mental processes. - are drugs that bind strongly to opioid receptors but do not
Gl: activate them.
nausea, vomiting, constipation, billary spasm. -They block the opioid receptors and reverse the effects of
GU: opioids like respiratory depression and sedation.
ureteral spasm, urinary retention, hesitancy, loss of libido Indications: indicated for complete or partial reversal of narcotic
Others: sweating, physical and psychological dependence depression; diagnosis of suspected opioid overdose.
Narcotic-induced respiratory center depression: respiratory
depression with apnea, cardiac arrest, shock.
NURSING RESPONSIBILITIES
- Maintain open airway and provide artificial ventilation and
INTERACTIONS cardiac massage as needed to support the patient.
Barbiturates, phenothiazines, MAOis. - Administer vasopressors as ordered and as needed to manage
increased likelihood of respiratory depression, hypotension, and narcotic overdose
sedation. - Administer naloxone challenge before giving naltrexone
SSRIs, MAOis, TCAs, and St, John's Wort because of the serious risk of acute withdrawal.
: increased risk of potentially life- threatening serotonin - Provide safety measures (e.g. adequate lighting, raised side
syndrome if taken with tapentadol, the newest narcotic agonists rails, etc.) to prevent injuries.
that blocks norepinephrine reuptake in the CNS. - Ensure that patients receiving naltrexone have been narcolic-
Methyinaltrexone bromide (Relistor) free for 7-10 days to prevent severe withdrawal syndrome.
is the treatment for opioid-induced constipation in palliative care - Educate client on drug therapy to promote understanding and
patients who are no longer responding to traditional laxatives. compliance
NARCOTIC AGONISTS-ANTAGONISTS (Pentazosine (Taiwin)
Therapeutic action:
-act on certain opioid receptors but block other such receptors.
- They have less potential for abuse compared to narcotic
agonists but are able to exert similar analgesic effect as morphine
indications: narcotic agonists-antagonists are indicated for the
following medical conditions.
- Rellet of moderate to severe pain; preanesthetic medication
and a supplement to surgical anesthesia.
- May be desirable for relleving chronic pain in patients who are
susceptible to narcotic dependence.
NURSING RESPONSIBILITIES
