Lecture 6 Pharmacology

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Lecture 6 Pharmacology

• Analgesics
• Non Narcotics
• Narcotics
• Sedatives
• Hypnotic

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Comfort/Rest/Sleep

• Assess Pain
• Intervene
• Drugs that prevent relieve pain
• Review Pain pathways

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Release of Prostaglandin by Damaged Tissue
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Non-narcotic Analgesics

• Salicylates ASA
• absorbed well po
• distributed widely
• Metabolized in the liver
• Excreted by kidneys

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Mechanisms of Action

• Analgesia- inhibit prostaglandin synthesis
• Antipyretic (fever reducer) - hypothalamic
  stimulationvasodilationdiaphoresis
• Anti-Inflammation - may inhibit prostaglandin
  synthesis release
• Anticoagulation - inhibits platelet aggregation

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Therapeutic Uses

• Mild pain relief
• Antipyretic (reduce fever)
• Mild inflammation
• Reduce risk of coagulation (cardiac disease)
• Combined with Narcotics

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Drug Interactions

• Many r/t highly protein bound
• Increases displaced Drugs Effect
• False in urine tests

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Adverse Reactions

• Predictable
• Gastric Distress
• Hearing Loss with prolonged use
• ringing
• tinnitus

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Unpredictable Reactions

• Allergic reaction
• Reyes Syndrome
• encephalopathy
• fatty degeneration of liver
• multisystem disorder
• heart kidney

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Nursing Implications

• Take with full glass of water
• Check labels of OTC drugs
• Do not use in children or adolescents
• Do not use prior to major surgery
• Assess for HX of ulcers
• Teach s/sx of bleeding

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ParaAminophenol Derivative

• acetaminophen (Tylenol)
• Absorbed well po
• Distributed widely
• Metabolized by hepatic enzymes
• Excreted by kidneys breast milk

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Mechanism of Action

• Analgesic - inhibit prostaglandin synthesis
• Antipyretic - direct action on heat regulation
  center of hypothalamus
• (No antiplatelet or anti-inflammatory effects)

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Therapeutic Uses

• Fever
• Muscle aches
• Flu
• combined with Narcotics

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Drug Interactions

• Alcohol (chronic use)
• Barbiturates
• Charcoal

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Adverse Reactions

• Overdose - Liver Toxicity
• Coagulation defects
• kidney damage
• Few with normal dosage
• Unpredictable
• allergy

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Nursing Implications

• Contraindicated in Pt with anemia, liver damage
• Read labels carefully
• Check OTC drugs- in many

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Nonsteroidal Anti Inflammatory Drugs (NSAIDS)

• Absorbed well po
• Distributed widely
• Metabolized in liver
• Excreted by kidney

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Mechanism of Action

• decreases inflammation pain by inhibiting
  prostaglandin synthesis
• antipyretic by action to hypothalamus

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Therapeutic uses

• Inflammatory response
• Mild to moderate pain
• Soft tissue injuries

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Types of NSAIDS

• Ibuprofen - Advil, motrin, Nuprin
• Indomethacin - Indocin
• Napsoxen - Napsosyn
• Toredol

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Drug Interactions

• Wide variety r/t highly protein bound
• Anticoagulants
• Antihypertensives

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Adverse Reactions

• Predictable
• CNS- dizzy, drowsy, HA, confusion
• Eyes- blurred vision
• GI - pain, bleeding, anemia
• Renal - cystitis, hematuria
• Unpredictable
• allergic reaction like asthma

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Nursing Implications

• Contraindicated in asthma
• Pain continues gt 5 days call MD
• Check for cross-sensitivity to ASA
• May take several weeks to produce therapeutic
  effect
• Check blood vision before starting long term
  therapy

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Narcotic Opiate Agonists

• Derived from active opium poppy
• Agonist -affinity to receptor site stimulate
  function
• Morphine is standard of effectiveness
• Demerol is synthetic narcotic

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Narcotic Equianalgesic

• Codeine 120 mg
• Morphine 10 mg
• Hydromorphone 1.5 mg
• (Dilaudid)
• Levodromerone 2 mg
• Meperedine 75-100 mg
• (Demerol)
• Fentanyl 0.1-0.2 mg

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Pharmacokinetics

• Absorbed well po large first by-pass
• Distributed widely
• Metabolized in liver
• Excreted by kidneys

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Mechanism of Action

• Binds at Opiate receptor sites
• Decreased pain impulse
• Decreases response to pain

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Narcotic Actionsites

• Cough suppression
• Diaphoresis flushing
• Depresses Respiration
• Slow GI tract
• Urine retention (poor bladder tone)

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Therapeutic Uses

• Severe pain acute, chronic or terminal illness
• Preoperative to decrease anxiety
• Pain from MI
• Schedule II
• No ceiling effect

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PCA order

• Patient
• Controlled
• Analgesia

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Codeine

• Schedule II mild - moderate pain
• Antitussive
• Not used in chronic pain
• Has ceiling effect

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Drug Interactions all Opiates

• Alcohol
• Sedatives
• Hypnotic
• Drugs that cause Resp. Depression

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Adverse Reactions

• Respiratory Depression
• Vasodilatation- flushing, Orthostatic Hypotension
• GI- N/V, Constipation,
• Prolonged labor, depressed fetus
• Allergic reactions
• Kidney dysfunction

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Nursing Implications

• Hold if resp. rate 8-10/min
• Check for Urinary retention
• Check peristalsis
• Assess pain with each dose
• Administer before pain is severe
• Double locked, signed out of controlled drugs
• counted each shift, witness any waste
• Assess tolerance and increase dose prn

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Narcotic Antagonist

• Naloxone (Narcan)
• Competes with agonist at receptor sites
• Usually IV or IM
• Rapid onset, duration 2-3 min.
• May need to repeat dose

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Uses

• Narcotic OD
• Reverse respiratory depression

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Adverse Reactions

• Nausea/Vomiting
• Hypertension
• Tachycardia
• Hyperventilation

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Nursing Implications

• Use cautiously with cardiac irritability
• Safe to use when cause resp. depression unknown

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Drugs to promote Sleep

• Sedatives
• decrease activity, excitement, calm
• Hypnotic
• larger dose of sedative, induce sleep

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Benzodiazepines

• Site of Action unknown - several in CNS
• used in insomnia, Preop
• Examples Dalmane
• Halcion

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Drug Interactions

• Alcohol
• narcotics
• Barbiturates
• Anticonvulsant
• Any CNS depressant

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Adverse Drug Reactions

• Hangover effect
• Daytime sedation
• dizziness, confusion
• Depression, suicidal
• allergic reaction
• Idiosyncratic nervousness, excitement

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Nursing Implications

• Contraindicated- sensitive pt., liver disease,
  pregnant
• Caution - pulm. insuff, psychosis
• Assess CNS resp function
• Assess dependency abuse
• Teach pt not to take with other CNS depressants
• Not to drive or use heavy machinery
• Safety precautions (side rails, call light)

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Barbiturates

• Sedative
• Hypnotic
• Anesthetic
• Anticonvulsant
• Antianxiety

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Pharmacokinetics

• Absorbed well po IM (painful)
• Distributed to all tissue fluids
• Metabolized in the liver
• Excreted by the kidneys

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Duration of Action

• Varies ultra short to long action
• depends on rate of metabolism
• depends on route of administration

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Site of Action

• Primary site at neuronal fibers synapses
• Less selective than benzodiazepenes
• Produces sequential CNS depression
• sedation
• reduced anxiety
• anesthesia
• coma

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Therapeutic Uses

• daytime sedation
• hypnotic
• anesthesia
• anticonvulsant
• pre-operative

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Examples of Barbiturates

• Nembutal (pentobarbital) Schedule II
• Seconal (secobarbital) Schedule II

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Drug Interactions

• Many especially CNS depressants
• ETOH
• narcotics
• anticonvulsants
• tricyclic antidepressants
• Diet low in protein may increase duration of
  action

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Adverse Reactions

• Predictable
• drowsiness
• vertigo
• hypoventilation
• bradycardia

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Adverse reactions Cont

• bronchospasm
• hypotension
• respiratory depression
• developed tolerance with prolonged use
• Psychological /or Physical Dependency
• Unpredictable- allergic reactions
• Idiosyncratic reactions

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Nursing Implications

• No longer drug of choice due inc. toxicity
  dependence
• Contraindicated in pulmonary insufficiency
• renal disease
• depression/suicidal/abuse HX
• Teach patient- only dose prescribed
• Dont drive
• No ETOH
• Dont share Rx
• Keep out of reach of children