What is the mechanism of opioids and common adverse effects?
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Stimulate opioid receptors in the CNS. Pure agonists like Morphine bind to
receptors to produce analgesia that increase with dose without ceiling
effect. They block pain, not treat the cause of pain. The opioids exert their
analgesic efficacy by stimulating opioid receptors Mu (μ), kappa (κ), and
delta (δ)
,hydroxyzine, diphenhydramine, Ondansetron
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nausea / emesis
dose 25-100mg PO/IM q 4-6 PRN
dose 25-50mg PO/IM q 6 PRN
dose 4-8 mg PO TID
headache diary
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: Keeping detailed records of HA to provide additional insight about
triggers and how to avoid them. It also helps identify patterns and track
characteristics of HA.
Opioids use
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moderate/severe pain, pre-operative to sedate and ease anxiety, intra-op
analgesia.
Severe acute pain, moderate to severe cancer pain, moderate to severe
chronic non-malignant and severe neuropathic pain (third or fourth line)
has gained more acceptance in recent years.
*Practice question: What could you use for prophylaxis of migraines?
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Beta-blockers if not contraindicated (or CCB), low-dose TCAs
(amitriptyline, venlafaxine), and antiepileptics (topiramate, valproic acid,
and divalproex sodium). (pg 590-591)
How does IHS classify migraine headaches (w or w/o aura) and cluster headaches:
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Primary headaches are migraines, tension-type, cluster, and other
trigeminal autonomic cephalgias. Oral NSAIDs and combination analgesics
with caffeine: first-line treatment choices for mild to moderate attacks or
severe attacks that have responded in the past to similar treatment Triptans
- First line therapy for moderate to severe migraines, especially when
nonspecific (including OTCs (e.g. Excedrine Migraine)) medications are
ineffective. Use for migraines with predictable pattern (Example: menstrual
cycle). Triptans can be tried in patients unresponsive to NSAIDs, but
generally not considered to standard of practice
Opioid Side Effects
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- Euphoria
- Sedation
- Respiratory Depression
- Miosis
- Nausea and Vomiting
- Constipation
- Pruritis (Itching)
, Acetaminophen Hepatotoxicity
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-Hepatic injury starts 24 to 72 hours after ingestion
-Injury possible with high therapeutic doses-pts with preexisting liver
disease
-Injury possible with high therapeutic doses in malnutrition & alcoholics
-Can result in hepatic failure and in some instances death
Occurs in doses greater than 4 grams per day.
Initiation of Therapy Objective:
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to find the medication that provides the best pain relief with the fewest
adverse events.
maximum daily dose of APAP in older adults
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3000 mg in older adults and less than 2,000 mg a day in frail patients or
those over 80 years of age who consume alcohol or with impaired liver
function.
Acetaminophen
Give this one a try later!
Stimulate opioid receptors in the CNS. Pure agonists like Morphine bind to
receptors to produce analgesia that increase with dose without ceiling
effect. They block pain, not treat the cause of pain. The opioids exert their
analgesic efficacy by stimulating opioid receptors Mu (μ), kappa (κ), and
delta (δ)
,hydroxyzine, diphenhydramine, Ondansetron
Give this one a try later!
nausea / emesis
dose 25-100mg PO/IM q 4-6 PRN
dose 25-50mg PO/IM q 6 PRN
dose 4-8 mg PO TID
headache diary
Give this one a try later!
: Keeping detailed records of HA to provide additional insight about
triggers and how to avoid them. It also helps identify patterns and track
characteristics of HA.
Opioids use
Give this one a try later!
moderate/severe pain, pre-operative to sedate and ease anxiety, intra-op
analgesia.
Severe acute pain, moderate to severe cancer pain, moderate to severe
chronic non-malignant and severe neuropathic pain (third or fourth line)
has gained more acceptance in recent years.
*Practice question: What could you use for prophylaxis of migraines?
,Give this one a try later!
Beta-blockers if not contraindicated (or CCB), low-dose TCAs
(amitriptyline, venlafaxine), and antiepileptics (topiramate, valproic acid,
and divalproex sodium). (pg 590-591)
How does IHS classify migraine headaches (w or w/o aura) and cluster headaches:
Give this one a try later!
Primary headaches are migraines, tension-type, cluster, and other
trigeminal autonomic cephalgias. Oral NSAIDs and combination analgesics
with caffeine: first-line treatment choices for mild to moderate attacks or
severe attacks that have responded in the past to similar treatment Triptans
- First line therapy for moderate to severe migraines, especially when
nonspecific (including OTCs (e.g. Excedrine Migraine)) medications are
ineffective. Use for migraines with predictable pattern (Example: menstrual
cycle). Triptans can be tried in patients unresponsive to NSAIDs, but
generally not considered to standard of practice
Opioid Side Effects
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- Euphoria
- Sedation
- Respiratory Depression
- Miosis
- Nausea and Vomiting
- Constipation
- Pruritis (Itching)
, Acetaminophen Hepatotoxicity
Give this one a try later!
-Hepatic injury starts 24 to 72 hours after ingestion
-Injury possible with high therapeutic doses-pts with preexisting liver
disease
-Injury possible with high therapeutic doses in malnutrition & alcoholics
-Can result in hepatic failure and in some instances death
Occurs in doses greater than 4 grams per day.
Initiation of Therapy Objective:
Give this one a try later!
to find the medication that provides the best pain relief with the fewest
adverse events.
maximum daily dose of APAP in older adults
Give this one a try later!
3000 mg in older adults and less than 2,000 mg a day in frail patients or
those over 80 years of age who consume alcohol or with impaired liver
function.
Acetaminophen
