OPIATES

Drugs
I. Mu receptor Agonists –
morphine like drugs
II. Opiate agonist-antagonist
(Bruprenex, Talwin)
III. Mu agonist
tramadol (ultram)
IV. tapentadol (Nucynta)
V. Opiate antagonist
- naloxone (Narcan)
- naltrexone (Re via)
MOA and other information Effects Nursing Implications & Client Teachings
- Binds to mu & kappa receptors → opiate CNS : PNS: - Cause physical dependence
analgesia - Pupil constriction (miosis) - Constipation - Morphine = gold standard b/c no ceiling
effect
- Analgesia - Diaphoresis/flushing
- N/V - Hypotension
- Cough suppression - Urinary retention
- Respiratory depression - Urticaria
- Euphoria
- ↓ anxiety & fear
- ↑ sleep & pain threshold
- Highly promotes Kappa receptors & slightly - - Not for physically dependent narcotic pts
blocks mu receptors → may go through *narcotic withdrawals
- Weakly binds to mu receptors - ↓ seizure potential = ↑ occurrences - Caution: pts with prior addiction →
- Inhibits NE & 5-HT reuptake - constipation *narcotic withdrawals
- Mod to severe pain - ↓ addiction potential
- New opiod - ↓ less constipation and n/v
- Inhibits NE reuptake
- Bind to mu & kappa & prevents a response -
→ Tx respiratory distress & constipation → Excruciating pain!
→ Cut down alcohol cravings

* narcotic withdrawals: flu-like symptoms → anxiety, irritability, chills & hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, n/v/d, abdominal cramps

NON-OPIATES
Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
I. NSAIDs - Inhibits cox-1 & cox-2 - G.I. bleeding, dyspepsia - Take with H2O or w/ meals → ↓ GI upset
- Ibuprofen (Advil, - mild to mod pain - Liver toxicity/renal damage - X: Patients with ulcers & undergoing surgery;
Motrin) - good for dysmenorrhea - Edema Alcoholics, those taking glucocorticoids;
- antipyretic, 1st line anti-inflammatory - LT use ↑ CV risk Cardiac & CHF patients;
- Inhibit platelet aggregation (reversible) - cause false + toxicology results for Those taking ACEIs & ARBs
- Highly protein bound marijuana

- Aspirin / ASA - Inhibits cox-1 & cox-2 - G.I. bleeding, dyspepsia - Take with H2O or w/ meals → ↓ GI upset
- Analgesic, antipyretic & anti-inflammatory - Tinnitus (toxicity sign) - X: children < 15 y.o. → may develop Reye's syndrome
- ↓platelet aggregation (irreversible) - Excessive bruising Pts BP > 160 systolic → risk for bleeding stroke
- highly protein bound - highly lethal in OD → no known antidote
- Celecoxib (celebrex) - Cox-2 inhibitor - NO G.I. S/Es because Cox-1 not inhibited - For LT use of anti-inflammatory
- Acute pain & dysmenorrhea - 2ndary effects: may prevent colon CA - Caution still: G.I bleeding, A/Es on C/V
- Anti-inflammatory
II. acetaminophen - Weak cox-1 & 2 inhibitor - Has ceiling effect - take only: 2.4-4g/day
(Tylenol) - mild to mod pain - Liver failure in large doses - NOT for prolonged use
- combined w/ opiods to tx mod to severe pain - Caution: alcoholics; hepatic or renal dz, children, elderly
- analgesic & antipyretic - OD → use acetylcysteine
 HEADACHE MEDICATIONS
I. Migraine
Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
A. Abortive (acute) Tx
1. Triptans - Serotonin agonists that cause: - Well tolerated w/ good S/E profile - X: pts w/ CV dz or w/ other vasoconstricting
- Intracranial vasoconstriction - ↓potential for addiction agent
- ↓ edema & ↓pain - Administer at 1st sign of HA → ↑ effectiveness
- Gold standard for migraine
2. NSAIDs, Aspirin or - mild to moderate pain
acetaminophen w/ caffeine
3. barbiturate or codeine
4. antiemetic
metoclopramide (Reglan)

B. Prophylactic Tx
1. β-Blockers: anti-HTN → propanolol (Inderal)
2. Anti-convulsants / mood stabilizers → Depakote, Topamax
3. Antidepressants → TCAs, SSRIs
4. Ca2+ Channel Blockers (CCB) → anti-HTN
5. Hormone therapy

II. Cluster HA
Drugs
A. Abortive (acute) Tx
1. SL ergotamine
2. Inhalation of 100% O2
B. Prophylactic Tx
- Avoid alcohol, smoking
- Possible w/ lithium, prednisone & Depakote (Used for all HA)

* LT use of any analgesic → rebound HA worse than original

** Narcotics not used for HA → may produce HA & dependency w/ chronic