© Paradigm Publishing, Inc.1 Chapter 6 Anesthetics and Narcotics.
Anesthetics, Analgesics & Narcotics
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Transcript of Anesthetics, Analgesics & Narcotics
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Anesthetics, Analgesics & Narcotics
Pain ManagementOpioids (Narcotics)
Management of Migraine
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General Anesthesia
Reversible unconsciousnessAbsence of a response to painful stimuliCharacteristics
UnawarenessAnalgesiaSkeletal & muscle relaxationAmnesia on recovery
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Types of General Anesthesia
Inhalant AnestheticsNitrous Oxide
Injectable AnestheticsBarbiturates, BenzodiazepinesKetamine – dissociative amnesia
AntagonistsNaloxone
Neuromuscular Blockers
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Local Anesthetics
Transient, reversible loss of sensation in a specific body areaNo change in alertness or mental functioningIndications
Sunburn, bites, cuts, dental work, hemorrhoids
Chemical AgentsBenzocaine, lidocaine, cocaine
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What is Pain?
An unpleasant sensory or emotional experience which we primarily associate with tissue damage.Pathway damages the nerve pain impulse to brain
Opioid Receptor Brain Distribution
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Pain Syndromes
Acute Pain recent onset, transient, identifiable cause
Chronic Pain persistent or recurrent pain, beyond usual course of acute illness or injury
NonmalignantDiagnosed or undiagnosed cause such as a nonmalignant disease
MalignantDisease present pain severity worsens as progresses
Breakthrough Pain transient pain, severe or excruciating, over baseline of moderate pain
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ABC’s of Pain Management
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Non-Drug Pain Management Techniques
DistractionIce/HeatTV/ read/visiting
RelaxationBreathing, yogaTapes, music
MassageBiofeedbackAcupunctureImagery
Pleasant mental picture
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Pain NeuroTransmitters Pain Relief Meds
Substance PGlutamateGABANorepinephrineSerotoninHistamine
NSAIDSAntidepressantsAnti seizure medsMuscle relaxantsLocal salves- capsaicin Narcotics
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Opioids (God Morpheus of Dreams)Narcotics (Narcosis—stupor)
Produce analgesia by binding to opiate receptors in the CNS, brain and spinal cord involved with the transmission of pain impulses.Endogenous opioids are present at brain sites
Released during stress, pain & anticipation of pain
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Common Opioid Side Effects
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Clinical Indications
AnalgesiaAcute Pulmonary EdemaCoughDiarrheaAnesthesia
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Toxicity Opioid Antagonists
ToleranceDependence
PhysicalPsychological
OverdoseDrug InteractionsContraindications
AgentsNaloxoneNaltrexone
MOAIndications
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Analgesic Ladder
NSAID (ASA)Adjuvant analgesic (APAP, antihist)
Non-narcotic analgesic (NSAID)Weak opioid (Codeine, propoxyphene)
Strong opioid (Morphine) with adjuvant analgesic
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PCA (patient-controlled analgesia pump)
Why a Pump?
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Oxycontin Abuse
When tablets are crushed, snorted or extracted & injected.Effective, less toxic, well-tolerated medication.Backlash ‘war on drugs’ challenges legitimate users
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Non-Opioid AgentsNon-Steroidal Anti-Inflammatory Drugs (NSAIDS)
Aspirin (prototype)Indications
Anti-inflammatoryAnalgesicAnti-pyreticAnti-platelet
DosageToxicity
Reye’s Syndrome brain pressure
COX-2 InhibitorsCelebrexMobic
MOAToxicity
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Headache Classification
Primary: no known cause
Tension type EpisodicChronic
Migraine
Secondary: known cause
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Headache Triggers
Physical causesHormonal factors
Menstrual migrainesSleep
Oversleeping, fatigueEnvironmental causes
Weather, seasons, light, odors, altitude...MedicationsDietary factors
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Migraine Tension Headache
Lasts 4-72 hoursProdrome or auraUnilateral,pulsatingModerate-severeAggravated by strainNausea, vomitingphoto/phono phobia
Lasts 30min to 7daysBilateralNo pulsationMild to moderateNot aggravated by strain
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Migraine Headaches
PathogenesisVasodilation5-HT mediated
Ergot PreparationsConstrict blood vesselsRebound HA w/overuseCaution > 40yr
Heart attack risk
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Therapeutic Management
Selective 5-HT receptor agonistBind to serotonin receptors to cause vasoconstriction of the blood vessels
Anti emeticsReduces nausea, vomiting and gastritis
Opioid analgesicsBlocks impulses to the brain
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Prophylaxis Management
AnticonvulsantsBeta blockers
Prevents vasodilation
Ca channel blocker
NSAIDRelieve inflammation & are non-sedating
TCAInduces sleep, relaxation
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Herbal Remedies
FeverfewPeppermint oilValerian rootGinkgoLemon balmCaffeine
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Nondrug Treatments
Physical TherapyAcupunctureAcupressureMassageAroma therapy
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Summary Slide
General AnesthesiaABC’s of Pain Management (drug & nondrug)
Narcotics/Opiates Organ EffectsCommon Opioid Side EffectsAnalgesic LadderNon-Steroidal Anti-Inflammatory Drugs (NSAIDS)
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Summary Slide (cont.)
Headache ClassificationTherapeutic Agents