Analgesics

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INDIAN DENTAL ...
ANALGESICS
Medications that relieve pain without causing
loss of consciousness
 Painkillers


www.indiandentalacademy.co...
CLASSIFICATION OF PAIN
BY ONSET AND DURATION

Acute pain
 Sudden



Chronic pain
 Persistent

or recurring
 Often dif...
CLASSIFICATION OF PAIN
Somatic



Visceral



Superficial



Vascular



Referred



Neuropathic



Phantom



Canc...
CLASSIFICATION OF PAIN BY
SOURCE
Vascular pain
Possibly originates from vascular or
perivascular tissues

Neuropathic pain...
PAIN TRANSMISSION GATE THEORY
Most common and well-described
 Uses the analogy of a gate to describe how
impulses from da...
PAIN TRANSMISSION

These substances stimulate nerve endings,
starting the pain process.

www.indiandentalacademy.com

Tiss...
PAIN TRANSMISSION

www.indiandentalacademy.com

There are two types of nerves stimulated:
 “A” fibers
and
 “C” fibers
PAIN TRANSMISSION
“C” Fibers
No myelin sheath
Small fiber size
Conduct slowly
Facilitate pain
transmission
Dull and
nonloc...
PAIN TRANSMISSION


Types of pain related to proportion of
“A” to “C” fibers in the damaged areas
www.indiandentalacademy...
PAIN TRANSMISSION
These pain fibers enter the spinal cord
and travel up to the brain.
 The point of spinal cord entry is ...
PAIN TRANSMISSION
This gate regulates the flow of sensory impulses
to the brain.
 Closing the gate stops the impulses.
 ...
GATE THEORY OF PAIN
TRANSMISSION

www.indiandentalacademy.com

INSTRUCTORS MAY WANT TO USE
EIC IMAGE #37:
PAIN TRANSMISSION
Activation of large “A” fibers CLOSES gate
 Inhibits transmission to brain


perception of pain

www.i...
PAIN TRANSMISSION
Activation of small “B” fibers OPENS gate
 Allows impulse transmission to brain


perception

www.indi...
PAIN TRANSMISSION
Gate innervated by nerve fibers from brain,
allowing the brain some control over gate
 Allows brain to:...
PAIN TRANSMISSION

www.indiandentalacademy.com

“T” cells
 Cells that control the gate have a threshold
 Impulses must o...
PAIN TRANSMISSION


Body has endogenous neurotransmitters
 Enkephalins

Produced by body to fight pain
 Bind to opioid ...
PAIN TRANSMISSION

 GATE

closed, recognition of pain REDUCED
 Same pathway used by opiates

www.indiandentalacademy.com...
OPIOID ANALGESICS
Pain relievers that contain opium,
derived from the opium poppy
or
 chemically related to opium


www....
OPIOID ANALGESICS
codeine sulfate
 meperidine HCl (Demerol)
 methadone HCl (Dolophine)
 morphine sulfate
 propoxyphene...
OPIOID ANALGESICS

www.indiandentalacademy.com

Three classifications based on their actions:
 Agonist
 Agonist-antagoni...
OPIOID ANALGESICS: SITE OF
ACTION
Large “A” fibers
 Dorsal horn of spinal cord


www.indiandentalacademy.com
OPIOID ANALGESICS:
MECHANISM OF ACTION
Bind to receptors on inhibitory fibers,
stimulating them
 Prevent stimulation of t...
OPIOID ANALGESICS:
MECHANISM OF ACTION

www.indiandentalacademy.com

Three types of opioid receptors:
 Mu
 Kappa
 Delta
OPIOID ANALGESICS: THERAPEUTIC
USES
 Cough

center suppression
 Treatment of constipation

www.indiandentalacademy.com

...
OPIOID ANALGESICS: SIDE
EFFECTS
Euphoria
 Nausea and vomiting
 Respiratory depression
 Urinary retention
 Diaphoresis ...
OPIATE ANTAGONISTS

Used for complete or partial reversal of
opioid-induced respiratory depression

www.indiandentalacadem...
OPIATES: OPIOID TOLERANCE
A common physiologic result of chronic opioid
treatment
 Result:
larger dose of opioids are req...
OPIATES: PHYSICAL DEPENDENCE


The physiologic adaptation of the body to
the presence of an opioid
www.indiandentalacadem...
OPIATES: PSYCHOLOGICAL
DEPENDENCE
(ADDICTION)



www.indiandentalacademy.com

A pattern of compulsive drug use characteri...
OPIATES


www.indiandentalacademy.com

Opioid tolerance and physical dependence are
expected with long-term opioid treatm...
OPIATES


www.indiandentalacademy.com

Misunderstanding of these terms leads to
ineffective pain management and contribut...
OPIATES


 Narcotic

withdrawal
 Opioid abstinence syndrome

www.indiandentalacademy.com

Physical dependence on opioid...
OPIATES

 anxiety,

irritability, chills and hot flashes, joint pain,
lacrimation, rhinorrhea, diaphoresis, nausea,
vomit...
OPIOID ANALGESICS:
NURSING IMPLICATIONS
Before beginning therapy, perform a thorough
history regarding allergies, use of o...
OPIOID ANALGESICS:
NURSING IMPLICATIONS


 Assessment

of pain is now being considered
a “fifth vital sign.”

www.indian...
OPIOID ANALGESICS:
NURSING IMPLICATIONS
Be sure to medicate patients before the pain
becomes severe as to provide adequate...
OPIOID ANALGESICS:
NURSING IMPLICATIONS
Oral forms should be taken with food to minimize
gastric upset.
 Ensure safety me...
OPIOID ANALGESICS:
NURSING IMPLICATIONS
Follow proper administration guidelines for IM
injections, including site rotation...
OPIOID ANALGESICS:
NURSING IMPLICATIONS
 Constipation

www.indiandentalacademy.com

is a common side effect and
may be pr...
OPIOID ANALGESICS:
NURSING IMPLICATIONS
Patients should not take other medications or
OTC preparations without checking wi...
OPIOID ANALGESICS:
NURSING IMPLICATIONS

www.indiandentalacademy.com

Monitor for side effects:
 Should VS change, patien...
OPIOID ANALGESICS:
NURSING IMPLICATIONS

www.indiandentalacademy.com

Monitor for therapeutic effects:
 Decreased complai...
Thank you

www.indiandentalacademy.com

www.indiandentalacademy.com

Leader in continuing dental education
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opioid analgesics / /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

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  • opioid analgesics / /certified fixed orthodontic courses by Indian dental academy

    1. 1. Analgesics Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com INDIAN DENTAL ACADEMY
    2. 2. ANALGESICS Medications that relieve pain without causing loss of consciousness  Painkillers  www.indiandentalacademy.com
    3. 3. CLASSIFICATION OF PAIN BY ONSET AND DURATION  Acute pain  Sudden  Chronic pain  Persistent or recurring  Often difficult to treat www.indiandentalacademy.com in onset  Usually subsides once treated
    4. 4. CLASSIFICATION OF PAIN Somatic  Visceral  Superficial  Vascular  Referred  Neuropathic  Phantom  Cancer  Psychogenic  Central www.indiandentalacademy.com 
    5. 5. CLASSIFICATION OF PAIN BY SOURCE Vascular pain Possibly originates from vascular or perivascular tissues Neuropathic pain  Results from injury to peripheral nerve fibers or damage to the CNS Superficial pain  Originates from skin or mucous membranes www.indiandentalacademy.com 
    6. 6. PAIN TRANSMISSION GATE THEORY Most common and well-described  Uses the analogy of a gate to describe how impulses from damaged tissues are sensed in the brain  www.indiandentalacademy.com
    7. 7. PAIN TRANSMISSION These substances stimulate nerve endings, starting the pain process. www.indiandentalacademy.com Tissue injury causes the release of:  Bradykinin  Histamine  Potassium  Prostaglandins  Serotonin
    8. 8. PAIN TRANSMISSION www.indiandentalacademy.com There are two types of nerves stimulated:  “A” fibers and  “C” fibers
    9. 9. PAIN TRANSMISSION “C” Fibers No myelin sheath Small fiber size Conduct slowly Facilitate pain transmission Dull and nonlocalized www.indiandentalacademy.com “A” Fibers Myelin sheath Large fiber size Conduct fast Inhibit pain transmission Sharp and well-localized
    10. 10. PAIN TRANSMISSION  Types of pain related to proportion of “A” to “C” fibers in the damaged areas www.indiandentalacademy.com
    11. 11. PAIN TRANSMISSION These pain fibers enter the spinal cord and travel up to the brain.  The point of spinal cord entry is the DORSAL HORN.  The DORSAL HORN is the location of the “GATE.”  www.indiandentalacademy.com
    12. 12. PAIN TRANSMISSION This gate regulates the flow of sensory impulses to the brain.  Closing the gate stops the impulses.  If no impulses are transmitted to higher centers in the brain, there is NO pain perception.  www.indiandentalacademy.com
    13. 13. GATE THEORY OF PAIN TRANSMISSION www.indiandentalacademy.com INSTRUCTORS MAY WANT TO USE EIC IMAGE #37:
    14. 14. PAIN TRANSMISSION Activation of large “A” fibers CLOSES gate  Inhibits transmission to brain  perception of pain www.indiandentalacademy.com  Limits
    15. 15. PAIN TRANSMISSION Activation of small “B” fibers OPENS gate  Allows impulse transmission to brain  perception www.indiandentalacademy.com  Pain
    16. 16. PAIN TRANSMISSION Gate innervated by nerve fibers from brain, allowing the brain some control over gate  Allows brain to:  identify, and localize the pain  Control the gate before the gate is open www.indiandentalacademy.com  Evaluate,
    17. 17. PAIN TRANSMISSION www.indiandentalacademy.com “T” cells  Cells that control the gate have a threshold  Impulses must overcome threshold to be sent to the brain
    18. 18. PAIN TRANSMISSION  Body has endogenous neurotransmitters  Enkephalins Produced by body to fight pain  Bind to opioid receptors  Inhibit transmission of pain by closing gate  www.indiandentalacademy.com  Endorphins
    19. 19. PAIN TRANSMISSION  GATE closed, recognition of pain REDUCED  Same pathway used by opiates www.indiandentalacademy.com Rubbing a painful area with massage or liniment stimulates large sensory fibers  Result:
    20. 20. OPIOID ANALGESICS Pain relievers that contain opium, derived from the opium poppy or  chemically related to opium  www.indiandentalacademy.com Narcotics: very strong pain relievers
    21. 21. OPIOID ANALGESICS codeine sulfate  meperidine HCl (Demerol)  methadone HCl (Dolophine)  morphine sulfate  propoxyphene HCl  www.indiandentalacademy.com
    22. 22. OPIOID ANALGESICS www.indiandentalacademy.com Three classifications based on their actions:  Agonist  Agonist-antagonist  Partial agonist
    23. 23. OPIOID ANALGESICS: SITE OF ACTION Large “A” fibers  Dorsal horn of spinal cord  www.indiandentalacademy.com
    24. 24. OPIOID ANALGESICS: MECHANISM OF ACTION Bind to receptors on inhibitory fibers, stimulating them  Prevent stimulation of the GATE  Prevent pain impulse transmission to the brain  www.indiandentalacademy.com
    25. 25. OPIOID ANALGESICS: MECHANISM OF ACTION www.indiandentalacademy.com Three types of opioid receptors:  Mu  Kappa  Delta
    26. 26. OPIOID ANALGESICS: THERAPEUTIC USES  Cough center suppression  Treatment of constipation www.indiandentalacademy.com Main use: to alleviate moderate to severe pain  Opioids are also used for:
    27. 27. OPIOID ANALGESICS: SIDE EFFECTS Euphoria  Nausea and vomiting  Respiratory depression  Urinary retention  Diaphoresis and flushing  Pupil constriction (miosis)  Constipation  www.indiandentalacademy.com
    28. 28. OPIATE ANTAGONISTS Used for complete or partial reversal of opioid-induced respiratory depression www.indiandentalacademy.com naloxone (Narcan) naltrexone (Revia)  Opiate antagonists  Bind to opiate receptors and prevent a response
    29. 29. OPIATES: OPIOID TOLERANCE A common physiologic result of chronic opioid treatment  Result: larger dose of opioids are required to maintain the same level of analgesia  www.indiandentalacademy.com
    30. 30. OPIATES: PHYSICAL DEPENDENCE  The physiologic adaptation of the body to the presence of an opioid www.indiandentalacademy.com
    31. 31. OPIATES: PSYCHOLOGICAL DEPENDENCE (ADDICTION)  www.indiandentalacademy.com A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief
    32. 32. OPIATES  www.indiandentalacademy.com Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with psychological dependence (addiction).
    33. 33. OPIATES  www.indiandentalacademy.com Misunderstanding of these terms leads to ineffective pain management and contributes to the problem of undertreatment.
    34. 34. OPIATES   Narcotic withdrawal  Opioid abstinence syndrome www.indiandentalacademy.com Physical dependence on opioids is seen when the opioid is abruptly discontinued or when an opioid antagonist is administered.
    35. 35. OPIATES  anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea www.indiandentalacademy.com Narcotic Withdrawal Opioid Abstinence Syndrome  Manifested as:
    36. 36. OPIOID ANALGESICS: NURSING IMPLICATIONS Before beginning therapy, perform a thorough history regarding allergies, use of other medications,health history, and medical history.  Obtain baseline vital signs and I & O.  Assess for potential contraindications and drug interactions.  www.indiandentalacademy.com
    37. 37. OPIOID ANALGESICS: NURSING IMPLICATIONS   Assessment of pain is now being considered a “fifth vital sign.” www.indiandentalacademy.com Perform a thorough pain assessment, including nature and type of pain, precipitating and relieving factors, remedies, and other pain treatments.
    38. 38. OPIOID ANALGESICS: NURSING IMPLICATIONS Be sure to medicate patients before the pain becomes severe as to provide adequate analgesia and pain control.  Pain management includes pharmacologic and nonpharmacologic approaches. Be sure to include other interventions as indicated.  www.indiandentalacademy.com
    39. 39. OPIOID ANALGESICS: NURSING IMPLICATIONS Oral forms should be taken with food to minimize gastric upset.  Ensure safety measures, such as keeping side rails up, to prevent injury.  Withhold dose and contact physician if there is a decline in the patient’s condition or if VS are abnormal—especially if respiratory rate is below 12 breaths/minute.  www.indiandentalacademy.com
    40. 40. OPIOID ANALGESICS: NURSING IMPLICATIONS Follow proper administration guidelines for IM injections, including site rotation.  Follow proper guidelines for IV administration, including dilution, rate of administration, and so forth.  www.indiandentalacademy.com CHECK DOSAGES CAREFULLY
    41. 41. OPIOID ANALGESICS: NURSING IMPLICATIONS  Constipation www.indiandentalacademy.com is a common side effect and may be prevented with adequate fluid and fiber intake.  Instruct patients to follow directions for administration carefully, and to keep a record of their pain experience and response to treatments.  Patients should be instructed to change positions slowly to prevent possible orthostatic hypotension.
    42. 42. OPIOID ANALGESICS: NURSING IMPLICATIONS Patients should not take other medications or OTC preparations without checking with their physician.  Instruct patients to notify physician for signs of allergic reaction or adverse effects.  www.indiandentalacademy.com
    43. 43. OPIOID ANALGESICS: NURSING IMPLICATIONS www.indiandentalacademy.com Monitor for side effects:  Should VS change, patient’s condition decline, or pain continue, contact physician immediately.  Respiratory depression may be manifested by respiratory rate of less than 12/min, dyspnea, diminished breath sounds, or shallow breathing.
    44. 44. OPIOID ANALGESICS: NURSING IMPLICATIONS www.indiandentalacademy.com Monitor for therapeutic effects:  Decreased complaints of pain  Increased periods of comfort  With improved activities of daily living, appetite, and sense of well-being
    45. 45. Thank you www.indiandentalacademy.com www.indiandentalacademy.com Leader in continuing dental education

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