Before pain returns, attempt to keep dosage in therapeutic range.

Before pain becomes too severe (inhibits healing process)

o   Tolerance

§  Larger and larger doses need for same effect

·         (i.e. analgesic, euphoric, sedative and respiratory depression effects)

§  Tolerance to respiratory depression is good because when a higher dose of drug is used, the risk of resp. dep. Remains relative

§  There can be a cross tolerance between drugs

o   Physical Dependence

§  Physical dependence is an addiction of the substance, this can lead to tolerance.

§  Withdraws can results from taking a smaller dose or abstinence completely.

o   Respiratory depression

§  If given IV onset within minutes

§  Persists for 4-5 hours

o   Constipation

o   Orthostatic hypotension

o   Urinary retention

o   Cough suppression

o   Biliary colic

o   Emesis

o   Elevation of intracranial pressure

o   Eupohoroia/Dysphoria

o   Sedation

o   Miosis

o   Neurotoxicity

o   Prolonged use

§  Hormonal changes

§  Alter immune function

o   Decrease in blood pressure

o   Coma

o   Pinpoint pupils

Overdose of narcotics

S&S and treatment

§  S&S:

·         Respiratory depression

·         Blood pressure drop

·         Pinpoint pupils

·         Coma

·         Death

§  Treatment:

·         Opioid antagonist (Narcan)

§  Main S&S

·         Acidosis

·         Hyperthermia

·         Sweating

·         Dehydration

·         Electrolyte imbalance

·         Stupor and coma

§  Mild (salicylism)

·         Tinnitus, HA, dizziness, drowsiness, confusion, paresthesias, ventilator stimulation, GI distress

§  Salicylate poisoning

·         Altered resp (increased rate, then depression)

·         Altered fluid/lytes and acid-base balance (alkalosis to acidosis)

§  Watch for possible GI bleeding

§  Expect effects of severe anticoagulation

§  Renal failure if already renal insufficiency

§  Treatment:

·         The sooner the better, no antidote

·         Induce emesis

·         Ventilator support

·         Correct acid-base balance

·         External cooling

·         Hasten excretion

§  S&S:

·         Produces less gastric bleeding than Aspirin

·         Produces less inhibition of platelet aggregation

·         May pose a risk of MI and stroke

·         Impair renal function

o   Can cause hypertension and edema

§  Treatment:

·         Entirely supportive 

§  S&S:

·         LIVER DAMAGE!!!!

·         Increased by fasting, chronic alcohol use, taking more than 4gm/day

·         Principle: hepatic overdose

·         Early: N/V, diarrhea, sweating, abdominal discomfort

§  Treatment:

·         Antidote: acetylcysteine

o   Anti-inflammatory

§  Suppresses inflammation (antiprosaglandin)

o   Antipyretic

§  Inhibits formation of fever causing substances that raise body’s thermostatic controls

o   Antiplatelet

§  Decreases the stickiness of platelets ~ 7 days

o   Prevents colon cancer

o   Prophylaxis of recurrent MI or stroke

o   Tylenol:

§  No anti-inflammatory and antirheumatic actions

§  Does not suppress platelet aggregation

§  Does not cause gastric ulceration

§  Does not decrease renal blood flow or cause renal impairment

§  Preferred to NSAIDs for use by children with chickenpox/influenza because of its lack of association with Reye’s syndrome

§  Preferred for pt with peptic ulcer disease

§  Stage 1—analgesia

·         Administration to loss of consciousness

§  Stage 2—excitement

·         Reflexes still present, may be exaggerated

§  Stage 3—surgical anesthesia

·         Increasing depth of anesthesia, affects respiration, loss of reflexes, flaccidity, lower body temp

§  Stage 4—medullary paralysis (toxic)

·         Respiratory arrest and vasomotor collapse

§  Action

·         Stabilizes or elevates threshold of excitation of nerve cells, prevents depolarization and transmission of nerve impulses

§  Effect

·         Loss of sensation without skeletal muscle involvement

§  Types

·         Topical, infiltrates—tissue, nerve, spinal

§  Can awaken with HA

§  Cannot be released if cannot void

§  Shaking and moving extremities does not hasten recovery (can cause joint injury)

§  High falls risk

• respiratory and cardiac depression
• sensitization of the heart to catecholamines
• malignant hyperthermia!!! genetic disposition
• aspiration of gastric contents
• hepatotoxicity
• toxicity to operating room personnel

§  IV sedative-hypnotic used for induction and maintenance of anesthesia

§  SE: PROFOUND respirations and hypotension

§  Increase risk of bacterial infection due to medium drug is in, very bacteriogenic

§  Cant be used with pt with egg allergies