Alright, in this video, we will continue talking about analgesics. Specifically, we'll be talking
about an anticonvulsant that is used as an analgesic. We'll talk about opioid analgesics as
well as topical analgesics. And then, finally, we'll discuss vascular headache suppressants.
Alright. So let's first talk about an anticonvulsant that is used to treat certain
types of pain. Pregabalin or brand name Lyrica is a medication that is used to treat neuropathy
as well as fibromyalgia, restless-leg syndrome, and it is also sometimes
used in the treatment of seizures. So the way I remember this medication,
if you look at the word pregabalin, it helps to prevent Gabby's neuropathic pain.
That's just how I remember what it's for. So the mode of action of pregabalin
is that it binds to calcium channels in the central nervous system which decreases the
release of excitatory neurotransmitters. It does not bind to opioid receptors.
Side effects can include drowsiness, dry mouth, dizziness, and possible edema.
If your patient is on pregabalin, you want to advise them to not consume alcohol because
that is also a CNS depressant, so it will really exacerbate the side effects of pregabalin. Also,
if they are planning to discontinue pregabalin, they should do so gradually.
Alright. Now, let's talk about opioid agonists. So this is a very important class of medication
that you need to know as a nurse for your NCLEX and for your nursing exams.
If you're following along with cards, I'm on card 74, and you definitely need to know the
information that is on the back of this card. So let's talk about which medications fall within
this class. It includes fentanyl, morphine, Dilaudid as well as oxycodone, and there
are others as well, but those are four really important ones that I would be familiar with.
These medications are used for moderate to severe pain and they work by binding
to opioid receptors in the CNS. There are some very serious side
effects associated with opioid agonists. This includes respiratory depression,
which is probably the most important one to know as well as sedation, constipation,
GI upset, hypotension, and urinary retention. Opioid analgesics do carry a black box warning
because of the life-threatening risk for respiratory depression as well as the risk
for abuse and addiction to these medications. So when your patient is on an opioid analgesic,
you're going to want to very carefully monitor their pain level, their vital
signs as well as their respiratory status. If your patient is getting this for cancer pain,
you really want to administer it around the clock to kind of get ahead of that pain.
You're going to administer these medications slowly through the IVs. You're not going to
just slam it in there. Even though some of your patients may ask you to do that, you're not going
to do that. You're going to administer slowly. Keep in mind that the antidote for opioid
analgesics is naloxone or Narcan. When you give a patient naloxone,
which you will, in all likelihood, have to do at some point as a nurse, keep in mind that
this will reverse analgesia and it also can cause hypertension, tachycardia as wall as agitation.
So my one tip on remembering some of the key side effects with this medication is that
you may need to RUSH to give naloxone to your patient who is taking an opioid analgesic
in response to Respiratory depression, Urinary retention, Sedation, and Hypotension. So you
need to RUSH. And then, the R is respiratory depression, U is urinary retention, S is sedation,
H is hypotension, and that will help you remember at least those four key side effects.
Alright. Now, let's talk about a topical analgesic which is lidocaine. Lidocaine can
be used for conditions or procedures involving the skin or mucus membranes. I actually use it
pretty often at work when I do painful wound vac dressing changes at the hospital. So the lidocaine
kind of helps numb the area for the patients to make that procedure a little less painful.
Lidocaine works by blocking the conduction of pain impulses in a specific area.
Side effects are usually pretty rare. It can include a little bit of stinging
or erythema at the site of application. One medication that contains lidocaine is
Emla cream. So this is used a lot in the pediatric population. So if you want to try to decrease the
pain with an IV insertion, you can apply Emla cream and then apply an occlusive dressing over
top of that, wait one hour, and then when you're getting ready to do the procedure,
you would remove that dressing and then thoroughly clean the area before doing the IV insertion.
Okay. So the last type of analgesics that I want to go over are vascular headache
suppressants. Medications that fall within this class include ergotamine and sumatriptan.
These medications are used to treat migraine headaches as well as cluster headaches.
And the mode of action which is important to know, is that they cause vasoconstriction of
the intracranial blood vessels. So the way I remember this mode of action
is I think of a sumo wrestler that trips and sits on my head,
which causes vasoconstriction of the blood vessels in my head—probably
cause a lot more damage, too, but we're going to stick with the vasoconstriction.
So that just helps me to remember that sumatriptan causes that vasoconstriction.
In terms of side effects, ergotamine carries common side effects such as
GI upset and hypertension, and then, sumatriptan causes dizziness and vertigo
as well as a warm, tingling sensation. Both of these medications do have black
box warnings and they would be contraindicated for patients who have ischemic coronary artery disease
or peripheral vascular disease, which means, basically, if your patient is having trouble
getting blood flow to their heart or to their extremities, we don't really want to do
vasoconstriction because that will just decrease blood flow to those areas.
For your patients with migraines, you want to also provide some important teaching,
so you should advise them to lay down in a dark, quiet place to help with symptoms.
They should also avoid alcohol and foods that are rich in tyramines as that can sometimes trigger
migraines. So if you recall, foods that are rick in tyramines are all those yummy foods, like,
aged cheeses, smoked meats, avocado, red wine, chocolate, that type of thing.
So they really should avoid those because they can sometimes be triggers for migraines.
Alright. In my next video, we will go over medications that are used to treat glaucoma.
So definitely hang in there with me and we'll get through these meds together!