Administrating Pain Medication

There is no question that dependence on narcotics, with physical components, can develop quickly with repeated administration. When medical patients receive morphine by injection every four hours, some degree of dependence can occur in as few as twenty-four hours. If the drug is stopped even after a short period of use, mild withdrawal symptoms may occur — including sweating, nausea, weakness, headache, restlessness, and increased sensitivity to pain. 

A component of the new JCAHO standard is documentation of pain assessment and intensity in all patients. In addition, the interventions that are performed based on the pain assessment, such as administration of a pain medication, need to be documented along with the reassessment of the effect of these interventions. Pharmacists can play a key role in developing standardized assessment forms that include recommendations for pain medications based on the results. 

Many PACU nurses are given standing orders to use their judgment about the route of administration of postoperative pain medications. The theory of administering the medications by both routes is that the chent will receive immediate rehef from the IV route and the IM route will provide rehef when the IV medication has worn off. The nurse should always chart accurately what was done and how. 

The nurse abides by the five rights of medication administration, including the right time. Pain medication is prescribed at specific time intervals. The nurse must make sure the time interval has passed and it is time for more medication. 

In addition, the problems inherent in delivering analgesia to a patient with difficult intravenous access, to a patient who would not need an intravenous line except to receive pain medication, or in the out-of-hospital setting make the idea of having an effective inhaled analgesic very attractive. Inhaled fentanyl may also be able to be given more quickly than intravenous analgesia and the equipment costs of nebulizers compare favorably with the cost of the supplies needed for intravenous administration. Inhaled fentanyl also proved to be beneficial in the pediatric population, where it is easy to administer and does not cause additional pain or distress to the child. 

During the preadministration assessment, the nurse reviews the patient s chart for the medical diagnosis and reason for administration of the prescribed drug. The nurse questions the patient regarding the type and intensity of symptoms (such as pain, discomfort, diarrhea, or constipation) to provide a baseline for evaluation of the effectiveness of drug therapy. 

Like the medical treatment of uterine leiomyomas, danazol, gestrinone, mifepristone, and GnRH-a, with or without add-back therapy, have been proposed for the treatment of endometriosis as well (Olive et al. 2001 Stones et al. 2004), but unlike leiomyomas, oral contraceptive pills, in cyclic or continuous administration, and medroxyprogesterone acetate also seem to be effective (Olive et al. 2001 Stones et al. 2004). A significant benefit in terms of pelvic pain relief also is obtained with the use of nonsteroidal anti-inflammatory drugs (Olive et al. 2001 Stones et al. 2004). 

Incidents of vincristine overdosage have been reported relatively frequently in the medical literature. Some of these have involved inadvertent administration of the intravenous formulation into the central nervous system by the intrathecal route this produces devastating results by a combination of chemical damage to sensitive neuronal tissue as well as biochemical perturbations. Two representative cases of vincristine overdose were described (46) involving administration of vincristine to patients scheduled to receive vinblastine. In one patient toxicity initially involved vomiting and diarrhea with subsequent constipation and paralytic ileus (inhibition of motor activity in the small intestine). Muscle pain... 

East N, Dube J, Perreault EL. Postpartum pain relief a randomized comparison of self-administered medication and standard administration. J Obstet Gynaecol Can2007 29(12) 975-81. 

Diazepam, lorazepam, and midazolam are used for preanesthetic medication and as adjuvants during surgical procedures performed under local anesthesia. As a result of their sedative, anxiolytic, and amnestic properties, and their ability to control acute agitation, these compounds are considered to be the drugs of choice for premedication. (The basic pharmacology of benzodiazepines is discussed in Chapter 22.) Diazepam and lorazepam are not water-soluble, and their intravenous use necessitates nonaqueous vehicles, which cause pain and local irritation. Midazolam is water-soluble and is the benzodiazepine of choice for parenteral administration. It is important that the drug becomes lipid-soluble at physiologic pH and can readily cross the blood-brain barrier to produce its central effects. 

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