Quiz 25: Pharmacotherapy of Severe Pain and Migraines

Nursing

The drug of choice for R's pain management would be morphine sulphate, which belongs to the therapeutic class of narcotic analgesic. Morphine sulphate is prescribed for acute and severe chronic pain. Morphine does not have upper end dosage limits which make it more appropriate medication for treating cancer related pain. Initially, Rita's pain can be manages by either extended release tables (MS Contin, Oramorph SR) or capsules (Avinza, Kadian). The initial therapy is usually started with shorter acting agents. Morphine mode of action comprises of occupying mu and kappa receptor sites in the brain and dorsal horn of the spinal cord that alter the release of afferent neurotransmitters. The dominant effect alters the perception of and emotional response to pain producing analgesia and euphoria. The drug mimics the actions of endogenous endorphins.

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L's postoperative pain should be managed with equianalgesic dose. Larry's pain medication should be transitioned from intravenous (IV) medication after surgery to post-operative analgesics before discharge. With the help of relative potency information, the primary healthcare provider can determine the appropriate new dose. L's post-operative pain can be managed by prescribing parenteral opioid for severe pain, an oral opioid for moderate pain, and a combination opioid and nonopioid for mild pain. The nurse can use this referral in choosing the drug and dose when a range of analgesic options is ordered.

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