1. Pharmacologic
   1. Opioids
      1. For moderate to severe pain
      2. Mechanism of Action
         1. Modifies pain perception by binding to opiate receptors of the central nervous system (CNS)
      3. Routes
         1. PO, IV, SQ, nasal, transdermal, rectal, epidural
      4. Opioid Medications
         1. Common opioids:
            1. - Morphine Sulfate - Hydrocodone - Hydromorphone (Dilaudid) - Tramadol (Ultram)
         2. Combination opioids:
            1. - Codeine/Acetaminophen (Tylenol 3) - Hydrocodone/Acetaminophen (Loratab,Vicodin, or Norco) - Oxycodone/Acetaminophen (Percocet) - Oxycodone/Aspirin (Percodan)
      5. Side effects
         1. *Sedation
            1. Assess oxygen level and respiration rate
            2. Have oxygen at bedside
         2. *Respiratory Depression
            1. The reversal agent: Naloxone (Narcan)
         3. Constipation
            1. Stool softeners and laxatives aka the mush and push
            2. Encourage fluid intake
            3. Fiber
            4. Exercise
         4. Orthostatic Hypotension
            1. Monitor vital signs
            2. Keep head of bed (HOB) elevated >30
            3. Teach patient to change positions slowly
         5. Nausea and Vomiting
            1. Administer antiemetic
            2. Recommend changing medication
         6. Pruitus
            1. Benadryl
            2. Lotion
            3. cool packs
            4. Diversion techniques
         7. Urinary Retention
            1. Monitor urinary output and bladder scan if needed
            2. Encourage fluid
            3. Possible need Naloxone (Narcan)
         8. Important to look at how to monitor and intervene
   2. Non-Opioids
      1. First Drug of Choice
      2. For mild to moderate
      3. Can be used in combination with opioids for optimal pain relief
      4. Non-Opioid Medications
         1. Acetaminophen
            1. Mechanism of Action: - Analgesic and antipyretic but no anti-inflammatory effects
            2. Side effects: Liver damage or Kidney damage ( no >3000-4000 mg in a 24 hour period)
         2. NSAIDS
            1. Mechanism of Action: - Act on peripheral nerve ends at the injury site to decrease the level of inflammatory mediators - Has analgesic, antipyretic, and anti-inflammatory effects
            2. Types: - Aspirin - Ibuprofen - Naproxen
            3. Side effects: - Gastrointestinal irritation - Renal Toxicity - Bleeding
   3. Adjuvant Drugs
      1. Medication used for another condition but can effective in reducing pain
      2. Adjuvant Medications
         1. Anti-depressants
         2. Anti-convulsants
         3. Anti-anxiety
         4. Muscle Relaxants
2. Non-Pharmacologic
   1. Body
      1. Massage
      2. Cutaneous stimulation
      3. Healing Touch
      4. Acupuncture
      5. Hot and Cold
      6. Exercise
      7. Positioning
   2. Mind
      1. Distraction
      2. Relaxation
      3. Music
   3. Social
      1. Pet therapy
      2. Friends
   4. Spiritual
      1. Prayer
      2. Affirmations