nociceptive neurotransmitters acetylcholine
nociceptive neurotransmitters acetylcholine
1- 300 minimum words for question, you can go up to 700 words.
2- 2-3 Scholarly references ( NO MAYO CLINIC/AHA)
3- References should be within 5 years
4- I am in acute care nurse practitioner program.
DQ-1
Select a medication used for pain management and review available evidence and treatment guidelines to determine appropriate therapeutic options. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including CAM. In addition, share an example where you have observed an adverse event from a pain medication and explain the management taken regarding this adverse event. If you do not have an example, select an adverse event from the pain medication and explain what interventions you could make to mitigate this adverse event. Include references using APA format.
DQ-2
Read and summarize the Topic Material “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016.” Discuss any ethnic, cultural, or genetic differences that need to be considered for the use of opioids to treat chronic pain. How do you intend to use the guidelines in your future practice?
DQ-3
Oxycodone is an opioid agonist for pain management of acute or chronic moderate to severe pain. It binds to opiate receptors, G-protein coupled receptors, in the central nervous systems (CNS) and activates the GDP for a GTP, which inhibits the adenylate cyclase and decreases the intracellular cAMP (Sadiq, Dice, & Mead, 2019). Consequently, oxycodone inhibits the nociceptive neurotransmitters acetylcholine, dopamine, GABA, noradrenaline, and substance P, altering perception and response to pain and producing CNS depression (Sadiq et al., 2019). Oxycodone is available in tablets and capsules in immediate-release and extended-release. Immediate-release doses range from 5 to 15 mg every 4 to 6 hours as needed while ER tablets are 10 mg and capsules are 9 mg every 12 hours (“Oxycodone,” 2019). Dosages may vary depending on opioid-tolerant patients, and for adequate pain control, dosages should titrate upwards with monitoring for potential side effects. The most common adverse effects include constipation, weakness, dizziness, dry mouth, nausea, vomiting, headache, and pruritis (Sadiq et al., 2019). Throughout initial therapy or increased dosage, the patient’s blood pressure, heart rate, and respiratory rate should be monitored, as well as, the side effects. Oxycodone may impair mental and physical abilities and cause hypotension and respiratory depression. It is important extended-release tablets are swallowed whole as crushing or chewing can cause rapid release leading to respiratory depression and further carbon dioxide retention can exacerbate sedating effects, which may be fatal (“Oxycodone,” 2019). Drug interactions that may increase the oxycodone serum concentration and enhance adverse effects, include CYP450 inhibitors, benzodiazepines, amphetamines, anticholinergic, CNS depressants, rufinamide, selective serotonin reuptake inhibitors, and zolpidem (“Oxycodone,” 2019). Complementary and alternative medicine (CAM) interactions with oxycodone include ephedra, Jamaica dogwood, kava kava, and lavender, as this may enhance the effects of CNS depressants, whereas St. John’s Wort may decrease the serum concentration of oxycodone.
There are always patients that deal with constipation after taking oxycodone. A patient came in the ER with severe abdominal pain, nausea, and vomiting. The CT scan showed a bowel obstruction and the patient was taking to the OR for an exploratory laparotomy with bowel resection. When the section of the bowel was removed, the surgeon pulled out pieces of fecal that was hard as a rock. According to the notes, the patient was at a rehab facility due to a hip hemiarthroplasty four weeks prior. Current medications included an opioid for post-operative pain management. Patient had no prior abdominal conditions, but opioid use, age, and possible concomitant medications can be causative factors for the bowel obstruction. In elderly patients, constipation is more common, which can be due to decreased mobility, medical conditions, and/or concomitant medications; however, stool softeners may be beneficial for many patients as it may improve bowel function and quality of life (Morlion et al., 2017). Other recommendations may be to increase fiber into their diet or increase physical activity to increase bowel movement. Also, other therapies should be recommended instead of prolonging the use of opioids, such as acetaminophen or NSAIDS. As prescribers it is essential to monitor all side effects and appropriate use of any opioids as we have to consider to discontinue the medication if the benefits don’t outweigh the risks.
References
Morlion, B. J., Mueller-Lissner, S. A., Vellucci, R., Leppert, W., Coffin, B. C., Dickerson, S. L., & O’Brien, T. (2017). Oral prolonged-release oxycodone/naloxone for managing pain and opioid-induced constipation: A review of the evidence. Pain Practice, 18(5), 647-665. doi:10.1111/papr.12646
Oxycodone. (2019). Retrieved from https://www.drugs.com/ppa/oxycodone.html
Sadiq, N. M., Dice, T. J., & Mead, T. (2019). Oxycodone. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482226/
DQ-4
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