[5] MIDTERM | ANALGESICS & ANTI-INFLAMMATORY AGENTS Flashcards
Are a class of medications designed specifically to relive pain
Analgesics
ANALGESICS
This includes ____ analgesics or by prescription when combined with another drug, and ____, which are only available by prescription
This includes over the counter (OTC) analgesics or by prescription when combined with another drug, and opiods (narcotics), which are only available by prescription
1-3 Mild Pain: ____
4-7 Moderate Pain: ____
8-10: ____
1-3 Mild Pain: Acetaminophen or Paracetamol
4-7 Moderate Pain: NSAIDs
8-10: Morphine or Tramadol
NSAIDS
N - ____ (for bones; arthritis)
S - ____ (e.g. Aspirin)
A - ____ (e.g. Paracetamol)
I - ____ (e.g. Alaxan FR) / ____ (for PDA)
D - ____ (e.g. Mefenamic Acid)
NSAIDS
N - Naproxen Sodium (for bones; arthritis)
S - Salicylates (e.g. Aspirin)
A - Acetaminophen (e.g. Paracetamol)
I - Ibuprofen (e.g. Alaxan FR) / Indomethacin (for PDA)
D - Diclofenac (e.g. Mefenamic Acid)
OPIODS, MORPHINE SOLUTION, TRAMADOL: WOF ____ AND ____
OPIODS, MORPHINE SOLUTION, TRAMADOL: WOF CNS AND RESPIRATORY DEPRESSION
- Response to tissue injury and infection
- Protective mechanism
- Other causes: trauma, surgical
- interventions, extreme hot and cold, and caustic chemical agents.
Inflammation
INFLAMMATION
TISSUE INJURY -> ____ & ____
TISSUE INJURY -> VASOCONSTRICTION & RELEASE OF CHEMICAL MEDIATORS
INFLAMMATION
EXAMPLES OF CHEMICAL MEDIATORS
HISTAMINE, KININS, PROSTAGLANDIN
INFLAMMATION
RELEASE OF CHEMICAL MEDIATORS
1. ____ -> Redness, Erythema
2. ____ -> Swelling Edema
3. ____ - Pain
4. ____ - Heat
RELEASE OF CHEMICAL MEDIATORS
1. VASODILATION -> Redness, Erythema
2. INC. CAPILLARY PERMEABILITY -> Swelling Edema
3. PAIN - Pain
4. FEVER - Heat
INFLAMMATION
ERYTHEMA, SWELLING EDEMA, PAIN, AND HEAT -> ____
ERYTHEMA, SWELLING EDEMA, PAIN, AND HEAT -> LOSS OF FUNCTION
Enzyme responsible for
conversion of arachidonic acid
into prostaglandins
CYCLOOXYGENASE (COX)
- Protects stomach lining
- Regulates blood platelets
COX-1
- Triggers inflammation and pain
COX-2
- Relieve pain (analgesic)
- Reduce elevated body temperature (antipyretic)
- Inhibit platelet aggregation (anticoagulant)
- Prostaglandin Inhibitors
- NSAIDs
ANTIINFLAMMATORY AGENTS
SEVEN GROUPS OF NSAIDs
- Salicylates
- Para-Chlorobenzoic Acid derivatives or indoles
- Phenylacetic Acids
- Propionic Acid derivatives
- Fenamates
- Oxicams
- Selective Cox-2 inhibitors
Aspirin, also known as acetylsalicylic acid (ASA)
SALICYLATES
SALICYLATES
Functions:
* A____
* A____
* A____
Therapeutic serum salicylate level: ____ mg/dl
Toxic serum salicylate level: ____ mg/dl
Functions:
* Anti-inflammatory
* Antiplatelet
* Antipyretic effects
Therapeutic serum salicylate leve0: 10–30 mg/dl
Toxic serum salicylate level: >40–50 mg/dl
ANTICOAGULANTS SHOULD NOT BE GIVEN DURING ____
ANTICOAGULANTS SHOULD NOT BE GIVEN DURING BLEEDING
SALICYLATES
Drug Interactions:
* A____
* G____
* O_____
Hypersensitivity to salicylate products: ____, vertigo, _____
Drug Interactions:
* anticoagulants
* glucocorticoids
* oral hypoglycemic
Hypersensitivity to salicylate products: tinnitus, vertigo, bronchospasm
SALICYLATES
GI UPSET
* Should be taken with ____, WATER OR FOOD
REYE SYNDROME
* Not be taken by children with ____ symptoms
C/I: ____
GI UPSET
* Should be taken with MILK, WATER OR FOOD
REYE SYNDROME
* Not be taken by children with flu symptoms
C/I: PREGNANCY
It is an extremely serious pathological condition associated with swelling of liver and brain
REYE SYNDROME
REYE SYNDROME
- ____ - lethargy, confusion, seizures, coma
- ____ - Tiredness, Nausea, Elevated AST, Elevated ALT
- Encephalopathy - lethargy, confusion, seizures, coma
- Liver Damage - Tiredness, Nausea, Elevated AST, Elevated ALT
PARA-CHLOROBENZOIC ACID
- ____
- ____
Indications:
* R____
* G____
* O____
May cause Increased BP and sodium & water retention
- **Indomethacin (Indocin)
- Sulindac (Clinoril)**
Indications:
* Rheumatoid arthritis
* Gouty arthritis
* Osteoarthritis
May cause Increased BP and sodium & water retentio
PHENYLACETIC ACID DERIVATIVES
- ____
Indications:
* R____
* O____
* A____
- Diclofenac Na (Voltaren)
Indications:
* Rheumatoid Arthritis
* Osteoarthritis
* Ankylosing spondylitis
PHENYLACETIC ACID DERIVATIVES
- short term management of pain
- 1st injectable NSAIDs
- Greater analgesic effect
- ANST
KETOROLAC
PROPIONIC ACID DERIVATIES
- ____
- Drug interactions: increase effects of ____, sulfonamides, certain cephalosporin, ____, insulin, ____
- Side effects: gastric upset (to be
taken with food)
- Ibuprofens (Alaxan, Advil and Medicol)
- Drug interactions: increase effects of warfarin, sulfonamides, certain cephalosporin, phenytoin, insulin, oral hypoglycemic
- Side effects: gastric upset (to be
taken with food)
FENAMATES
- ____
- ____
Indications:
* Acute & chronic ____ conditions
SE: Gastric irritation
Contraindication:
* patient with ____
- Mefenamic Acid (Ponstel) (Ponstan)
- Meclofenamate Na Monohydrate (Meclomen)
Indications:
* Acute & chronic arthritic conditions
SE: Gastric irritation
Contraindication:
* patient with peptic ulcer
PAIN MEDICATION ADMINISTRATION: WOF ____ AND ____ FUNCTION
PAIN MEDICATION ADMINISTRATION: WOF LIVER AND KIDNEY FUNCTION
OXICAMS
- ____
- ____
Indication:
* ____ arthritic conditions
- S/E: lower incidence of gastric problems; ____; ____ distress
- Should NOT BE taken with ____; other NSAIDs
- Piroxicam (Feldene Flash),
- Meloxicam
Indication:
* Long term arthritic conditions
- S/E: lower incidence of gastric problems; ulceration; epigastric distress
- Should NOT BE taken with aspirin; other NSAIDs
COX-2 INHIBITORS
Drug agents
* C____
* R____
* N____
Drug agents
* Celecoxib (Celebrex)
* Rofecoxib (Vioxx)
* Nabumetone (Relafen)
COX-2 INHIBITORS
Caution: not to be taken during
____ trimester of pregnancy
* NSAIDs in the ____
* Assessment of ____ function
* Prescribed NSAID dose may need to be decreased
Caution: not to be taken during third
trimester of pregnancy
* NSAIDs in the elderly
* Assessment of renal function
* Prescribed NSAID dose may need to be decreased
- Suppressing and preventing many of the components of the inflammatory process at the injured site.
- Dexamethasone
- Prednisone
- Prednisolone
CORTICOSTEROIDS
EXAMPLES OF CORTICOSTEROIDS
- Dexamethasone
- Prednisone
- Prednisolone
COMMON SIDE EFFECTS OF STEROIDS: INCREASED ____
STEROIDS CAN ALSO BE USED FOR ____ DISORDERS
PROLONG USED OF STEROID RESULT IN DECREASED ____
COMMON SIDE EFFECTS OF STEROIDS: INCREASED APPETITE
STEROIDS CAN ALSO BE USED FOR AUTO-IMMUNE DISORDERS
PROLONG USED OF STEROID RESULT IN DECREASED IMMUNITY
- Inflammation of the joints
- Uric Acid
ANTIGOUT DRUGS
ANTIGOUT DRUGS
- For Acute Gout Attack
- ____ - inhibit leukocytes on the inflamed site
- Gastric irritation
- ____
- Diarrhea
- ____ pain
- For Acute Gout Attack
- Colchicine - inhibit leukocytes on the inflamed site
- Gastric irritation
- NV
- Diarrhea
- Abdominal pain
ANTIGOUT DRUGS - URIC ACID INHIBITOR
____:
- Inhibit final steps of uric acid synthesis
- No caffeine and alcohol
- Indicated gout patients with renal impairment
____:
- Increase level of uric acid
Allopurinol:
- Inhibit final steps of uric acid synthesis
- No caffeine and alcohol
- Indicated gout patients with renal impairment
Thiazide diuretics (e.g. Hydrochlorothiazide):
- Increase level of uric acid
ANTIGOUT DRUGS - URIC ACID INHIBITOR
____:
* Alleviating chronic gout
____:
* Increase rate of uric acid excretions in the kidneys.
* SE: Sore gums, headache, flushed skin
Uricosurics:
* Alleviating chronic gout
Probenecid:
* Increase rate of uric acid excretions in the kidneys.
* SE: Sore gums, headache, flushed skin
ANALGESICS
- ____ – acts on PNS
- ____ – acts on CNS
- NONOPIOID – acts on PNS
- OPIOID – acts on CNS
Unpleasant sensory and emotional experience related to tissue injury
PAIN
Relief of Pain
ANALGESIC
NONOPIOD ANALGESICS - NSAIDs
____:
* Safe, effective analgesic and antipyretic drug used for muscular aches, pains and fever caused by viral infections
- ____; little to no GI distress
- Therapeutic serum range: ____ mcg/ml
- ANTIDOTE: ____
ACETAMINOPHEN:
* Safe, effective analgesic and antipyretic drug used for muscular aches, pains and fever caused by viral infections
- Hepatotoxic; little to no GI distress
- Therapeutic serum range: 5- 20 mcg/ml
- ANTIDOTE: ACETYLCYSTEINE
(MUCOMYST)
OPIOD ANALGESICS
* Opioid ____
- Can cause addiction
- Analgesia, ____, euphoria, and ____
- ____ suppression
- ____ effect
- S/E: nausea, vomiting, constipation, decrease in ____, urinary retention, ____ effects
OPIOD ANALGESICS
* Opioid agonists
- Can cause addiction
- Analgesia, respiratory depression, euphoria, and sedation
- Cough suppression
- Antidiarrheal effect
- S/E: nausea, vomiting, constipation, decrease in BP, urinary retention, antitussive effects
OPIOD ANALGESICS
____:
* Pain medicine similar to an opioid. It acts in the ____ to relieve pain.
- ____ have been reported in patients taking tramadol. The risk is higher if you are taking higher doses than recommended.
- Maximum dose: ____ mg per day.
- Tramadol ( TDL HCL) ____ mg/cap
- Tramadol HCL ____ mg, Paracetamol 325 mg ( ____ )
TRAMADOL:
* Pain medicine similar to an opioid. It acts in the central nervous system (CNS) to relieve pain.
- Seizures have been reported in patients taking tramadol. The risk is higher if you are taking higher doses than recommended.
- Maximum dose: 400 mg per day.
- Tramadol ( TDL HCL) 50 mg/cap
- Tramadol HCL 37.5 mg, Paracetamol 325 mg (DOLCET)
OPIOD ANALGESICS
____:
* ____ (AMI), CA, ____ edema
- As pre op medication - relieve ____
- Oral; IV; IM; SUBQ
- ANTIDOTE: ____
Nursing responsibilities:
* Monitor RR, BP, UO, BS
- Antidote at bedside
- No ____ / ____
- Safety
MORPHINE SULFATE:
* Acute Myocardial Infarction (AMI), CA, pulmonary edema
- As pre op medication - relieve anxiety
- Oral; IV; IM; SUBQ
- ANTIDOTE: NALOXONE (NARCAN)
Nursing responsibilities:
* Monitor RR, BP, UO, BS
- Antidote at bedside
- No alcohol / CNS depressants
- Safety
OPIOD ANALGESICS
____:
* Shorter duration of action than Morphine
- Oral, IM, IV
- No ____ property
- Less S/E than morphine
- ____
- Can decrease ____
MEPERIDINE (DEMEROL):
* Shorter duration of action than Morphine
- Oral, IM, IV
- No antitussive property
- Less S/E than morphine
- Neurotoxic
- Can decrease BP
OPIOD ANALGESICS
____:
* More potent than morphine
- ____ onset, ____ duration of action than Morphine
- Oral, rectal, subcutaneous, IM, IV
- ____ (SIVP)
- ____ – irritability, diaphoresis, muscle twitching, increase in PR and BP
HYDROMORPHONE:
* More potent than morphine
- Faster onset, shorter duration of action than Morphine
- Oral, rectal, subcutaneous, IM, IV
- Slow IV Push (SIVP)
- Withdrawal syndrome – irritability, diaphoresis, muscle twitching, increase in PR and BP
HEADACHES: MIGRAINE & CLUSTER
Preventive treatment:
* Beta-adrenergic blockers ( ____ & ____ )
* Anticonvulsant ( ____ & ____ )
* TCA ( ____ & ____ )
Treatment/ cessation of attack:
* Opioid analgesics
* ____
* Selective serotonin ( ____ )
HEADACHES: MIGRAINE & CLUSTER
Preventive treatment:
* Beta-adrenergic blockers (Propranolol & Atenolol)
* Anticonvulsant (Valproic Acid & Gabapentin)
* TCA (amitriptyline & imipramine)
Treatment/ cessation of attack:
* Opioid analgesics
* Ergot alkaloids
* Selective serotonin (Triptans)
OPIOD ANALGESICS
____:
* Oxycontin- long acting opioid analgesic medications for round the clock for acute and chronic ____.
- ____- immediate acting opioid analgesic medications for breakthrough pain.
- Available in oral and IV
- ____ – this is for the management of moderate to severe chronic pain unresponsive to non-narcotic analgesia. Treatment and /or Prophylaxis of OPIOID-Induced constipation.
OXYCODONE:
* Oxycontin- long acting opioid analgesic medications for round the clock for acute and chronic pain.
- Oxynorm- immediate acting opioid analgesic medications for breakthrough pain.
- Available in oral and IV
- TARGIN - (Oxycodone + Naloxone) – this is for the management of moderate to severe chronic pain unresponsive to non-narcotic analgesia. Treatment and /or Prophylaxis of OPIOID-Induced constipation.
OPIOD ANALGESICS
____:
* Powerful opioid used as a pain medication and together with other medications for anesthesia.
- ____ to ____ times more potent than Morphine
- Available in Transdermal patch and Ampule
- For example of transdermal - ____
- For example of ampule - ____
FENTANYL:
* Powerful opioid used as a pain medication and together with other medications for anesthesia.
- 50 to 100 times more potent than Morphine
- Available in Transdermal patch and Ampule
- For example of transdermal - Durogesic D- Trans
- For example of ampule - Hospira Fentanyl Citrate
