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NR-NUR124 | Pharmacology > [5] MIDTERM | ANALGESICS & ANTI-INFLAMMATORY AGENTS > Flashcards

[5] MIDTERM | ANALGESICS & ANTI-INFLAMMATORY AGENTS Flashcards

1
Q

Are a class of medications designed specifically to relive pain

A

Analgesics

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2
Q

ANALGESICS

This includes ____ analgesics or by prescription when combined with another drug, and ____, which are only available by prescription

A

This includes over the counter (OTC) analgesics or by prescription when combined with another drug, and opiods (narcotics), which are only available by prescription

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3
Q

1-3 Mild Pain: ____
4-7 Moderate Pain: ____
8-10: ____

A

1-3 Mild Pain: Acetaminophen or Paracetamol
4-7 Moderate Pain: NSAIDs
8-10: Morphine or Tramadol

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4
Q

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)

A

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)

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5
Q

OPIODS, MORPHINE SOLUTION, TRAMADOL: WOF ____ AND ____

A

OPIODS, MORPHINE SOLUTION, TRAMADOL: WOF CNS AND RESPIRATORY DEPRESSION

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6
Q
  • Response to tissue injury and infection
  • Protective mechanism
  • Other causes: trauma, surgical
  • interventions, extreme hot and cold, and caustic chemical agents.
A

Inflammation

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7
Q

INFLAMMATION

TISSUE INJURY -> ____ & ____

A

TISSUE INJURY -> VASOCONSTRICTION & RELEASE OF CHEMICAL MEDIATORS

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8
Q

INFLAMMATION

EXAMPLES OF CHEMICAL MEDIATORS

A

HISTAMINE, KININS, PROSTAGLANDIN

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9
Q

INFLAMMATION

RELEASE OF CHEMICAL MEDIATORS
1. ____ -> Redness, Erythema
2. ____ -> Swelling Edema
3. ____ - Pain
4. ____ - Heat

A

RELEASE OF CHEMICAL MEDIATORS
1. VASODILATION -> Redness, Erythema
2. INC. CAPILLARY PERMEABILITY -> Swelling Edema
3. PAIN - Pain
4. FEVER - Heat

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10
Q

INFLAMMATION

ERYTHEMA, SWELLING EDEMA, PAIN, AND HEAT -> ____

A

ERYTHEMA, SWELLING EDEMA, PAIN, AND HEAT -> LOSS OF FUNCTION

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11
Q

Enzyme responsible for
conversion of arachidonic acid
into prostaglandins

A

CYCLOOXYGENASE (COX)

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12
Q
  • Protects stomach lining
  • Regulates blood platelets
A

COX-1

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13
Q
  • Triggers inflammation and pain
A

COX-2

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14
Q
  • Relieve pain (analgesic)
  • Reduce elevated body temperature (antipyretic)
  • Inhibit platelet aggregation (anticoagulant)
  • Prostaglandin Inhibitors
  • NSAIDs
A

ANTIINFLAMMATORY AGENTS

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15
Q

SEVEN GROUPS OF NSAIDs

A
  1. Salicylates
  2. Para-Chlorobenzoic Acid derivatives or indoles
  3. Phenylacetic Acids
  4. Propionic Acid derivatives
  5. Fenamates
  6. Oxicams
  7. Selective Cox-2 inhibitors
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16
Q

Aspirin, also known as acetylsalicylic acid (ASA)

A

SALICYLATES

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17
Q

SALICYLATES

Functions:
* A____
* A____
* A____

Therapeutic serum salicylate level: ____ mg/dl
Toxic serum salicylate level: ____ mg/dl

A

Functions:
* Anti-inflammatory
* Antiplatelet
* Antipyretic effects

Therapeutic serum salicylate leve0: 10–30 mg/dl
Toxic serum salicylate level: >40–50 mg/dl

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18
Q

ANTICOAGULANTS SHOULD NOT BE GIVEN DURING ____

A

ANTICOAGULANTS SHOULD NOT BE GIVEN DURING BLEEDING

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19
Q

SALICYLATES

Drug Interactions:
* A____
* G____
* O_____

Hypersensitivity to salicylate products: ____, vertigo, _____

A

Drug Interactions:
* anticoagulants
* glucocorticoids
* oral hypoglycemic

Hypersensitivity to salicylate products: tinnitus, vertigo, bronchospasm

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20
Q

SALICYLATES

GI UPSET
* Should be taken with ____, WATER OR FOOD

REYE SYNDROME
* Not be taken by children with ____ symptoms

C/I: ____

A

GI UPSET
* Should be taken with MILK, WATER OR FOOD

REYE SYNDROME
* Not be taken by children with flu symptoms

C/I: PREGNANCY

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21
Q

It is an extremely serious pathological condition associated with swelling of liver and brain

A

REYE SYNDROME

22
Q

REYE SYNDROME

  • ____ - lethargy, confusion, seizures, coma
  • ____ - Tiredness, Nausea, Elevated AST, Elevated ALT
A
  • Encephalopathy - lethargy, confusion, seizures, coma
  • Liver Damage - Tiredness, Nausea, Elevated AST, Elevated ALT
23
Q

PARA-CHLOROBENZOIC ACID

  • ____
  • ____

Indications:
* R____
* G____
* O____

May cause Increased BP and sodium & water retention

A
  • **Indomethacin (Indocin)
  • Sulindac (Clinoril)**

Indications:
* Rheumatoid arthritis
* Gouty arthritis
* Osteoarthritis

May cause Increased BP and sodium & water retentio

24
Q

PHENYLACETIC ACID DERIVATIVES

  • ____

Indications:
* R____
* O____
* A____

A
  • Diclofenac Na (Voltaren)

Indications:
* Rheumatoid Arthritis
* Osteoarthritis
* Ankylosing spondylitis

25
# PHENYLACETIC ACID DERIVATIVES * short term management of pain * 1st injectable NSAIDs * Greater analgesic effect * ANST
**KETOROLAC**
26
# 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)
27
# 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**
28
PAIN MEDICATION ADMINISTRATION: WOF ____ AND ____ FUNCTION
PAIN MEDICATION ADMINISTRATION: WOF **LIVER AND KIDNEY FUNCTION**
29
# 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
30
# COX-2 INHIBITORS Drug agents * C____ * R____ * N____
Drug agents * **Celecoxib (Celebrex)** * **Rofecoxib (Vioxx)** * **Nabumetone (Relafen)**
31
# 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
32
* Suppressing and preventing many of the components of the inflammatory process at the injured site. * Dexamethasone * Prednisone * Prednisolone
CORTICOSTEROIDS
33
EXAMPLES OF CORTICOSTEROIDS
* Dexamethasone * Prednisone * Prednisolone
34
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**
35
* Inflammation of the joints * Uric Acid
ANTIGOUT DRUGS
36
# 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**
37
# 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
38
# 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
39
# ANALGESICS * ____ – acts on PNS * ____ – acts on CNS
* **NONOPIOID** – acts on PNS * **OPIOID** – acts on CNS
40
Unpleasant sensory and emotional experience related to tissue injury
PAIN
41
Relief of Pain
ANALGESIC
42
# 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/m**l * ANTIDOTE: **ACETYLCYSTEINE (MUCOMYST)**
43
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**
44
# 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**)
45
# 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
46
# 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**
47
# 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
48
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**)
49
# 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.
50
# 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**

NR-NUR124 | Pharmacology (16 decks)

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