Analgesics Flashcards
What is the MOA of Ibuprofen (NSAID)
Non-selective reversible inhibition of COX 1 and CoX 2 enzymes resulting in decrease pain
What are some ADRs of Ibuprofen (NSIAD)
Gastric irritation
Reduction in GFR leading to fluid retention
Prolonged bleeding time
Increased risk of MI and Asthma attacks
What is some patient education when giving Ibuprofen
Take with food
Do not administer with Aspirin
NSAIDs can alter the effect of other drugs eg digoxin, warfarin
What is the MOA of paracetamol
Has both local and central action
Local action – COX inhibition
Central action- inhibition of prostaglandin synthesis in the CNS
What are some ADRs of paracetamol
ADRs are rare but potential - weak inflammatory effect
What is some patient education when giving paracetamol
Lots of other over the counter medications contain paracetamol in them e.g cold and flu - caution with exceeding daily dose
What is an Opioid agonist
Morphine
What is an Opioid antagonist
Naloxone
What is the MOA of Morphine
activation of descending inhibitory pathways of the CNS as well as inhibition of the nociceptive afferent neurons of the PNS
What are some ADRs of Morphine
resp. depression, excessive sedation, dysphoria, constipation, nausea and vomiting, tolerance and dependence
What does Naloxone do?
Reverse the effect of an opioid
What assessments should be taken prior to prescribing Ibuprofen and what findings may led to a prescription being contraindicated
History of ulcer disease or GI bleeding
use of anticoagulants, steroids or other NSAIDS
Significant co-morbidities
What is the analgesic ladder
flowchart for the step-wise pharmacological management of pain
Step 1: 1-3 mild pain
Step 2: 4-6 moderate pain
Step 3: 7-10 severe pain
What are the different types of pain
Acute- sudden onset
Chronic - reoccurring difficult to treat
Nociceptive- Stimulation of receptors
Neurogenic - lesions orPNS/CNS
Psychogen
What serious adverse effect is possible from too much morphine. What is to be given?
Sedation and resp. depression. Naloxone should be given
Your patient feels sick and may vomit while on Morphine, what antiemetic should ideally be prescribed?
Metocloprimide, works on increasing gut motility along with central effect as dopamine antagonist
Avoid ondansetron - leads to constipation as does the opioid
What does opioid Sparing mean?
Refers to the fact that with a non-opioid is combined with an opioid, the opioid dose can be lowered without compromising pain relief
What is the MOA of tramadol
Stimulates mu receptors
Also Inhibits the reuptake of nor adrenaline and serotonin
What are some contraindications for Naloxone
Patient hypersensitivity to drug
What are the contraindications of tramadol and Morphine
Conditions associated with increased intracranial pressure
Head injuries
What are some contraindications to Ibuprofen
Hypersensitivity to aspirin or other NSAIDs
Severe HF
Hx of GI ulceration
What are some contraindications for paracetamol
Severe hepatocellular insufficiency, hepatic failure, acute liver disease
What is some patient education for Morphine and Tramadol
Avoid drinking alcohol, drowsiness avoid driving, addictive
What is the MOA of Loperamide
Binds to opiate receptor in gut wall, reducing propulsive peristalsis, increasing intestinal transit time and enhancing resorption of water and electrolytes
What are some ADRs of loperamide
nausea, abdominal cramps, dizziness, drowsiness,
What are some contraindication of loperamide
conditions where peristalsis should be avoided
What is some patient education when taking loperamide
take as directed
Can be taken with and with our food
Laxatives may react with loperamide
What does Endogenous morphine
Elicits changes in endorphins
Once a patient is given Naloxone what do you watch for
Vital signs, sedation score, VIP score
Endogenous ligand
A small molecule that elicits a conformational change upon binding
