Analgesics Flashcards
Salycilates properties
Antipyretic, analgesic, anti-inflammatory
Salicylate MOA
antipyretic: Decrease body temperature by dilating peripheral blood vessels, analgesic: inhibit prostaglandins,
Salicylate indications
Prolong bleeding time, mild-moderate pain, maintain pregnancy, rheumatoid arthritis, osteoarthritis, rheumatic fever, reducing elevated body temperature
Salicylate ex
Aspirin, magnesium salicylate, sodium salicylate
Aspirin interactions
Valproic acid, beta blockers, ACE inhibitors, diuretics, anticoagulants
Acetaminophen classification
Nonsalicylate
Acetaminophen side effects
Leading cause of acute liver failure, potentially hepatoxic, skin eruptions, urticaria, hemolytic anemia, hypoglycemia, pancytopenia, jaundice
Acetaminophen considerations
Often found in other medications, preferred for elderly, may alter blood glucose test results
NSAIDs classification
Nonsalicylates
NSAIDs interactions
Decreased effectiveness of diuretics, anticoagulants increase risk of bleeding, increased effectiveness of lithium and possible lithium toxicity, increased effectiveness of cyclosporine, increase effectiveness of hydantoins, decreased effectiveness of antihypertensive drugs, increased risk of renal impairment with long term acetaminophen use
NSAIDs aren’t for people with
Impaired renal function, heart failure, increased risk of cardiovascular disease, relieve postoperative pain from a coronary artery bypass graft (CABG), 3rd trimester of pregnancy, lactation,
NSAIDs side effects
Dyspepsia (mild digestion disorder), nausea, heartburn, epigastric pain (upper, central, abdomen)
Topical analgesics indications
Strains and sprains
Topical analgesics ex
Camphor, menthol, methyl salicylate, methyl nicotinate, trolamine sacilylate, capsacin
Topical analgesics aren’t for people with
Anticoagulation therapy
Topical analgesics considerations
Don’t put tight bandages on area, don’t use with heating devices
NSAIDs MOA
Block COX enzymes, inhibit prostaglandin synthesis
NSAIDs indications
Mild-moderate pain, headaches, migraines, osteoarthritis, rheumatoid arthritis, sprains and strains, toothache, primary dysmenorrhea, fever
COX-1 primary side effects
GI- related
COX-2 primary side effects
Cardiovascular related
NSAIDs- COX-1 ex
Flurbiprofen, ketorolac (more GI side effects), ketoprofen, tolmetin, aspirin
Non-selective NSAIDs ex
Ibuprofen, naproxen
COX-2 selective NSAIDs ex
Indomethacin (more GI side effects), sulindac, piroxicam, mefenamic acid, meloxicam, diclofenac (more heart related side effects), celecoxib (more heart related side effects), etodolac
NSAIDs restrictions
Don’t use before or after heart surgery, most aren’t for kids under 18 (except ibuprofen), elderly more likely to have life threatening side effects
NSAIDs side effects
Can increase risk of heart attack or stroke, edema, hyperkalemia, high blood pressure, palpitations, heart failure, asthma, decreased neutrophil, hives, vertigo, seizures
Opioids MOA
Bind to mu, delta, or kappa receptors in CNS (change how patients perceived pain in the brain)
Opioid classes
Phenanthrenes, phenylheptylamines, phenylpiperdines
Opioids adminsitration
Well absorbed through subcutaneous, IM, oral, or transdermal patch, undergo 1st pass metabolism, excreted by kidneys
When to give opioids for analgesic purposes
Sever constant pain with terminal illnesses or cancer
What opioid for acute pulmonary edema
IV morphine
What opioid for diarrhea
Phenylpiperdines or synthetic opiates because of selective GI effects
Opioids for cough- adminstration and what drugs
Use of opioids for cough had decreased, but can use codeine, or dextrometorphan
When to give opioids for anesthesia
Most common use, used as adjunctive therapy, epidural, or in high risk surgeries to decrease cardiovascular depression
Opioids side effects general
Respiratory depression, decreased GI motility, miosis, pruritus, rash, urticaria, sweating, pain at injection site, and local tissue irritation
Opioids main concern
Tolerance and dependency
Strong opioid Agonists ex
Phenanthrenes: morphine, hydromorphone; phenylheptylamines: methadone; phenylpiperdines: fentanyl, meperidine
Mild to moderate opioid Agonists ex
Phenanthrenes: codeine, oxycodone, hydrocodone; phenylheptylamines: propoxyphene; phenylpiperdines: diphenoxylate, loperamide
Opioid mixed receptor actions
Nalpuphine, butorphanol, pentazocine
Opioid antagonists ex
Naloxone, naltrexone
Opioid antagonists MOA
Block effects of opioids by competitive binding (reverses all effects, not just a specific side effect)
Anesthesia considerations
Stop taking herbal supplements 2-3 weeks before surgery, discontinue aspirin and blood thinners before surgery
Cyclooxygenase
Enzyme responsible for prostaglandin synthesis, and contributes to integrity of stomach lining, pain and inflammation
Dysmenorrhea
Painful cramping during menstruation
Dysuria
Painful or difficult urination
Ecchymosis
Bruise like subcutaneous hemorrhage
5th vital sign
Inclusion of pain inquiry when temperature, pulse, respirations, and blood pressure readings are taken
Referred pain
Pain felt in an area remote from the site of origin, possibly along the same dermatome
Oliguria
Reduced urine output
Phenylketonuria (PKU)
A genetic birth defect causing the amino acid phenylalanine to build up toxic levels in the body
Polyuria
Increased urination
Purpura
Excessive skin hemorrhage causing red-purple patches under the skin
Somnolence
Excessive drowsiness or sleepiness
Stomatitis
Inflammation of a cavity opening, such as the oral cavity
Transient ischemic attack (TIA)
Temporary interference with blood supply to the brain causing symptoms related to the portion of the brain affected (ie temporary blindness, aphasia, dizziness, numbness, difficulty swallowing, or paresthesias), they may last a few moments to several hours, after which no neurological damage is evident
3 types of pain intensity scales
Simple descriptive pain intensity scale, 0-10 numeric pain intensity scale, visual analog scale (VAS)
Celecoxib risks
Increased risk of serious cardiovascular thrombosis, myocardial infection, and stroke
Which NSAIDS aren’t used for rheumatoid arthritis or osteoarthritis
Ketorolac, mefenamic, and meloxicam
Celecoxib contraindications
Allergy to sulfonamides, and history of cardiac disease or stroke
Ibuprofen contraindications
Hypertension, peptic ulceration, GI bleeding
Arthrotec combined what 2 drugs
Diclofenac and misoprostol
Arthrotec contraindications
Pregnancy
NSAIDs precautions
Pregnancy (cat B), elderly , bleeding disorders, renal disease, cardiovascular disease, and hepatic impairment
Migraine headache meds ex
Prophylactic treatment includes drugs from the following categories: beta blockers, CCBs, antidepressants, or anti epileptics, drugs include sumatriptan (most end in Triptan)
Maigraine headache meds actions
Activation of the 5-HT receptors causes vasoconstriction and reduces neurotransmission
Migraine headache meds adverse reactions
Dizziness, nausea, fatigue, pain, dry mouth, flushing, coronary artery vasospasm, cardiac arrhythmia, tachycardia, and myocardial infarction
Migraine headache meds contraindications
Allergy to selective serotonin Agonists
5-HT Agonists contraindications
Ischemic heart disease (ex: angina or myocardial infarction), TIAs, uncontrolled hypertension, people taking MAOIs