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Pharm > Anti-inflammatories & Analgesics > Flashcards

Anti-inflammatories & Analgesics Flashcards

1
Q

Five cardinal signs of inflammation

A

redness, swelling (edema), heat, pain, & loss of function

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2
Q

Inflammation is a response to

A

tissue injury

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3
Q

What do anti-inflammatories do?

A

reduce fluid migration and pain –> lessening loss of function and increasing mobility & comfort

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4
Q

First gen NSAIDs

A

salicylates (aspirin) and propionic acid derivatives (ibuprofen)

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5
Q

Second gen NSAIDs

A

COX-2 inhibitors (celecoxib)

COX-2 triggers inflammation and pain

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6
Q

Is acetaminophen an NSAID?

A

No, has no anti-inflammatory action

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7
Q

Intended response of NSAIDs

A

reduced redness, pain, swelling, and warmth at site of
inflammation; increased function; reduced fever

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8
Q

Side effects of NSAIDs

A

bleeding, GI ulcers, GI pain, fluid retention, HTN

Encourage glass of water to protect stomach and kidneys

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9
Q

Adverse effects of NSAIDs

A

possible kidney damage, induction of asthma and allergic reactions

Encourage glass of water to protect stomach and kidneys

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10
Q

Prostaglandin inhibitor that decreases the inflammatory process- both COX-1 & COX-2

Reduces pain, inflammation sx, and fever

Also considered an antiplatelet drug for pts w/cardiac or cerebrovascular disorders

High doses usually needed to relieve inflammation

A

aspirin

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11
Q

Side effects of aspirin

A

Gastric distress is common (anorexia, dyspepsia, NV, diarrhea, constipation, abdominal pain)

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12
Q

Adverse reactions of aspirin

A

tinnitus, hearing loss, GI bleeding, ulceration, perforation/anaphylaxis, Reye syndrome, Stevens-Johnson syndrome, thrombocytopenia, leukopenia, agranulocytosis, hepatotoxicity

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13
Q

True or False

Aspirin can be taken with other NSAIDs

A

False

Aspirin should NOT be taken with other NSAIDs (decreases blood level and effectiveness of NSAIDs)

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14
Q

Aspirin Contraindications

A

Hypersensitivity to salicylates or NSAIDs, GI bleeding

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15
Q

How does aspirin effect labs

A
  • Increase PT, bleeding time, INR, uric acid (gout)
  • Decreased cholesterol, T3 and T4 levels
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16
Q

Motrin and Advil are forms of

A

ibuprofen

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17
Q

Inhibition of prostaglandin synthesis, relieving pain and inflammation

Reduces inflammatory process; relieves pain; reduce fever

Side effects: Same as aspirin, blurred vision, pruritis

Adverse reactions: Same as aspirin

Take with food/full glass of water to relieve gastric distress

A

ibuprofen

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18
Q

Drugs of choice for patients with severe arthritic conditions who need high doses of an anti-inflammatory drug

A

Selective COX-2 inhibitors

Ex: celecoxib

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19
Q

Celecoxib side effects

A

same as aspirin and ibuprofen, add tendon rupture

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20
Q

NSAID administration

A

Before:
* Previous problems with NSAIDs, including OTCs
* Give after meals with full glass of water or milk
* Blood pressure

After:
* Bleeding, even with one dose (aspirin particularly)
* Sensitivity reaction

Patient teaching:
* Do not take on an empty stomach
* Monitor for bleeding
* Do not take with warfarin (Coumadin)

21
Q

NSAID Life span considerations

A

Pediatric:
* Only ibuprofen is recommended
* Avoid aspirin (Reye’s syndrome)

Pregnancy:
* Category C drug for first 6 months
* Avoid during last 3 months (can harm fetus)

Older adults:
* May increase risk of fluid overload and hypertension due to sodium and water retention
* More likely to have renal or GI problems

22
Q

End in *lone or *sone

A

corticosteriods

23
Q

Prevent or limit inflammation by slowing or stopping all known pathways of inflammatory mediator production

A

corticosteriods

24
Q

Side effects of corticosteriods

A
  • Short term therapy – hypertension, acne, insomnia,
    nervousness, increased blood glucose
  • Long term therapy – adrenal gland suppression,
    reduced immune function, delayed wound healing,
    “Cushingnoid appearance”
  • (may also have changes in mental status such as
    euphoria, depression, psychosis)
25
Q

Cushingnoid appearance

A

moon face, buffalo hump, hirsutism, weight gain, skin ulcers, HTN & cardiac hypertrophy, muscle wasting, osteoporosis, erectile dysfunction, amenorrhea, emotional disturbances

26
Q

Adverse effects of corticosteriods

A

adrenal gland atrophy, masking of infection, delayed wound healing

27
Q

Patient teaching for corticosteriods

A

do not suddenly stop taking drug, take w/food, avoid crowds

28
Q

What happens if we don’t taper corticosteriods?

A

acute adrenal insufficiency crisis (medical emergency caused by a lack of cortisol)

29
Q

Corticosteroid Lifespan considerations

A

Pediatric:
* At risk for same side effects as adults

Pregnancy and breastfeeding:
* Drugs cross placenta, are excreted in breast milk

Older adults:
* Extra precautions to avoid infection
* Monitor blood glucose levels

30
Q

Inflammatory disease of joints, tendons, and other tissues. Usually occurs in the great toe. Defect in purine metabolism leads to uric acid accumulation.

A

Gout

31
Q

Purine containing foods

A

organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer)

32
Q
  • Inhibit migration of leukocytes to inflamed site (antiinflammatory)
  • Uses: Decreases pain and inflammation in acute gout attacks, prevents future gout attacks
  • Side effects: GI distress
  • Nursing Implications: Taken with food to avoid GI distress and avoid grapefruit juice
  • Contraindications: Severe renal, cardiac, or GI problem
A

Antigout Drugs: Colchicine

33
Q
  • Not an anti inflammatory drug
  • Inhibits final steps of uric acid biosynthesis and lowers serum uric acid levels (prevents uric acid from forming)
  • This will prevent an attack
  • Frequently used as a prophylactic to prevent gout, long term-use
A

Antigout Drug: Allopurinol

34
Q
  • Both nonopioid and opioid
  • Prescribed for the relief of pain
  • Choice depends on the severity of pain
  • Mild to moderate pain frequently relieved
    with the use of nonopioids (e.g., NSAIDs)
  • Moderate to severe pain usually requires an
    opioid (narcotic)
A

analgesics

35
Q

Examples of non-opioid analgesics

Less potent than opioid analgesics, used to treat mild to moderate pain

Usually purchased OTC, but COX-2 inhibitors require prescription

Effective for dull, throbbing pain of headaches, menstrual pain (dysmenorrhea), inflammation, minor abrasions, muscular aches and pain, and mild and moderate arthritis

A

ASA (aspirin), acetaminophen, ibuprofen, and naproxen

36
Q

ASA should not be given to children or adolescents younger than 19 years old because ASA can cause Reye syndrome. What is Reye syndrome?

Acetaminophen is recommended instead.

A

Rare but serious condition associated with viral infections treated with salicylates that causes swelling of brain and liver.

37
Q
  • Nonopioid that is not an NSAID (not drug of choice for inflammation)
  • Safe, effective drug when given at therapeutic doses
  • Causes little to no gastric distress, does not interfere with platelet aggregation
  • Toxic when taken at high doses, too often, or with alcohol
  • Risk for permanent liver or kidney damage
A

acetaminophen

38
Q

What are the early symptoms of hepatic damage from excessive acetaminophen?

A

N/V, diarrhea, abdominal pain

39
Q

Acetaminophen overdose antidote

A

N-acetylcysteine

Ex: Mucomyst, Acetadote

40
Q

Opioid agonist

Prescribed to moderate to severe pain

Acts on CNS- activated u receptors, suppresses pain impulses, possess antidiarrheal and antitussive effects

Side effects – constipation, nausea/vomiting, drowsiness (mild sedation), orthostatic hypotensive

Adverse effects – anaphylaxis, respiratory depression, addiction, dependence, tolerance, withdrawal, seizures, urinary retention in older
adults

Naloxone as antidote

A

Opioid analgesics

Ex: morphine

41
Q

Opioid patient teaching

A
  • Take with food
  • Do not drive or operate heavy machinery (while titrating)
  • Change positions slowly
  • Increase fluids, fiber, and activity
  • Avoid stopping suddenly if taking for longer than 2-3 weeks due to withdrawals
42
Q

What are the benefits of using combo of drugs (NSAIDS w/opioids) to treat pain?

A

May decrease drug dependency that may result from possible long-term use of an opioid

43
Q

Medications used for Patient Controlled Analgesia (PCA)

  • Loading dose given initially to achieve pain relief
  • Predetermined safety limits, patient controls administration
  • Patient pushes a button, specific dose of analgesic into IV
    line
  • Lockout mechanism prevents patient from continuously
    pushing the button
  • Near-constant analgesic level, avoiding episodes of severe
    pain or oversedation
A
  • Morphine most often used for PCA
  • Also fentanyl, hydromorphone
44
Q

Older adults should avoid the opioid meperidine (Demerol) because

A

it can cause delirium

45
Q

A semisynthetic opioid similar to morphine w/ analgesic effect 6x more potent.

A

hydromorphone (Dilaudid)

46
Q

Provide a continuous “around-the-clock” pain control that is helpful to patients who suffer from chronic pain

Ex: fentanyl (Duragesic)

A

transdermal opioid analgesic

47
Q

Block opioid activity
* Compete for opioid receptor, displaces opioid
* Reverse symptoms of addiction, toxicity, and overdose

A

Opioid antagonist

Ex: Naxalone (Narcan)

48
Q

Side effects of opioid antagonist

A
  • Sweating, flushing, agitation, dyspnea
  • Hypo/hypertension, tachycardia
  • Nausea, vomiting
  • Reversal of analgesia (rapid)
49
Q

Opioid Withdrawal (3 or more symptoms)

A
  • Dysphoric (negative) mood
  • N/V
  • Muscle aches
  • Runny nose or watery eyes
  • Dilated pupils
  • Goosebumps or sweating
  • Diarrhea
  • Fever
  • Insomnia

Pharm (19 decks)

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