Anti-inflammatories & Analgesics Flashcards
Five cardinal signs of inflammation
redness, swelling (edema), heat, pain, & loss of function
Inflammation is a response to
tissue injury
What do anti-inflammatories do?
reduce fluid migration and pain –> lessening loss of function and increasing mobility & comfort
First gen NSAIDs
salicylates (aspirin) and propionic acid derivatives (ibuprofen)
Second gen NSAIDs
COX-2 inhibitors (celecoxib)
COX-2 triggers inflammation and pain
Is acetaminophen an NSAID?
No, has no anti-inflammatory action
Intended response of NSAIDs
reduced redness, pain, swelling, and warmth at site of
inflammation; increased function; reduced fever
Side effects of NSAIDs
bleeding, GI ulcers, GI pain, fluid retention, HTN
Encourage glass of water to protect stomach and kidneys
Adverse effects of NSAIDs
possible kidney damage, induction of asthma and allergic reactions
Encourage glass of water to protect stomach and kidneys
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
aspirin
Side effects of aspirin
Gastric distress is common (anorexia, dyspepsia, NV, diarrhea, constipation, abdominal pain)
Adverse reactions of aspirin
tinnitus, hearing loss, GI bleeding, ulceration, perforation/anaphylaxis, Reye syndrome, Stevens-Johnson syndrome, thrombocytopenia, leukopenia, agranulocytosis, hepatotoxicity
True or False
Aspirin can be taken with other NSAIDs
False
Aspirin should NOT be taken with other NSAIDs (decreases blood level and effectiveness of NSAIDs)
Aspirin Contraindications
Hypersensitivity to salicylates or NSAIDs, GI bleeding
How does aspirin effect labs
- Increase PT, bleeding time, INR, uric acid (gout)
- Decreased cholesterol, T3 and T4 levels
Motrin and Advil are forms of
ibuprofen
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
ibuprofen
Drugs of choice for patients with severe arthritic conditions who need high doses of an anti-inflammatory drug
Selective COX-2 inhibitors
Ex: celecoxib
Celecoxib side effects
same as aspirin and ibuprofen, add tendon rupture
NSAID administration
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)
NSAID Life span considerations
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
End in *lone or *sone
corticosteriods
Prevent or limit inflammation by slowing or stopping all known pathways of inflammatory mediator production
corticosteriods
Side effects of corticosteriods
- 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)
Cushingnoid appearance
moon face, buffalo hump, hirsutism, weight gain, skin ulcers, HTN & cardiac hypertrophy, muscle wasting, osteoporosis, erectile dysfunction, amenorrhea, emotional disturbances
Adverse effects of corticosteriods
adrenal gland atrophy, masking of infection, delayed wound healing
Patient teaching for corticosteriods
do not suddenly stop taking drug, take w/food, avoid crowds
What happens if we don’t taper corticosteriods?
acute adrenal insufficiency crisis (medical emergency caused by a lack of cortisol)
Corticosteroid Lifespan considerations
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
Inflammatory disease of joints, tendons, and other tissues. Usually occurs in the great toe. Defect in purine metabolism leads to uric acid accumulation.
Gout
Purine containing foods
organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer)
- 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
Antigout Drugs: Colchicine
- 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
Antigout Drug: Allopurinol
- 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)
analgesics
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
ASA (aspirin), acetaminophen, ibuprofen, and naproxen
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.
Rare but serious condition associated with viral infections treated with salicylates that causes swelling of brain and liver.
- 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
acetaminophen
What are the early symptoms of hepatic damage from excessive acetaminophen?
N/V, diarrhea, abdominal pain
Acetaminophen overdose antidote
N-acetylcysteine
Ex: Mucomyst, Acetadote
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
Opioid analgesics
Ex: morphine
Opioid patient teaching
- 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
What are the benefits of using combo of drugs (NSAIDS w/opioids) to treat pain?
May decrease drug dependency that may result from possible long-term use of an opioid
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
- Morphine most often used for PCA
- Also fentanyl, hydromorphone
Older adults should avoid the opioid meperidine (Demerol) because
it can cause delirium
A semisynthetic opioid similar to morphine w/ analgesic effect 6x more potent.
hydromorphone (Dilaudid)
Provide a continuous “around-the-clock” pain control that is helpful to patients who suffer from chronic pain
Ex: fentanyl (Duragesic)
transdermal opioid analgesic
Block opioid activity
* Compete for opioid receptor, displaces opioid
* Reverse symptoms of addiction, toxicity, and overdose
Opioid antagonist
Ex: Naxalone (Narcan)
Side effects of opioid antagonist
- Sweating, flushing, agitation, dyspnea
- Hypo/hypertension, tachycardia
- Nausea, vomiting
- Reversal of analgesia (rapid)
Opioid Withdrawal (3 or more symptoms)
- Dysphoric (negative) mood
- N/V
- Muscle aches
- Runny nose or watery eyes
- Dilated pupils
- Goosebumps or sweating
- Diarrhea
- Fever
- Insomnia
