Chapter 41 Non opioid analgesics Flashcards
what are the the seven main principles of pain management***
-Immediate goal is to reduce pain so that a person can perform ADLS
-patient should be considered expert in their own pain
-pain management is a patients right
-Non pharmacological interventions should be encouraged because of less adverse effects
-combo therapy is best (opioid non opioid) since it reduces adverse effects
-dosing should be individualized
-adverse effects should be anticipated and prevented
what is a useful way to create an objective rating for pain***
use a pain scale ie pain on a scale of 1-10
why is around the clock dosing important for pain management
because it is easier to maintain pain free level than eliminate escalating pain
what are the 5 common truths about pain***
-Patients who are in pain may not appear to be in pain
-Patients can sleep when their in pain
-Very few patients become addicted to their medication (0.01%)
-patients who are addicted to medication do not necessarily over report pain because they are drug seeking
-Vital signs are not a reliable indicator of pain
What is the definition of analgesia
absence of sensibility to pain
what is another indication of tricyclic antidepressants besides depression***
used for neuropathic pain
at what stage of the analgesic ladder can tricyclic antidepressants be used
they can be used at all three steps of the analgesic ladder
how do antidepressants work as an adjuvant drug
they block the reuptake of serotonin and norepinephrine to block the transmission of pain
what are the three things that Non Opioid analgesics are characterized by ***
- they have a ceiling effect
- They do not produce tolerance or physical dependance
- many are available without a prescription
what are the two categories of Non opioid analgesics
NSAIDS
Acetaminophen
What are the three major classes of NSAIDS
- Salicylates
- Ibuprofen/COX-1 inhibitors
- Cyclooxygenase COX 2 inhibitors
What medication is used to treat or prevent a MI***
ASA not Ibuprofen
What are NSAIDS used for***
- Anti inflammatory
- Analgesic
- Antipyretic
why does inflammation occur in the body***
upon injury cells release numerous chemicals into extracellular space (think the soup) which increases permeability of blood vessels which causes the edema
What do ASA and ibuprofen inhibit to prevent pain***
they inhibit cyclooxygenase COX synthesis
what is the max dose of ibuprofen in one day
3,200 mg/day as long as the person is over 70 kg
What does ASA stand for
Acetylsalicylic Acid
what is the brand name of ASA
aspirin
what COX does Aspirin block
ASA blocks both COX-1 and COX-2
what COX does ibuprofen block
Ibuprofen blocks both COX-1 and COX-2
what is the max dose of aspirin per day
max dose is 4 g per day
how does ASA produce an antiinflammatory effect and what is an adverse effect of this***
ASA block the production of prostaglandins however as it is absorbed through the stomach it causes cellular damage and it also reduces the amount of protective mucus in the stomach
what are three conditions where the antiplatelet effects of ASA are helpful
TIAs
Unstable angina
MI
is ASA more effective in women or men***
more effective in males than females
what are 5 adverse effects of aspirin**
Stomach pain
Heartburn
Nausea
Vomiting
Diarrhea
what are 4 signs of ASA overdose ***
Occult bleeding (GI bleeding)
Nephrotoxicity
Hepatotoxicity
Tinnitus or hearing loss
What pregnancy category is ASA
C/D
what are the drug to drug interactions of ASA
any other drug that interacts with the blood can have adverse effects when paired with ASA
What are three lab values to monitor when someone is using ASA***
- Prothrombin time
- INR
- Fasting blood glucose if diabetic
What age group should never use ASA and why?
anyone under 18 should never take ASA because it increases the risk of reye’s syndrome especially if the child has just had a viral illness
What is reyes syndrome
very serious condition that affects all organs in the body but mostly the brain and the liver
Do COX-1 inhibitors have a ceiling effect
yes all non opioid analgesics do
What are the adverse effects of COX-1 inhibitors
Gastric ulcers
GI bleeding
renal damage
are COX-1 inhibitors acidic or basic and why is this important***
most are weak acids which can damage GI mucosa so you have to monitor for a GI bleed
what are the two most important things to monitor when someone is taking NSAIDS**
Remember the two G’s
Kidneys (GFR)
GI bleed
what is a more common NSAID COX-1 inhibitors or COX-2 inhibitors and why?
COX-1 inhibitors since COX-2 inhibitors have limited use because the increase the risk of MI or stroke
what should NSAIDS be taken with to reduce the side effects
can be taken with food so they are not so hard on the stomach
what are two main functions of Acetaminophen
Analgesic
antipyretic
does acetaminophen have any anti inflammatory properties
NO
does Acetaminophen cause GI bleeding
NO
how does acetaminophen work to reduce a fever***
works directly on the hypothalamus to cause sweating and vasodilation
which route is faster for acetaminophen rectally or PO*****
PO is faster than rectal
What is the max dose of Acetaminophen in a day***
Max dose is 4 g per day
what dosage of acetaminophen will no longer provide any extra analgesic affect ***
doses of 1,000 mg every six hours does not provide any more analgesia than 650 mg every 4 hrs the analgesia will last longer but not increase so the celing for ACET is 650 mg every 4 hours
what is the main adverse effect of acetaminophen***
Liver toxicity
