Chapter 41: Non opioids Flashcards
what is the goal of pain management?
immediate goal is to reduce pain levels to allow the pt to perform reasonable ADLs
what is combo therapy?
use of opioid and non-opioid drugs, which is the best combo to relieve pain synergistically and reduces the risk of side effects
how do you track pain?
use a pain scale
what are common truths about pain?
-pts may not appear to be in pain
-pts can sleep through pain
-only a few pt can get addicted to their meds
-Vs are not reliable indicators of pain
-pts that are addicted do not over report because they are drug seeking
what kind of pain do tricyclic antidepressants help with?
neuropathic pain (tingling/burning nerve pain)
what are non opioid drugs characterized by?
-they have ceiling effect (once you’ve reached the max dose, increasing the dose won’t do anything)
-they don’t produce tolerance or physical dependence
-may are available without a prescription
what are the two categories of nonopioids?
acetaminophen and NSAIDs
what do you give for someone with MI?
aspirin
what are the 3 properties of NSAIDS?
anti-inflammatory, analgesic, antipyretic
what is the dosing for ibuprofen?
-max dose = 3,200 mg/day, unless less than 70 kg then decrease the dose
-800 mg q6hr provides greater anti-inflammatory but not greater analgesia than 400 mg every 6 hours
what is the dosing for aspirin?
-supplied as 81 mg and 325 mg tablets (EC option)
-for active heart attack, give 300 mg
-650 mg PO is equipotent of about 2 mg IM morphine
what is the dosing for acetaminophen
-for children and small individuals: 6 mg/kg to 12mg/kg q4h
-for adults: max dose is 4g/day, doses above 1000 q6h don’t provide greater analgesia than 650 mg q4h
what is the prototype drug for NSAIDS?
ASA or acetylsalicylic acid
what are the properties of ASA?
-anti-inflammatory (watch the stomach): inhibits the release of prostaglandins, causing direct cellular injury as the drug is absorbed absorbed across the stomach mucosa
-antipyretic effect
-antiplatelet agent: use with TIA, unstable angina and MI (more effective in males than females)
what are the adverse effects of ASA?
-n/v,diarrhea, heartburn
-stomach irritation, and stomach pain
what is a serious adverse effect of ASA?
tinnitus and/or hearing loss
what are s/s of salicylate poisoning and severe toxicity?
-increased temp
-n/v
-lethargy/excitability
-tinnitus
-hyperventilation leading to respiratory alkalosis
-toxicity: metabolic acidosis and seizures
what are nrsg considerations for aspirin?
-aspirin is considered an antiplatelet
-check for prothrombin time (PT: measures how long it takes for your blood to clot) and international normalized ratio (INR: standardized way of measuring PT) with concurrent anticoagulant use
-check for fasting blood glucose if diabetes
-watch for aspirin toxicity
-never give to children (especially after an illness as it increases risk for Reye’s syndrome, which is fatty liver and encephalopathy that can lead to death)
for NSAIDS COX 1 inhibitors, what do you watch for?
watch for GI bleeds
does oral or rectal acetaminophen get into the band?
oral
when would you give 300 mg vs 81 mg of aspirin?
-300: the therapeutic dose give immediately to those with an active heart attack, to prevent the clot from getting bigger and reduces complication
-used for emergencies like a heart attack to provide quick, strong anti-platelet effect
-81: a daily lose dose of aspirin used for long term prevention, not sufficient for an emergency
what is 650 mg po Aspirin eqipotent to? compare the two
-2 mg IM Morphine
-Aspirin: is an NSAID used for mild to moderate pain, related to inflammation
-Morphine: used for severe pain, not primarily related to inflammation
what is the dose times for ibuprofen and acetaminophen?
-4-6 hours
-doses above 1000 mg every 6 hours do not provide more analgesia than 650 mg every 4 hours
what is the main concern for NSAIDs and acetaminophen?
-NSAIDS: gi bleed and GFR
-acetaminophen: liver
