Chapter 41: Non opioids

Question 1

what is the goal of pain management?

Answer 1

immediate goal is to reduce pain levels to allow the pt to perform reasonable ADLs

Question 2

what is combo therapy?

Answer 2

use of opioid and non-opioid drugs, which is the best combo to relieve pain synergistically and reduces the risk of side effects

Question 3

how do you track pain?

Answer 3

use a pain scale

Question 4

what are common truths about pain?

Answer 4

-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

Question 5

what kind of pain do tricyclic antidepressants help with?

Answer 5

neuropathic pain (tingling/burning nerve pain)

Question 6

what are non opioid drugs characterized by?

Answer 6

-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

Question 7

what are the two categories of nonopioids?

Answer 7

acetaminophen and NSAIDs

Question 8

what do you give for someone with MI?

Answer 8

aspirin

Question 9

what are the 3 properties of NSAIDS?

Answer 9

anti-inflammatory, analgesic, antipyretic

Question 10

what is the dosing for ibuprofen?

Answer 10

-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

Question 11

what is the dosing for aspirin?

Answer 11

-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

Question 12

what is the dosing for acetaminophen

Answer 12

-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

Question 13

what is the prototype drug for NSAIDS?

Answer 13

ASA or acetylsalicylic acid

Question 14

what are the properties of ASA?

Answer 14

-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)

Question 15

what are the adverse effects of ASA?

Answer 15

-n/v,diarrhea, heartburn
-stomach irritation, and stomach pain

Question 16

what is a serious adverse effect of ASA?

Answer 16

tinnitus and/or hearing loss

Question 17

what are s/s of salicylate poisoning and severe toxicity?

Answer 17

-increased temp
-n/v
-lethargy/excitability
-tinnitus
-hyperventilation leading to respiratory alkalosis

-toxicity: metabolic acidosis and seizures

Question 18

what are nrsg considerations for aspirin?

Answer 18

-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)

Question 19

for NSAIDS COX 1 inhibitors, what do you watch for?

Answer 19

watch for GI bleeds

Question 20

does oral or rectal acetaminophen get into the band?

Answer 20

oral

Question 21

when would you give 300 mg vs 81 mg of aspirin?

Answer 21

-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

Question 22

what is 650 mg po Aspirin eqipotent to? compare the two

Answer 22

-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

Question 23

what is the dose times for ibuprofen and acetaminophen?

Answer 23

-4-6 hours
-doses above 1000 mg every 6 hours do not provide more analgesia than 650 mg every 4 hours

Question 24

what is the main concern for NSAIDs and acetaminophen?

Answer 24

-NSAIDS: gi bleed and GFR
-acetaminophen: liver