DRUGS FOR PAIN AND INFLAMMATION Flashcards
Uses: mild to moderate pain of the skeletal
muscle & joint
➔ NOT addictive & are less potent than
narcotic analgesics
ANALGESICS (NON-OPIOD/NON NARCOTIC)
MOA: act on peripheral nervous system at the pain receptor sites by inhibiting prostaglandin synthesis
ANALGESICS
Effective for dull, throbbing pain of
headache, dysmenorrhea, pain from
inflammation, minor abrasions, muscular pain and mild-moderate arthritis
ANALGESICS
ASPIRIN - a salicylate, oldest non narcotic
analgesic drug
ANALGESICS
CI: children < 12 years old (Reye’s syndrome)
ANALESICS
DI: +warfarin, heparin, thrombolytics = increase bleeding ibuprofen + insulin/OHA =
hypoglycemia
ANALGESICS
SE: gastric irritation, excess bleeding might
occur during the first two days of menstruation
ANALGESICS
Nursing Responsibilities:
➔ take with food
➔ with glass of water
➔ monitor platelet bleeding time PT
➔ d/c aspirin 7 days prior to surgery
ANALGESICS
MOA: weakly inhibits prostaglandin synthesis which decreases pain sensation & heat
ACETAMINOPHEN (TYLENOL, TEMPRA)
Is safe, effective analgesic & antipyretic
drug used for muscular aches & fever caused by viral infections
ACETAMINOPHEN
➔ causes no / little gastric distress; does
not interfere with platelet aggregation, no anti inflammatory effect
ACETAMINOPHEN
CI: severe hepatic / renal disease, alcoholism, hypersensitivity
ACETAMINOPHEN
DI: +caffeine = increase effect +oral
contraceptives, anticholinergics = decrease
effects
ACETAMINOPHEN
SE/ AE: hepatotoxicity, early symptoms of
hepatic damage (N/V, diarrhea & abdominal
pain)
ACETAMINOPHEN
Nursing Considerations:
➔ Liver enzymes,self medications should not
be used for more than 10 days for adults & 5
days for children
➔ keep out of children’s reach
➔ acetylcysteine (antidote)
➔ no alcohol
ACETAMINOPHEN
MOA: binds to opiate receptors in the CNS,
reduces stimuli from sensory nerve end, pain threshold is increased
NARCOTIC ANALGESICS/ OPIOID ANALGESICS
USES:
➔ moderate - severe pain
➔ suppresses pain muscles
➔ suppresses respiratory & coughing by acting on the respiratory & cough centers in the medulla of the brainstem
NARCOTIC ANALGESICS/ OPIOID ANALGESICS
CI: with respiratory dysfunction, head injuries, increase ICP, hepatic and renal disease, alcoholism
NARCOTIC ANALGESICS, OPIOID ANALGESICS
DI: +alcohol, sedatives-hypnotics and other
CNS depressants + increase CNS depression; may increase ALT/ AST
NARCOTIC ANALGESICS/ OPIOID ANALGESICS
SE:
- N/V (particularly in ambulating patients)
- constipation (less in demerol)
- moderate decrease of blood pressure
- orthostatic hypotension (high dose)
- antitussive effect (except demerol)
- CNS: drowsiness, dizziness, confusion,
sedation,
- PUPIL CONSTRICTION - pinpoint pupil - sign of toxicity
NARCOTIC ANALGESICS/ OPIOID ANALGESICS
Codeine: not as potent as morphine
NARCOTIC ANALGESICS/ OPIOID ANALGESICS
Morphine sulfate: potent analgesics (can depress respiration), effective against MI,
dyspnea-pulmonary edema, pre op meds
NARCOTIC ANALGESICS/ OPIOID ANALGESICS
: shorter duration of action than morphine, potency varies according to dosage
MEPERIDINE (DEMEROL)
most commonly used narcotic for
alleviating post op pain, no antitussive property
MEPERIDINE (DEMEROL)
- preferred in pregnancy (does not
diminish uterine contractions & causes less
neonatal respiratory depression) - not prescribed for long term used
MEPERIDINE (DEMEROL)
**withdrawal symptoms called: ABSTINENCE SYNDROME occurs 24-48 hours after last
MEPERIDINE (DEMEROL)
Nursing Considerations:
- VS do not give if RR is < 10/min, BP <
90/70 mmHg
- Administer before pain reaches its peak
to maximize the effectiveness
- Should not taken with alcohol or
sedative -hypnotics
- Check urine output & bowel elimination
- Assist patient in ambulation
- Have naloxone (Narcan) ready as
antidote
- Do not abruptly withdraw medicine
- Assess for toxicity due to overdose
- Instruct about deep breathing &
coughing exercises especially in patients with altered pulmonary function
NARCOTICE ANALGESICS/ OPIOID ANALGESICS
Antidotes for overdoses of narcotic
analgesic
NARCOTIC ANTAGONIST
Have higher affinity to the opiate receptor site than the narcotic being taken
NARCOTIC ANTAGONIST
Blocks the receptor & displaces any narcotic that would be at the receptor, thus
inhibiting the neurotic action
NARCOTIC ANTAGONIST
Reverses respiratory and CNS depression
NARCOTIC ANTAGONIST
EG: naloxone (Narcan) - IM, IV
NSG: Vs q5, q15, q30 until stable
NARCOTIC ANTAGONIST
a narcotic but cause less
dependency that the narcotics it is replacing
- Helps the narcotic addicted person to
withdraw from narcotics without causing
withdrawal symptoms
- Given OD (longer half life)
METHADONE
a narcotic but cause less
dependency that the narcotics it is replacing
- Helps the narcotic addicted person to
withdraw from narcotics without causing
withdrawal symptoms
- Given OD (longer half life)
METHADONE
pentazocine (Talwin)
NARCOTIC AGONIST - ANTAGONIST
Butorphanol tartrate (Stadol)
NARCOTIC AGONIST - ANTAGONIST
Nalbuphine HCL (Nubain),
NARCOTIC AGONIST - ANTAGONIST
Buprenorphine (Buprenex)
NARCOTIC AGONIST - ANTAGONIST
Salicylate (aspirin)
NONSTEROIDAL ANTI-INFLAMMATORY
Non-salicylate Parachorobenzoic acid
- Indomethacin (Indocin)
- sulindac
- tolmetin
NONSTEROIDAL ANTI-INFLAMMTORY
Pyrazolone derivatives
- phenylbutazone
NONSTEROIDAL ANTI-INFLAMMATORY
Propionic acid derivatives
- ibuprofen (Alaxan, Advil)
- naproxen
- ketoprofen (Orudis)
NONSTEROIDAL ANTI-INFLAMMATORY
Fenamates
- meclofenamate (Meclofen)
- mefenamic acid (ponstan)
NONSTEROIDAL ANTI-INFLAMMATORY
Oxicam
- meloxicam (Mobic)
NONSTEROIDAL ANTI-INFLAMMATORY
Phenylacetic acid derivatives
- diclofenac Na (Voltaren, Cataflam)
- ketorolac (Toradol)
NONSTEROIDAL ANTI-INFLAMMATORY
Selective COX2 inhibitors
- celecoxib
NONSTEROIDAL ANTI-INFLAMMATORY
MOA: inhibits the enzyme cyclooxygenase
(COX) that is needed for the biosynthesis of
prostaglandin
NONSTEROIDAL ANTI-INFLAMMATORY
USES:
- reduce inflammatory process
- relieve pain
- Reduce fever
NONSTEROIDAL ANTI-INFLAMMATORY
CI: severe renal and hepatic disease. GI bleed, hypersensitivity (**aspirin: tinnitus, vertigo, bronchospasm especially asthmatic)
NONSTEROIDAL ANTI-INFLAMMATORY
SE: GI irritation, anorexia, N/V, dizziness,
confusion, hearing loss, heartburn, drowsiness
NONSTEROIDAL ANTI-INFLAMMATORY
AE: GI bleed, tinnitus, life threatening (BM
depression, hepatotoxicity, bronchospasm,
cardiac dysrhythmias
NONSTEROIDAL ANTI-INFLAMMATORY
DI: +anticoagulants, anti platelets,
thrombolytics = increase GI bleed
NONSTEROIDAL ANTI-INFLAMMATORY
Nursing Responsibilities:
- Take with meals
- Check hypersensitivity
- Monitor bleeding
- Avoid alcohol
- Inform clients that it may take several
weeks to experience the desired effect of some NSAIDs
- Direct client to inform the dentist or
surgeon before a procedure when taking
ibuprofen or other NSAIDs for a continuous
period
NONSTEROIDAL ANTI-INFLAMMATORY
MOA: suppress the intensity of the
inflammatory process; can control inflammation by suppressing or preventing many of the components of inflammatory process at the injured site
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
USES: Myocarditis, pericarditis, arthritis,
tendonitis, bursitis, ulcerative colitis, dermatitis
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
Major side effects:
Buffalo hump - accumulation of fat on
the back of the neck
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
Major side effects:
Moon face - rounded, puffy face
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
Major side effects:
immunosuppressant effect -inability of
the immune system to respond to
antigenic stimulation
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
Major side effects:
- Growth retardation
- Mood swing
- Acne
- Trunkal obesity
- Sterility
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
Major side effects:
- Cardiac dysrhythmias - tachycardia
most common
- Inhibited CHON synthesis
- Hypokalemia, hypocalcemia,
hyperglycemia, hypernatremia, hypertension
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
NURSING CONSIDERATIONS:
- Usually recommended for short term
use
- Taper off slowly to prevent adrenal
insufficiency
- High CHON, potassium, calcium, low
sodium intake
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
- Daily eight, report weight gain > 5 lbs
- Check CBC. Strengthen immune system
- Take with food
- Avoid vaccines without APs approval
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
cortisone acetate (Corstitan)
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
hydrocortisone (Cortisol)
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
prednisone (Deltasone)
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
fluticasone (Flixotide)
STEROIDAL ANTI-INFLAMMATORY CORTICOTEROIDS
dexamethasone (Decadrone)
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
betamethasone (Celestone)
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
budesonide (Budecort)
STEROIDAL ANTI-INFLAMMATORY CORTICOSTEROIDS
Common drugs Colchicine (Novovolchine)
- Anti inflammatory
- Inhibits migration of leukocytes at
inflamed site
- Does not inhibit uric acid, does not
promote uric acid excretion
ANTI-GOUT AGENTS
Probenecid (Benemid)
- Uricosuric agent
- Increase rate of uric acid excretion by
inhibiting its reabsorption
- Should not be used in acute attack
ANTI-GOUT AGENTS
Sulfinpyrazone (Anturane)
- More potent than probenecid
ANTI-GOUT AGENTS
Allopurinol (Zyloprim)
- Uric acid inhibitor, not anti inflammatory
- Inhibits final step of uric acid biosynthesis
- Useful for client who do not respond well
to uricosurics
ANTI-GOUT AGENTS
USES:
- Comtrol acute inflammation of the attack
- Increase excretion of uric acid
- Decrease production of uric acid
- Gouty arthritis
- Control uric acid production with
antineoplastic drug therapy
ANTI-GOUT AGENTS
SE: kidney stones, N/V, diarrhea, HA, flushed skin & rash, metallic taste, drowsiness
ANTI-GOUT AGENTS
AE: Bone Marrow depression
ANTI-GOUT AGENTS
Nursing Responsibilities:
- Fluid intake (at least 2L/day)
- Alkaline urine: Milk, Fruits except
cranberries, plums, prunes, Most vegetables,
Small amount of beef
- Compliance, low purine foods: (high)
beer, wine, shellfish, legumes, gravy, organ
meat, salmon, sardines
- CBC
- Acetaminophen instead of ASA (elevate
uric acid)
- Avoid large doses of Vit C
- Take with food
ANTI-GOUT AGENTS
