Drugs (Opioids & NSAIDs) Flashcards
Morphine
(OPIOID) Indicated for moderate to severe pain
Can stimulate histamine release, leading to pruritus (itching)
Tablets gotta be taken whole
Hydromorphone
(OPIOID) Slightly shorter duration than morphine
Indicated for moderate to severe pain
Methadone
(OPIOID) High oral and rectal bioavailability
Accumulates with repeated dosing; Use with caution in older adults Used in treatment of opioid use disorder
Risk of QT interval prolongation with high doses
Fentanyl
(OPIOID) Immediate onset after IV route; 7-8min after IM route; 5-15min after transmucosal route; up to 6 hr transdermal route
For procedures; IV fentanyl often combined with benzodiazepines
Very potent, dosage is in micrograms
Transdermal fentanyl only indicated for chronic pain and should not be administered to opioid-naive patients
Oxycodone
(OPIOID) Available as single entity and in combination with a nonopioid
Can be used similarly to oral morphine for moderate to severe pain
Hydrocodone
(OPIOID) Used for moderate or moderately severe pain
Generally indicted for short-term management of moderate to severe acute pain (trauma, musculoskeletal)
Codeine
(OPIOID) Associated with higher incidence of nausea and constipation than other mu agonists
Many codeine preparations are combined with acetaminophen
5-10% of European Americans lack the enzyme to metabolize codeine to morphine
Tramadol
(OPIOID) Dual mechanism of act; mu opioid agonist and blocks reuptake of norepinephrine and serotonin
Used for moderate pain. Generally better tolerated with the older population. Less side effects of respiratory depression.
Acetaminophen
(Tylenol) (Antipyretic) MAX daily dose of 3-4g (4000mg for adults, 3200 for geriatric, 2000mg for patients with chronic alcoholism)
MOA: Inhibits the synthesis of prostaglandins that may serve as mediators for pain and fever in the CNS
Therapeutic Effect: Relief of mild pain and fever, does NOT have anti inflammatory properties
Adverse effects: skin reddening, blisters, rash , hepatoxicity, Liver failure
PT teaching: no drinking, do not exceed 10 days, report rash
Aspirin
(NSAID/ Antipyretic)
MOA: Aspirin produces analgesia and reduces inflammation and fever by inhibiting the production of prostaglandins. Also decreases platelet aggregation
Indications for Use: used for mild pan and fever
Adverse Effects: Possibility of upper GI bleeding, GI upset and tinnitus
Used more commonly in low doses as a cardioprotective measure for analgesia
Pt Teaching: avoid drinking, report tinnitus, unusual bleeding, fever lasting >3 days
Ibuprofen (Motrin, Nuprin, Advil)
(NSAID) Limit treatment to 5 days
May precipitate renal failure in dehydrated patients
Inhibits prostaglandin synthesis
Indication for use: for mild-moderate pain and fever; inflammatory disorders including rheumatoid arthritis and osteoarthritis, and pain associated with dymenorrhea (painful menstruation)
Adverse Effects: headache, GI bleed, constipation, dyspepsia(indigestion), renal failure
Pt teaching: consume with full glass of water, remain upright for 30 min, avoid alcohol, no longer than 10 days, Report rashes, visual changes, tinnitus, weight gain, flu like symptoms
Naproxen (Naprosyn, Aleve)
(NSAID) Use lowest effective dose for shortest possible duration
Longer acting NSAID. Monitor renal function. Do not crush.
Naproxen (Naprosyn, Aleve)
(NSAID) Use lowest effective dose for shortest possible duration
Longer acting NSAID. Monitor renal function. Do not crush.
Ketorolac (Toradol)
(NSAID) Causes fewer GI side effects (bleeding) than other NSAIDs but still risk. Short term use only. IT is more costly than other NSAIDs
May increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.
Risks may increase with duration of use, preexisting cardiovascular disease, or risk factors for cardiovascular disease. Monitor renal function.
Diclofenac K (Voltaren)
(NSAID) Use lowest effective dose for shortest possible duration. Monitor renal function.
