drugs used to manage pain Flashcards
Nonnarcotic Analgesics: Salicylates
and Nonsalicylates (action, use, adverse reactions, interactions, administration)
ACTION:
SALICYLATES: Has analgesic (relieves pain), antipyretic (reduces elevated body temperature), and anti-inflammatory effects. Analgesic & anti-inflammatory effect is thought to come from the inhibition of prostaglandins (fatty acid derivatives found in many tissues), lowers an elevated body temperature by dilating peripheral blood vessels, which cools the body.
Aspirin (is special) inhibits prostaglandins synthesis more, prolongs the bleeding time by inhibiting the aggregation (clumping) of platelets (irreversible for the 7-10 lifespan of platelets)
NONSALICYLATES: Acetaminophen is a nonsalicylate nonnarcotic analgesic and has analgesic and antipyretic activity. Does not possess anti-inflammatory action
USE:
SALICYLATES: Relief of mild to moderate pain, reduction of elevated body temperature, treatment of inflammatory conditions, reduction of the risk of myocardial infarction in those with unstable angina or previous myocardial
infarction (aspirin only), reduction of the risk of transient ischemic attacks or strokes in men who have had transient ischemia of the brain due to fibrin platelet emboli
(aspirin only)
NONSALICYLATES: Relieve mild to moderate pain, reduce elevated body temperature (fever), particularly useful for those with aspirin allergy, bleeding disorders, and those who have recently had minor surgical procedures. Although acetaminophen has no anti-inflammatory action, it may be used to relieve pain and discomfort associated with arthritic disorders.
ADVERSE REACTIONS:
SALICYLATES: Gastric upset, heartburn, nausea, vomiting, anorexia, GI bleeding (significant when taken over a period of time), Salicylate toxicity (leads to salicylism)
NONSALICYLATES: Skin eruptions, urticaria, hemolytic anemia,
pancytopenia, hypoglycemia, jaundice, hepatotoxicity, and hepatic failure (usually happens during chronic use or when the recommended dosage is exceeded). Acetaminophen toxicity (symptoms: nausea, vomiting, confusion, liver tenderness, hypotension, arrhythmias, jaundice, acute hepatic and renal failures)
INTERACTIONS:
SALICYLATES: Food containing salicylate (curry powder, paprika,
licorice, prunes, raisins, and tea) may increase the risk of adverse reactions, decreases the absorption of the salicylates w/ activated charcoal, Antacids may decrease the effects of the salicylates, increases the risk of salicylism w/ carbonic anhydrase inhibitors, Aspirin may increase the risk of bleeding during heparin administration, increases NSAID blood levels w/ NSAIDs
NONSALICYLATES: Avoid alcohol (hepatotoxicity) if taking more than an occasional dose of acetaminophen and avoid taking it concurrently with the salicylates or the NSAIDs. Use with barbiturates, hydantoins, isoniazid, and rifampin may increase the toxic effects and possibly decrease the therapeutic effects of acetaminophen. The effects of loop diuretics may be decreased when administered with acetaminophen.
ADMINISTRATION:
SALICYLATES: w/ food, milk, or a full glass of water to prevent gastric upset, patients should avoid salicylates for at least 1 week before any type of major or minor surgery and should not use salicylates after any type of surgery until complete healing has occurred
NONSALICYLATES: w/ a full glass of water, may take w/ meals or on an empty stomach
Nonnarcotic Analgesics: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (action, use, adverse reactions, interactions, administration)
ACTION: Have anti-inflammatory, antipyretic, and analgesic effects. thought to act by inhibiting prostaglandin synthesis by inhibiting the action of the enzyme cyclooxygenase. Inhibits cycloo1xygenase-1 (COX-1, the enzyme that helps to maintain the stomach lining) and cyclooxygenase-2 (COX-2, the enzyme that triggers pain and inflammation). Inhibition of COX-2 for anti-inflammatory effects of the NSAIDs and inhibition of COX-1 causes GI adverse reactions. Newer NSAIDs (celecoxib and rofecoxib) appear to work by inhibiting the COX-2 enzyme, without inhibiting the COX-1 enzyme. Traditional NSAIDs (ibuprofen and naproxen) regulate pain and inflammation by blocking COX-2, they also inhibit COX-1 causing GI reactions. Traditional NSAIDs (ibuprofen and naproxen) regulate pain and inflammation by blocking COX-2, also inhibits COX-1 (causes GI adverse reactions)
USE: Relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, and other musculoskeletal disorders, mild to moderate pain relief, primary dysmenorrhea, fever reduction
ADVERSE REACTIONS: Reactions (not that common though) can affect the GI tract, central nervous system, cardiovascular, renal, special senses, hematologic, skin, and metabolic/endocrinologic
CELECOXIB: Dyspepsia, abdominal pain, diarrhea, nausea, headache,
compromises renal function, elevates aminotransferase levels
IBUPROFEN: Headache, dizziness, somnolence, nausea, dyspepsia, GI pain, and rash
NAPROXEN: Headache, vertigo (dizziness), somnolence, insomnia,
nausea, dyspepsia, GI pain, and rash
ROFECOXIB: Headache, dizziness, somnolence, insomnia, dyspnea,
hemoptysis, and rash
INTERACTIONS: Prolongs bleeding time and increases the effects of anticoagulants, lithium, cyclosporine, and hydantoins. May decrease the effects of diuretics or antihypertensive drugs. Long-term use of w/ acetaminophen may increase the risk of renal impairment
CELECOXIB: Increased risk for
bleeding w/ anticoagulants
IBUPROFEN: Increased risk of lithium toxicity w/ lithium, decreased effect of the diuretic w/ ibuprofen, decrease in the antihypertensive effect of the beta-adrenergic blocking drug w/ ibuprofen
NAPROXEN: Increases the risk of
lithium toxicity w/ lithium, increases the risk for bleeding w/ anticoagulants, decreases the antihypertensive effect w/ antihypertensives, and coadministration of naproxen w/ the diuretics decreases the diuretic effect
ROFECOXIB: Similar to other NSAIDs, increased risk of bleeding when taken w/ anticoagulants and a risk of lithium toxicity when taken concurrently w/ lithium.
ADMINISTRATION: W/ food, milk, or antacids. A full glass of water helps with GI effects.
