Exam 1 Analgesics (new) Flashcards
what 4 drugs are used for pain? (opioid agonists)
o fentanyl
o hydromorphone
o morphine
o codeine
opioid indications
o pain
o cough (codeine only)
o diarrhea (S/E of opioids is constipation which will help with diarrhea)
how do opioid works? (MOA)
they activate opioid receptors resulting in decreased pain and decrease CNS function
SE/AE of opioids
o respiratory depression
o constipation
o nausea
o sedation
most common SE/AE of opioids
constipation
opioid BBW
o avoid alcohol and other CNS depressants
o respiratory depression
o risk for abuse and dependency
what opioid antagonists is used to reverse opioid overdose with signs of respiratory depression?
naloxone
- restores normal breathing by blocking the effects of opioid which causes respiratory depression due to difficulty breathing (reverses resp. depression)
what must you assess before and after administering opioids and naloxone?
o assess pain and LOC
o pulse ox (oxygen)
o lung sounds
o respiratory rate
o respiratory depth
what to look out for regarding respiratory depression
o respiratory rate
o respiratory depth
why are opioids produced in combination medications with acetaminophen?
intended to lower the overall opioid used and increase relief
- warning: risk for acetaminophen OD (too much is harmful and this combination puts people at risk)
example of a opioid and acetaminophen combination medication
Vicodin
- hydrocodone (opioid) & acetaminophen
if you suspect a patient to have an addiction, can you withhold pain relief/medication?
no
document and discuss with provider but do not withhold
o pump that is controlled by pt. giving them control of pain and treatment
o gives pt. extra small doses on top of what is administered by healthcare provider
o wont be able to OD on this because pump has a lock system when it detects patient has taken an excessive amount in a short period of time
patient controlled analgesia (PCA)
what drug is used for acute cluster headache and acute migraines?
sumatriptan
what drug class is sumatriptan part of?
serotonin 5-HT agonist
what is the allotted amount of sumatriptan to avoid causing rebound headaches?
o should not be prescribed more than 9x/month
o it is first line agent for acute migraines
o teratogenic
o can cause rebound headaches if taken in excess
o can cause serotonin syndrome if taken with other serotonin medications
sumatriptan
sumatriptan is contraindicated for patients with what?
o cardiac disease
o uncontrolled hypertension
what is sumatriptan OD treated with?
beta-adrenergic antagonist
NSAID
non-steroidal anti-inflammatory drug
what 6 drugs are used for inflammation? (NSAID)
o ibuprofen
o ketorolac
o meloxicam
o naproxen
o indomethacin
o aspirin
what enzyme results in inflammation?
cyclooxygenase
o cox I
o cox II
how does NSAIDs work? (MOA)
inhibit (block) cox 1 & 2
o body from producing stomach protective lining
o which allows acid to break through
o inhibits prostaglandins which cause inflammation
NSAIDs indications
o anti-inflammatory (RA, gout)
o analgesia
o antipyretic
what is aspirin specifically also used for?
suppression of platelet aggregation
o used for prevention of cardiovascular events
(should be stopped before major surgery and childbirthc
NSAIDs BBW
o GI bleeding
o cardiac events
which NSAIDs are Rx only?
o meloxicam
o indomethacin
o ketorolac
NSAIDs SE/AE
o GI bleeding
o nephrotoxicity (nephro = kidney)
o hepatotoxicity (hepa = liver)
what SE/AE is caused due to aspirin only?
tinnitus
aspirin should not be used in children under 18 yo due to risk of what?
reye’s syndrome
what drug class only inhibits cox II?
NSAID - cox 2 inhibitors
name the drug that falls under the drug class NSAID - COX 2 inhibitors?
celecoxib
celecoxib indication
anti-inflammatory such as RA and OA
celecoxib MOA
o inhibits COX2
what does COX 1 do?
produces protective lining in our stomach
what does COX 2 do?
responsible for inflammation
o releases prostaglandins that cause inflammation
why is NSAID - COX 2 inhibitors not used as 1st line drug in anti-inflammatory situations?
high risk of adverse cardiovascular events
- but less risk of adverse GI effects
what drug is used for analgesia and antipyretic
o does not have anti-inflammatory properties
acetaminophen (tyleonol)
what drug class does acetaminophen belong to?
central acting antagonist
acetaminophen BBW
hepatotoxicity
what is used to reverse acetaminophen OD
N-acetylcysteine
inhibits (block) COX at the CNS level causing the same relief of pain and anti-fever as NSAIDs but do not have the same risk of GI bleeding as NSAIDs
o best for those who have kidney disease instead of NSAIDs because it is not nephrotoxic
central acting antagonist
o acetaminophen (tylenol)
signs of hepatotoxicity
o ALT/AST
o jaundice
o liver inflammation
what is AST/ALT?
o aspartate transaminase
o alanine transaminase
o enzymes
o increase levels of AST or ALT may mean some type of liver damage
most commonly used class of drug?
NSAIDs
