MCP: Analgesics Flashcards
Non-Pharmacologic Options for Pain Management
- R.I.C.E
- Heat
- Physical Therapy
- Exercise
- Acupuncture
- Massage
- Hypnosis
- Cognitive Behavioral Therapy
- Visualization
- Breathing Techniques
Using these may help save money, get full relief, not need to take as high of doses
What is Pain?
- Sensation that causes discomfort
- Types of Pain:
- Nociceptive
- Neuropathic
- Migraine
- Universal Pain Assessment Tool
- Rank pain on a scale of 1-10
Nociceptive Pain
- Definition
- Classes of medications used
- Definition: Pain caused by damage to body tissues
- Classes of medications used:
- Acetaminophen
- NSAIDs
- Nonselective
- COX-2 selective inhibitors
- Opioid analgesics
- Other: tramadol
Indications for Acetaminophen
- Mild-moderate pain
- Sometimes severe pain
- Fever
What major toxicity should you be concerned about with acetaminophen?
- Hepatotoxicity
What is the maximum daily dose of acetaminophen you should recommend to a patient?
- 3g according to package
- 4g according to FDA
Acetaminophen: Pearls
- Remember many OTC medications and opioid analgesic combinations contain acetaminophen
- Make sure not taking over daily recommended maximum
- Preferred analgedic in pregnant or breastfeeding women
- Infant and children acetaminophen weight based dosing
- Double check what concentration using
NSAID: Nonselective vs. Selective
- Celebrex is brand only
NSAIDs: MOA
- Inhibit enzymes that convert arachidonic acid into prostaglandins
- COX-1
- Expressed in almost all body tissues
- Resonsible for “housekeeping” function (gastric mucosa, platelet aggregation, kidney function, etc.)
- COX-2
- Expressed in sites of inflammation
Nonselective NSAIDs: Uses
- Mild to moderate pain (arthritis, dysmenorrhea, inflammation)
- Acetaminophen NOT for inflammation
Nonselective NSAIDs: Onset of Action
- ~30-60 min
Nonselective NSAIDs: Side Effects
- Dizziness
-
GI upset
- Nausea/Vomiting
- Heartburn
- Dyspepsia (Indigestion)
- *Instruct patients to take with food or milk (carbohydrates)
Nonselective NSAIDs: Precautions/Warnings
- Risk of gastrointestinal ulcers or bleeding
- Risk of cardiovascular events including heart attack or stroke
- *Associated with higher doses and longer periods of use*
Nonselective NSAIDs: Use with Caution In
- Kidney dysfunction
- Cardiovascular risk or disease
- Older adults
- Less GI mucosa protection
- Avoid taking two NSAIDs concurrently
- Saturates COX enzymes, not get anymore benefit, get more side effects
Nonselective NSAIDs: Contraindications
- Allergy to aspirin or any NSAID
Selective NSAIDs: celecoxib (Celebrex®) Uses
- Arthritis
- Dysmenorrhea
- Acute Pain
Celecoxib: Onset of Action
- ~1 hour (acute pain)
- 1-2 weeks (chronic pain)
Celecoxib: Side Effects
- GI upset
- Not as common as nonselective NSAID
- Not as common as nonselective NSAID
*May be taken with or without food*
Celecoxib: Precautions/Warnings
- Similar to nonselective NSAIDs
Celecoxib: Contraindications
- Allergy to aspirin or other NSAIDs
- Allergy to sulfonamides
Opioid Analgesics
- Actiq is brand only
- Lolipop
Opioid Analgesics: MOA
- Binds to µ-opiate receptors in the CNS to alter perception of pain
- Brain and spinal cord
- Spinal Column
- Alters how pain is sent to brain
- Brain
- Alter brain’s processing and perception of pain
Opioid Analgesics: Uses
- Moderate to severe pain
- Post operative pain
- Acute pain
- Chronic pain