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
Opioid Analgesics: Time to Effect
- Varies
- usually within 15-30 minutes; longer for ER formulations
Opioid Analgesics: Side effects
- Drowsiness/sedation
- Take 1st dose at home to see how affects patient before driving
- Nausea/vomiting
- GI upset
- Constipation
- Common
- Because smooth muscle processes slowed down
Opioid Analgesics: Contraindications
- Certain respiratory disorders
- Severe asthma or respiratory depression
Opioid Analgesics: Administration Instructions
- Take with food or milk
- If dose is a range, start with lower dose
- Take 1 tab, if no relief, then take another at specified time interval
Opioid Analgesics: Precautions/Warnings
- Respiratory depression
- Avoid alcohol
- Respiratory depression
- May cause CNS depression
- Caution with driving
- Habit-forming; potential for abuse/misuse
- Not preferred for chronic pain
- May cause euphoria in some patients, causing dependency
- Combination products with acetaminophen; emphasize maximum daily dose of acetaminophen
Tramadol
Tramadol: MOA
- Binds to µ-opiate receptors in the CNS to alter perception of pain and alters concentrations of serotonin and norepinephrine in the brain
Tramadol: Uses
- Moderate to moderately-severe pain
Tramadol: Time to Effect
- ~1 hour
Tramadol: Side Effects
- Dizziness
- Drowsiness
- Constipation
- Nausea/Vomiting
Not cause GI upset
Tramadol: Administration Instructions
- Take with or without food
Tramadol: Precautions/Warnings
- May cause CNS depression
- Take 1st dose at home
- Caution with driving
- Avoid alcohol
- lowers threshold for seizures
- Potential for abuse/misuse
- May increase risk of seizures
- Use with caution in those with seizure disorders or seizure risk
- Ultracet®; emphasize maximum daily dose of acteminophen
Neuropathic Pain
- Definition
- Medications
- Definition: Pain originating from nerve damage
- Diabetics
- uncontrolled glucose levels lead to syrupy blood
- Block capilaries, tissue death, nerve damage
- Diabetics
- Medications
- GABA analouge
- gabapentin
- pregabalin
- GABA analouge
Gabapentin: Brand name
- Neurontin®
Gabapentin: MOA
- Unknown
Gabapentin: Uses
- Seizure disorders
- Neuropathic pain (unlabeled use)
- Other
Gabapentin: Time to Effect
- May take several days or a few weeks
- counsel paitents on taking regularly to feel the full effect
Gabapentin: Side Effects
- Dizziness
- Most common
- Somnolence
- Ataxia
- Difficulty moving
- Fatigue
Start @ low dose and titrate up due to side effects
Gabapentin: Administration Instructions
- May take with or without food
- No GI upset
- Administer at least 2 hours after antacids
- Alters absorption
Gabpentin: Precautions/Warnings
- CNS depression
- Caution with driving
- Avoid alcohol
Pregabalin
Brand only: Lyrica®
- Schedule V: sometimes causes euphoria
Pregabalin: MOA
- Unknown
Pregabalin: Uses
- Seizure disorders
- Neuropathic pain
- Other
Pregabalin: Time to Effect
- As early as first week of therapy
- Not prn, take regularly
Pregabalin: Side Effects
- Dizziness
- Somnolence
- **Blurred vision or diptopia **
- Weight gain
- **Peripheral edema **
Pregabalin: Administration Instructions
- May take with or without food
Pregabalin: Precautions/Warnings
- CNS effects
- Caution with driving
- Avoid alcohol
- Caution in heart failure
- Because of peripheral edema
- May worsen
- Caution in kidney dysfunction
- also gabapentin
- almost all renally cleared, may accumulate
- Angioedema
- Rare, but may be life-threatening
- Notify healthcare provider of swelling of face or mouth
- Can happen at anytime in treatment
Migraine: Definition
- Chronic neurological disorder
- moderate to severe headache
- Other symptoms
- Unilateral, frontal or global
- Gradual onset lasting 4-72 hours
- Nausea, light/sound sensitivity
- With or without aura (see spot/light)
Migraine: Medications
Serotonin (5-HT18, 10) receptor agonists
Serotonin Receptor Agonists: Medications
Serotonin Receptor Agonists: MOA
- Bind to serotonin receptors in cranial arteries, causing local vasoconstriction therby relieving migraines
Serotonin Receptor Agonists: Dosage Forms
- Rizatriptan: Oral tablet, oral disintegrating tablet
- Sumatriptan: Oral tablet, nasal spray, subutaneous injection
- Zolmitriptan: Oral tablet, oral disintegrating tablet, nasal spray
Serotonin Receptor Agonist: Time to Effect
- Rizatriptan: within 2 hours
- Sumatriptan: oral ~30 min, nasal ~10-20 min, subcutaneous ~10 min
- Zolmitriptan: oral ~60 min
Serotonin Receptor Agonist: Side Effects
- Nausea/Vomiting (nasal spray)
- Dizziness
- Weakness
- Paresthesias (subcutaneous)
- tingly in extremities
- tingly in extremities
Serotonin Receptor Agonist: Administration Instructions
- Administer as soon as migraine symptoms appear; may need to be redosed within two hours if symptoms persist
- Orally disintegrating tablet; place under tongue and allow to dissolve
- Nasal spray; pre-loaded with one dose
- Warn patient not to test dose
Serotonin Receptor Agonists
- Precautions/Warnings
- Abortive, not preventative agents
- @ onset of symptoms
- Serotonin syndrome
- Caution with pro-serotonergic drugs
- Serotonin overload
- Overuse may lead to rebound headaches (more than 10 dose/month)
- detox from drug, if more headaches than 10/month, see doctor for preventative measures
- Abortive, not preventative agents
- Use with caution in those with:
- Seizure disorder
- Coronary heart disease or cardiovascular risk factors
