MCP: Analgesics Flashcards

1
Q

Non-Pharmacologic Options for Pain Management

A
  • 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

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2
Q

What is Pain?

A
  • Sensation that causes discomfort
  • Types of Pain:
    • Nociceptive
    • Neuropathic
    • Migraine
  • Universal Pain Assessment Tool
    • Rank pain on a scale of 1-10
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3
Q

Nociceptive Pain

  • Definition
  • Classes of medications used
A
  • Definition: Pain caused by damage to body tissues
  • Classes of medications used:
    • Acetaminophen
    • NSAIDs
      • Nonselective
      • COX-2 selective inhibitors
    • Opioid analgesics
    • Other: tramadol
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4
Q

Indications for Acetaminophen

A
  • Mild-moderate pain
    • Sometimes severe pain
  • Fever
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5
Q

What major toxicity should you be concerned about with acetaminophen?

A
  • Hepatotoxicity
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6
Q

What is the maximum daily dose of acetaminophen you should recommend to a patient?

A
  • 3g according to package
  • 4g according to FDA
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7
Q

Acetaminophen: Pearls

A
  • 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
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8
Q

NSAID: Nonselective vs. Selective

A
  • Celebrex is brand only
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9
Q

NSAIDs: MOA

A
  • 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
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10
Q

Nonselective NSAIDs: Uses

A
  • Mild to moderate pain (arthritis, dysmenorrhea, inflammation)
  • Acetaminophen NOT for inflammation
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11
Q

Nonselective NSAIDs: Onset of Action

A
  • ~30-60 min
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12
Q

Nonselective NSAIDs: Side Effects

A
  • Dizziness
  • GI upset
    • Nausea/Vomiting
    • Heartburn
    • Dyspepsia (Indigestion)
  • *Instruct patients to take with food or milk (carbohydrates)
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13
Q

Nonselective NSAIDs: Precautions/Warnings

A
  • Risk of gastrointestinal ulcers or bleeding
  • Risk of cardiovascular events including heart attack or stroke
  • *Associated with higher doses and longer periods of use*
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14
Q

Nonselective NSAIDs: Use with Caution In

A
  • 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
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15
Q

Nonselective NSAIDs: Contraindications

A
  • Allergy to aspirin or any NSAID
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16
Q

Selective NSAIDs: celecoxib (Celebrex®) Uses

A
  • Arthritis
  • Dysmenorrhea
  • Acute Pain
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17
Q

Celecoxib: Onset of Action

A
  • ~1 hour (acute pain)
  • 1-2 weeks (chronic pain)
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18
Q

Celecoxib: Side Effects

A
  • GI upset
    • Not as common as nonselective NSAID
      ​​

*May be taken with or without food*

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19
Q

Celecoxib: Precautions/Warnings

A
  • Similar to nonselective NSAIDs
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20
Q

Celecoxib: Contraindications

A
  • Allergy to aspirin or other NSAIDs
  • Allergy to sulfonamides
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21
Q

Opioid Analgesics

A
  • Actiq is brand only
    • Lolipop
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22
Q

Opioid Analgesics: MOA

A
  • 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
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23
Q

Opioid Analgesics: Uses

A
  • Moderate to severe pain
    • Post operative pain
    • Acute pain
    • Chronic pain
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24
Q

Opioid Analgesics: Time to Effect

A
  • Varies
    • usually within 15-30 minutes; longer for ER formulations
25
Q

Opioid Analgesics: Side effects

A
  • 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
26
Q

Opioid Analgesics: Contraindications

A
  • Certain respiratory disorders
    • Severe asthma or respiratory depression
27
Q

Opioid Analgesics: Administration Instructions

A
  • 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
28
Q

Opioid Analgesics: Precautions/Warnings

A
  • 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
29
Q

Tramadol

A
30
Q

Tramadol: MOA

A
  • Binds to µ-opiate receptors in the CNS to alter perception of pain and alters concentrations of serotonin and norepinephrine in the brain
31
Q

Tramadol: Uses

A
  • Moderate to moderately-severe pain
32
Q

Tramadol: Time to Effect

A
  • ~1 hour
33
Q

Tramadol: Side Effects

A
  • Dizziness
  • Drowsiness
  • Constipation
  • Nausea/Vomiting

Not cause GI upset

34
Q

Tramadol: Administration Instructions

A
  • Take with or without food
35
Q

Tramadol: Precautions/Warnings

A
  • 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
36
Q

Neuropathic Pain

  • Definition
  • Medications
A
  • Definition: Pain originating from nerve damage
    • Diabetics
      • uncontrolled glucose levels lead to syrupy blood
      • Block capilaries, tissue death, nerve damage
  • ​Medications
    • GABA analouge
      • gabapentin
      • pregabalin
37
Q

Gabapentin: Brand name

A
  • Neurontin®
38
Q

Gabapentin: MOA

A
  • Unknown
39
Q

Gabapentin: Uses

A
  • Seizure disorders
  • Neuropathic pain (unlabeled use)
  • Other
40
Q

Gabapentin: Time to Effect

A
  • May take several days or a few weeks
    • counsel paitents on taking regularly to feel the full effect
41
Q

Gabapentin: Side Effects

A
  • Dizziness
    • Most common
  • Somnolence
  • Ataxia
    • Difficulty moving
  • Fatigue

Start @ low dose and titrate up due to side effects

42
Q

Gabapentin: Administration Instructions

A
  • May take with or without food
    • No GI upset
  • Administer at least 2 hours after antacids
    • Alters absorption
43
Q

Gabpentin: Precautions/Warnings

A
  • CNS depression
    • Caution with driving
  • Avoid alcohol
44
Q

Pregabalin

A

Brand only: Lyrica®

  • Schedule V: sometimes causes euphoria
45
Q

Pregabalin: MOA

A
  • Unknown
46
Q

Pregabalin: Uses

A
  • Seizure disorders
  • Neuropathic pain
  • Other
47
Q

Pregabalin: Time to Effect

A
  • As early as first week of therapy
  • Not prn, take regularly
48
Q

​Pregabalin: Side Effects

A
  • Dizziness
  • Somnolence
  • **Blurred vision or diptopia **
  • Weight gain
  • **Peripheral edema **
49
Q

Pregabalin: Administration Instructions

A
  • May take with or without food
50
Q

Pregabalin: Precautions/Warnings

A
  • 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
51
Q

Migraine: Definition

A
  • 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)
52
Q

Migraine: Medications

A

Serotonin (5-HT18, 10) receptor agonists

53
Q

Serotonin Receptor Agonists: Medications

A
54
Q

Serotonin Receptor Agonists: MOA

A
  • Bind to serotonin receptors in cranial arteries, causing local vasoconstriction therby relieving migraines
55
Q

Serotonin Receptor Agonists: Dosage Forms

A
  • Rizatriptan: Oral tablet, oral disintegrating tablet
  • Sumatriptan: Oral tablet, nasal spray, subutaneous injection
  • Zolmitriptan: Oral tablet, oral disintegrating tablet, nasal spray
56
Q

Serotonin Receptor Agonist: Time to Effect

A
  • Rizatriptan: within 2 hours
  • Sumatriptan: oral ~30 min, nasal ~10-20 min, subcutaneous ~10 min
  • Zolmitriptan: oral ~60 min
57
Q

Serotonin Receptor Agonist: Side Effects

A
  • Nausea/Vomiting (nasal spray)
  • Dizziness
  • Weakness
  • Paresthesias (subcutaneous)
    • tingly in extremities
58
Q

Serotonin Receptor Agonist: Administration Instructions

A
  • 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
59
Q

Serotonin Receptor Agonists

A
  • 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
  • ​​Use with caution in those with:
    • Seizure disorder
    • Coronary heart disease or cardiovascular risk factors