Non Opioid Analgesics

Question 1

Therapeutic effect

Answer 1

Anti-inflammatory, antipyretic, and analgesic actions

Question 2

What types of meds are included?

Answer 2

Nonsteroidal anti-inflammatory drugs and acetaminophen

Question 3

First-generation NSAID list

Answer 3

• Aspirin
• Ibuprofen
• Naproxen
• Indomethacin
• Diclofenac
• Ketorolac
• Meloxicam

Question 4

Second-gen NSAID

Answer 4

Celecoxib (selective COX-2 inhibitor)

Question 5

Expected pharmacologic action of Non-opioid analgesics

Answer 5

• Inhibition of COX-1: decreased platelet aggregation and kidney damage
• Inhibition of COX-2: decreased pain, inflammation, and fever but does not decrease platelet aggregation

Question 6

Therapeutic uses

Answer 6

• mild to moderate pain
• inflammation
• fever
• dysmenorrhea
• protection against stroke and MI
• celecoxib also can protect against colorectal cancer

Question 7

GI side effects

Answer 7

• dyspepsia (indigestion)
• abdominal pain
• heartburn
• nausea

Question 8

GI long term complications

Answer 8

• peptic ulcers
• increased risk in smokers, elderly, previous ulcers, and alcoholism
• administer omeprazole (proton pump inhibitor) or cimetidine (H2 receptor antagonist)

Question 9

Kidney complications

Answer 9

• decreased urine output
• weight gain
• increased BUN and creatinine

Question 10

Cardio complications

Answer 10

Increased risk of heart attack and stroke (non aspirin)
Use smallest effective dose

Question 11

Salicylism

Answer 11

Tinnitus, sweating, headache, dizziness, respiratory alkalosis

Question 12

Reye’s syndrome

Answer 12

• rare
• when aspirin is used for fever in children who have a virus

Question 13

Aspirin toxicity

Answer 13

• progresses from salicylism to sweating, high fever, acidosis, dehydration, electrolyte imbalance, coma, resp depression
• Medical emergency: charcoal, hemodialysis, IV fluids, bicarbonate, gastric lavage

Question 14

Contraindications for first gen NSAIDS

Answer 14

• pregnancy
• Peptic ulcer disease
• Bleeding disorders
• Hypersensitivity
• Viral illness in children

Question 15

Precautions for first gen NSAIDS

Answer 15

• older adults
• smokers
• alcoholism
• H pylori infection, hypovolemia, asthma, urticaria, bleeding disorders
• ACE inhibitors

Question 16

Contraindications/precautions for 2nd gen NSAID

Answer 16

• celecoxib is last choice for chronic pain due to increased MI and stroke risk (suppresses vasodilation)
• contraindicated for sulfa allergy

Question 17

Interactions

Answer 17

• anticoagulants increase bleeding risk
• glucocorticoids increase gastric bleeding risk
• alcohol increases bleeding risk
• ibuprofen decreases antiplatelet effects of low dose asprin to decrease MI
• Ketorolac with other NSAIDS increases their adverse effects
• fevervew, garlic, ginger, ginkgo increase bleeding risk

Question 18

Indication for ketorolac

Answer 18

moderate to severe pain (postoperative)
Use with opioids to minimize adverse effects

Question 19

How far in advance should you stop aspirin before surgery?

Answer 19

1 week

Question 20

Pharmacologic action of acetaminophen

Answer 20

slows production of prostaglandins in CNS

Question 21

Therapeutic use of acetaminophen

Answer 21

pain and fever

Question 22

Adverse effects of acetaminophen

Answer 22

• toxicity: liver damage progressing to hepatic failure, coma, death
• rare adverse effects at therapeutic dose

Question 23

Recommended intake of acetaminophen

Answer 23

• should not exceed 4 g/day for most adults, 3 g/day for malnourished adults, and 2 g/day for alcoholic

Question 24

Acetaminophen contraindications

Answer 24

• Pregancy risk category B for oral and rectal, and C for IV
• hypersensitivity
• severe liver disease or kideny disease
• alcoholism
• malnourishment
• Use IV cautiously when breastfeeding

Question 25

Acetaminophen interactions

Answer 25

• alcohol increases liver damage risk
• slows metabolism of warfarin = bleeding