Non Opioid Analgesics Flashcards
Therapeutic effect
Anti-inflammatory, antipyretic, and analgesic actions
What types of meds are included?
Nonsteroidal anti-inflammatory drugs and acetaminophen
First-generation NSAID list
- Aspirin
- Ibuprofen
- Naproxen
- Indomethacin
- Diclofenac
- Ketorolac
- Meloxicam
Second-gen NSAID
Celecoxib (selective COX-2 inhibitor)
Expected pharmacologic action of Non-opioid analgesics
- 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
Therapeutic uses
- mild to moderate pain
- inflammation
- fever
- dysmenorrhea
- protection against stroke and MI
- celecoxib also can protect against colorectal cancer
GI side effects
- dyspepsia (indigestion)
- abdominal pain
- heartburn
- nausea
GI long term complications
- peptic ulcers
- increased risk in smokers, elderly, previous ulcers, and alcoholism
- administer omeprazole (proton pump inhibitor) or cimetidine (H2 receptor antagonist)
Kidney complications
- decreased urine output
- weight gain
- increased BUN and creatinine
Cardio complications
Increased risk of heart attack and stroke (non aspirin)
Use smallest effective dose
Salicylism
Tinnitus, sweating, headache, dizziness, respiratory alkalosis
Reye’s syndrome
- rare
- when aspirin is used for fever in children who have a virus
Aspirin toxicity
- progresses from salicylism to sweating, high fever, acidosis, dehydration, electrolyte imbalance, coma, resp depression
- Medical emergency: charcoal, hemodialysis, IV fluids, bicarbonate, gastric lavage
Contraindications for first gen NSAIDS
- pregnancy
- Peptic ulcer disease
- Bleeding disorders
- Hypersensitivity
- Viral illness in children
Precautions for first gen NSAIDS
- older adults
- smokers
- alcoholism
- H pylori infection, hypovolemia, asthma, urticaria, bleeding disorders
- ACE inhibitors
Contraindications/precautions for 2nd gen NSAID
- celecoxib is last choice for chronic pain due to increased MI and stroke risk (suppresses vasodilation)
- contraindicated for sulfa allergy
Interactions
- 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
Indication for ketorolac
moderate to severe pain (postoperative)
Use with opioids to minimize adverse effects
How far in advance should you stop aspirin before surgery?
1 week
Pharmacologic action of acetaminophen
slows production of prostaglandins in CNS
Therapeutic use of acetaminophen
pain and fever
Adverse effects of acetaminophen
- toxicity: liver damage progressing to hepatic failure, coma, death
- rare adverse effects at therapeutic dose
Recommended intake of acetaminophen
- should not exceed 4 g/day for most adults, 3 g/day for malnourished adults, and 2 g/day for alcoholic
Acetaminophen contraindications
- 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
Acetaminophen interactions
- alcohol increases liver damage risk
- slows metabolism of warfarin = bleeding
