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NUR 325 PATHO > Non Opioids and Adjuvants (Exam 2) > Flashcards

Non Opioids and Adjuvants (Exam 2) Flashcards

1
Q

Atypical pain Medications: tramadol

A

Centrally acting analgesic

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2
Q

tramadol: MOA

A

-Binds weakly to mu opioid receptors

-Inhibit reuptake of norepi and serotonin

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3
Q

tramadol: Indications

A

Treat moderate to serve pain

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4
Q

tramadol: Adverse effects

A
  • Seizures when combined with other CNS depressants (SSRI-MAOI)
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5
Q

Aptyipical pain Medication: Anti-convulsnats

A

Gabapentin and pregablin

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6
Q

Anti-convulsants: MOA

A

-Unknown, but thought to spontaneously suppress neuronal firing

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7
Q

Ant-convulsants: Indication

A

-To complement affects of opioids

-Used for neuropathic pain (chronic) (CNS)

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8
Q

Anti-convulsants: Adverse Effects

A

-Drowsy, dizzy, visual problems

-Can only be partially reversed with Naloxone (overdose reverse)

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9
Q

gabapentin has what effect?

A

Ceiling effect. 1800 mg per day.

taking more than that doesn’t give anymore benefit

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10
Q

Non-Opioid Analgesics

A

-NSAIDS
(Non-sterodial anti-inflammatory drugs)

-Acetaminophen
(Not an NSAID) (NO ANTI-INFLAMMATORY properties)

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11
Q

2 categories of NSAIDS

A

-Nonselective COX inhibitors

-Selective COX-2 inhibitors

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12
Q

NSAIDS: MOA

A

-Anti-prostaglandinds (Inhibit prostaglandin function)

-Decrease prostaglandins by blocking a key enzyme: cyclooxygenase (COX) that is crucial to the production of prostaglandins

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13
Q

2 types of cyclooxygenase (COX)

A

-COX 1: Enzyme that protect the gastric mucosa and needed for thomboxane synthesis (Synthesis of prostoglandins)

-COX-2 enzyme: Responsible for inflammation and fever and bone formation

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14
Q

Asprin special characteristic

A

-Being a irreversible inhibitor of COX 1 receptor in platelets itself

-Reduces the formation of thromboxan which reduces platelet aggravation. Patient is less likely to clot

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15
Q

Traditional (non specific NSAIDS)

A

-Blocking COX 1 and COX 2 action

-Stoping gastric protection, platelet function, pain, bone formation, and fever

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16
Q

Selective NSAIDS

A

-Blocks COX-2

-Only inhibits pain, bone formation, and fever

-Maintain Gastric Protection and platelet function

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17
Q

NSAIDS: Non-Selective COX inhibitors

A

asprin
ibuprofin
naproxen
ketorolac

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18
Q

NSAIDS: Selective COX-2

A

celecoxib

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19
Q

asprin

A

-non selective COX inhibitor

-Combined with caffeine is excedrin

20
Q

ibuprofen

A

-most common

-easiest on stomach

21
Q

naproxen

A

hard on kidney

last longer (once day)

22
Q

ketorolac

A

-IV NSAID

-Hard on kidneys

23
Q

celecoxib

A

COX-2 selective inhibitor

-decrease GI side effects

24
Q

NSAID indications

A

-Moderate pain
-Inflammation
-Fever
-Pain

25
Q

NSAID: Non Selective: Side effects

A

-ASA, ibuprofen, naproxen, ketorolac

-Both COX-1 and COX-2 inhibited——prostaglandins and thromboxan synthesis is blocked = analgesia, anti-pryetic and anti-thrombotic

-GI upset, stomach ulcers, GI bleeding, rash, edema, kidney failure, increases BP, inhibits platelet aggregation, SOA in asthma patients

26
Q

NSAID: Selective COX-2 Inhibitors: Side Effects

A

-GI mucosa still protected and platelet function not impacted

-No impact/effect on platelets

-More serious thrombotic events (More Heart attack and Stroke)

27
Q

Aspirin in not a part of which black box warning list for all the NSAIDS

A

Cardiovascular Risk

28
Q

Black Box Warnings with NSAIDS

A

Cardiovascular Risk

Gastrointestinal Risk

29
Q

asiprin specific side effect

A

-Salicylate poisoning/toxicity

-Acute: N/V, seizures, cerebral edema

-Chronic: N/V, tinnitus

-Reyes Syndrome: NO ASPRIN FOR KIDS (rare life threatening illnnes of swelling of liver and brain)

30
Q

Do you give aspirin to kids?

A

No

Reyes Syndrome:
-Rare-life threatening
-Children <15 who have been given aspirin to treat a-viral infection
-Swelling of brain and liver (High mortality rate)

31
Q

ketorolac: Indication

A

-Most potent NSAID

-Given IV or IM

-Used to treat acute (short term) moderate to severe pain

-Similar to morphine but without respiratory depression

32
Q

ketorolac: Nursing consideration

A

-Used for 5 days or less

-Has a very hard impact on the kidneys and GI tract

33
Q

ketorolac: side effects

A

GI ulcers and high risk of renal dysfunction

34
Q

acetaminophen: MOA

A

-Unknown

-possible decrease prostaglandin synthesis in the CNS

35
Q

acetaminophen: Indications

A

-Mild to moderate pain and fever (anti-pyretic) (Hypothalamus)

36
Q

Acetaminophen: Limitations

A

-Ceiling effect

-Non anti-inflammatory properties

37
Q

Acetaminohphen: Side effects

A

-With normal doses (not really any)

-Large amounts (hepatic necrosis = liver failure)

-Nephropathy: Jaundice, elevated LFT’s and creatinine levels

38
Q

Acetaminophen: Adult dose restriction

A

4 gams/24 hours

-Total of 4 grams per day. Must count normal Tylenol and other medications combinations with Tylenol

(will see a question asking if the total Tylenol limit is safe)

39
Q

acetaminophen toxicity and overdose management

A

-Potentially lethal drug when taken in overdose

-Hepatotoxicity: One primary toxic metabolites is detoxifed in the liver by glutathione. Overdose depletes glutathione stores. So the toxic metabolite is able to accumulate in the liver resulting in necrosis

40
Q

Acetaminophen acute ingestion antidote

A

acetylcysteine (Oral or IV) (Oral makes patients want to puke)

41
Q

acetaminophen and alcohol

A

-Bad mixture

-Chronic alcohol user should limit Tylenol use (Less than 2 grams / 24 hrs)

42
Q

Who should avoid taking aceteminophen

A

Patients who have hepatitis or liver dysfunction

43
Q

IV aceteminophen

A

Ofirmev

Same MOA

Advantage: manage pain with less opioid use with fewer side effects

44
Q

Ofrimev: Indications

A

Acute pain/post opp

Usually in combination with opioids

somtimes first IV dose givin at time of incision or pre-opp

STILL COUNTED TOWARD Tylenol total

45
Q

Pearls for Practice: non-opioid analgesics

A

-Can alternate true NSAID’s with acetaminophen

-Good to give with conjuctnion with opioids for mediate to severe pain

-Choose NSAID if inflammation is the causative factor (cut on hand that is inflamed)

46
Q

What opioids do we not want to give with acetaminophen

A

PERCOCET

47
Q

Liver Disease or a-lot of alcohol

A

-2 grams/24hrs

NUR 325 PATHO (30 decks)

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