Non Opioids and Adjuvants (Exam 2)

Question 1

Atypical pain Medications: tramadol

Answer 1

Centrally acting analgesic

Question 2

tramadol: MOA

Answer 2

-Binds weakly to mu opioid receptors

-Inhibit reuptake of norepi and serotonin

Question 3

tramadol: Indications

Answer 3

Treat moderate to serve pain

Question 4

tramadol: Adverse effects

Answer 4

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

Question 5

Aptyipical pain Medication: Anti-convulsnats

Answer 5

Gabapentin and pregablin

Question 6

Anti-convulsants: MOA

Answer 6

-Unknown, but thought to spontaneously suppress neuronal firing

Question 7

Ant-convulsants: Indication

Answer 7

-To complement affects of opioids

-Used for neuropathic pain (chronic) (CNS)

Question 8

Anti-convulsants: Adverse Effects

Answer 8

-Drowsy, dizzy, visual problems

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

Question 9

gabapentin has what effect?

Answer 9

Ceiling effect. 1800 mg per day.

taking more than that doesn’t give anymore benefit

Question 10

Non-Opioid Analgesics

Answer 10

-NSAIDS
(Non-sterodial anti-inflammatory drugs)

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

Question 11

2 categories of NSAIDS

Answer 11

-Nonselective COX inhibitors

-Selective COX-2 inhibitors

Question 12

NSAIDS: MOA

Answer 12

-Anti-prostaglandinds (Inhibit prostaglandin function)

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

Question 13

2 types of cyclooxygenase (COX)

Answer 13

-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

Question 14

Asprin special characteristic

Answer 14

-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

Question 15

Traditional (non specific NSAIDS)

Answer 15

-Blocking COX 1 and COX 2 action

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

Question 16

Selective NSAIDS

Answer 16

-Blocks COX-2

-Only inhibits pain, bone formation, and fever

-Maintain Gastric Protection and platelet function

Question 17

NSAIDS: Non-Selective COX inhibitors

Answer 17

asprin
ibuprofin
naproxen
ketorolac

Question 18

NSAIDS: Selective COX-2

Answer 18

celecoxib

Question 19

asprin

Answer 19

-non selective COX inhibitor

-Combined with caffeine is excedrin

Question 20

ibuprofen

Answer 20

-most common

-easiest on stomach

Question 21

naproxen

Answer 21

hard on kidney

last longer (once day)

Question 22

ketorolac

Answer 22

-IV NSAID

-Hard on kidneys

Question 23

celecoxib

Answer 23

COX-2 selective inhibitor

-decrease GI side effects

Question 24

NSAID indications

Answer 24

-Moderate pain
-Inflammation
-Fever
-Pain

Question 25

NSAID: Non Selective: Side effects

Answer 25

-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

Question 26

NSAID: Selective COX-2 Inhibitors: Side Effects

Answer 26

-GI mucosa still protected and platelet function not impacted -No impact/effect on platelets -More serious thrombotic events (More Heart attack and Stroke)

Question 27

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

Answer 27

Cardiovascular Risk

Question 28

Black Box Warnings with NSAIDS

Answer 28

Cardiovascular Risk Gastrointestinal Risk

Question 29

asiprin specific side effect

Answer 29

-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)

Question 30

Do you give aspirin to kids?

Answer 30

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)

Question 31

ketorolac: Indication

Answer 31

-Most potent NSAID -Given IV or IM -Used to treat acute (short term) moderate to severe pain -Similar to morphine but without respiratory depression

Question 32

ketorolac: Nursing consideration

Answer 32

-Used for 5 days or less -Has a very hard impact on the kidneys and GI tract

Question 33

ketorolac: side effects

Answer 33

GI ulcers and high risk of renal dysfunction

Question 34

acetaminophen: MOA

Answer 34

-Unknown -possible decrease prostaglandin synthesis in the CNS

Question 35

acetaminophen: Indications

Answer 35

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

Question 36

Acetaminophen: Limitations

Answer 36

-Ceiling effect -Non anti-inflammatory properties

Question 37

Acetaminohphen: Side effects

Answer 37

-With normal doses (not really any) -Large amounts (hepatic necrosis = liver failure) -Nephropathy: Jaundice, elevated LFT's and creatinine levels

Question 38

Acetaminophen: Adult dose restriction

Answer 38

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)

Question 39

acetaminophen toxicity and overdose management

Answer 39

-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

Question 40

Acetaminophen acute ingestion antidote

Answer 40

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

Question 41

acetaminophen and alcohol

Answer 41

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

Question 42

Who should avoid taking aceteminophen

Answer 42

Patients who have hepatitis or liver dysfunction

Question 43

IV aceteminophen

Answer 43

Ofirmev Same MOA Advantage: manage pain with less opioid use with fewer side effects

Question 44

Ofrimev: Indications

Answer 44

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

Question 45

Pearls for Practice: non-opioid analgesics

Answer 45

-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)

Question 46

What opioids do we not want to give with acetaminophen

Answer 46

PERCOCET

Question 47

Liver Disease or a-lot of alcohol

Answer 47

-2 grams/24hrs