Pain Flashcards
What are the body’s three natural pain killers?
Serotonin
Enkephalins
Endorphins
What are the four pain mediating chemicals?
Substance P
Prostaglandins
Bradykinins
Histamine
What do opioid receptors do to mu, kappa, and delta?
mu: analgesia, resp. depression, euphria, sedation and physical dependence
kappa: analgesia, sedation, and psychotomimetic effects, hallucination and delusion
delta: no pharmacology-related effects
What chemicals create an inflammatory response?
bradykinins, histamine, prostaglandins, and leukotrienes
How does the adrenal gland suppress inflamation?
pituitary releases ACTH, which stimulates adrenal glands to produce cortisol and release aldosterone
What drug interferes with prostaglanding production?
NSAIDs
What are the three types of analgesics?
NSAIDS
opioids
opioid antagonists
What are the types of anti-inflammatories?
glucocorticoids
uricosurics
What are t
What are the four types of nonopioid analgesics?
1st gen
NSAIDs, COX-1 and COX-2 inhibitors
2nd gen
acetaminophen
dual- mechanism analgesic agents
Whtat is the prototype drug for NSAIDs?
ibuprofen
NSAIDs inhibits what?
inhibits action of cyclooxygenase
What does cyclooxygenase do?
enzyme that converts arachidonic acid into prostaglandins when tissue injury occurs
What do prostaglandins do?
they cause chronic pain and inflammation
fever and pain
reduce blood pressure
clots blood at injury
What are the functions of COX-1 enzymes?
stimulate the release of prostaglandins that maintain homeostasis in the body
protect gastric mucosa, enhance platelet aggregation, and promote renal function
What are the functions of COX-2 enzymes?
stimulate the release of prostaglandins in response to injury
What are some common ADR to COX-1 and 2 inhibiting NSAID?
gastric upset/ulceration
heartburn
nausea
How does Reye’s syndrome present?
vomiting, confusion, seizures, and loss of consciousness
What are some interventions for COX-1 and 2 inhibiting NSAID?
bleeding- tarry stool
ab pain, nausea, and hematemesis
bruising, petechia
one sided numbness
SOB and chest pain
What should be monitored for COX-1 and 2 inhibiting NSAID?
I&O
BUN and creatinine
tinnitis, dizziness headaches
diaphoresis/tachypnea
What is the dose of aspirin to inhibit platelet aggregation?
81 mg
What should be done before surgery for aspirin?
discontinue one week before surgery
How should COX-1 and 2 inhibiting NSAID be taken?
swallowed with food, milk or 8 oz or water
What are some contraindications to aspirin?
pregnancy teratogenic drug
hypersensitivity
PUD
bleeding disorders (hemophilia/vit K deficiency
children with chickenpox or influenza
hypertension
What are some interactions to aspirin?
bleeding with anticoag, glucocorticoids, and alcohol
renal failure: ACE inhibitors and angiotensin receptor blockers
What are COX-2 inhibitor prototypes?
celecoxib
What are the expected pharmacologic action on COX-2 inhibitors?
initially to minimize COX-1 ADR, but actually decrease gastric drug react and renal impairments are similar to COX-1 and 2 inhibitors
COX-2 inhibitors ADR
GI upset/ulceration, diarrhea
heartburn
nausea
renal and CV and cerebro problems
What should be monitored for COX-2 inhibitors?
BUN, creatinine, and I&O
CVA
MI
When should COX-2 inhibitors be given in terms relation to magnesium or aluminum-based antacids?
two hours before and after
What does Celecoxib interact with to decrease diuretics effects?
furosemide (Lasix)
What can increase celecoxib levels?
Fluconazole and Diflucan
Acetaminophen is a what inhibitor?
COX inhibitor
Acetaminophen is limited to the what?
CNS
Why doesn’t Acetaminophen affect other systems?
it is limited to CNS
Acetaminophen can cause what in women with long-term use?
hypertension with daily use
What is the antidote to Acetaminophen toxicity?
acetylcysteine IV or orally
What is the max amount of Acetaminophen that should be taken by people over 12?
4g/day
What are some contraindications for Acetaminophen ?
alcoholism
What are interactions with Acetaminophen ?
warfarin increases risk of bleeding
cholestyramine will reduce absorption of Acetaminophen
Dual-mechanism analgesic agent ADR
sedation/dizziness
headache, nausea, vomiting, and constipation
RR depression
holding pee
How long does it take for to take effect?
1 hour
What is the prototype of opioid agonist?
morphine
Why do opioid agonists have a high proclivity to addiction?
They can create a euphoric effect
What is cross tolerance?
tolerance for opioid types creates tolerance for other opiods
What should opioid analgesics be careful
What are the immediate risks of taking opiods?
RR decrease
orthostatic hypertension
When are opioid analgesics contraindicated?
pregnant
renal failure
increased intracranial pressure
Biliary colic/surgery
What are opioid analgesic interactions?
CNS depressants cush as barbituates, benzodiazepines, and alcohol
anticholingercs with antihistamines and tricyclic antidepressants can cause constipation and urinary rention
What can be used as an adjunct to anesthesia?
opioid agonist-antagonist
opioid agonist-antagonist prototype
butorphanol and pentazocine (talwin)
expected action of opioid agonist-antagonist
mu receptor antagonists and kappa agonists
ADR of opioid agonist-antagonists
limited respiratory depression, sedation, dizziness and lightheadedness
Interventions for opioid agonist-antagonist
ask about opiod use before administering
Baseline vitals
RR monitor ambulating
MI or cardiac insufficency
how long should opioid agonist-antagonist be used?
short term
Client instructions for opioid agonist-antagonist
do not drive or activities requiring mental alertness
Contraindications for opioid agonist-antagonist
do not give if RR are before 12/min
Contraindications for opioid agonist-antagonist
acute MI
dependent on opiods
head injury
increased intercranial pressure
reduced respiratory reserve
heaptic or renal disease
cardiac insufficiency
opioid agonist-antagonist interactions
CNS depressants will increase CNS depression
Opioid antagonists do what?
reverse effects of opioid and treat overdose
Opioid antagonist actions
blocks opioid receptors
ADR for Opioid antagonist
ventricular arrhythmias
withdrawal symptoms for opioid dependent
Interventions for Opioid antagonists?
monitor heart rhythms
dangerous elevations in BP
seizure/tumormonitor 5-15 minutes after administration and for several hours after conclusion
How long do the effects of naloxone last?
60-90 minutes
Contraindications for Opioid antagonist
opioid-dependent or respiratory depression from nonopioid drugs
antihyperuricemias do what?
lower the hyperuricemia
What is gout caused by, and what body parts does it affect?
occurs to high levels of uric acid in the blood and affects small joints in the body and the bog joint in particular
antihyperuricemias prototype
allopurinol (antigout/antihyperuricemic
Allopurinol and febuzostat work how?
inhibit the enzyme zanthin oxidase form converting hypoxanthine and xanthine into uric acid?
How does probenecid work?
inhibits tubular reabsorption of uric acid in kidneys, thus promoting excretion
what are the major ADR’s for uricosurics?
hypersensitivity, liver and kidney dysfunction
What is the prototype for Glucocorticoids?
prednisone (deltasone)
Glucocorticoids uses?
skin disorders, allergic reactions associated with inflammatory and autoimmune disorders
prevent organ rejection
adjunctive therapy for some cancers
Mineralocorticoids are a type of what?
corticosteroid
Glucocorticoids help regulate what?
carb, fat, and protein metabolism
produced in response to stress to restore emotional stability
mineralocorticoids help with what?
includes hormone aldosterone which is a member, promote the retentionof sodium by the kidneys and fluid electrolyte levels in the body
What is an ADR for Glucocorticoids?
hperglycemia
inhibits prostaglandin synthesis making them at risk for PUD and GI distress
redistribute fat to make moon face and buffalo hump, drawing up Ca from the bones
