Pain! Flashcards
Factor’s influencing pain
3
Patient’s fear of what is causing the pain- when they find out it is lessened
Psychological stressors and past pain experiences
Pain “threshold”**
Acute/Temporary Pain Treatment
steps?
3
- Identify source of pain:
- Remove the cause if possible
- There is a lag period before pain subsides
- Treat pain EARLY before it has increased to a level where it is more difficult to control** - Use the least potent analgesic w/ the fewest side effects
- Properly titrate the dose & administer for an adequate amount of time
Mechanism of action for acetaminophen?
3
Weak COX-1 & COX-2 inhibitor in peripheral tissues
Decreases pain but has NO anti-inflammatory effect
Anti-pyretic
Doasge for acetominophen?
max daily dose?
4000mg
4grams per day
Onset of acetominophen?
15 to 30 min
Side effects of acetominophen?
3
Large doses can cause liver toxicity & be lethal
Large doses can cause dizziness and disorientation
Renal damage can occur even w/ normal dosages!
Mechanism of action for aspirin?
4
- Inhibits COX and platelet aggregation
- reduces pain by reducing inflammation
- Anti-pyretic
- Lower incidence of colon cancer and decreases DVT after CABG
Side effetcs of aspirin?
3
Gastric upset and ulcers
Hepatotoxicity and renal toxicity
Asthma and rashes
What is salicylism?
vomiting, tinnitus, decreased hearing and vertigo are reversible by reducing the dosage
What will toxic levels of aspirin cause?
4
- metabolic acidosis
- respiratory depression
- cardiotoxicity
- Overdoses are a medical emergency
Mechanism of action in NSAIDs?
Decreases prostaglasdins!! main mechanism of action
Non selective for COX1 and COX2
What do prostagladins cause?
inflammation
So acetominophen is a weak COX inhibitor. What does this indicate about inflammation?
Since it is a weak inhibitor it does not decrease prostaglandin activity and thus does not decrease inflammation
What are the physiological effects of prostaglandin?
5
- Activation of the inflammatory response
- Elicitation of pain and fever
- Contraction and relaxation of smooth muscle** (can help with pain there)
- Inhibition of acid synthesis and increased secretion of the protective mucus in the stomach
- Increased blood flow to the kidneys
Why is prostaglandin good for the GI tract?
can help with pain there because it controls contraction and relaxation of smooth muscle
inhibits acid synthesis and increases protective mucous for the stomach
GI Side Effects of NSAIDs?
4
N/V,
heartburn,
ulcers/bleeding,
diarrhea
Cant pregnant women take NSAIDS?
They shouldnt but can while lactating and postpartum
Renal side effects of NSAIDS
4
- Salt and water retention
- HTN**
- Can be particularly damaging if patient is taking other nephrotoxic drugs
- Interferes w/ platelet aggregation for 2-4 days
NSAIDs can cause photosensitivity
statement
What kind of patients do we see experiencing adverse renal events and acute kidney injury?
4
- Chronic kidney disease (decreased GFR)
- Volume depletion (diuresis, vomiting, diarrhea)
- CHF, nephrotic syndrome or cirrhosis
- Older age
Max dose for ibuprofen?
3200mg
Max dose for Naproxen (aleve)?
1000mg
What are COX-2 inhibitors good for?
3
They are just as effective as other NSAIDs
Less GI toxic
Good for treating artritis
Considerations/risk for gastroduodenal toxicity in NSAIDS?
Age >65 Use of anticoagulant therapy Previous GI bleed Acute PUD Concomitant use of glucocorticoids (if on steriods give them something else besides both can cause ulcers)