Pain Flashcards
WHO recommendations for mild oain
acetaminophin, ibuprofen
Who rec for moderate pain
morphine
Acetaminophine MOA
analgesic, antipyretic. Centrally acting, may block cytokines in the dorsal horns, blocks PG release in the CNS
Acetaminophen indications
temp relief of minor aches and pains, fever reducer.
ACR First line for treatment of knee, hip, osteoarthritis
Acetaminophen
acetaminophen max daily doses
adults 4 g, peds 5 doses of 50-75mg/kg
Acetaminophen warning
severe liver damage may occur with move than 4g in 24 hrs.
Things to think about with acetametophine
liver, alcohol and combo drugs
Acetaminophen toxic metabolite
NAPQI
early Signs and symptoms of Acetaminophen toxicity
NV, altered mental status, metabolic acidosis, increased PT/INR
Stage 1 toxicity
no liver injury, asymptomatic, early signs/symptoms, normal LFT, NV, diaphoresis, pallor, malaise
Stage 2 toxicity
liver injury in 24-36 hrs, AST elevated, RUQ pain, possible nephrotoxicity, increased PT, Bilirubin, sCR, BUN, proteinuria, hematuria, red cell casts
Stage 3 toxicity
maximum liver injury in 72-96 hrs, hepatic failure, encephalopathy, coma, hemorrhage, NV, high ammonia, AST/ALT elevated, abnormal PT, creatinine, glucose pH, bilirubin, lactate. fatal after 3-5 days of OD
Stage 4 toxicity
recovery
acetominophen OD antidoteq
N-acetylcysteine.
N-acetylcysteine MOA
prevents liver injury by inhibiting formation of NAPQI when administered within 8 hrs of OD
NAC IV ADR
anaphylaxis, rash, flush, NV, brochospasm
NSAIDs MOA
inhibit cycloxygenase enzymes Cox-1 and COX-2
NSAID uses
acute or chronic pain, cancer pain, anti-inflammatory, antipyretics
NSAID common ADR
Nausea, dyspepsia, anorexia, abd pain, flatulence, diarrhea, GI bleed, ulcers.
Naproxen/esomeprazole
Vimovo. decreases GI ADR
Duexis
ibuprofen + Famotidine. decreases GI ADR
Misoprostol MOA
synthetic prostaglandin E1 analog. inhibits gastric acid secretion and protects GI mucosa
Misoprostol ADR
Nausea, Diarrhea, abdominal pain,
Misoprostal warnings
Abortifacient and teratogenic
NSAIDs renal risk
acute renal insufficiency, tubulointerstital nephropathy, hyperkalemia, renal papillary necrosis,
NSAID warnings
avoid in 3rd trimester, liver impairment, SJS
NSAID drug interactions
ASA (ibuprofen blocks antiplatelet effects, take 30mins after ASA) anticoags, antihypertensive, diuretics, hypoglycemics
Salicylates
Aspirin
Aspirin MOA
nonselective suicide COX inhibitor. antiplatelet, analgesic, anti-inflammatory, anticancer?
Treatment for Aspirin OD
Bicarb sodium
Aspirin max dose
4 g daily
proprionic acids
ibuprofen, Ketoprofen, naproxen
Ibuprofen dosing
Rx: 3200mg, OTC: 2400mg
Naproxen dosing
1500mg
Carboxylic acids
ketorolac, etodolac, diclofenac, sulindac, indometheacin, nabumetone
Diclofenac warnings
increases cardiac events, causes liver toxicity, GI toxicity
Indomethacin indications
first line in gout, PDA in neonates
Enolic acids
meloxican, piroxicam, semi-selective COX 2 inhibitors
Meloxicam indications
oseoarthritis and rheumatoid arthritis. adjust for kidney impairment
Piroxicam indications
OA and RA, adjust for liver impairment
Celecoxib
COX2 inhibitor for familial adenomatous polyposis
