Pain and inflammation Flashcards
NSAIDS
Cox 1 inhibitors
Stimulates release of protective prostaglandins (protect gastric mucosa, enhances platelet aggregation, maintain kidney function)
o When you block cox 1, these protective effects don’t take place, at risk for renal dysfunction, GI ulcers, bleeding
NSAIDS
Cox 2 inhibitors
Stimulates release of prostaglandins related to injury and causes inflammation, pain, fever
o Cox 2 blocked, analgesia, anti-inflammatory, antipyretic, pTT aggregation, and vasoconstriction.
LOX- stimulate leukotriene release
aspirin (ASA- acetylsalicylic acid); ibuprofen (Motrin); naproxen (Aleve), indomethacin (Indocin); ketorolac (Toradol)
Cox 1 inhibitors
recognize that ASA is in a class of its own. As a salicylate, it has effects of decreasing platelet aggregation unlike the rest. It is generally no longer given for the treatment of pain, but instead for its antiplatelet properties.
Which NSAID is the only one considered cardioprotective?
aspirin
NSAID
NC
• Adverse Effects are all related to the inhibition of Cox 1 and 2.
GI upset and or ulceration:
o Most of the tablets will come EC or SR – do not chew or crush
o Consider PPI—Proton pump inhibitor. Anything that ends in -prazole
Asthma Exacerbation:
o Blocking Cox 1 and 2, body makes excess LOX which causes release of leukotrienes. Increases asthma exacerbation.
Bleeding: ibuprofen doesn’t cause too much ptt aggregation at lower doses. Does cause issues at higher doses. Coffee ground emesis, black stools
Reye’s syndrome: Give Tylenol for children w/ viral infections to avoid risk of Reyes syndrome. Causes liver and brain swelling. More risk if viral and not bacterial
Renal: BUN, Cr baseline levels, watch trends. Not recommended for pts with renal insufficiency.
• Salicylism (Aspirin Overdose):
Initially respiratory alkalosis leading to respiratory depression and acidosis. Hyperthermia, sweating, dehydration, electrolyte imbalance. Will eventually lead to coma and ultimately death from resp failure., tinnitus, loss of hearing, sweating***
Lethal dose for adults is 20-25 gm
Lethal dose for children can be as little as 4 gm
• Salicylism (Aspirin Overdose): treatment
Focuses on respiratory support, cooling (for hyperthermia), fluid replacement, hemodialysis if needed.
Bicarbonate can be given to correct resp acidosis.
Activated charcoal may be given to decrease absorption.
Perform gastric lavage within 1 hr. of ingestion
Cox 2 inhibitor
Celecoxib
Platelet aggregation Increases risk of stroke and MI Only one on the market increases bleeding w patients on warfarin, steroids, ETOH Cross allergy to sulfa
Acetaminophen overdose
o Based on body weight, will vary based on amount of Tylenol they took.
o Will give predetermined amounts in 3 stages.
150mg/kg over first hour
50 mg/kg over next 4 hours.
100mg/kg over next 16 hours.
Acetylcysteine
Acetylcysteine other uses
Mucomist-decreases mucus
Prevention of further kidney complications in patient receiving dye.
Tylenol overdose
Centrally acting nonopioids
Tramadol
Tramadol
NC
• Avoid concurrent use w/ antidepressants and patient will have increased risk for serotonin syndrome (increases serotonin reuptake)
sedation, dizziness, urinary retention, seizures w/ known seizure disorders (decreases seizure threshold)
Oral med, should give 1 hr before treatment.
Opioid receptor locations
Head, GI tract, Heart
give morphine to decrease myocardial 02 demand.
opioid overdose
Naloxone-
Initially 0.1-0.2 mg IV repeated every 2-3 mins until adequate response
Give slowly over 30 sec- can cause cardiac arrhythmias if given too quickly, also withdrawal, cardiopulmonary edema
What could happen if you give naloxone or naltrexone to a chronic opioid user?
They can go straight to withdrawals.
opioid agonist-antagonist
buprenorphine, nalbuphine
bupenorphine
nalbuphine
B: treatment of opioid dependence, can cause withdrawal
N:treatment of itching symptoms of opioids.
Opiate withdrawal symptoms
Early: anxiety, muscle aches, agitation, insomnia, sweating Late: Abdominal cramping diarrhea dilated pupils nausea and vomiting
opioid AE
• Depressed respiration, hypotension, bradycardia, constipation, urinary retention, N/V, pupils should constrict, if they are dilated, they are close to dying.
• Interact w/ all other CNS type depressants—increase all effects
• Pregnancy Risk Category D in (long term or high dose use, or 3rd trimester)
• Interventions include: Monitor vitals, bp, hr, rr,
o RR below 12 stop administering them and stimulate
Depends on situation but may give Narcan
o Give something for nausea, constipation
o Do not chew or crush unless immediate release, usually controlled release.
Steroids
prednisone, hydrocortisone, methyprednisolone
-sone, -lone
Steroid theraputic use
- Inflammatory disorders (arthritis, COPD, etc.)
- Autoimmune disorders (RA, SLE, etc.)
- Allergic reactions
- Immunosuppression for organ rejection
Steroid
NC
• Adrenal insufficiency & Myopathy: may have muscle aches. Sign that adrenal insufficiency is starting. May need to adjust dose.
• Infection: Immunosuppressants
• Hyperglycemia: Impaired glucose metabolism, insulin resistance.
• Fluid and Electrolyte disturbance: Hypernatremia & Hypokalemia: more often with drugs considered mineral corticoids. May see it with glucocorticoids too.
• Psychologic disturbances
a. From stopping too fast (hpa access)
b. Super high doses.
• Cataracts and glaucoma increased risk
• Ulcers: May give with food, give PPI
• Teach on taper/dose regimen
• High WBC—can’t lay down when on steroids so they are just floating around.
• Dose and length of therapy dependent.
• Thin skin: bruise easily, rip skin
• Too little: addison’s disease, too much cushings disease.
steroid (cushing syndrome)
• Cushing’s Syndrome: Weight gain (trunk/face, but not limbs), “moon” face, “buffalo hump”, thinning of skin, bone loss (osteoporosis)—bones can’t lay down new cells.
Steroid stress dosing
a. Acute event happening, body’s natural response is asleep, have to increase dose during these times.
