Pain and Inflammation Flashcards
Aspirin (ASA) class
First gen NSAIDs COX inhibitors
Aspirin (ASA) therapeutic use
relieves mild to moderate pain, fever, inflammation, dysmenorrhea
reduces risk of TIAs, CVAs, and MIs
Aspirin (ASA) EPA
inhibits actions of COX 1 and 2
blocks pain impulses centrally and peripherally
acts on the hypothalamus as antipyretic
suppresses platelet aggregation
Aspirin (ASA) ADRs
nausea, epigastric pain, heartburn, GI bleed, hemorrhage, petechiae, bruising
toxicity causes metabolic acidosis, respiratory failure, cardiac collapse
salicylism is toxicity due to chronic use, characterized by dizziness, tinnitus, and mental confusion
Aspirin (ASA) contraindications and interactions
known bleeding risk
teratogenic
age <18
Aspirin (ASA) interventions and education
take with food
watch for bleeding or hearing loss
avoid alcohol
avoid for a week before surgery or dental procedures
Aspirin (ASA) black box warning
risk of reye’s syndrome if given to children or teenagers
ibuprofen (Advil and Motrin) class
First gen NSAIDs COX inhibitors
ibuprofen (Advil and Motrin) therapeutic use
Relieves mild to moderate pain, fever, inflammation, dysmenorrhea
ibuprofen (Advil and Motrin) EPA
: Inhibits the actions of COX-1 & COX-2, but slightly more selective with COX-2
ibuprofen (Advil and Motrin) ADRs
dry mouth, nausea, heartburn, GI ulceration, nephrotoxicity
ibuprofen (Advil and Motrin) black box warning
do not give to patients after coronary artery bypass surgery
ibuprofen (Advil and Motrin) interventions and education
take with food
stay hydrated
watch for bleeding
avoid alcohol
ibuprofen (Advil and Motrin) contraindications and interactions
known bleeding risk
teratogenic
renal disease
celecoxib (Celebrex) class
second gen NSAIDs Cox 2 inhibitor
celecoxib (Celebrex) therapeutic use
treat swelling in joints caused by RA and OA by suppressing inflammation
celecoxib (Celebrex) EPA
Inhibits COX-2 enzyme to decrease inflammation, it does not affect the COX-1 enzyme
protects the lining of the GI tract and does not inhibit clotting factors
celecoxib (Celebrex) ADRs
GI upset, kidney dysfunction, cardio and cerebrovascular events
celecoxib (Celebrex) black box warning
increased risk for MI and CVA
celecoxib (Celebrex) contraindications and interactions
kidney disease
bleeding disorders
allergy to sulfa
CVA or MI history
celecoxib (Celebrex) interventions and education
give with food
give 2 hours before magnesium or aluminum based antacids
report chest pain or CVA symptoms
acetaminophen (Tylenol) class
nonopioid analgesic
acetaminophen (Tylenol) EPA
acts on hypothalamus to increase vasodilation and sweating to reduce fever
inhibits COX to decrease pain but does not have anti-inflammatory and anticoagulant effects
acetaminophen (Tylenol) therapeutic use
reduce fever
decrease minor pain
acetaminophen (Tylenol) ADRs
hepatotoxicity
hypertension
acetaminophen (Tylenol) contraindications and interactions
alcohol use disorder
liver and kidney disease
acetaminophen (Tylenol) interventions and education
do not exceed 4,000 mg in 24 hours
check BP regularly
tramadol (Ultram) class
centrally acting nonopioid
tramadol (Ultram) therapeutic use
moderate to severe pain
tramadol (Ultram) EPA
binds to select opioid receptors and block reuptake of norepinephrine and serotonin in the CNS
tramadol (Ultram) ADRs
sedation and dizziness
rarely respiratory depression
tramadol (Ultram) contraindications and interactions
seizure disorders
respiratory depression
tramadol (Ultram) interventions and education
take with food
only take short term when needed
do not take prior to driving or activities that require mental awareness
morphine class
opioid agonist
morphine therapeutic use
moderate to severe pain
morphine EPA
mimics action of endorphins and enkephalins by binding with mu receptors at opioid receptor sites.
stimulation of opioid receptors causes analgesia, sedation, euphoria, and respiratory depression.
morphine ADRs
respiratory depression
lightheadedness
dizziness
constipation
abuse or tolerance
morphine contraindications and interactions
respiratory depression
pregnancy
caution with older adults and infants
renal or kidney disease
morphine interventions and education
antidote is naloxone
monitor respiratory status
schedule II - highest risk while still legal
take only when needed, short term
do not take before driving
gradual position change
stool softener or laxative
buprenorphine (Buprenex) class
opioid agonist-antagonist
buprenorphine (Buprenex) therapeutic use
moderate to severe pain
anesthesia adjunct
treat opioid use disorder
buprenorphine (Buprenex) EPA
mu receptor antagonist and kappa receptor agonist
fewer mu-related ADRs: resp depression and euphoria
milder analgesic effects
buprenorphine (Buprenex) ADRs
increased cardiac workload
respiratory depression (less common)
nausea
constipation
buprenorphine (Buprenex) contraindications and interactions
respiratory depression
acute MI
renal or hepatic disease
buprenorphine (Buprenex) interventions and education
antidote is narcan, may require repeated dose
monitor respiratory status
schedule IV
take short term only when needed
do not take before driving
change positions gradually
naloxone (Narcan) class
opioid antagonist
naloxone (Narcan) therapeutic use
reverse opioid effects, overdose
naloxone (Narcan) EPA
block opioid receptors, reversing or antagonizing effects of opioids
naloxone (Narcan) ADRs
ventricular arrhythmias
increase HR and RR
withdrawal symptoms: HTN, vomiting, tremors
naloxone (Narcan) contraindications and interactions
opioid dependence
cardiac irritability
naloxone (Narcan) interventions and education
monitor VS
drug can increase pain because it reverses opioids
administer every 2-3 minutes until opioid effects are reversed
observe for nausea, vomiting, tachycardia, and sweating
allopurinol (Zyloprim) class
antigout/antihyperuricemic
allopurinol (Zyloprim) therapeutic use
manage signs and symptoms of gout and reduce uric acid concentrations
allopurinol (Zyloprim) EPA
inhibits the enzyme that converts purines to uric acid, reducing uric acid production
allopurinol (Zyloprim) ADRs
GI - N/V, diarrhea
bone marrow depression
agranulocytosis
allopurinol (Zyloprim) contraindications and interactions
interferes with warfarin
bone marrow depression
hepatic or renal dysfunction
allopurinol (Zyloprim) interventions and education
take after meals
at least 3L fluid per day
report decreased output or cloudy urine
avoid alcohol, meat, fish, asparagus, spinach, peas
