Pain and Inflammation Flashcards
What are NSAIDs?
Nonsteroidal Anti-inflammatory Drugs
What do first generation and second generation NSAIDs block?
- First generation NSAIDS: Block COX-1 and COX-2
- Second generation NSAIDs: Block only COX-2
aspirin (ASA): class
first generation NSAIDS cox-1 & cox-2 inhibitor
aspirin (ASA): Use
Relieves mild to moderate pain, fever, inflammation, dysmenorrhea and reduces the risk of TIAs, CVAs and MIs
aspirin (ASA): EPA
- Inhibits the actions of COX-1 & COX-2
- Analgesic-acts both centrally and peripherally to block pain impulses
- Antipyretic-reduces fever by acting on the hypothalamus
- Antiplatelet-suppress platelet aggregation, blocks the synthesis of thromboxane A2
aspirin (ASA): administration
baby dose - 81 mg
adult dose - 325 mg
aspirin (ASA): ADRs
Nausea, epigastric discomfort, heartburn, GI bleed and hemorrhage, petechiae and bruising, acute toxicity, salicylism
What is acute toxicity of Aspirin?
Metabolic acidosis, respiratory failure, renal failure and cardiac collapse.
What is salicylism?
toxicity due to chronic use of aspirin Characterized by dizziness, tinnitus and mental confusion
aspirin (ASA): contraindications
Known risk for bleeding
Pregnancy-teratogenic
Anyone 18 years of age or less should not take b/c of risk of Reye’s Syndrome
BLACK BOX WARNING
aspirin (ASA): BLACK BOX WARNING
Children or teenagers should not take b/c of risk of Reye’s Syndrome
aspirin (ASA): RN Interventions
Take with food or after meals
Watch for bleeding or hearing loss
Avoid alcohol
Avoid aspirin for approx. 1 weeks before or after major surgeries or dental procedures
ibuprofen (Advil & Motrin): class
first generation NSAIDS (cox 1 and cox 2 inhibitor
ibuprofen (Advil & Motrin): other medication
naproxen (Aleve) & ketorolac (Toradol)-given IV
ibuprofen (Advil & Motrin): Use
Relieves mild to moderate pain, fever, inflammation, dysmenorrhea.
ibuprofen (Advil & Motrin): EPA
Inhibits the actions of COX-1 & COX-2, but slightly more selective with COX-2.
ibuprofen (Advil & Motrin): ADR
GI effects-dry mouth, nausea, heartburn and GI ulceration with blood loss, nephrotoxic (Kidney)!!
ibuprofen (Advil & Motrin): Contraindications
Known risk for bleeding
Pregnancy-teratogenic
Renal disease
BLACK BOX WARNING
ibuprofen (Advil & Motrin): BLACK BOX WARNING
Should not be given to patients after coronary artery bypass surgery to treat pain
ibuprofen (Advil & Motrin): RN Interventions
Take with food
Drink 2 to 3 courts of fluid daily
Watch for bleeding
Avoid alcohol
celecoxib (celebrex): class
second generation NSAIDS cox-2 inhibitor
celecoxib (celebrex): Use
Given to 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, thus protecting the lining of the GI tract and not inhibiting clotting factors.
celecoxib (celebrex): ADR
Gastric upset, kidney dysfunction, cardiovascular & cerebrovascular events, BLACK BOX WARNING
celecoxib (celebrex): BLACK BOX WARNING
increased risk for MI and CVA
celecoxib (celebrex): contraindications
Kidney disease
Anyone with known bleeding disorder
Allergy to sulfa or sulfonamides
Hx of CVA or MI - Recent CABG surgery
celecoxib (celebrex): RN Interventions
- Give with food
- Give 2 hr before or after magnesium-or aluminum-based antacids
- Report chest pain or symptoms of a CVA.
acetaminophen (Tylenol): class
Nonopioid Analgesics
acetaminophen (Tylenol): EPA
To reduce fever, acts directly on hypothalamus to increase vasodilation and sweating. Inhibits COX to decrease pain but has no anti-inflammatory or anticoagulant effects.
acetaminophen (Tylenol): Use
reduce fever and decrease minor pain
acetaminophen (Tylenol): administration
DO NOT exceed 4000mg in 24 hours
325 mg tablets - Adult dose: 325-650 mg
500 mg tablets (extra strength)
acetaminophen (Tylenol): ADR
hepatotoxicity and HTN
acetaminophen (Tylenol): contraindications
alcohol use disorder, liver and kidney disease
acetaminophen (Tylenol): RN Intervention
do not exceed recommended dose, have BP checked regularly
tramadol (Ultram): class
centrally acting nonopioid
tramadol (Ultram): Use
treat moderate to moderately severe pain
tramadol (Ultram): EPA
Binds to select opioid receptors and blocks reuptake of norepinephrine and serotonin in the CNS
tramadol (Ultram): ADR
sedation, dizziness, and resp. depression is rare
tramadol (Ultram): contraindication
seizure disorder, respiratory depression
tramadol (Ultram): RN Intervention
Take with food
Take med only when needed and for short-term
Do not take prior to driving or activities that require mental awareness
What are the different opioid receptors in the body?
- Mu receptor: feelings of euphoria, respiratory depression, dependence, & sedation
- Kappa receptor: pupil constriction, total sedation, dysphoria
- Delta receptor: enables body to feel pain relief
morphine: class
opioid agonists
morphine: other medications
fentanyl, codeine, oxycodone, & methadone
Methadone EPA and Use
Methadone-chemically like morphine but blocks the euphoric effects of opioids and reduces cravings. Used to treat Opioid Use Disorder (OUD).
morphine: use
treat moderate to severe pain
morphine: EPA
Mimics the action of naturally occurring opioids, endorphins, and enkephalins. Does this by binding with the mu receptors at the opioid receptor sites. Stimulation of these receptors causes analgesia, sedation, euphoria, and respiratory depression.
morphine: ADR
lightheadedness, dizziness, constipation, and potential for abuse along with tolerance.
M: miosis
O: out of it
R: respiratory depression
P: pneumonia (aspiration/ cough suppression)
H: hypotension
I: Infrequent stools
N: Nausea
E: euphoria
morphine: contraindications
Resp. depression
Pregnancy
Older adults, infants
Hepatic or kidney disease
morphine: RN Interventions
- Antidote: naloxone (Narcan)
- Monitor respiratory status
- Schedule II controlled substance
- Take med only when needed and for short-term
- Do not take prior to driving or activities that require mental awareness
- Change positions gradually
- Encourage bowel meds
buprenorphine (Buprenex): class
opioid agonist- antagonist
buprenorphine (Buprenex): Use
Analgesia for moderate to severe pain. Anesthesia adjunct. Also used to treat Opioid Use Disorder (OUD)
buprenorphine (Buprenex): EPA
Mu receptor antagonists and kappa receptor agonists. Fewer mu-related adverse effects, such as resp. depression, euphoria, and dependence. Produces milder analgesic effects.
buprenorphine (Buprenex): ADR
Respiratory depression (limited), nausea, constipation, increased cardiac workload.
buprenorphine (Buprenex): contraindications
Resp. depression
Acute MI
Hepatic or kidney disease
buprenorphine (Buprenex): RN Interventions
- Antidote: naloxone (Narcan)*May need repeated doses
- Monitor respiratory status
- Schedule IV controlled substance
- Take med only when needed and for short-term
- Do not take prior to driving or activities that require mental awareness
- Change positions gradually
naloxone (Narcan): class
opioid antagonists
naloxone (Narcan): Use
Reversal of opioid effects, overdose
naloxone (Narcan): EPA
Block opioid receptors, effectively reversing or antagonizing the effects of opioids.
naloxone (Narcan): ADR
Ventricular arrythmias, increase in HR and RR, can cause withdrawal symptoms (HTN, vomiting, & tremors)
naloxone (Narcan): Contraindications
Opioid dependence
Cardiac irritability
naloxone (Narcan): RN Interventions
Monitor vital signs
Be aware-drug can increase pain because it is reversing the opioid effects
Prepare to administer every 2 to 3 minutes until reversal of undesirable effects.
Observe for nausea, vomiting, tachycardia, and diaphoresis (indications of opioid reversal)
allopurinol (zyloprim): class
antigout/antihyperuricemic
allopurinol (zyloprim): other medication
colchicine
allopurinol (zyloprim): use
Management of the signs and symptoms of gout to reduce uric acid concentrations
allopurinol (zyloprim): EPA
Inhibits the enzyme that is responsible for the conversion of purines to uric acid, therefore reducing uric acid production.
allopurinol (zyloprim): ADR
GI disturbances (N/V/D), bone marrow depression, and agranulocytosis.
allopurinol (zyloprim): Contraindications
Interferes with warfarin (Coumadin)
Bone marrow depression
Liver or kidney dysfunction
allopurinol (zyloprim): RN Intervention
- Take after meals to ensure absorption
- Ingest at least 3L/day of fluid
- Report decreased urine output or cloudy urine, which could be signs of a uric acid stone formation
- Low purine diet, avoid: beer, alcohol, meat, sardines, anchovies, scallops, asparagus, spinach, peas
