PAIN AND INFLAMMATORY AGENTS Flashcards
class of medications designed specifically to relieve pain
analgesics
- response to tissue injury and infection
- protective mechanism
inflammation
enzyme responsible for conversion of arachidonic acid intro prostaglandins
cyclooxygenase (COX)
COX:
- protects stomach lining
- regulates blood platelets
COX-1
COX:
- triggers inflammation and pain
COX-2
- prostaglandin inhibitors
- relieve pain
- reduce elevated temperature
- inhibits platelet aggregation
- NSAIDs
anti-inflammatory agents
seven groups of nsaids
salicylates
para-chlorobenzoic acid derivatives / indoles
phenylacetic acids
propionic acid derivatives
fenemates
oxicams
selective cox-2 inhibitors
- aspirin, also known as acetylsalicylic acid
- anti-inflammatory
- antiplatelet
- antipyretic effects
salicylates
therapeutic serum salicylate level
10-30 mg/dl
toxic serum salicylate level
> 40-50 mg/dl
salicylates + anticoagulants
affects blood clotting = risk for bleeding
salicylates + glucocorticoids
risk for stomach ulcers / GI bleeding
salicylates + oral hypoglycemic drugs
risk for low blood sugar / hypoglycemia
salicylates should be taken with ___ to reduce GI upset
milk, water, or food
why should salicylates not be taken by children with flu symptoms?
to avoid reye syndrome
true or false: salicylates are contraindicated to pregnant women
true
swelling of liver and brain
reye syndrome
- indomethacin / sulindac
- may cause increased BP and sodium and water retention
para-chlorobenzoic acid
indicated for:
- rheumatoid arthritis
- gouty arthritis
- osteoarthritis
para-chlorobenzoic acid
- diclofenac na
indicated for: - rheumatoid arthritis
- osteoarthritis
- ankylosing spondylitis
phenylacetic acid dervatives
- for short term management of pain
- 1st injectable NSAIDs
- greater analgesic effect
ketorolac
- ibuprofens (alaxan, advil, medicol)
- increase effects of warfarin, sulfonamides, cephalosporins, phenytoin, insulin, and oral hypoglycemics
propionic acid derviatives
true or false: propionic acid derivates can be taken with an empty stomach because it is not irritating to the GI lining
false - it can cause gastric upset, always take with food
- for acute and chronic arthritic conditions
- SE: gastric irritation
fenamates
fenamates are contraindicated to patients with ___
peptic ulcer
- mefenamic acid (ponstel, ponstan)
- meclofenamate sodium monohydrate (meclomen)
fenamates
- proxicam (feldene flash), meloxicam
- for long term arthritic conditions
oxicams
SE: lower risk of GI problems, ulceration; epigastric distress
should not be taken with aspirin / other NSAIDs
oxicams
drug agents:
- celecoxib (celebrex)
- rofecoxib (vioxx)
- nabumetone (relafen)
cox-2 inhibitors
- not to be taken during 3rd trimester of pregnancy
- NSAIDs in the elderly
- assessment of renal function
- prescribed NSAID dose may need to be decreased
cox-2 inhibitors
- suppressing and preventing many of the components of the inflammatory process at the injured site
- dexamethasone, prednisone, prednisolone
corticosteroids
reduces inflammation of the joints due to increased uric acid
antigout drugs
- inhibit leukocytes on the inflamed site
- SE: gastric irritation, NV, diarrhea, abd pain
colchicine
2 uric acid inhibitors
allopurinol
thiazide diuretics
uric acid inhibitors
- inhibits final steps of uric acid synthesis
- no caffeine and alcohol
- indicated gout patients with renal impairment
allopurinol
uric acid inhibitor
- treats hypertension and prevent fluid retention
- increase level of uric acid
thiazide diuretics
alleviates chronic gout
uricosurics
uricosurics:
- increase rate of uric acid excretions in the kidneys
- SE: sore gums, headache, flushed skin
probenecid
nonopioid analgesics act on ___, while opioid analgesics act on ___
PNS, CNS
unpleasant sensory and emotional experience related to tissue injury
pain
2 types of nonopioid analgesics
- NSAIDS
- acetaminophen
- safe, effective analgesic and antipyretic drug used for muscular aches, pain and fever caused by viral infection
- hepatotoxic
- little to no GI distress
acetaminiphen
therapeutic serum range of acetaminophen
5-20 mcg/ml
antidote for acetaminophen
acetylcysteine (mucomyst)
- opioid agonists
- can cause addiction
- analgesia, respi depression, euphoria, and sedation
opioid analgesics
- cough suppression
- antidiarrheal effect
- SE: NV, constipation, decrease in BP, urinary retention, antitussive effects
opioid analgesics
- pain medicine similar to an opioid
- act in the CNS to relieve pain
tramadol
___ have been reported in patients taking tramadol. risk of this is high if taking higher doses than recommended
seizures
maximum dose of tramadol
400 mg per day
tramadol usual dose TDL HCL
50 mg/cap
DOLCET components
tramadol HCL 37.5 mg
paracetamol 325 mg
- AMI, CA, pulmonary edema
- as pre-op medication - relieve anxiety
- oral, iv, im, sq
morphine
antidote for morphine
naloxone (narcan)
nursing responsibilities for morphine
- monitor RR, BP, UO, BS
- antidote at bedside
- no alcohol / CNS depressants
- safety
- shorter duration of action than morphine
- oral, im, iv
- no antitussive property
meperidine (demerol)
- less SE than morphine
- neurotoxic
- can decrease BP
meperidine (demerol)
- more potent than morphine
- faster onset, shorter duration of action than morphine
- oral, rectal, sq, im, iv
hydromorphone
what should be done to hydromorphone to reduce risk of withdrawal synrome?
SIVP - slow IV push
what are the symptoms associated with withdrawal syndrome?
irritability
diaphoresis
muscle twitching
increased PR and BP
preventive treatment for headaches: migraine and cluster
- beta-adrenergic blockers
- anticonvulsant
- tricyclic antidepressants
treatment / cessation of attack for headaches: migraine and cluster
opioid analgesics
ergot alkaloids
selective serotonin
long acting opioid analgesics medications for round the clock for acute and chronic pain
oxycontin
immediate acting opioid analgesic medications for breakthrough pain
oxynorm
- oxycodone + naloxone
- for the management of moderate too severe chronic pain unresponsive to non-narcotic analgesia
- treatment / prophylaxis of opioid-induced constipation
targin
- powerful opioid used as a pain medication and together with other medications for anesthesia
- 50-100 x more potent than morphine
- available in transdermal patch and ampule
fentanyl
