Pain & Comfort Flashcards
How do NSAIDS work?
Inactivate cyclooxygenases (COX 1 & COX 2) enzymes needed for prostaglandin formation resulting in anti-inflammatory, analgesic and antipyretic effects.
ALL CAUSE NEPHROTOXICITY
COX 1 Enzymes
Inhibit undesirable effects (side effects)- include GI distress, renal tract, platelet function, and macrophage differentiation.
COX 2 Enzymes
Inhibit desirable effects (therapeutic outcome) - reduces inflammation and fever (antipyretic)
Misoprostol
Medication used to protect stomach from getting ulcers while taking NSAIDS.
DO NOT GIVE TO PREGNANT WOMEN
Salicylates
Asprin (ASA)
CAN CAUSE REYES SYNDROME IN KIDS/TEENS- very serious neurologic complication causing brain swelling/death.
Toxicity- acute or chronic (salicylism)- tinnitus, hyperventilation, seizures
ALSO USED TO PREVENT BLOOD CLOTS
Other NSAIDS (Cox 1 & Cox 2 Inhibitors)
Ibuprofen, naproxen, ketoprofen, meloxicam
KNOW KETOROLAC (TORADOL)
Ibuprofen Maximum Daily Allowance
2400mg
Selective Cox -2 Inhibitors
CELECOXIB- KNOW THIS MED- “Coxib” family
originally created for Arthritis, less GI problems, BUT risk for thromboembolism
Acetaminophen (APAP)
Used for mild pain and FEVER
DOES NOT HAVE ANTI-INFLAMMATORY EFFECT
causes HEPATOXICITY
Acetaminophen Daily Allowance
4000mg
What is the antidote for Acetaminophen?
Acetylcysteine
Osteoarthritis (OA)
Degenerative joint disease (DJD)- joint inflammation
Treatment of OA
NSAIDS- diclofenac, nabumetone
COX 2 slective medications- celecoxib, meloxicam (low dose is COX 1, high dose is COX 1 & COX 2)
Herbal Treatment for OA
Glucosamine- watch with diabetes patients, and made from oyster and crab shells so watch for shellfish allergies
SAMe (S-adenosyl-L-methionine)- also antidepressant so watch for SEROTONIN SYNDROME
Flexium- combination of glucosamine and SAMe- EXPENSIVE BUT BEST RESULTS
GOUT
Metobolic disorder of purine metabolism- can be hereditary or occur in conditions that increase uric acid (bone cancer, thiazide diuretics).
ALSO DIET RELATED
Medication for ACUTE episodes of GOUT
NSAIDS, Steroids
COLCHICINE- DRUG OF CHOICE
Medication for CHRONIC GOUT
Vitamin C 1000mg/day- uricosuric acid
ALLOPURINOL- TAKEN DAILY TO PREVENT
Probenecid- 2nd line (if other 2 aren’t working) BLACK BOX WARNING- Crcl < 30ml/min
What is the definition of Opioid?
A drug that binds to opiate receptors in the brain and produces morphine like action
What are the 3 mechanisms of action of opiate medication?
Agonist (most opiates)- binds with and produces actions at the opiate receptors (mu, delta, kappa- mostly mu)
Partial Agonist- binds with pain receptors and produces a weaker action than agonist
Antagonist- binds with pain receptors but DOES NOT REDUCE PAIN. (competes with and reverses effects of the agonist medications)
Narcotic or Opioid Agonist
Mimic the action of endorphins on opiate receptors in the brain
Morphine- prodrug- all come from this
-Codeine
-Meperidine (Demerol)- metabolites make drug effects last longer
-hydromorphone (Dilaudid)- synthetic version of morphine *used often in hospital
-oxycodone- most abused
1. Percocet- w/ acetaminophen
2. Percodan- w/ aspirin
3. Oxycontin- sustained release
4. Fentanyl- 100x more potent than
morphine. (transmucosal lollipop-
Actiq- used for kids)
-methadone- moderate pan and treatment of narcotic withdrawal.
Morphine
Prototype drug for all other narcotic analgesics
-Roxanol- liquid morphine
-Duramorph- epidural after C-section
DO NOT COMBINE WITH OTHER DOWNERS
Fentanyl
Strongest opiate available (100x stronger than morphine)- used for CHRONIC severe pain such as cancer
Patch- teach patients do not cut in half and do not dispose in trash
Hydromorphone
Trade name is Dilaudid (synthetic morphine)
Oxycodone
Oxycontin- significant abuse- created a tamper resistant formulation
Combo with Acetaminophen- Percocet
Combo with aspirin- Percodan
Hydrocodone
Trade names- Vicodin, hycodan, Lortab
Meperidine
No longer drug of choice- leads to accumulation of normeperidine (renally toxic metabolite)- NOT LONGER THAN 48hrs
Codeine
Alone is CII and combo is CIII
Good cough suppressant- must be 18 years of age
Methadone
Used for opiate addiction withdrawal or pain relief
Half-life is longer than duration of action- high risk of death for OD
TRAMADOL- MUST KNOW
Can cause SEROTONIN SYNDROME When combined with SSRI’s or other serotonin-active drugs, Symptoms are high temp, high blood pressure, agitation, increased reflexes, tremor, sweating, seizures, dilated pupils, and diarrhea
Contraindications
severe renal or hepatic dysfunction , older adults, people with seizures
MORHPINE ADMINISTRATION
**FIRST draw up dose from vial dispensed to you.
SECOND, dilute with 5ml (sterile water or normal saline)
RATE OF ADMINISTRATION IS 2.5-15mg OVER 5 MINUTES!!!!!!!
Narcotic Antagonist
Compete with opiate receptors leading to reversal of the effects of opiates
Opiate Antedote
NALOXONE- IV, IM, SQ, PO, OTC…
CAN BE INHALED- common used
Addiction Treatment
buprenorphine- implantable x 6 mos.
buprenorphine + naloxone (Suboxone)
naltrexone- antagonist; try and use and opiates do not work. Must be opiate free at least 1 week.
