Pain/Inflammation

Question 1

Nonopioid Analgesics: NSAIDS
+ aspirin, ibuprofen (Motrin)
+ naproxen (Aleve)

Answer 1

INDICATIONS: Mild to moderate pain, fever, inflammation.

MODE OF ACTION: Inhibits prostaglandin synthesis.

SIDE EFFECTS: GI upset, GI BLEEDING, RENAL TOXICITY, rash; Aspirin - tinnitus, Reye syndrome (do not use for fever in children w/viral infection).

KEY POINTS: Do not use in patients with peptic ulcer disease, bleeding disorders. Avoid alcohol. Monitor for signs of salicylic with aspirin.

Question 2

Nonopioid Analgesiss: acetaminophen

+ acetaminophen (Tylenol)

Answer 2

INDICATIONS: Mild to moderate pain, fever.

MODE OF ACTION: Inhibits prostaglandin synthesis in CNS.

SIDE EFFECTS: HEPATOTOXICITY IN HIGH DOSES.

KEY POINTS: DO NOT EXCEED 4G/DAY. Many OTC medications contain acetaminophen. ACETYLCYSTEINE IS ANTIDOTE FOR OVERDOSE!

Question 3

Opioid Agonists

+ morphine

Answer 3

OTHER OPIOID AGONISTS: Fentanyl, oxycodone

INDICATIONS: Moderate to severe pain, promotion of sedation.
MODE OF ACTION: Binds to opioid receptors in CNS.

SIDE EFFECTS: RESPIRATORY DEPRESSION, SEDATION, constipation, GI upset, hypotension, urinary retention.

KEY POINTS: NALOXONE IS ANTIDOTE! Monitor pain level, vital signs, respiratory status. Administer slowly. Administer around the clock for cancer paink. Increase fluid and fiber intake.

Question 4

Opioid Antagonists

+ naloxone (Narcan)

Answer 4

INDICATIONS: Opioid overdose.

MODE OF ACTION: Competitively blocks opioid receptors in the CNS.

SIDE EFFECTS: Hypertension, tachycardia, agitation, GI upset.

KEY POINTS: Monitor respiratory status, pain, (naloxone reverses analgesia).

Question 5

Anti-gout medications

Answer 5

colchicine: Used to decrease inflammation and pain in an ACUTE gout attack.
SIDE EFFECTS: GI upset, thrombocytopenia.

probenecid: Inhibits uric acid resorption. Treats hyperuricemia r/t CHRONIC gout.
SIDE EFFECTS: GI upset, renal calculi (kidney stones).

allopurinol: inhibits uric acid production. Treats hyperuricemia r/t CHRONIC gout.
SIDE EFFECTS: GI upset, rash, hepatotoxicity, nephrotoxicity.

Question 6

Migraine medications: Ergot alkaloids

+ ergotamine (Ergomar)

Answer 6

INDICATIONS: Vascular headaches (MIGRAINE headaches, cluster headaches).

MODE OF ACTION: VASOCONSCTRICTION of inter cranial blood vessels.

SIDE EFFECTS: GI upset, muscle pain, numbness/tingling, hypertension.

KEY POINTS: Advise patients in lay down in dark, quite place to help with symptoms. Avoid tyramine-rich foods and alcohol, which can trigger migraines.

Question 7

Migraine medications: Triptans

+ sumatriptan (Imitrex)

Answer 7

INDICATIONS: Acute attacks of vascular headaches (MIGRAINE headaches, cluster headaches).

MODE OF ACTION: VASOCONSTRICTION of intercranial arteries.

SIDE EFFECTS: Warm/tingling sensation, dizziness, angina, injection action site discomfort.

KEY POINTS: Advise patients lay down in dark, quite place to help with symptoms. Avoid tyramine-rich foods and alcohol, which can trigger symptoms.

Question 8

Local Anesthetic (topical and parenteral)
\+ Lidocaine (Xylocaine)

Answer 8

TOPICAL: Used to decrease pain in conditions involving the skin and mucous membranes, IV insertion.

PARENTERAL: used to decrease pain in minor surgical procedures, epidurals, diagnostic procedures.

MODE OF ACTION: Blocks conduction of pain impulses in a circumscribed area.

SIDE EFFECTS: (parenteral lidocaine): Hypotension, bradycardia, prolonged labor, spinal headache, allergic reactions.

KEY POINTS: For EMLA cream, apply 1 hour before procedure and cover w/occlusive dressing.