Pain Meds Flashcards
Naproxen
NSAID
Indomethacin
NSAID
Diclofenac
NSAID
Ketorolac
NSAID
Meloxican
NSAID
Piroxican
NSAID
Ketoprofen
NSAID
Which medication(s) get prioritized?
Antiduretics and Microbial
Celecoxib
Second Generation NSAID (selective COX-2 inhibitor)
What can COX-1 result in?
Decreased platelet aggregation & kidney damage
What does COX-2 result in?
Suppresses inflammation, mild to moderate pain, dysmenorrhea and fever reduction
Complications of NSAIDS
-damage to gastric mucosa can lead to GI bleed
-risks increased if smoke or drink or have history with peptic ulcers
Nurses actions to complications of NSAIDS?
-observe for GI bleeding, black tarry stool and abdominal pain N+V
-administer PPI (-prazole) or H2 antagonist (-iodine)
Teach the client about what when taking NSAIDs?
Take with food or 8oz of water or Milk and avoid alcohol
Complication of NSAIDs: kidney
Impaired kidney function- look for decreased urine output, weight gain from fluid retention, increased BUN & creatine levels
NSAID dose for patients with CV disease?
Use the smallest effective dose
Manifestations with NSAIDS?
Tinnitus, sweating, headache, dizziness, and respiratory alkalosis
Aspirin antidote?
Charcoal
How and where is an aspirin toxicity managed?
As a medical emergency in the hospital
Signs of aspirin toxicity
Fever, sweating and dehydration
Cool patient with tepid water when fever occurs
Interactions with NSAIDs
Anticoagulants: heparin and warfarin INCREASE risk of bleeding
Monitor PPT, PT and INR and alert client of risk of bleeding
What can you not take concurrently with Aspirin?
Ibuprofen
OTC interactions with NSAIDs?
Feverfew, garlic and ginger can increase risk for bleeding
To avoid interaction what should you tell the to patient do?
Notify HCP of any OTC, vitamins or herbal supplements
What does Acetaminophen do?
-slows the production of prostaglandins in the CNS
-relieves pain, preferred NSAID for children w/ viral infection
-reduce fever
Complications of acetaminophen
Liver damage
Liver damage manifestations?
N+V, diarrhea, sweating, and abdominal discomfort, hepatic failure, coma, and death
When does hepatic injury appear after an acetaminophen acute toxicity?
48-72 hours
Daily acetaminophen total intake
4 g/day for most clients
3 g/day for malnourished
2 g/day for 3+servings of alcohol daily
Acetaminophen antidote
Acetylcysteine via duodenal tube to prevent emesis and aspiration
Precautions when giving acetaminophen
Avoid in patients w
-hypersensitivity,
-severe liver impairment/disease, -impaired kidney,
-chronic alcohol use and malnutrition
What does acetaminophen do to warfarin and heparin
Slows the metabolism of warfarin which increases levels of warfarin
-monitor prothrombin time & INR levels
-observe for bleeding indications (bruising, petechiae, hematuria)
Alcohol does what with acetaminophen ?
Increases the risk of liver damage
Tolerance
A normal biological adaptation to long-term use of a drug
Physical dependence
Normal physiological response that that ppl experience after a week or more of continuous opioid use
Somatic Pain
Localized in the muscles or bones
Visceral pain
Organ pain; ex. cramping/pressure, bowel obstruction & tumors in the lung
Neuropathic pain
-Associated w injury to PNS or CNS
-poorly localized and may be along nerve pathway
-occurs in patients w fibromyalgia, diabetic neuropathy and shingles
-fees like numbing, tingling, sharp, shooting or shocklike.
Agonists
Stimulators
Ex. Meperidine (Demerol)
Antagonists
Blockers
What do opioid and opioid combinations do?
Bind to opioid receptors in the CNS to alter perception of pain
Nursing implications for opioids and opioid combinations?
-can be combined with non opioid
-monitor vitals, level of sedation & RR
-Encourage fluids & fiber to prevent contipation
-Never crush extended release tabs
Codeine (in Tylenol)
Contraindicated in pediatric patients
Fentanyl
Sublimaze, Duragesic
-avoid patch in patients with fever..heat increases absorption
-transdermal & IV
-relieve post operative care & stable chronic pain
-path lasts up to 48-72hrs
Hydromorphone
Dilaudid, Exalgo
Opioid
Methadone
Dolophine
Long acting (bone pain)
Tramadol
Ultram
Opioid
Lowers seizure threshold
Corticosteroids
Toxic to some cancer cells; reduce pain by decreasing inflammation
End in -one
Administer with food
Benzodiazepines
Treat anxiety or muscle spasms associated with pain
End in -Pam and -lam
Can cause sedation & increase risk of falls
No driving or heavy lifting
Tricyclic antidepressant
Help relieve neuropathic pain
End in -ine
Serotonin-Norepinephrine Reuptake Inhibitor
Treats nerve pain and depression
Ex. Duloxetine (Cymbalta)
Takes weeks to feel desired effects
Anticonvulsants
Treat nerve pain
Must be taken regularly
Which opioid are controlled released?
Oxycodone (OxyContin) & Morphine (MS Contin
Naloxone
Narcan
-opioid antagonist that reverses or antagonizes effect of opioid
-treats overdose
-check RR; if less than 12RR, pinpoint pupils notify HCP
-opioid & alcohol increase respiratory depression coma and death
Patient-Controlled Analgesia (PCA
Bolus
-only patient can push to dispense pain med
Heat
-increases circulation, induce muscle relaxation
-contradicted in trauma bc it causes swelling by vasodilation
-don’t apply directly to the skin
Cold
Reduces swelling, bleeding and pain in new injury
Massages and exercise
Stretches and regain muscle tendon length and relaxes muscles
2/10
Mild pain
5/10
Moderate pain
9/10
Severe pain
