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320 Pharmacology > Pain: Non-Opioids > Flashcards

Pain: Non-Opioids Flashcards

1
Q

What does inflammatory soup contain?

A
  • Includes PROSTAGLANDINS
  • NSAIDS/Corticosteroids can help suppress Prostaglandins from the Inflammatory Soup
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2
Q

What do prostaglandins do?

A
  • Vasodilation (blood vessels, kidneys)
  • Stop platelet aggregation (PGI2- Prostacyclin)
  • Inflammation and pain
  • Protect gastric mucosa
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3
Q

What do COX-1 enzymes do?

A
  • Gastric mucosa protection (reduces stomach acid, promotes blood flow to GI tract)
  • Platelet aggregation (allows platelets to stop a bleed)
  • Supports renal function (blood flow to the kidneys)
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4
Q

What do COX-2 enzymes do?

A
  • sites of tissue injury “inflammation”
  • in brain: mediates fever and pain
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5
Q

What are the two groups of NSAIDs?

A
  • Salicylates/Irreversible NSAIDS
    - ASPIRIN ONLY
  • Non-Salicylates/ Reversible NSAIDS
    • All other NSAIDS are in this category
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6
Q

What does salicylate NSAID treat?

A
  • once daily dosing
    • MI/stroke reduction (prevention of clots)
      (NSAIDS can compete. Do not take aspirin and ibuprofen at literal same time)
  • PRN every 4 hours
    • Rheumatoid Arthritis
    • Osteoarthritis
    • Joint pain, swelling, inflammation (arthritis, tendonitis, bursitis, etc.)
    • Fever
    • MILD PAIN
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7
Q

What is the half-life of aspirin when it comes to pain relief?

A

~ 20min
dosed every 4-6 hours

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8
Q

Why use aspirin?

A

used for its artery benefits (STROKE AND MI PREVENTION)

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9
Q

What are adverse effects of aspirin?

A
  • Bleeding
    • Inhibition of platelets (thromboxane A2)
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10
Q

What are symptoms of salicylism toxicity?

A
  • Tinnitus
  • Respiratory Alkalosis (rapid breathing)
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11
Q

What is ASPIRIN adverse effect for aspirin?

A
  • Asthma
  • Salicylism poisoning (N/V/D, breathing)
  • Premature closure of ductus arteriosus/Platelet disaggregation/ Peptic Ulcer Disease
  • Intestinal bleeding
  • Reye Syndrome/Renal Impairment/Rapid breathing
  • Idiosyncratic Reaction
  • Noise (Tinnitus)/Nephropathy(kidneys)
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12
Q

What are drug interaction concerns of aspirin in the GI tract?

A

GI ULCER RISK
- Steroids, NSAIDS can hurt GI tract (risk for ulcer/bleed)
- Smoking/Alcohol can increase risk for bleeding

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13
Q

What are drug interaction concerns of aspirin regarding blood thinners?

A

BLEEDING RISK
- Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin.
- Common to see patients on aspirin + Warfarin or other “blood thinners”, but increases the risk of bleeding

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14
Q

What are drug interaction concerns of aspirin with other NSAIDs?

A

increased risk for all the adverse effects!

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15
Q

What are some reversible NSAIDs?

A
  • First Generation
    • ibuprofen
    • naproxen
    • ketorolac
    • indomethacin
    • diclofenac
  • Second Generation
    • Celecoxib
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16
Q

What do reversible NSAID treat?

A
  • Joint pain, swelling, inflammation (arthritis, tendinitis, bursitis, etc.)
  • Fever
  • Mild – moderate pain
  • Dysmenorrhea
  • Closing patent ductus arteriosus (PDA) in pre-term infants
17
Q

Reversible NSAIDs prefixes

A

Common suffixes:

  • “profen”
    • Ibuprofen, ketoprofen, flurbiprofen
  • “fenac”
    • Diclofenac, Bromfenac
    • Ketorolac sort of sounds like “fenac”
  • Dr. Mueller’s favorite: Flurbiprofen
    • Why? The brand name is ANSAID® (Another Non-Steroidal Anti-Inflammatory Drug)
18
Q

What are adverse effects of reversible NSAIDs?

A
  • GI effects, bleeding for ALL
  • Cardio thrombotic events (MI/Stroke)
19
Q

What are GI concerns from reversible NSAIDs?

A
  • take with food or water/milk
  • Educate for S/S of GI Bleed
  • Higher risk with smoking/alcohol, steroids, other NSAIDs, anticoagulants
20
Q

What are Kidney Concerns from reversible NSAIDs?

A
  • Monitor urine output, BUN, creatinine
  • Usually only a concern if dehydrated + other nephrotoxic meds, or history of renal issues
  • Contra-indicated to use in people with Chronic Kidney Disease (acute or chronic)
21
Q

What are MI/Stroke Concerns from reversible NSAIDs?

A
  • Avoid in history of heart disease/MI (Contra-indication)
  • Remember aspirin is the unique exception that protects from heart attack and stroke
22
Q

What are Fluid Retention Concerns from reversible NSAIDs?

A

Avoid in heart failure patients (Contra-Indication)

23
Q

What are some drug interaction concerns with reversible NSAIDs?

A
  • Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin
  • Smoking, Alcohol, Steroids, NSAIDs can hurt GI tract (risk for ulcer/bleed)
24
Q

What does Acetaminophen/APAP/Paracetamol treat?

A
  • Pain or Fever
  • This is NOT an NSAID, does NOT work for inflammation
25
Q

What are adverse effects of Acetaminophen/APAP/Paracetamol?

A
  • Hepatotoxicity: extremely rare at therapeutic dosages
    • Single Dose Max is 1000 mg
    • 4000 mg/day (FDA suggestion is for 3000 mg/day)
    • 3000 mg/day for Older Adults
    • 2000 mg/day if you drink 3 or more alcoholic beverages
26
Q

Why do people accidentally overdose?

A
  • Dayquil® contains acetaminophen 325 mg
  • Mucinex- Fast-Max® contains acetaminophen 325 mg
  • Norco® contains acetaminophen 325 mg

(Causes 50% of liver failure cases in U.S. and 20% of liver transplants)

27
Q

What are signs of acetaminophen overdose?

A
  • Patients may present ASYMPTOMATIC if caught early
  • Signs will include liver damage (DILI, Hepatotoxicty > AST/ALT)
  • Symptoms can include diaphoresis, Nausea and Vomiting (always a good guess in overdose patients)
28
Q

What is an antidote to acetaminophen overdose?

A

Acetylcysteine (Acetadote®)

29
Q

What are the types of Acetylcysteine?

A
  • IV VERSION: Acetadote®
    • Helps protect the liver
    • Oral Version is also used as antidote
  • INHALED VERSION: Mucomyst®
    • Mucolytic to thin secretions
    • Can see used in lung diseases like cystic fibrosis and emphysema
30
Q

What are concerns for herbal medications?

A

an Herbal that starts with F,G,S, usually the concern is bleeding risk if added with “blood thinners” aka Anticoagulants

31
Q

What are some herbal medications and their concerns?

A
  • Ginger (Nausea)
  • Gingko biloba (Memory)
  • Garlic (Cholesterol + Blood Pressure)
  • Glucosamine (Joint pain)
  • Feverfew (Miscellaneous Pain)
  • Fish Oil (Cholesterol + Blood Pressure)
  • St. Johns Wort (this is a liver enzyme inducer)
  • Saw Palmetto (Prostate Health)

320 Pharmacology (36 decks)

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