Pain: Non-Opioids Flashcards
What does inflammatory soup contain?
- Includes PROSTAGLANDINS
- NSAIDS/Corticosteroids can help suppress Prostaglandins from the Inflammatory Soup
What do prostaglandins do?
- Vasodilation (blood vessels, kidneys)
- Stop platelet aggregation (PGI2- Prostacyclin)
- Inflammation and pain
- Protect gastric mucosa
What do COX-1 enzymes do?
- 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)
What do COX-2 enzymes do?
- sites of tissue injury “inflammation”
- in brain: mediates fever and pain
What are the two groups of NSAIDs?
- Salicylates/Irreversible NSAIDS
- ASPIRIN ONLY - Non-Salicylates/ Reversible NSAIDS
- All other NSAIDS are in this category
What does salicylate NSAID treat?
- once daily dosing
- MI/stroke reduction (prevention of clots)
(NSAIDS can compete. Do not take aspirin and ibuprofen at literal same time)
- MI/stroke reduction (prevention of clots)
- PRN every 4 hours
- Rheumatoid Arthritis
- Osteoarthritis
- Joint pain, swelling, inflammation (arthritis, tendonitis, bursitis, etc.)
- Fever
- MILD PAIN
What is the half-life of aspirin when it comes to pain relief?
~ 20min
dosed every 4-6 hours
Why use aspirin?
used for its artery benefits (STROKE AND MI PREVENTION)
What are adverse effects of aspirin?
-
Bleeding
- Inhibition of platelets (thromboxane A2)
What are symptoms of salicylism toxicity?
- Tinnitus
- Respiratory Alkalosis (rapid breathing)
What is ASPIRIN adverse effect for aspirin?
- 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)
What are drug interaction concerns of aspirin in the GI tract?
GI ULCER RISK
- Steroids, NSAIDS can hurt GI tract (risk for ulcer/bleed)
- Smoking/Alcohol can increase risk for bleeding
What are drug interaction concerns of aspirin regarding blood thinners?
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
What are drug interaction concerns of aspirin with other NSAIDs?
increased risk for all the adverse effects!
What are some reversible NSAIDs?
- First Generation
- ibuprofen
- naproxen
- ketorolac
- indomethacin
- diclofenac
- Second Generation
- Celecoxib
What do reversible NSAID treat?
- Joint pain, swelling, inflammation (arthritis, tendinitis, bursitis, etc.)
- Fever
- Mild – moderate pain
- Dysmenorrhea
- Closing patent ductus arteriosus (PDA) in pre-term infants
Reversible NSAIDs prefixes
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)
What are adverse effects of reversible NSAIDs?
- GI effects, bleeding for ALL
- Cardio thrombotic events (MI/Stroke)
What are GI concerns from reversible NSAIDs?
- take with food or water/milk
- Educate for S/S of GI Bleed
- Higher risk with smoking/alcohol, steroids, other NSAIDs, anticoagulants
What are Kidney Concerns from reversible NSAIDs?
- 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)
What are MI/Stroke Concerns from reversible NSAIDs?
- Avoid in history of heart disease/MI (Contra-indication)
- Remember aspirin is the unique exception that protects from heart attack and stroke
What are Fluid Retention Concerns from reversible NSAIDs?
Avoid in heart failure patients (Contra-Indication)
What are some drug interaction concerns with reversible NSAIDs?
- Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin
- Smoking, Alcohol, Steroids, NSAIDs can hurt GI tract (risk for ulcer/bleed)
What does Acetaminophen/APAP/Paracetamol treat?
- Pain or Fever
- This is NOT an NSAID, does NOT work for inflammation
What are adverse effects of Acetaminophen/APAP/Paracetamol?
-
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
Why do people accidentally overdose?
- 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)
What are signs of acetaminophen overdose?
- 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)
What is an antidote to acetaminophen overdose?
Acetylcysteine (Acetadote®)
What are the types of Acetylcysteine?
- 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
What are concerns for herbal medications?
an Herbal that starts with F,G,S, usually the concern is bleeding risk if added with “blood thinners” aka Anticoagulants
What are some herbal medications and their concerns?
- 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)
