PAIN- NSAIDs + Flashcards
What drug is mainstay for post op?
OPIATES
FOR malignant Pts what are Opiates good for?
improve QOL, fx, comfort, acceptance. DO NOT WITHOLD d/t fear of addiction
Should opiates be used for chronic pain?
rare,NEVER- evidence of serious SE
Mr. Durant c/o stiff throbbing ache, sore, squeezing, hurting pain in his calf. What type of pain is this?
Nociceptive- ACUTE use OPIOIDS
Mrs. Baynes c/o numbness, paresthesia, cold, fire, burning, foot asleep, shock like, shooting pain, comes and goes pain in L foot. What type of pain is this?
Neuropathic- AVOID OPIODS
How does the pathology of opioids and pain modulation work?
Opioid dull perception and transmission of pain
Opioids work on which primary receptors?
– mu-1: mostly analgesia
– mu-2: sedation, constipation, antidiuretic, respiratory depression, bradycardia, euphoria, physical dependence
When Opioids work on G protein receptor the DEC what?
DEC CAMP/Ca2+
DEC= release of neurotransmitters DA, Ach, NE, serotonin, sub P-pain
What is important to consider prior to pain management?
Type, Allergies, Prev pain use, Pain score, Renal, AGE
This elevates pain threshold; peripherally blocks pain
impulse generation, antipyresis, block Cox in CNS?
Acetaminophen (Ofirmev, Paracetamol, Tylenol®); APAP-Acetyl-P-AminoPhenol-
What are benefits of APAP?
- NOT ANTI-inflammatory.
- Less GIB.
- Less SE.
- Good with Opiates to DEC Pain, but Less DOSEa
What are warnings with APAP?
BBW OD metabolite Liver toxicity- hepatic necrosis
MAX 325mg.
1. Avoid use w/ ETOH
2. DI- warfarin
3. Often used in combo. Risk of OD on other med, ie codeine
If a Pt has allergy not responding to NSAID what else could be used?
Another Catogory 1. Salcytes- aspirin 2. Propion Acids- profen 3. Indole-indomethacin 4. Acetic Ace- Diclofenac 5. Napthylakanone- 6. Oxicam, 7- Pryanocaroxilc Acide 8. Fenamates
What has a max ceiling effect of 3200, no added dose will inc effects, analgesic, and antipyretic?
Non Selective AIDs- Not as effective for pain as opioid,
Minor injuries
What are some myths about NSAIDS?
Delayed healing in tissue and bone fracture, NON UNION.
Ok to use early in TX pain, (but recall pts rarely sees MD Day 1 I prefe Tylenol 24-48hr)
If a Pt has PMH of GERD, PUD, what should be avoided and why?
- NSAIDs- inhibit COX 1-2, COX
2. DEC prostaglandins -GI protective, renal protective, platelet forming
What RX only affect COX2?
Cox 2 inhibitor and Corticosteroids
What is dose for Ibuprofen?
200-800mg TID/QID,
Max 3200mg/day (Advil, Motrin)
1-2hr onset
What is dose for Naproxen?
250-500 BID/TID 1250 (Aleve)
MAX 1250mg
2-4hr onset
What has the worst GI irritation
ASPIRIN
What are COX 2 selects with less GIB?
-COXIB, -NAC.
What COX 1 inhib is worse and not to give more than 5 days d/t GIB?
Ketoralac- strong but too much risk GIB
99% bound.
AVOID; 1. labor, peds 2. PUD 3. CABG, 4. Renal 5. minor pain 6. NSAIDS combo
Avoid these Pt with Non selective d/t risk of GIB?
>60 yrs • History of GI problems • Current corticosteroid or anticoagulant use • CV, DM • Chronic use and high-dose NSAID
What meds can be used with NSAIDs to MAYBE MINIMIZE dec GI?
proton pump inhibitors-omeprazole
Histamine 2 blockers- famotidine.
