Pain Pharm Flashcards
NSAIDs function and MOA
Non-steroidal anti-inflammatories that also have an analgesic and antipyretic effect (lower fever); inhibits COX which prevents release of prostaglandin, causing analgesic, anti-pyretic, and anti-thrombolytic properties (nonselective COX inhibitors)
Arachidonic acid
Cause production of COXs
COX 1
Protects gastric mucosa and needed for thromboxone (clotting) synthesis
COX-2
Causes pain;
Ibuprofen (Advil) class and MOA
NSAIDs; non-selective COX inhibitor
Naproxen (Aleve) class and MOA
NSAIDs; non-selective COX inhibitor
Naproxen SE and NC
Hardest on kidneys; longer-lasting than advil
Ketorolac
NSAIDs; non-selective COX inhibitor
Ketorolac SE and NC
Acute/short-tern moderate-severe pain (under 5 days); GI ulcers, renal dysfunction, especially if baseline issue; Hard on kidneys; don’t give with hx renal disease; analgesic w/o resp depression and works great as IV
Celocoxib class and MOA
NSAIDs; COX2 selective; blocks COX2 which normally causes pain and protects gastric mucosa
Celocoxib SE and NC
black box cardiovascular warning, clots, cerebral embolus; don’t give with CVD; GI mucosa protected
Acetaminophen (Tylenol) Class and MOA
Analgesic and anti-pyretic; not true NSAID; unknown cause (might Dec prostaglandin synthesis in CNS)
Tylenol SE and NC
Large amounts—Liver failure, hepatic necrosis, mild nephropathy; 4g/24h dose restriction
Watch liver indicators (jaundice, elevated PFTs, creatinine levels); don’t give chronically bc causes liver probs; NO mix with alcohol, have liver prob or hepatitis, don’t use when hungover, watch amount of other drugs that may contain Tylenol
Antidote for acute Tylenol ingestion
Acetylcysteine
How do NSAIDs work with other drugs?
Can alternate TRUE NSAIDs with acetaminophen; work well in conjunction with opioids (accept Percocet and Tylenol—liver); use if inflammation is a cause
Opioids are high alert meds
Assess LOC, BP, pulse, resp before admin; poor choice if resp under 10, pt appears sedated or low
biggest concern w/ opioids
Respiratory depression
How are opioids made now
Synthetically
Narcotics
Morphine, hydromorphone, fentanyl, merperidine, codeine, oxycodone, hydrocodone, methadone
Morphine MOA
Mu agonist; mimics endogenous opioids at the mu receptor and binds; schedule 2
Morphine SE and NC
resp dep, CNS dep, constipation, drowsy, confusion, dry mouth, itchy, impaired mental/physical abilities, nausea; Interacts with alcohol; mostly for patients who are not opioid naive; don’t drive with it; watch VS, respirations before admin
Hydromorphone (Dilaudid)
Similar to morphine but stronger; schedule 2; patients with higher tolerance prefer
Opioid naive
New to opioid use; usually elderly or young patients, need to know their baseline neuro state before giving, always start with the lowest dose
Fentanyl (Duragesic)
Synthetic; extremely strong, 1mg IV Fentanyl=10mg IV morphine; for post-op, chronic pain; PO buccal, IV, IM, transdermal patch
Merperidine (Demerol)
acute migraine or post-op shiver; Less Resp dep, constipation, drowsy, CNS stimulation and seizures, nausea; Many drug-drug interactions, don’t give repeated doses bc seizures from toxic metabolites; don’t use with hx seizures; weaker than morphine
Codeine
Given for coughing (anti-tussive), usually given with other analgesics (acetaminophen and aspirin), not for kids under 18 bc can cause breathing problems; GI side effects—might cause some to say they’re allergic
Oxycodone
Schedule 2, just for pain, semi-synthetic derivative of codeine—PO only; 10x stronger than codeine
Hydrocodone
Antitussives, analgesic similar to codeine; often mixed with Tylenol—Norco/Lortab
Methadone
Fully synthetic; schedule 2; choice of opioid for detox; longer half-life than other opioids; only PO
Naloxone (Narcan)
Opioid antagonist for all opioids; binds to opioid receptors but doesn’t activate (just clogs); onset under 2 minutes; nasal, IV, IM; SE abrupt reversal including reversal of pain relief, BP, cough; also for heroin; may need to give twice
Nursing considerations and SE for all opioids
All cause constipation that can progress to paralytic ileus; N/V common (may give anti-emetic but be careful bc these can contribute to respiratory depression); consider alternative first
Paralytic ileus
Huge backup of stool bc intestines are depressed (especially in post-op patients)
Which NSAID is easiest on the stomach?
Ibuprofen
non-selective NSAID general side effects and nursing considerations
GI ulcers, GI bleed, rash, edema, kidney failure, increased BP, decreased platelet aggregation, SOB with asthma; Not best for people with asthma; black box for GI issues—don’t give to elderly and people with past hx, must eat first
Percocet
Tylenol mixed with oxy
OxyContin
Highly addictive form of oxy that is slow time response
