Pain Pharm

Question 1

NSAIDs function and MOA

Answer 1

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)

Question 2

Arachidonic acid

Answer 2

Cause production of COXs

Question 3

COX 1

Answer 3

Protects gastric mucosa and needed for thromboxone (clotting) synthesis

Question 4

COX-2

Answer 4

Causes pain;

Question 5

Ibuprofen (Advil) class and MOA

Answer 5

NSAIDs; non-selective COX inhibitor

Question 6

Naproxen (Aleve) class and MOA

Answer 6

NSAIDs; non-selective COX inhibitor

Question 7

Naproxen SE and NC

Answer 7

Hardest on kidneys; longer-lasting than advil

Question 8

Ketorolac

Answer 8

NSAIDs; non-selective COX inhibitor

Question 9

Ketorolac SE and NC

Answer 9

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

Question 10

Celocoxib class and MOA

Answer 10

NSAIDs; COX2 selective; blocks COX2 which normally causes pain and protects gastric mucosa

Question 11

Celocoxib SE and NC

Answer 11

black box cardiovascular warning, clots, cerebral embolus; don’t give with CVD; GI mucosa protected

Question 12

Acetaminophen (Tylenol) Class and MOA

Answer 12

Analgesic and anti-pyretic; not true NSAID; unknown cause (might Dec prostaglandin synthesis in CNS)

Question 13

Tylenol SE and NC

Answer 13

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

Question 14

Antidote for acute Tylenol ingestion

Answer 14

Acetylcysteine

Question 15

How do NSAIDs work with other drugs?

Answer 15

Can alternate TRUE NSAIDs with acetaminophen; work well in conjunction with opioids (accept Percocet and Tylenol—liver); use if inflammation is a cause

Question 16

Opioids are high alert meds

Answer 16

Assess LOC, BP, pulse, resp before admin; poor choice if resp under 10, pt appears sedated or low

Question 17

biggest concern w/ opioids

Answer 17

Respiratory depression

Question 18

How are opioids made now

Answer 18

Synthetically

Question 19

Narcotics

Answer 19

Morphine, hydromorphone, fentanyl, merperidine, codeine, oxycodone, hydrocodone, methadone

Question 20

Morphine MOA

Answer 20

Mu agonist; mimics endogenous opioids at the mu receptor and binds; schedule 2

Question 21

Morphine SE and NC

Answer 21

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

Question 22

Hydromorphone (Dilaudid)

Answer 22

Similar to morphine but stronger; schedule 2; patients with higher tolerance prefer

Question 23

Opioid naive

Answer 23

New to opioid use; usually elderly or young patients, need to know their baseline neuro state before giving, always start with the lowest dose

Question 24

Fentanyl (Duragesic)

Answer 24

Synthetic; extremely strong, 1mg IV Fentanyl=10mg IV morphine; for post-op, chronic pain; PO buccal, IV, IM, transdermal patch

Question 25

Merperidine (Demerol)

Answer 25

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

Question 26

Codeine

Answer 26

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

Question 27

Oxycodone

Answer 27

Schedule 2, just for pain, semi-synthetic derivative of codeine—PO only; 10x stronger than codeine

Question 28

Hydrocodone

Answer 28

Antitussives, analgesic similar to codeine; often mixed with Tylenol—Norco/Lortab

Question 29

Methadone

Answer 29

Fully synthetic; schedule 2; choice of opioid for detox; longer half-life than other opioids; only PO

Question 30

Naloxone (Narcan)

Answer 30

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

Question 31

Nursing considerations and SE for all opioids

Answer 31

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

Question 32

Paralytic ileus

Answer 32

Huge backup of stool bc intestines are depressed (especially in post-op patients)

Question 33

Which NSAID is easiest on the stomach?

Answer 33

Ibuprofen

Question 34

non-selective NSAID general side effects and nursing considerations

Answer 34

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

Question 35

Percocet

Answer 35

Tylenol mixed with oxy

Question 36

OxyContin

Answer 36

Highly addictive form of oxy that is slow time response