Pain treatment lecture 2 Flashcards
What do Ibuprofen type NSAIDs do?
-COX 1 and COX 2 inhibitor
What amount of Ibuprofen is needed for an analgesic effect?
-400 mg
What amount of ibuprofen is needed for anti-inflammation?
-800 mg
What type of pain do you use ibuprofen for?
-Mild to moderate pain relief
What are the side effects of ibuprofen type NSAIDs?
- GI ulcers
- Anti-clotting
- Cardiovascular effects
What amount of ibuprofen is needed for antipyretic action?
-400 mg
What type of people should you be cautious in giving ibuprofen?
- Heart disease
- High blood pressure
- Diabetes
- Strokes
What are some special properties of ibuprofen like NSAIDs?
- Ketoprofen (Orudis)
- Naproxen (Naprosyn)
How does ketoprofen compare to ibuprofen?
-More potent at lower doses
How does Naproxen (alleve) compare to Ibuprofen?
-Longer lasting and slower acting
Why would you use Celecoxib?
-Lacks GI and anti-clotting action because it is a COX-2 selective antagonist
T/F Celecoxib has been linked with cardiovascular side effects
True
What are some other NSAID agents? (these are used in arthritis)
- Indomethacin
- Meloxicam
- Diflunisal (Dolobid)
What is Indomethacin?
-Potent non-selective NSAID/due to side effects not a common analgesic
What is Meloxicam?
- Preferentially inhibits COX-2 over COX-1 which means less GI problems
What is Diflunisal (Dolobid)?
-Related to salicylates and is supposed to be good for bone pain
What are the possible mechanisms of Acetaminophen?
-Inhibits a COX3 enzyme or serotonin
What are the side effects of acetaminophen?
- Liver toxin in high doses
- Pts with compromised livers should not use
What are the analgesic uses of NSAIDs?
- Somatic pain
- Mild to moderate pain
What type of somatic pain could you use NSAIDs for?
- Most dental pain
- Most headaches (Tension and congestion types not migraines)
- Most muscle and joint pains
- Most earaches
What are some NSAID contraindications?
- Pt on anticoagulants
- Hemophiliac
- Ulcers
- Already taking high doses
- Child or adolescent
- History of allergies
What are some anticoagulants?
- Coumadin (Warfarin)/ Pradaxa
- Joint replacement
- Heart attack/ stroke
- Major surgery
- Atrial fibrillation
What are some signs of a possible ulcer?
- Frequent upset stomach
- Bleeding in stool
- Take antacids
- Takes H2 blockers (tagamet)
What are the therapeutic uses of opioid narcotics?
- Analgesia
- Somatic and visceral pain
- Mild to severe
- Antitussive (blocks the coughing center)
- Antidiarrheal
What are six of the most commonly used narcotics?
- Morphine
- Hydromorphone
- Oxymorphone
- Oxycodone
- Hydrocodone
- Codeine
What are the more potent forms of narcotics?
-Morphine/morphones
What is a less potent narcotic?
-Codeine/Codone
Are hydros or oxys more potent?
-Oxy
What type of narcotics are lortab and vicodin?
-Hydrocodone + acetaminophen
What is Meperidine (Demerol)?
-Narcotic analgesic for moderate pain
What is Pentazocine (Talwin)?
-A Narcotic analgesic that is a Mixed agonist/antagonist that treats moderate pain
What is methadone?
-Narcotic analgesic for moderate to strong pain that is used to treat opioid addiction and as an analgesic
What is Buprenorphine?
-Narcotic analgesic for moderate analgesic mixed agonist and antagonist that is used to treat opioid addiction
What is one of the most potent narcotics?
-Fentanyl .1 mg
What are the major opioid agonist side effects?
- Respiratory depression
- Decreased pulmonary reflex
- Constipation/slow bowel movement
- Sedation/additive or synergistic with other CNS depressants
- Euphoria/dependence/addiction
What is the treatment for opioid overdose?
-Inject naloxone (Narcan)
What type of drug is Oxycontin/Percodan?
-Oxycodone
What are contraindications for opioids?
- History of substance abuse
- Sever constipation or upset stomach
- Respiratory problems
- CNS depressants
- Allergies
When managing neuropathic pain what is the first line treatment drugs?
- Gabapentin
- Duloxetine
- Nortriptyline
What is the next line of treatment of managing neuropathic pain?
-Tramadol
