Pharmacology Week 11: Pain and Inflammation Management Agents; Reproductive, Genitourinary and Gender Related Drugs

Question 1

Pain and Inflammation Management Agents

Answer 1

• Opioid Analgesics (Morphine Sulfate)
• Non-Opioid Analgesics (Acetaminophen)
• Corticosteroids (Prednisone)

Question 2

Pharmacological Pain Management

Answer 2

drugs used to control pain range from mild, over-the-counter (OTC) preparations to controlled substances and potent general anesthetics

• Pain assessment = 5th vital sign and is an essential nursing intervention to all patients
• Variety of pain assessment scales, most common involves patient rating their pain on a scale between 0 to 10

Question 3

Pain

Answer 3

an unpleasant sensation and emotional response to the sensation

• effects all areas of a persons life
• besides pain scale, the nurse needs to assess the QUALITY and DURATION of the patients pain

Question 4

To Assess Quality of Pain

Answer 4

ask the patient to describe the pain as:

• sharp/ dull
• aching
• stabbing
• burning
• throbbing
• tinging
• searing etc.

Question 5

To Assess Duration of Pain

Answer 5

• Acute (short term)
• Chronic (6 months or longer)
• Intractable (chronic and resistant to relief)

Question 6

Non-Opioid Analgesics

Answer 6

used for pain management and have antipyretic (fever reducer) and anti-inflammatory effects

ex: acetaminophen (Tylenol)
- inhibit prostaglandin synthesis peripherally for analgesic effect and centrally for antipyretic effect

Question 7

Acetaminophen

Answer 7

• Non-Opioid Analgesic
• produces analgesic and antipyretic effects and is used in many OTC preparations
• Adverse Reactions: skin rash, liver damage
• recommended for short term use only
• do not take with alcohol
• may be taken with other OTC pain relievers
• exceeding the recommended dosage can lead to liver + kidney function problems

Question 8

Acetaminophen Adverse Reactions

Answer 8

-skin rash
-liver damage
(recommended for short term use, do not take with alcohol)
-alcohol use with this drug increases risk of hepatotoxicity
-exceeding the recommended dosage can lead to liver + kidney function problems

Question 9

Opioid Analgesics

Answer 9

reduce pain by binding to opiate receptor sites in the peripheral and central nervous systems blocking the pain response

• stimulation of the opiate receptors mimic the effect of endorphins that are naturally occurring opiates in the body
• this receptor-site binding produces the therapeutic effects of analgesia and cough suppression

Question 10

Opioid Analgesics Receptor-Site Binding Therapeutic Effects

Answer 10

• analgesia

- cough supression

Question 11

Adverse Reactions of Opioid Analgesics

Answer 11

• respiratory depression
• constipation
• confusion
• sedation
• hypotension

Question 12

Opioid Analgesics: Morphine

Answer 12

may be administered by a variety of routes:
-mouth (PO)
-subcutaneously (sub q or sq)
-intramuscular (IM)
-rectally
-intravenously (IV)
-intrathecal (in spinal cord) 
>may be given orally in short or long acting forms 
>injectable
>IV as intermittent injection
>continuous infusion
>patient controlled analgesia that allows the patient control over when pain medication will be administered

Question 13

Nurses Role in Opioid Administration

Answer 13

• assess type, location, and intensity of patients pain prior to administering opioids and 1 hour after
• monitor vital signs, mental status and bowel function/constipation (laxatives may be needed with long-term use because of constipation)
• monitor signs of physical and psycho-social dependence on the drug
• prolonged use of this drug an lead to opioid addiction or abuse
• assess level of consciousness + vital signs before and after administration
• Naloxone may be given with overdose to reverse respiratory depression or coma

Question 14

What May Be Given To Reverse the Effects of Overdose in Opioids?

Answer 14

Naloxone

-may be given with overdose to reverse respiratory depression

Question 15

Anti-Inflammatory Medications

Answer 15

protect the body from invading foreign substances and reduce inflammation in the body
-Sub-classifications–> antihistamines, corticosteroids, uricosurics

Question 16

Anti-histamine

Answer 16

• sub-classification of anti-inflammatory medication

- block histamine effects that occur in allergic reactions

Question 17

Uricosurics

Answer 17

• sub-classification of an anti-inflammatory medication
• exert their anti-inflammatory actions on uric acid
• commonly used to treat gout

Question 18

Corticosteroids

Answer 18

• sub-classification of anti-inflammatory medication
• multiple drug interactions
• suppress immune response and reduce inflammation
• used systemically and locally in the management of a wide variety of chronic diseases including inflammatory, allergic, hematologic, neoplastic (cancer) and autoimmune disorders

Question 19

Corticosteroids: Prednisone (Patient Teaching)

Answer 19

• Take drug as ordered. Missed doses and stopping the drug can result in complications
• report sudden weight gain, swelling, slow healing, black tarry stools, bleeding, bruising, blurred vision, emotional changes and other unusual effects
• medication should be administered in the morning to coincide with the bodys normal secretion of cortisol

Question 20

Complications of Long-Term Therapy of Corticosteroid Prednisone

Answer 20

• Cushings Syndrome: “moon-like” face, weight gain, thin, easily bruised skin, hypertension, depression and diabetic symptoms: thirst, polyuria, polyphagia (extreme hunger)
• can decrease calcium and vitamin D levels, cause osteoporosis and infection

Question 21

Corticosteroid: Prednisone

Answer 21

• be aware of early signs of adrenal insufficiency including–> fatigue, muscle weakness, joint pain, fever, anorexia, nausea, dyspnea, dizziness + fainting
• must be withdrawn gradually from the drug
• abrupt withdrawal or increased stress can result in death because it causes acute adrenal insufficiency
• medication should be administered in the morning to coincide with the bodys normal secretion of cortisol

Question 22

Reproductive Hormones

Answer 22

• Oxytocin

- Estrogen Supplements

Question 23

Estrogens

Answer 23

mimic the physiological effects of the naturally occurring female sex hormones

• used to correct estrogen deficient states and in conjunction with hormonal contraceptives, prevent pregnancy
• treatment of hormone-sensitive tumors

Question 24

Androgens, Anti-Androgens, Progestins, and Gonadotropin-releasing Hormone Analogues

Answer 24

treat a variety of reproductive cancers including breast, prostate, endometrial and renal

Question 25

Reproductive Hormones: Estrogen Supplements

Answer 25

- prescribed primarily for estrogen replacement therapy in post-menopausal females - given to women with reduced ovarian hormonal secretion - for palliative treatment of advanced beast cancer - Women's health initiative study reported: increased heart attack, stroke, breast cancer, pulmonary emboli and deep vein thrombosis in women taking for 5 years or more

Question 26

Patient Teaching for Estrogen Replacement Therapy

Answer 26

- diabetic patients may experience symptoms of hyperglycemia or glycosuria (excretion of glucose in urine) - many adverse reactions may occur - keep timely schedule of gynecologic and mammogram appointments - can lead to development of cardiovascular and breast cancer

Question 27

Adverse Reactions of Estrogen Replacement Therapy

Answer 27

-elevated BP (hypertension) -breast tenderness -weight changes -thromboembolism (check for thromboembolic disorders; pain, swelling, tenderness in extremities, headache, chest pain, blurred vision) -shortness of breath -severe headaches -vision disturbances -vaginal bleeding/ discharge -breast lumps -edema of hands or feet -jaundiced skin -pain in chest, abdomen, legs, or buttocks

Question 28

Oxytocin

Answer 28

hormonal treatment utilized for induction of labor, facilitation of miscarriage, and postpartum control of bleeding -administered IV and stimulates uterine smooth muscle to contract

Question 29

Assessment Prior to Administration of Oxytocin

Answer 29

- fetal maturity - presentation and pelvic adequacy - character, frequency, and duration of uterine contractions and resting uterine tone - fetal heart rate - pulse and BP of mother - monitor for S+S of drowsiness, listlessness, confusion, headache, anuria - this drug occasionally causes water intoxication

Question 30

Genitourinary Medications

Answer 30

- Anticholinergics (Oxybutynin) | - Urinary Tract Analgesics (Phenazopyridine)

Question 31

Anticholinergic Medications

Answer 31

block the impulses of the neurotransmitter acetylcholine - used to treat spastic or hyperactive conditions of the GI or urinary tract because they relax muscles and decrease GI secretions - used to treat other conditions--> pre-operatively to reduce secretions, increase heart rate, dilate eyes during eye exams

Question 32

Uses for Anticholinergic Medications

Answer 32

- treat spastic or hyperactive conditions of the GI or urinary tract because they relax muscles and decrease GI secretions - treat pre-operatively to reduce secretions - increase heart rate - dilate eyes during eye exams

Question 33

Anticholinergic: Oxybutynin Therapeutic Effects

Answer 33

- decreased urge incontinence - decreased urinary frequency + urgency - increased bladder capacity and delayed desire to void

Question 34

Anticholinergic: Oxybutynin Side Effects

Answer 34

- dizziness - drowsiness - blurred vision - constipation - dry mouth - nausea - urinary retention

Question 35

Anticholinergic: Oxybutynin: What to Assess for and Avoid

Answer 35

- Assess for anaphylactic reaction, voiding patterns and intake + output, and assess abdomen for urinary retention - prior to administering medication, a bladder scan or post void catheterization may be performed to assess the patients bladder capacity - Avoid concurrent use of alcohol and other CNS depressants

Question 36

Urinary Tract Analgesics/ Selective NSAIDs Patient Teaching

Answer 36

- report history of allergic reactions to sulfonamides, aspirin or other NSAIDs - report signs of GI bleeding--> bloody vomitus, urine or stool or black tarry stool - monitor liver function as these drugs can effect liver function - take drug with food if stomach upset occurs - avoid other medications and alcohol

Question 37

Urinary Tract Analgesics: Phenazopyridine

Answer 37

provides anesthetic effect for patients with urinary tract symptoms from urinary tract infections or procedures by relieving urinary pain, itching, burning, urgency, + frequency -drug causes reddish-orange discoloration of the urine that may stain clothing

Question 38

Teaching for Urinary Tract Analgesic: Phenazopyridine

Answer 38

- drug causes reddish-orange discoloration of the urine that may stain clothing - discontinue medication when pain + discomfort has stopped (2-3 days) but continue taking full dose of antibiotic - administer with or after meals to decrease GI irritation - do not crush - can not be used prophylactically (this drug does not prevent UTIs but treats symptoms associated)