Pharmacology Week 11: Pain and Inflammation Management Agents; Reproductive, Genitourinary and Gender Related Drugs Flashcards
Pain and Inflammation Management Agents
- Opioid Analgesics (Morphine Sulfate)
- Non-Opioid Analgesics (Acetaminophen)
- Corticosteroids (Prednisone)
Pharmacological Pain Management
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
Pain
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
To Assess Quality of Pain
ask the patient to describe the pain as:
- sharp/ dull
- aching
- stabbing
- burning
- throbbing
- tinging
- searing etc.
To Assess Duration of Pain
- Acute (short term)
- Chronic (6 months or longer)
- Intractable (chronic and resistant to relief)
Non-Opioid Analgesics
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
Acetaminophen
- 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
Acetaminophen Adverse Reactions
-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
Opioid Analgesics
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
Opioid Analgesics Receptor-Site Binding Therapeutic Effects
- analgesia
- cough supression
Adverse Reactions of Opioid Analgesics
- respiratory depression
- constipation
- confusion
- sedation
- hypotension
Opioid Analgesics: Morphine
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
Nurses Role in Opioid Administration
- 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
What May Be Given To Reverse the Effects of Overdose in Opioids?
Naloxone
-may be given with overdose to reverse respiratory depression
Anti-Inflammatory Medications
protect the body from invading foreign substances and reduce inflammation in the body
-Sub-classifications–> antihistamines, corticosteroids, uricosurics
Anti-histamine
- sub-classification of anti-inflammatory medication
- block histamine effects that occur in allergic reactions
Uricosurics
- sub-classification of an anti-inflammatory medication
- exert their anti-inflammatory actions on uric acid
- commonly used to treat gout
Corticosteroids
- 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
Corticosteroids: Prednisone (Patient Teaching)
- 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
Complications of Long-Term Therapy of Corticosteroid Prednisone
- 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
Corticosteroid: Prednisone
- 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
Reproductive Hormones
- Oxytocin
- Estrogen Supplements
Estrogens
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
Androgens, Anti-Androgens, Progestins, and Gonadotropin-releasing Hormone Analogues
treat a variety of reproductive cancers including breast, prostate, endometrial and renal
Reproductive Hormones: Estrogen Supplements
- 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
Patient Teaching for Estrogen Replacement Therapy
- 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
Adverse Reactions of Estrogen Replacement Therapy
-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
Oxytocin
hormonal treatment utilized for induction of labor, facilitation of miscarriage, and postpartum control of bleeding
-administered IV and stimulates uterine smooth muscle to contract
Assessment Prior to Administration of Oxytocin
- 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
Genitourinary Medications
- Anticholinergics (Oxybutynin)
- Urinary Tract Analgesics (Phenazopyridine)
Anticholinergic Medications
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
Uses for Anticholinergic Medications
- 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
Anticholinergic: Oxybutynin Therapeutic Effects
- decreased urge incontinence
- decreased urinary frequency + urgency
- increased bladder capacity and delayed desire to void
Anticholinergic: Oxybutynin Side Effects
- dizziness
- drowsiness
- blurred vision
- constipation
- dry mouth
- nausea
- urinary retention
Anticholinergic: Oxybutynin: What to Assess for and Avoid
- 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
Urinary Tract Analgesics/ Selective NSAIDs Patient Teaching
- 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
Urinary Tract Analgesics: Phenazopyridine
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
Teaching for Urinary Tract Analgesic: Phenazopyridine
- 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)
