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PHARMACOLOGY > Reading 01: Non-Opioid Analgesics > Flashcards

Reading 01: Non-Opioid Analgesics Flashcards

1
Q

These drugs encompass the non-steroidal anti-inflammatory drugs (NSAIDS) and paracetamol (acetaminophen).

A

Non-opioid Analgesics

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2
Q

NSAIDS include what:

A

(A) Acetylsalicylic acid (Aspirin)
(B) Dipyrone (Metamizole)
(C) Numerous other drugs in diverse classes

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3
Q

NSAIDS are used to commonly treat what?

A

Mild and moderate acute or chronic pain. They can be used as monotherapy, but they have greater efficacy with weak and strong opioids.

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3
Q

NSAIDS have the potent potential of what:

A

(A) Anti-inflammatory
(B) Analgesic
(C) Antipyretic activity

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4
Q

Does long term use of non-steroidal anti-inflammatory drugs lead to physical dependence?

A

NO

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5
Q

In palliative medicine, what do non-opioid analgesics represent?

A

The first step of the World Health Organization ladder used for mild pain.

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6
Q

What are the disadvantages of non-opioid analgesics?

A

(A) Ceiling effect for pain relief and the risk for side effects.
(B) Associated with an increase of adverse gastrointestinal, renal, and cardiovascular effects.
(C) Hepatoxicity from overdosing with paracetamol.

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7
Q

How do adverse gastrointestinal, renal, and cardiovascular effects increase with non-opioid analgesics?

A

(A) They increase in ulcerative disease and in higher doses.
(B) They also increase with elderly above 65 years old.
(C) With concomitant administration with corticosteroids, anticoagulants and other NSAIDS.

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8
Q

These are increasingly emphasized in a variety of clinical settings as preferred, safe, and effective first line therapy for mild and moderate acute and chronic pain.

A

Non-Opioid Analgesics

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9
Q

Non-opioid analgesics include what?

A

(A) Acetaminophen
(B) Non steroidal anti-inflammatory drugs (NSAIDS)

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10
Q

What are other agents commonly used for mild and moderate acute and chronic pain?

A

(A) Anticonvulsants (including gabapentin and pregabalin)
(B) Antidepressants (including amitriptyline and duloxetine)
(C) Aspirin
(D) Topical agents (lidocaine and capsaicin)

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11
Q

This non-opioid analgesic have fever reducing effects. It is widely considered as the safest analgesic available, although liver injury is a concern with overdose.

A

Acetaminophen

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12
Q

These non-opioid analgesics are known to alleviate pain and reduce fever and inflammation by decreasing the synthesis and release of prostaglandins, which are pro-inflammatory molecules.

A

Aspirin and other NSAIDS

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13
Q

These are known to be pro-inflammatory molecules and are inhibited by Aspirin to reduce inflammation and to alleviate pain.

A

Prostaglandins.

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14
Q

This non-opioid analgesic also inhibit prostaglandin synthesis and release, but unlike Aspirin, it does not inhibit platelet aggregation.

A

Cyclooxygenase (COX-2)

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15
Q

These non-opioid analgesics have unknown mechanisms for their pain relieving properties. But studies suggest that there analgesic effects may due pre-synaptic inhibition of the re-uptake of serotonin and norepinephrine as well as the peripheral mechanism involving B2 adrenergic receptors.

A

Tricyclic antidepressants (amitriptyline) and serotonin-norepinephrine (noradrenaline)

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16
Q

These non-opioid analgesics provide an analgesic effect by lowering neurotransmitter release or neuronal firing.

A

Anticonvulsants

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17
Q

This type of topical treatment that acts locally works by blocking nerve signals that send the feeling of pain to the brain. It causes a temporary loss of feeling in the area to which it is applied.

A

Lidocaine

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18
Q

This type of topical treatment depletes local neurons of substance P, which is required in the transmission of a nociceptive output.

A

Capsaicin

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19
Q

What is the mechanism of action of acetaminophen?

A

It inhibits the synthesis of prostaglandins which serve as mediators of pain and fever primarily in the CNS.

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20
Q

Acetaminophen should be used for what?

A

Mild pain and fever because it does not have any anti-inflammatory properties.

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21
Q

What should be the nursing considerations of acetaminophen across lifespans?

A

(A) It is safe for all ages and to be administered using various routes.
(B) Among geriatric populations it should not exceed 3000 mg in 24 hours.
(C) Among chronic alcoholics, it should not exceed 2000 mg in 24 hours due to the risk of hepatoxicity.

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22
Q

What should be the patient teaching and education on acetaminophen?

A

(A) Should not be taken more than 10 days.
(B) Avoid drinking alcohol while taking it.
(C) If a rash occurs, should be reported immediately and promptly stoped.
(D) It could interfere with blood glucose monitoring.
(E) If fever lasts longer for more than three days or exceeds 39.5 C, consider alternatives.

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23
Q

What is the mechanism of action of aspirin or acetyl salicylic acid?

A

Aspirin produces analgesia and reduces inflammation by inhibiting the production of prostaglandins. It also decreases platelet aggregation.

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24
Q

Acetyl salicylic acid or aspirin should only be used for what?

A

Mild fever and pain (use only daily dosages to reduce the risk of heart attack and stroke)

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25
Q

What is the nursing consideration across lifespans for aspirin?

A

It is safe for all adults and children above 12 years old.

26
Q

Aspirin contains NSAID, which may cause acute severe upper gastrointestinal bleeding. The chance of bleeding is higher if a patient:

A

(A) Takes a higher or longer dose than directed
(B) Takes other drugs containing NSAIDS
(C) Has had stomach ulcers or bleeding problems
(D) Takes blood thinning (anticoags) or steroid drug
(E) ages 60 or older
(F) 3 or more alcoholic drunks everyday while using this product

27
Q

What is the contraindication of aspirin?

A

(A) Bleeding disorders such as hemophilia
(B) Recent history with upper and lower GI bleed

28
Q

What should be the patient teaching and education with aspirin?

A

(A) Patients should avoid concurrent use of alcohol to avoid gastric irritation.
(B) Report tinnitus, unusual bleeding or fever lasting more than 3 days

29
Q

Should aspirin be used to treat chickenpox or flu-like symptoms?

A

NO

30
Q

This primarily occurs in children in conjunction with a viral illness, it can cause symptoms such as persistent vomiting, confusion, loss of consciousness, and requires immediate medical attention.

A

Reye’s Syndrome

31
Q

What is the mechanism of action of ibuprofen?

A

Ibuprofen inhibits prostaglandin synthesis.

32
Q

What are the indications for use for ibuprofen?

A

Mild to moderate pain and fever, inflammatory disorders including rheumatoid arthritis and osteoarthritis and pain associated with menstruation.

33
Q

What is the nursing consideration across lifespans for ibuprofen?

A

(A) Safe for infants 6 months older.
(B) Do not use during the last 3 months of pregnancy.

34
Q

What are the other patient teaching and education for ibuprofen?

A

(A) Should consume with a full glass of water and remain upright for 30 minutes
(B) Avoid the use of alcohol
(C) Should not take longer than 10 days
(D) Report, rash, visual changes, tinnitus, weight gain, or influenza like symptoms

35
Q

What is the heart attack and stroke warning for ibuprofen?

A

All NSAIDS, except aspirin, increase the risk for fatal heart attack, heart failure, and stroke. Ibuprofen is contraindicated for the treatment of perioperative pain after CABG.

36
Q

This is commonly used to treat breakthrough pain that occurs during the treatment of severe acute pain being treated with opioids.

A

Ketorolac

37
Q

What is the mechanism of action of ketorolac?

A

Inhibits prostaglandin synthesis

38
Q

What is the indications for use of ketorolac?

A

For short term (up to 5 days in adults) management of moderate to severe pain that requires analgesia at the opioid level.

39
Q

What should be the nursing consideration across the lifespan for ketorolac?

A

(A) Safe for all adults
(B) Dosage should be modified for those 65 and over

40
Q

What should be the patient teaching for ketorolac?

A

(A) May cause dizziness and drowsiness
(B) Avoid alcohol or aspirin containing products
(C) Watch out for onset changes of rash, visual changes, tinnitus, weight gain or influenza like symptoms

41
Q

In terms of gastrointestinal risk, ketorolac is contraindicated with what?

A

Patients who have
(A) Active peptic ulcer disease
(B) GI bleeding or perforation
(C) Elderly patients are at greater risk for serious GI events.

42
Q

In terms of cardiovascular changes, ketorolac can cause what?

A

An increase of serious cardiovascular thrombotic events such as fatal MI or stroke.

43
Q

In terms of renal risk, ketorolac is contraindicated with what?

A

(A) Advanced renal impairment
(B) Risk for renal failure due to volume depletion

44
Q

In term of risk of bleeding, ketorolac inhibits what?

A

Platelet function, therefore is contraindicated with cerebrovascular bleeding, hemorhagic diathesis, incomplete hemostasis, and risk for bleeding.

45
Q

Ketorolac tromethamine is contraindicated as a ______________before anymajor surgery.

A

prophylactic analgesic

46
Q

Ketorolac tromethamine is contraindicated in patients with previously demonstrated hypersensitivity to ketorolac tromethamine or who have

A

Had allergic manifestations to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)

47
Q

These are a type of non-steroidal anti-inflammatory drug (NSAID) that directly targets cyclooxygenase-2, COX-2, an enzyme responsible for inflammation and pain.

A

COX 2 Inhibitors (coxib)

48
Q

Targeting selectivity for COX-2 reduces the risk of ___________and is the main feature of celecoxib, rofecoxib, and other members of this drug class.

A

peptic ulceration

49
Q

Clinical trials revealed that COX 2 inhibitors can cause a significant increase in what?

A

Heart attacks and stroke

50
Q

This was taken off the market in 2004 because of these concerns

A

Rofecoxib

51
Q

As of December 2011, only ________ is still available for purchase in the United States.

A

Celebrex (celecoxib)

52
Q

In the European Union, _______________ have been approved or use by the European Medicines Agency.

A

celecoxib, parecoxib and etoricoxib

53
Q

What is the mechanism of action of COX 2 Inhibitors?

A

It inhibits enzyme COX 2 enzyme which is required for the synthesis of prostaglandins.

54
Q

What is the indications for use of COX 2 inhibitors?

A

Pain associated with osteoarthritis, gout, rheumatoid arthritis, ankylosing spondylitis and dysmenorrhea.

55
Q

This is better than most analgesics and celecoxib being as useful as ibuprofen.

A

Etoricoxib

56
Q

What is the nursing consideration across all lifespans for celecoxib?

A

(A) Celecoxib is safe for children 2 years older.
(B) Dosage should be modified for those with hepatic impairment

57
Q

What is the patient teaching and education for celecoxib

A

(A) Take medication as directed and use the lowest effective dose.
(B) if signs of GI toxicity occur, report immediately.

58
Q

NSAIDS cause an increased risk of serious GI adverse effects including what?

A

(A) Bleeding
(B) Ulceration
(C) Perforation of the stomach and intestines

Patients with prior history of peptic ulcer disease or GI Bleeding are at greater risk for serious GI events.

59
Q

For this, COX-2 inhibitors appear to work as well as nonselective NSAIDS, such as Aspirin. They have not been compared to other treatment options such as colchicine or glucocorticoids.

A

Gout

60
Q

Under neuropsychiatric disorders, COX 2 inhibitors have been found to be effective in suppressing:

A

Inflammatory neurodegenerative pathways (schizophrenia, bipolar disorders, and obsessive compulsive disorders).

61
Q

COX 2 appears to be related to cancers and _______.

A

Abnormal growths in the intestinal tract.

62
Q

Overexpression of COX 2 produces what?

A

An excess of prostaglandins which have been shown to increase the possibility of colorectal growths.

63
Q

The FDA has approved Celebrex for treatment of _________.

A

familial adenomatous polyposis (FAP)

PHARMACOLOGY (9 decks)

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