Topic 7 Flashcards
inflammation patho
protective response top tissue injury and infection
a vascular reactions occurs causing fluid, blood elements, leukocytes and chemical mediators (prostaglandins) to accumulate at the injured site
what do prostaglandins do?
help dilate blood vessels to get more blood flow
what are the inflammatory phases
vascular phase
delayed phase
vascular phase
occurs 10-15 minuses after injury
vasodilation and increased capillary permeability
fluid and blood substances move to injured site
delayed phase
leukocytes infiltrate the inflamed tissue
what does the cyclooxygenase (COX) gene do?
converts arachidonic acid into prostaglandins
what are the two forms of cyclooxygenase
COX-1 and COX-2
COX-1
protects stomach lining and regulates blood platelets
COX-2
triggers inflammation and pain
what are the cardinal signs of inflammation
redness
swelling (edema)
heat
pain
loss of function
what are the anti-inflammatory drug groups
non steroidal inflammatory drugs (NSAIDs)
coticosteroids
disease modifying anti rheumatic drugs (DMARDS)
antigout drugs
what are the action of NSAIDs
INHIBIT biosynthesis of prostaglandins
analgesic effects
antipyretic effects
inhibit platelet aggregation
mimic effect of corticosteroid but are not chemically similar
inhibit COX enzyme
analgesic effet
pain relief
antipyretic effect
reduces fever
inhibit platelet aggregation
inhibit clotting
what are the first generation NSAIDs
salicylate (aspirin)
parachlorobenzoic acid derivatives
phenylacetic acids
propionic acid derivatives (ibuprofen)
fenamates
oxicams
INHIBIT BOT COX 1&2
what are second generation NSAIDs
SELECTIVE COX 2 inhibitor
action of salicylates (aspirin)
antiinflammaroty, antiplatelet, antipyretic
what is the therapeutic aspirin (salicylate) level
15-30 mg/dL
what is the mild toxicity level of aspirin
greater than 30 mg/dL
what is the severe toxicity level of aspirin
greater than 50mg/dL
what is a MAJOR sign of toxicity for aspirin
TINNITUS
Reye’s syndrome
Syndrome which is an acute inflammation of the brain, N/V, confusion. Usually follows a viral illness & linked to intake of aspirin. Use acetaminophen (not aspirin) to reduce fever with child with a communicable disease (virus) to prevent this.
what is the most widely used NSAID
Ibuprofen
what is the max amount of ibuprofen that can be taken
3200 mg/day
ibuprofen has _____ GI distress but is also ______ protein bound
Lower
very high
what is the action of corticosteroid
control inflammation by suppressing for preventing ,any of the components of the inflammatory process at the injured site
What is the use of corticosteroids?
arthritic flare-up
BUT NOT the drug of choice for arthritis because of the NUMEROUS side effects
what is important about the discontinuation of corticosteroids
taper off over 5-10 days
what is important about taking NSAIDS before menses?
avoid NSAIDs 1-2 days before menses to avoid excessive bleeding
what are the types of Disease Modifying Antirheumatic drugs
immunosuppressive agents
immunomodulators
antimalarials
what is the use fro DMARDS
alleviate symptoms of RA when other treatments fail
osteoarthritis, ankylosing spondylitis
psoriatic arthritis, sever psoriasis
chrons and UC
action of immunosuppressive agents
suppress inflammatory process caused by the immune system
what is the use of immunosuppressive agents
refractory RA unresponsive to antiinfalmmaotry drugs
what are the classifications of immunodmodulators
interleukin I (IL-I) receptor antagonistst
Tumor necrosis factor (TNF)
what is the action of immunomodulators
disrupt inflammatory process
delayed disease progression
neutralize TNF
what is the use for immunomodulators
RA, psoriatic arthritis, psoriasis, spondylitis, UC, chrons
what is important about immunomodulators
puts the patient at increases risk for infection becausse it suppresses the immune system
no live vaccines
what is gout
inflammatory disease of joints tendons and other tissues
what is the patho of gout
caused by build up of uric acid crystals
usually occurs in the great toe
DEFECT in purine metabolism leads to uric acid accumulation
patients with gout should avoid which foods
foods containing purine (organ meats, sarsdines, salmon, gravy, herring, liver, meat soups, alcohol especially beer) avoid deli meat
what is the difference between colchicine and allopurinol
colchicine is an anti inflammatory drug for gout, but DOES NOT inhibit uric acid synthesis
allopurinol is NOT an anti inflammatory, but rather inhibits the final steps of uric acid biosynthesis, preventing the gout attack
when should colchicine NOT be given
when the patient has severe renal, cardiac, or GI issues
fifth vital sign
pain
pain threshold
amount of stimulation required before a person experiences the sensation of pain
pain tolerance
the amount of pain a patient can endure without its interfering with normal function
analgesics
pain relievers (opiod and non opioid)
opioid
narcotic
nonopioid
nonnarcotic
Nociceptors
sensory receptors for pain
neuropathic pain
unusual sensory disturbance that often involves neural super sensitivity, this pain is due to PNS or CNS injury ir disease
often burning, tingling, electric shock sensations
gate-control theory
the theory is hat tissue injury activates nociceptors and causes release of chemical mediators such s substance P, prostaglandins, etc and these substances initiate an action potential along a sensory nerve fiber and sensitize pain receptors
acute pain
pain that is felt suddenly from injury, disease, trauma, or surgery (less than 3 months)
chronic pain
pain persists for more than 3 months and is difficult to treat or control
cancer pain
pain occurs from pressure on nerves and organs, blockage to blood supply or metastasis to bone
somatic pain
pain is in skeletal muscle ligaments and joints
superficial pain
pain is from surface ares such s skin and mucous membranes
vascular pain
pain occurs from vascular or perivascular tissues contributing to headaches or migraines
visceral pain
pain is from smooth muscle and organs
up to _____ of patients have unrelieved pain
75%
reasons fro under-treatment of pain
pt. may not be able to explain pain
fear of addiction
nurses ability to measure pain/lack of regular pain assessment
unwillingness to believe pt. report of pain
inadequate pain dose
effects of under-treatment of pain
increases in RR and HR
hypertension
increased stress response
urinary retention, fluid overload, electrolyte imbalance
glucose intolerance, hyperglycemia, pneumonia
atelectasis, anorexia, paralytic ileus
constipation, weakness, confusion, infection
use of nonopiod analgesics
less potent than opiod analgesics
use for mild to moderate pain (dull throbbing pain of HA, dysmenorrhea, inflammation, muscluar aches, ect)
action site of nonopiod analgesics
PNS at pain receptors sites
what is used for assessment of pain
pain scale
what are the types of NSAIDs
aspirin (salicylate)
ibuprofen (Motrin)
indomethacin (indocin)
ketotolac (Toradol)
effects of NSAIDs
analgesic
antipyretic
anti-inflammatory
use of opioid analgesics
moderate to severe pain
many opioids have _______ effects
antidiarrheal
(induce constipation)
many opioids have _______ effects
antidiarrheal
(induce constipation)
Action of Opioid Analgesics
acts on CNS to suppress pain impulses
suppress respiration and coughing by acting on respiratory and cough centers in the medulla
contraindications of opioid analgesics
head injury, respiratory disorders, hypotension
disposal of fentanyl patch
in locked box
use of fentanyl
moderate to severe pain, anesthesia induction and maintenance
Fentanyl is ____ times more potent than morphine, and has longer duration
100
Fentanyl is available as:
transdermal patchy IM IV
what is a major concern of opioids
withdrawal and dependence
use for hydromorphone (Dilaudid)
moderate to severe pain
hydromorphone is ___ more potent than morphine and has ___ onset and ___ duration
6x
faster
shorter
hydromorphone is available as
PO, rectal, SQ, IM, IV
oxycodone use
moderate to severe pain
oxycodone is ____ stronger than morphine and can be used when morphone does not provide relief
1.5-2x
oxycodone should be taken w food to..
avoid GI distress
what is important about the discontinuation of oxycodone
DO NOT stop abruptly , taper off
Percocet
oxycodone+acetaminophen
Percocet use
moderate to severe pain, take w food
what CAMS should not be taken with opioids and what do they do
kava kava, valerian and st johns wort increase sedation
st johns wort can also decrease effects of morphine
what is patient controlled analgesia (PCA)
Method of drug delivery that permits the client to self-administer opioids on an “As needed basis”.
PCA device has a timing control, limits the total dose that can be administered each hour.
**Patient controlled, NOT FAMILY!!
what medication is most often used for PCA
morphine
(sometimes fentanyl and hydromorphone)
PCA loading dose
predetermines safety limits
PCA lockouts mechanism
near-constant analgesic level
transdermal route
provide continuous pain control, helpful for chronic pain
Analgesics in children
use “ouch scale”
give meds before pain becomes severe
oral liquid medication is generally more acceptable
use drawings or pictures related to area of pain with smiling faces
analgesics in older adults
require dosage adjustments to avoid sever side effects
nurse must monitor pt. closely
tend to have fears about opioids as they think pain is inevitable or fear of addiction
don’t want to report pain in fear of being an burden
analgesics in cognitively impaired
may be unable to adequately report pain
physical signs of pain may be moaning, grimacing clenched teeth, noisy respirations restlessness
analgesics in oncology patient
pain is managed my WHO ladder
step1- mild pain (Nonopioids)
step2- moderate pain (nonopioid and mils opioids)
step3- severe pain (stronger opioids)
opioids are titrated until pain relief is achieved
analgesics in individuals w substance abuse HX
still require pain meds, shouldn’t be denied pain control
larger dosing may be requires
opioid agonist-antagonists should be avoided as I can cause withdrawal syndrome
adjuvant therapy
used alongside with nonopioid and opioid analgesics; not direct pain meds, but aid in relieving pain and assisting primary tx
adjuvant analgesics
effective for pain relief in neuropathy
ex: anticonvulsants, antidepressants, corticosteroids, antidysrhythmics, local anesthetics
Opioid agonist-antagonist
opioid antagontist is added to an opioid agonist (may help decrease opioid abuse)
-NOT given for cancer pain
-safe for use during labor
-safety during early pregnancy has not been established
action of opioid antagonists
blocks receptor and displaces opioid
Uses for opioid antagonists
antidote for opiate overdose
reverse effects of opiates including respiratory depression, sedation, hypotension
side/adverse effects of opioid antagonist
reversal of analgesis
agitation, GI effects
hypo/hypertension, tachycardia
elevated PTT, bleeding
nursing implications of opioid antagonist
monitor VS (especially BP) and bleeding continuously
characteristics of a migraine HA
unilateral throbbing pain
N/V photophobia
triggers of migraine headaches
cheese chocolate, red wine, aspartame, fatigue,stress, monosodium glutamate, missed meals, odors, light hormone, changes, drugs, weather, toomuch/little sleep
patho theory for migraine HA
due to neurovascular events in cerebral cortex
characteristics of cluster HA
severe unilateral, nonthrobbing pain
usually located around the eye
occur in a series of cluster attacks (one or more attacks every day for several weeks)
NOT associated with an aura
DOES NOT cause N/V
more common in males
what can be used in the prevention of migraine and cluster HA
beta-adrenergic blockers (propranolol, atenolol)
anticonvulsants (valproic acid, gabapentin)
tricyclic antidepressants (amitryptline, imipramine)
management of migriane and cluster HA
analgesics (aspirin w caffeine, acetaminophen, NSAIDS, ibuprofen, naproxen)
opioid analgesics (meperidine, butorphanol nasal spray)
ergot alkaloids (dihydroerotamine mesylate)
selestive serotonin receptor agonist (sumatriptan, zolmitriptan)
