U2: Pain Management Flashcards
How do NSAIDs function?
By blocking COX 1 and COX 2 enzymes responsible for making prostaglandins.
What are side effects of NSAIDs?
Bleeding risk, kidney / liver problems, hypertension, stomach upset / ulcers.
Why are NSAIDs contraindicated for patients who have had bariatric surgery?
Bariatric surgery decreases the surface area of the stomach lining, meaning an ulcer would potentially lead to malnutrition
What is the first generation NSAID?
Aspirin
Why is aspirin contraindicated for children?
High risk of Reye’s syndrome
Is acetaminophen (Tylenol) an NSAID?
No. It is a non-opioid anti-pyretic
What is a sign of aspirin toxicity?
Ringing in the ears / hearing loss.
What chemicals are released during an inflammation reaction?
Histamines, kinins, prostaglandins
What is an NSAID used long-term for inflammation?
Meloxicam
What is the first injectable NSAID?
Ketorolac tromethamine (Toradol)
What is the longest recommended use for Ketorolac tromethamine?
5 days or less.
What increases the risk of toxicity when taken with ibuprofen or naproxen?
Calcium channel blockers
What are some education points for ibuprofen and naproxen?
Take with food, do not take if pregnant, many drug interactions and highly protein bound.
What are side effects of acetaminophen?
N/V, constipation, insomnia, headache, anorexia, fatigue, peripheral edema
What are adverse reactions of acetaminophen?
Oliguria, hearing loss, elevated hepatic enzymes, renal / hepatic failure, hypokalemia, hemolytic anemia, agranulocytosis, low platelets
Patients with which conditions should use caution when taking acetaminophen?
Renal / hepatic disease, hypertension, Type 2 diabetes (DM), alcohol abuse, hypovolemia, malnutrition, older adults
What is the antidote for acetaminophen?
N Acetylcysteine
What is the brand name for Indomethacin?
Indocin - a strong prostaglandin inhibitor
Give three examples of corticosteroids.
Prednisone, prednisolone, Dexamethasone
What are side effects of corticosteroids?
Bone loss (osteoporosis), fluid retention, mood changes, peptic ulcer disease, moon-shaped face
Why are corticosteroids typically prescribed?
To fight inflammation.
Should corticosteroids be taken with or without food?
With food.
What should you educate the patient on about corticosteroids regarding compiance?
Do not stop taking corticosteroids abruptly.
Do corticosteroids have a long or short half life?
Long, which is why they’re typically given once a day.
How do steroids affect blood sugar?
Steroids raise blood sugar.
DMARDs stands for
Disease-modifying anti-rheumatic drugs
Three types of DMARDs:
Immunosuppressives, immunomodulators, and antimalarials
In which situations would immunosuppressives be prescribed?
When disease process does not react to NSAIDs. Treats RA and arthritis and can also be used to suppress cancer growth.
How do immunomodulators work and what is one example?
Treats RA by disrupting inflammatory process and delaying disease progression. Example: Infliximab (Remicade)
Which DMARD is a last line of defense to treat RA if other methods fail? How long does it take to become effective.
Antimalarials. 4-12 weeks.
What are side effects of DMARDs?
Decreases effectiveness of vaccines, increased risk of infection, hypo / hypertension, chest pain, dyspnea
What causes gout?
Ineffective clearance of uric acid by the kidneys
What should be checked before gout meds are prescribed?
Patient’s history of renal function
What are two anti-gout medications?
Colchicine and allopurinol
Which anti-gout medication is contraindicated for patients with renal disease?
Colchicine
What are the side effects of colchicine?
GI bleed, gastric irritation, headache
What are the side effects of allopurinol?
Bleeding, GI obstruction, N/V, depletion of uric acid
What should you educate a patient about regarding allopurinol?
Increase fluids to promote diuresis (increased production of urine.)
What should patients avoid while taking anti-gout medication?
Vitamin C, caffeine (diuretic) and purine in their diet (red meat, salmon, anchovies, legumes, organ meat and alcohol - especially beer.)
What should you educate a patient about regarding anti-gout medications?
Attend all scheduled appointments and lab draws, and report side effects immediately
What are six examples of opioid analgesics?
Morphine, codeine, hydrocodone, hydromorphone (Dilaudid), oxycodone (Roxicodone), and fentanyl
What is the antidote to an opioid overdose?
Naloxone (Narcan)
What are side effects of opioids?
N/V/D, dizziness, sleepiness, respiratory depression
When should you not medicate for pain?
When pt has increased intracranial pressure
What analgesic is used to treat migraines and cluster headaches?
Sumatriptan
