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Pharmacology: Test 1 > Week 4: Analgesics & Anti-inflammatories > Flashcards

Week 4: Analgesics & Anti-inflammatories Flashcards

1
Q

Analgesic

A

drug that relieves pain without causing loss of consciousness

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2
Q

Opioid

A

general term meaning any drug, natural or synthetic, that has actions, similar to morphine

effects on CNS

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3
Q

Opiate

A

more specific term meaning any compounds present in opium, such as morphine or codeine

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4
Q

Narcotic

A

many meanings: analgesic, drug that can cause dependence; CNS depressant; covers many drugs other than opioids

used interchangeably with opioids and opiates

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5
Q

Pain threshold

A

level of stimulus necessary to result in perception of pain

point in which you feel pain

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6
Q

Pain tolerance

A

amount of pain an individual can withstand and still function normally without treatment

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7
Q

Pain is….

A

subjective!!!

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8
Q

For central Pain

A

opioids and narcotics

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9
Q

for lacoal pain

A

Nsaids and nonsteriodals

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10
Q

What are the two pain companents

A

1) phycial
2) psychological

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11
Q

Physical pain

A

the patients actual sensation of pain

their pain threshold

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12
Q

Psychological

A

how pt deals with pain

patients emotional response to pain

pain tolerance

molded by age, sex, culture, previous experiences with pain and anxiety level

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13
Q

Pain threshold is lowered by

A

anger, anxiety, depression, fear, isolation, chronic pain, sleeplessness, fatigue

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14
Q

Pain threshold is raised by

A

diversion, empathy, rest, sympathy, emotional support, spiritual support, medication

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15
Q

Acute Pain

A

Intense pain occuring over a brief pd. usually less than 3 months

  • Sudden, sharp, localized, sweating, pallor, tachycardia, increased BP, limited duration
  • Causes such as MI, appendicitis, kidney stones, surgical procudures
  • usually subsides with treatment
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16
Q

Chronic Pain

A

Persist over a longer time. typically longer than 6 months

  • Slow onset, long duration, dull persistent aching
  • Causes such as arthritis, lower back pain, cancer
  • Ofte difficult to treat
  • Interferes with daily activities
  • results in feelings of hopelessness of pt
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17
Q

Pain can be classified by its source:

Injury to tissue

A

Nociceptive Pain

responds well to pain relief meds

typically described as “somatic pain” (sharp, localized sensation) or “visceral pain” (dull, throbbing, ache)

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18
Q

Pain can be classified by its source:

Injury to nerves

A

Neuropathic pain

burning, shooting, numb pain

harder to ease pain for pt.

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19
Q

Pain Management

A
  • must be individualized

Based on:
cause of pain, other existing medical conditions, pain characteristics, psychologic and cultural components, use of nonpharmacological measures such as massage

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20
Q

Nerve Blocks

A
  • Injection of alcohol or other neurotoxic substances directly into the neuronal tissue
  • may irreversibly stop impulse transmission and have the potential to provide total pain relief
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21
Q

Selection of Analgesic based on

A
  • Effectiveness of agent
  • duration of action
  • desired duration of therapy
  • ability to cause drug interactions
  • pt allergies
  • available routes of administration
  • Pediatric and geriatric considerations
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22
Q

Peds pts have __________ and _________ that involes immature ability to metabolize

A

less body mess and less weight

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23
Q

Geriatric Considerations with pain medication

A

Falls

ability to percieve pain

had to determine effectiveness

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24
Q

Opioid analgesics =

A

Nautral or synthetic morphine like substance, reduces pain

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25
Q

Narcotic substances -

A

produces analgesia and CNS depression

produces numbess or stupod like symptoms

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26
Q

Endogenous Neurotransmitters

A
  • Enkephalins, endorphins….mimic pain effect
  • The bodys natural pain killers
  • Involved in transmission of pain impulses (bind with opioid receptors to inhibit transmission of pain impulses, producing an analgesic effect)
  • Opioids mimic these transmitters
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27
Q

Agonist

A

activates specific opioid receptors

Morphine is a strong agnost

bind to opioid receptors and produce multiple responses

28
Q

Agonist-antagonist

A

alone will activate receptors, but given with pure agnost, can inhibit the effects of the agonist

side effects are less intense b/c of mix

29
Q

Antagonist

A

reverses respiratory and CNS depression caused by agonists

block opioid receptor

Ex. Narcan

30
Q

Morphine

A

Class: opioid receptor agent

  • prototype strong opioid agonist
  • Effects: analgesia, euphoria, respiratory depression, constipation, cough, suppression, sedation, orthostatic hypotension, N/V, urinary retention, tolerance and physical dependence
  • effective against severe, constant, dull pain
  • PO, IV, PCA pump
    onset: less than 60 min
    peak: 20 min IV
    duration: 7 hours
31
Q

Codeine

A

Class: opioid agonists

  • a little less effective than morphine
  • for moderate opioid agonist
  • cough suppression
  • primarly PO in tabs or liquid
  • often found in combination with NSAIDS
  • less abuse potential
    onset: 30-45 min PO
    peak: 60-120 PO
    duration: 4 hours
32
Q

Fentanyl (Sublimaze)

A
  • Class: opioid agonist
  • synthetic opioid
  • much more potent than morphine
  • for moderate to severe pain
  • IM, IV, IO
  • less hypotension than with morphine

-transdermal patch (duragesic)
(good for chronic pain, last 72 hours)

  • Side effects: confusion, apnea, double vision, resp. depression, N/V
    onset: 1-2 min IV
    peak: 3-5 min IV
    0. 5-1 hr IV
33
Q

PCA

A
  • often used for post-operative pts with pain, cancer, sickle cell anemia, trauma, and in labor
  • usually morphine, demerol, fentanyl, dilaudid
  • steady plasma levels in therapeutic range
  • more pt control, less nurse involvement
34
Q

Narcotic Nursing Considerations

A
  • Thourough assessment of pain
  • use with caution in pts with head injury, pregnancy, resp. insufficiency, infants, elderly
  • monitor closely for resp. depression, miltiple drug interactions
  • take PO meds with food to minimize GI distress
35
Q

Patient safety

A
  • At risk for falls
  • these drugs cause sedation and dizziness
  • no driving or any activity that requires mental alertness
  • NO ALCOHOL
36
Q

Pain relief

nonpharmacologic pain relief measures

A
  • meditation/prayer
  • heat/cold packs
  • accupucture
  • massage
  • relaxation therapy
  • art/music therapy
  • imagery
  • chriprotic
37
Q

Naloxone (Narcan)

A
  • Class: opioid receptor antagonist
  • prototype for pure opioid antagonist
  • drug of choice for treament of opioid-dependent, there will be an immediate withdrawal reaction
  • pt who go from state of somnolence from narcotic OD to wide awake may be combative
  • safe practice to give small doses of narcotics with frewuent re-eval instead of one giatn dose
  • Side effects: minimal toxicity, rapid loss of analgesis, increased BP, tremors, hyperventilion, N/V, drowsiness
    onset: 1-2 min IV
    peak: 5-15 min
    duration: 45 min
38
Q

Inflammation

A
  • nonspecific defense system of body
  • damaged tissues release chemical mediators to trigger the immune response
  • Histamine
  • Leukotrienes
  • Bradykinin
  • Complement
  • Prostaglandins
39
Q

Signs of inflammation

A

redness, heat, swelling, pain

inflammation DOES NOT mean infection

40
Q

Cyclooxygenase (COX)

what is it?

A
  • enzyme that produces prostaglandines
  • NSAIDS work by inhibiting this enzyme (cox)

-This action produces three primary therapeutic effects:
suppression of imflammation, pain relief, fever reduction

41
Q

Prostaglandins

A

help with healing and increase permability at the site

more blood flow

help immune cells come in

42
Q

Cyclooxygenase (Cox

The inhibition of prostaglandin synthesis also causes 3 prinicipal adverse effects:

A

1) Gastric Ulcers…by increasing gastric acid secretion, reducing protective mucosal layer and decreasing blood flow
2) suppressed platelet aggregation
3) induced acute renal failure (decreased renal blood flow)

43
Q

Cyclooxygenase (COX)

2 COX enzymes

A

COX-1 is found in most cells

COX-2 is only in cells that promote inflammation and immune response

44
Q

COX-1
Effects of Enzyme inhibition

A
  • fever reduction
  • pain reduction
  • stomach bleeding and ulcers
  • decreased blood clotting
45
Q

COX-2

Effects of Enzyme inhibition

A
  • pain reduction
  • decreased inflammation
  • may be given to pt who cant take NSAIDS or aspirin
  • Newer meds block only COX-2 in order to reduce adverse effects
46
Q

COX-1 responsible for:

A
  • gastric protection
  • maintain renal function
  • platelet aggregation
47
Q

COX-2 responsible for:

A
  • inflammation and pain in injured tissues
  • fever and pain in brain
48
Q

Therapeutic uses for NSAIDS

A
  • Mild to moderate pain
  • Acute gout
  • Musculoskeletal pain
  • Osteoarthritis
  • Rheumatoid arthritis
  • cramping with periods
  • fever
49
Q

Aspirin Therapeutic Uses

A
  • Most potent prostaglandin inhibitor
  • Antiinflammatory
  • Antipyretic

-Dysmenorrhea
(prostaglandins promote uterine contractions, so inhibition reduces cramping)

-suppress platelet aggregation

50
Q

Aspirin Adverse effects

A

-GI effects
(ulcers, gi bleeding, n/v)

-bleeding
(after ingestion of 2 aspirin, bleeding time is doubled for a week)

  • use contraindicated in pts with bleeding disorders
  • renal impairement
  • Salicylism (aspirin toxicity)
  • Reyes syndrome (when ASA given to child with chicken pox or flu like symptoms)

-hypersensitivity
(risk factors: asthma, nasal polyps)

51
Q

Nursing considerations for Aspirin

A
  • give with food or water or take enteric-coated tabs to minimize GI distress
  • monitor closely for GI bleeding
  • stop one week prior to surgery
  • monitor for drug interactions, esp. anticoagulants
  • do not give aspirin to children with a fever, flu-like symptoms or under 12 years old
52
Q

Ibuprofen (Advil, Motrin)

A
  • drug of choice for treatment of dysmenorrhea b/c it inhibits specific COX enzyme in uterine smooth muscle
  • also for treatment of arthritis, gout, dental pain, musculoskeletal pain
  • less gastric bleeding, effect on platelets
  • contraindicated in pregnancy, especially during last trimester
  • take WITH food or milk to minimize GI upset
  • Side effects: nause, heart burn, epigastric pain, dizziness, GI ulcers
  • CLASS: NSAIDS
    onset: 30-60 mints
    peak: 1-2 hrs
    duration: 4-6 hts
53
Q

Acetaminophen (Tylenol)

A
  • Analgesic, antipyretic
  • inhibits prostaglandin synthesis in CNS
  • cannot suppress inflammation, so not considered a TRUE NSAID
  • treats mild to moderate pain and fever
  • good for pts who cant take ASA
  • no platelet effects or gastric bleeding
  • no decrease in renal blood flow or renal function
  • adverse effects rare

overdose causes liver necrosis

ANTIDOTE= acetylcysteine (Mucomyst)

54
Q

Naproxen and Naproxen Sodium

A
  • Prolonged half life so only take once a day
  • indications: arthritis, bursitis, tendonitis, dysmenorrhea, mild pain
  • GI distress
55
Q

Ketorolac (Toradol)

A
  • most common in health care setting: IM or IV
  • anti-inflammatory, analgesic, antipyretic effects
  • Indications: acute, moderate to severe pain
  • works well with kidney stone pain as adjunt to opioids
  • limited to 5 days of therapy
  • Adverse effects: GI ulcers and bleeding, renal impairment, hypersensitivity
56
Q

Celecoxib (Celebrex)

A
  • prototype second generation NSAID
  • selective inhibiot of COX-2 (less adver effects on GI and plateles
  • treat severe arthritic conditions
  • GI distress. abdominal pain
  • contraindications and precautions with sulfa allergy and ASA allergy
57
Q

Corticosteroids

A
  • aka Glucocorticoids
  • example…prednisone
  • a powerfull anti-inflammatory and immunosuppressive actions by several mechanisms
  • metabolism of protein, carbohydrates, and fats
  • stimulate production of glycogen
58
Q

Therapeutic uses of corticosteroids

A
  • rheumatoid arthritis
  • systemic lupu erythematosus (SLE)
  • inflammatory bowel disease
  • allergic reactions
  • asthma
  • dermatologic disorders
  • neoplasms
  • tissue rejection
59
Q

Adverse effects:

Cortocosteroids

Adrenal insufficiency

A
  • suppresses production of endogenous steroids by adrenal glads
  • extent of suppression and time needed for recover base mostly on duration of steroid therapy
  • during times of emotional and physical stress (trauma and sugery) pts on long-term steroid therapy must have increased doses to support life. They will also need supplemental doses during times of stress after therapy is disontinued until their adrenal function has returened to normal
60
Q

Adverse effects of corticosteroids

A
  • Infection
  • PUD
  • Osteoporosis
  • Glucose intolerance (may need increase in insulin dosage)
  • myopathy (weakness in muscles)
  • Psychologic disturbances (hallucinations, mood swings
  • fluid and electrolye disturnaces
  • skin atrophy
  • decreases in muscle mass and fat redistribution
  • cataracts
  • growth retardation in children
  • delayed wound healing
  • drug interaction
61
Q

Contraindication for corticosteroids

A
  • systemic fungal infection
  • live virus vaccine
  • precautions with pediatric, pregnancy, lactaion, HTN, CHF, renal dysfunction, PUD, DM, osteoporosis, resistant or systemic bacterial infection
  • withdrawal of therapy SLOWLY
62
Q

Anti-gout agents

A
  • gout results in inappropriate uric acid metabolism
  • to much uric acid causes deposits of crystals in tissues and joints, causing severe pain
  • antigout agents target the underlying metabolic defect: either over production or underexcretion of uric acid.
63
Q

Allopurinol (Zyloprim)

A
  • inhibition of enzyzme to prevent uric acid production
  • Adverse effects: hematologic effects, fatal skin conditions
  • PO ONLY
64
Q

Colchicine

A
  • weak anti-inflammatory activity, no effect on uric acid exretion
  • no analgesic action
  • seems to reduce inflammatory response to the uric acid crystal deposits
  • very toxic
  • used primarily for acute gout attacks
  • Adverse effects: gi effects, can lead to hemmorage, renal failure, PO IV
  • given every 1-2 hours during acute attack until pain resolves or N/V/D develop
65
Q
A

Pharmacology: Test 1 (4 decks)

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