Week 9 - Analgesics Flashcards
Essential function of COX-1 and COX-2
COX 1 - protects the stomach lining and regulates platelets
COX 2 - Triggers inflammation and pain
First generation NSAIDs relationship to gastric ulcers
NSAIDS inhibit both COX1 and COX2 – inhibition COX 1 leads to loss of stomach lining protection which leads to ulcers, and inhibits blood clotting leading to more bleeding
Celecoxib (Celebrex) Class: Who doesn't benefit? Contraindications (4) Caution (4)
2nd generation NSAID
-Patients who take ASA for MI or stroke do NOT benefit because ASA decreases the serum level of NSAIDs
Contraindications: severe renal or hepatic disease, asthma, peptic ulcers
Caution: bleeding disorders, early pregnancy, lactation, lupus
Naloxone (Narcan)
Class/function:
Nursing actions
Class: Opioid ANTAGONIST, antidote for opioid overdose, knocks opioid off the receptor sites, and knocks endorphins off receptor sites
-Do NOT push an entire vial immediately unless the condition warrants it
What does pushing an entire vial of Narcan immediately lead to?
Pain crisis
Fentanyl (Sublimaze) Class/function: Comparison to Morphine Metabolized by Routes Given when Dosage
Class/function: Opioid ANALGESIC, adjunct to anesthesia
Comparison to Morphine: 100x more potent, more lipid soluble (faster onset)
Metabolized by liver
Routes - IM, IV, transdermal (for continuous pain control, caution with febrile patients)
Given in open heart surgery to protect myocardium from excessive O2 demands
Dosage in mcg
Aspirin (ASA)
Class:
Uses (5):
Mechanism:
Class: 1st generation NSAID
Uses (5): analgesic, anti-inflammatory, anti-platelet, anti-pyretic, CAD and MI/embolic stroke prophylaxis
Mechanism: Inhibits prostaglandin synthesis, inhibits hypothalamic heat regulator center, blocks thromboxane A2 synthesis
Aspirin (ASA) Dosage
- Antiplatelet, analgesic
- Arthritis
- Antiplatelet, analgesic: 81 mg (Baby ASA), 325-650 mg PO q4hrs PRN – max 4 g/day
- Arthritis: ceiling of 3-5 g/day
Aspirin (ASA)
- Absorption
- Distribution
Absorption: 80-100%
Distribution: 59-90% protein bound
Crosses placenta
Aspirin (ASA)
- Metabolism (Half life)
- Excretion
- Contraindications (3)
Metabolism: 2-3 hrs (low dose), 2-20 hrs (high dose)
Excretion: 50% urine
Contraindications: hypersensitivity to salicylates or NSAIDS, 3rd trimester, flue or virus symptoms in kids (leads to Reyes)
Aspirin (ASA) Drug interactions (4)
- Increased risk of bleeding with anticoagulants
- Increased risk of hypoglycemia with oral hypoglycemic agents
- Increased ulcerogenic effect with glucocorticoids
- Potentiated by caffeine
Aspirin (ASA) Lab interactions (3)
- Decreased cholesterol (advantageous)
- Decreased K, T3, T4
- Increased PT, bleeding time, uric acid
Aspirin (ASA) side effects (9)
- N/V, diarrhea, stomach pain
- Heartburn
- Dizziness, confusion, drowsiness
- Rash
Aspirin (ASA)
Caution in
Adverse reactions (10)
Caution in renal and hepatic disorders
Adverse reactions: tinnitus, uticaria, peptic ulcer, anaphylaxis, bronchospasm, hepatotoxicity, agranulocytosis, hemolytic anemia thrombocytopenia, luekopenia
Aspirin (ASA)
- Signs of overdose/hypersensitivity (3)
- Treatment
- If hypersensitive, what else should you not give
- Foods that contain salicylates
- Signs of overdose/hypersensitivity (3): tinnitus, uticaria, peptic ulcer
- Treatment: activated charcoal
- If hypersensitive, what else should you not give: Difulnisal (NSAID derivative)
- Foods that contain salicylates: prunes, raisins, licorice, curry powder, paprika
Interactions between Aspirin and anticoagulants
Aspirin INCREASES BLEEDING with anticoagulants
Acetaminophen (Tylenol)
Uses:
Mechanism:
Routes (3):
Uses: Analgesic, anti-pyretic
Mechanism: Inhibits prostaglandins and heat-regulatory center in hypothalamus
Routes (3): PO, IV, suppository
Acetaminophen (Tylenol) Dosage: Onset: Half life: Antidote to:
Dosage: 325-650mg q 4-6hrs
Onset: 10-30 min
Half life: 2-4 hrs
Antidote to: Acetylcystine (Mucolytic), and charcoal (within 60 min of ingestion)
Difference between Acetaminophen and NSAIDs
NSAIDs have anti-inflammatory effects where as acetaminophen does not – both are antipyretic and analgesic.
Ibuprofen (Motrin, Advil) Class: Uses: Adult Dosage: Child Dosage:
Class: 1st generation NSAID, propionic acid derivative
Uses: Anti-inflammatory, analgesic, anti-pyretic
Adult Dosage: 200-800 mg PO tid/qid; max below 3.2g/day
Child Dosage: based on age and weight
Ibuprofen (Motrin, Advil) Absorption: Half Life: Excretion: Contraindications (3) Caution (4)
Absorption: PO is well distributed
Half Life: 2-4 hrs
Excretion: Urine and Bile (NSAIDs THINK KIDNEY)
Contraindications (3): severe renal or hepatic disease, asthma, peptic ulcers
Caution (4): bleeding disorders, early pregnancy, lactation, lupus
Ibuprofen (Motrin, Advil) Drug interactions (4)
- INCREASED BLEEDING with anticoagulants
- INCREASED effects WITH phenytoin, sulfonamides, warfarin
- DECREASED EFFECT with Aspirin (do NOT take WITH aspirin)
- Increases severe side effects of lithium
Ibuprofen (Motrin, Advil)
Side effects (12)
Adverse (6)
Side Effects:
- N/V, diarrhea, anorexia
- Rash, edema, purpura
- Fatigue, dizziness, lightheadedness, confusion
- Anxiety, tinnitus
Adverse: GI bleed, heart disease, life threatening blood dyscrasias, dysrthythmias, nephrotoxicity, anaphylaxis
Morphine Sulfate
Class:
Uses:
Mechanism:
Class: Opioid analgesic
Uses: Severe pain, pain/anxiety in MI, small doses for dyspnea
Mechanism: CNS depression depressed pain impulses
Gold standard for analgesic effectiveness
Morphine
Drug of choice for pulmonary edema
Morphine b/c it decreases preload
Morphine
Distribution (PB, implications):
Half life:
Excretion:
Distribution (PB, implications): PB 30%, can cross placenta, excreted in breast milk
Half life: 1.5 - 2 hrs
Excretion: 90% in urine (adjust for renal patients)
Morphine Dosage (PO) Adults: Break through dose: Sustained release: Duration of IR, SR:
Adults: 10-30 mg q 4 hrs PRN (limit on 24 hr amount)
Break through dose: q2hrs PRN
Sustained release: 15-30 mg q12hrs on the dot (titrate up PRN)
Duration of IR - 3-5 hrs
Duration of SR - 8-12 hrs
Morphine Dosage (SC/IM) Adults: Onset: Peak SC: Peak IM:
Adults: 2.5-15 mg q 2-6 hrs PRN
Onset: 15-30 min
Peak SC: 50-90 min
Peak IM: 30-60 min
Morphine Dosage (IV) Adults: Inject over how long? Onset: Peak: Duration: Absorption:
Adults: 2.5-15 mg q 2-6 hrs PRN Inject over 5 min, can be diluted Onset: rapid Peak: 20 min Duration: 3-5 hrs Absorption: rapid
Morphine Contraindications (6)
- Asthma + respiratory depression
- Increased ICP
- Shock
- Hypotension
- Ileus
- Sleep apnea
Morphine Caution (7)
- Respiratory disease, renal disease, hepatic disease
- MI
- Elderly
- Infants, children
Morphine Drug interactions (2)
- INCREASED EFFECTS with alcohol, sedatives, hypnotics, antipsychotics, muscle relaxants
- INCREASED SEDATION with kava kava, valerian, St. Johns wort
Morphine Lab interactions
Morphine INCREASES AST, ALT
Morphine side effects (17)
- Anorexia, N/V, constipation
- Urinary retention
- Drowsiness, confusion, sedation, hallucinations
- Dizziness, blurred vision
- Rash, pruritis, hives, itching at IV site
- Bradycardia, flushing
- Euphoria
Morphine Adverse reactions (4)
Hypotension, uticaria, life threatening ICP, seizures
Nalbuphine (Nabuain) Class: Uses: Side effects: Adverse reactions (3):
Class: Narcotic Agonist-Antagonist prototype
Uses: moderate to severe pain, labor pain
Side effects: fewer than opioid agonists
Adverse reactions (3): bradycardia, tachycardia, hypo/hypertension
What could Nalbuphine (Nabuain) produce?
Withdrawal symptoms
Frequent narcotic use or dependence is NOT meant for…
Chronic or cancer pain
Aspirin (ASA) and NSAID interaction
Aspirin decreases serum levels of NSAIDs
What should you NOT take NSAIDs with?
Aspirin
Relationship between NSAID and anticoagulants
INCREASED BLEEDING
Allopurinol (Zylorpim)
Class:
Mechanism:
Uses:
Class: Anti-gout, uric acid inhibitor
Mechanism: Inhibits production of uric acid to prevent precipitation of gout attack or prophylaxis
Uses: Renal impairment, unresponsive to uricosurics
Allopurinol (Zyloprpim)
Implications (5)
- Avoid purine foods (fermented foods), caffeine, alcohol
- Avoid large doses of vitamin C (risk for kidney stones)
- Annual eye exams
- INCREASE FLUID INTAKE to prevent kidney failure because it promotes diuresis and alkalinzation of urine
- Take acetaminophen instead of aspirin
