YES BOOK Pain meds Flashcards
What are analgesics?
Medications that relieve pain.
What is the analgesic ladder?
Step 1: Nonopiods for mild pain
Step 2: Opioids for mild to moderate pain
Step 3: Opioids for moderate to severe pain
Nonopiod Analgesic
There is a ceiling affect to their analgesic properties, increasing the dose to the upper limit provides no greater analgesia
What are NSAIDS used for?
Commonly used to relieve pain and reduce inflammation.
How do NSAIDs work?
Work by inhibiting enzymes called cyclooxygenases, inhibit synthesis of prostaglandins.
What is responsible for many of the side effects of NSAIDs?
Cyclooxygenases enzyme inhibition
What are the two types of NSAIDs?
nonselective/selective
What are nonselective NSAIDS?
NSAIDS that inhibit both COX-1 and COX2
What are COX1 enzymes responsible for?
Normally found in stomach, blood platelets, blood vessels
What are COX2 enzymes reponsible for?
Found at sites of inflammation, less likely to cause gastrointestinal injury.
What do selective NSAIDS do?
Inhibit COX2 only
Who is not recommended to take NSAIDs?
Not recommended for people with kidney disease, heart failure, cirrohosis, those who take diuretics, allergic to aspirin. Nsaids may also cause worsening of asthma
What would patients with mild pain (No 1-3) Receive?
Nonselective NSAIDS
COX 1/2 inhibitors
What are the main things about NSAIDs the nurse should know?
- Response varies to specific NSAIDs, if one is not effective try another.
- Do not take a second NSAID at the same time because of increased risk of side effects.
- Short Term use can cause stomach upset. (Dyspepsia)
- Long term use, especially at high doses can cause peptic ulcer disease
- Use of NSAIDs even for a short period can harm the kidneys.
- They are commonly available without a prescription
What is the max dose of ibuprofen?
3,200 mg/day
What is the max dose of Naproxen?
1500 mg/day
What is the max dose of naproxen sodium?
Do not exceed 1650 mg/day
Available in immediate and delayed release formations
What does the nurse have to remember about ketorolac tromethamine?
It is injectable
It is an NSAID
Limit the treatment to 5 days, many adverse effects
contraindicated with renal impairment, aspirin allergy
Can cause renal insufficiency in dehydrated patients
What does the nurse have to remember about COX2 inhibitors?
Sometimes recommended for patients with history of peptic ulcer, GI bleeding, GI upset.
- Less potential to cause ulcers or GI bleeding
- Should be avoided in patients with known coronary artery disease, history of stroke, narrowed arteries to the brain or those at high risk.
What is the max dose of Celecoxib (COX2) inhibitor?
Maximum dose of 200 mg a day.
What are the types of aspirin?
Acetylsalicyclic acid. (Aspirin, Ecotrin, Bayer)
Buffered aspirin products (Alka seltzer, bufferin, Ascriptin)
What does the nurse need to remember about Salicyclates?
- Inhibits both COX 1 and COX 2
- The combination of low dose aspirin and an NSAID can increase the risk of bleeding. Aspirin should be taken at least two hours before the NSAID.
- Can cause exacerbation of bronchospasm, rhinitis (With nasal polyps, asthma)
- Has antiplatelet effects (Increased risk of bleeding)
- Increased risk of bleeding when combined with oral anticoagulants, heparin)
- Increased risk of GI ulceration with steroids, alcohol, NSAIDs.
- Use cautiously with impaired renal functioning.
- Maximum doses vary according to indications for use. Up to 4 g/day
What is the nonaspirin pain reliever?
Acetaminophen
What should the nurse remember about acetaminophen?
It does not affect platelets
Not an anti-inflammatory agent
Doses of greater then 4g/day can cause acute overdose.
Patients with alcoholism or liver disease are at risk for hepatotoxicity
Increased toxicity with long term excessive ethanol ingestion.
