Anti-inflammatories & Analgesics

Question 1

Five cardinal signs of inflammation

Answer 1

redness, swelling (edema), heat, pain, & loss of function

Question 2

Inflammation is a response to

Answer 2

tissue injury

Question 3

What do anti-inflammatories do?

Answer 3

reduce fluid migration and pain –> lessening loss of function and increasing mobility & comfort

Question 4

First gen NSAIDs

Answer 4

salicylates (aspirin) and propionic acid derivatives (ibuprofen)

Question 5

Second gen NSAIDs

Answer 5

COX-2 inhibitors (celecoxib)

COX-2 triggers inflammation and pain

Question 6

Is acetaminophen an NSAID?

Answer 6

No, has no anti-inflammatory action

Question 7

Intended response of NSAIDs

Answer 7

reduced redness, pain, swelling, and warmth at site of
inflammation; increased function; reduced fever

Question 8

Side effects of NSAIDs

Answer 8

bleeding, GI ulcers, GI pain, fluid retention, HTN

Encourage glass of water to protect stomach and kidneys

Question 9

Adverse effects of NSAIDs

Answer 9

possible kidney damage, induction of asthma and allergic reactions

Encourage glass of water to protect stomach and kidneys

Question 10

Prostaglandin inhibitor that decreases the inflammatory process- both COX-1 & COX-2

Reduces pain, inflammation sx, and fever

Also considered an antiplatelet drug for pts w/cardiac or cerebrovascular disorders

High doses usually needed to relieve inflammation

Answer 10

aspirin

Question 11

Side effects of aspirin

Answer 11

Gastric distress is common (anorexia, dyspepsia, NV, diarrhea, constipation, abdominal pain)

Question 12

Adverse reactions of aspirin

Answer 12

tinnitus, hearing loss, GI bleeding, ulceration, perforation/anaphylaxis, Reye syndrome, Stevens-Johnson syndrome, thrombocytopenia, leukopenia, agranulocytosis, hepatotoxicity

Question 13

True or False

Aspirin can be taken with other NSAIDs

Answer 13

False

Aspirin should NOT be taken with other NSAIDs (decreases blood level and effectiveness of NSAIDs)

Question 14

Aspirin Contraindications

Answer 14

Hypersensitivity to salicylates or NSAIDs, GI bleeding

Question 15

How does aspirin effect labs

Answer 15

• Increase PT, bleeding time, INR, uric acid (gout)
• Decreased cholesterol, T3 and T4 levels

Question 16

Motrin and Advil are forms of

Answer 16

ibuprofen

Question 17

Inhibition of prostaglandin synthesis, relieving pain and inflammation

Reduces inflammatory process; relieves pain; reduce fever

Side effects: Same as aspirin, blurred vision, pruritis

Adverse reactions: Same as aspirin

Take with food/full glass of water to relieve gastric distress

Answer 17

ibuprofen

Question 18

Drugs of choice for patients with severe arthritic conditions who need high doses of an anti-inflammatory drug

Answer 18

Selective COX-2 inhibitors

Ex: celecoxib

Question 19

Celecoxib side effects

Answer 19

same as aspirin and ibuprofen, add tendon rupture

Question 20

NSAID administration

Answer 20

Before:
* Previous problems with NSAIDs, including OTCs
* Give after meals with full glass of water or milk
* Blood pressure

After:
* Bleeding, even with one dose (aspirin particularly)
* Sensitivity reaction

Patient teaching:
* Do not take on an empty stomach
* Monitor for bleeding
* Do not take with warfarin (Coumadin)

Question 21

NSAID Life span considerations

Answer 21

Pediatric:
* Only ibuprofen is recommended
* Avoid aspirin (Reye’s syndrome)

Pregnancy:
* Category C drug for first 6 months
* Avoid during last 3 months (can harm fetus)

Older adults:
* May increase risk of fluid overload and hypertension due to sodium and water retention
* More likely to have renal or GI problems

Question 22

End in *lone or *sone

Answer 22

corticosteriods

Question 23

Prevent or limit inflammation by slowing or stopping all known pathways of inflammatory mediator production

Answer 23

corticosteriods

Question 24

Side effects of corticosteriods

Answer 24

• Short term therapy – hypertension, acne, insomnia,
  nervousness, increased blood glucose
• Long term therapy – adrenal gland suppression,
  reduced immune function, delayed wound healing,
  “Cushingnoid appearance”
• (may also have changes in mental status such as
  euphoria, depression, psychosis)

Question 25

Cushingnoid appearance

Answer 25

moon face, buffalo hump, hirsutism, weight gain, skin ulcers, HTN & cardiac hypertrophy, muscle wasting, osteoporosis, erectile dysfunction, amenorrhea, emotional disturbances

Question 26

Adverse effects of corticosteriods

Answer 26

adrenal gland atrophy, masking of infection, delayed wound healing

Question 27

Patient teaching for corticosteriods

Answer 27

do not suddenly stop taking drug, take w/food, avoid crowds

Question 28

What happens if we don't taper corticosteriods?

Answer 28

acute adrenal insufficiency crisis (medical emergency caused by a lack of cortisol)

Question 29

Corticosteroid Lifespan considerations

Answer 29

Pediatric: * At risk for same side effects as adults Pregnancy and breastfeeding: * Drugs cross placenta, are excreted in breast milk Older adults: * Extra precautions to avoid infection * Monitor blood glucose levels

Question 30

Inflammatory disease of joints, tendons, and other tissues. Usually occurs in the great toe. Defect in purine metabolism leads to uric acid accumulation.

Answer 30

Gout

Question 31

Purine containing foods

Answer 31

organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer)

Question 32

* Inhibit migration of leukocytes to inflamed site (antiinflammatory) * Uses: Decreases pain and inflammation in acute gout attacks, prevents future gout attacks * Side effects: GI distress * Nursing Implications: Taken with food to avoid GI distress and avoid grapefruit juice * Contraindications: Severe renal, cardiac, or GI problem

Answer 32

Antigout Drugs: Colchicine

Question 33

* Not an anti inflammatory drug * Inhibits final steps of uric acid biosynthesis and lowers serum uric acid levels (prevents uric acid from forming) * This will prevent an attack * Frequently used as a prophylactic to prevent gout, long term-use

Answer 33

Antigout Drug: Allopurinol

Question 34

* Both nonopioid and opioid * Prescribed for the relief of pain * Choice depends on the severity of pain * Mild to moderate pain frequently relieved with the use of nonopioids (e.g., NSAIDs) * Moderate to severe pain usually requires an opioid (narcotic)

Answer 34

analgesics

Question 35

Examples of non-opioid analgesics Less potent than opioid analgesics, used to treat mild to moderate pain Usually purchased OTC, but COX-2 inhibitors require prescription Effective for dull, throbbing pain of headaches, menstrual pain (dysmenorrhea), inflammation, minor abrasions, muscular aches and pain, and mild and moderate arthritis

Answer 35

ASA (aspirin), acetaminophen, ibuprofen, and naproxen

Question 36

ASA should not be given to children or adolescents younger than 19 years old because ASA can cause Reye syndrome. What is Reye syndrome? Acetaminophen is recommended instead.

Answer 36

Rare but serious condition associated with viral infections treated with salicylates that causes swelling of brain and liver.

Question 37

* Nonopioid that is not an NSAID (not drug of choice for inflammation) * Safe, effective drug when given at therapeutic doses * Causes little to no gastric distress, does not interfere with platelet aggregation * Toxic when taken at high doses, too often, or with alcohol * Risk for permanent liver or kidney damage

Answer 37

acetaminophen

Question 38

What are the early symptoms of hepatic damage from excessive acetaminophen?

Answer 38

N/V, diarrhea, abdominal pain

Question 39

Acetaminophen overdose antidote

Answer 39

N-acetylcysteine Ex: Mucomyst, Acetadote

Question 40

Opioid agonist Prescribed to moderate to severe pain Acts on CNS- activated u receptors, suppresses pain impulses, possess antidiarrheal and antitussive effects Side effects – constipation, nausea/vomiting, drowsiness (mild sedation), orthostatic hypotensive Adverse effects – anaphylaxis, respiratory depression, addiction, dependence, tolerance, withdrawal, seizures, urinary retention in older adults Naloxone as antidote

Answer 40

Opioid analgesics Ex: morphine

Question 41

Opioid patient teaching

Answer 41

* Take with food * Do not drive or operate heavy machinery (while titrating) * Change positions slowly * Increase fluids, fiber, and activity * Avoid stopping suddenly if taking for longer than 2-3 weeks due to withdrawals

Question 42

What are the benefits of using combo of drugs (NSAIDS w/opioids) to treat pain?

Answer 42

May decrease drug dependency that may result from possible long-term use of an opioid

Question 43

Medications used for Patient Controlled Analgesia (PCA) * Loading dose given initially to achieve pain relief * Predetermined safety limits, patient controls administration * Patient pushes a button, specific dose of analgesic into IV line * Lockout mechanism prevents patient from continuously pushing the button * Near-constant analgesic level, avoiding episodes of severe pain or oversedation

Answer 43

* Morphine most often used for PCA * Also fentanyl, hydromorphone

Question 44

Older adults should avoid the opioid meperidine (Demerol) because

Answer 44

it can cause delirium

Question 45

A semisynthetic opioid similar to morphine w/ analgesic effect 6x more potent.

Answer 45

hydromorphone (Dilaudid)

Question 46

Provide a continuous “around-the-clock” pain control that is helpful to patients who suffer from chronic pain Ex: fentanyl (Duragesic)

Answer 46

transdermal opioid analgesic

Question 47

Block opioid activity * Compete for opioid receptor, displaces opioid * Reverse symptoms of addiction, toxicity, and overdose

Answer 47

Opioid antagonist Ex: Naxalone (Narcan)

Question 48

Side effects of opioid antagonist

Answer 48

* Sweating, flushing, agitation, dyspnea * Hypo/hypertension, tachycardia * Nausea, vomiting * Reversal of analgesia (rapid)

Question 49

Opioid Withdrawal (3 or more symptoms)

Answer 49

* Dysphoric (negative) mood * N/V * Muscle aches * Runny nose or watery eyes * Dilated pupils * Goosebumps or sweating * Diarrhea * Fever * Insomnia