Final: Non-Opioids Flashcards
Acetaminophen
Acts on thermoregulatory cells of hypothalamus to reduce fever; Acts on prostaglandin production in CNS to reduce pain
Indications: Antipyretic, analgesis
Contraindications: Hepatic dysfunction, chronic alcoholism
Adverse effects: Headache, hemolytic anemia, renal dysfunction, skin rash, fever. Hepatotoxicity usually associated with chronic use and overdose
Drug-drug: Bleeding risk with warfarin; Hepatotoxicity with barbiturates, carbamazepine, hydantoins, rifampin
Antidote: Acetylcysteine via duodenal tube
Monitor: Hx of liver disease or alcohol use; LFTs, renal function, CBC, stool guaiac test
Aspirin (Salicylate)
Inhibits COX 1 and COX 2 blocking inflammatory response by prostaglandins
Indications: Antipyretic, analgesic, antiplatelet (aspiring)
Contraindications: Bleeding abnormalities, impaired renal or liver function
Drug-drug: Interacts with other drugs by interfering with absorption
Adverse effects:
GI: Heartburn, nausea, abdominal pain (GI perforation, LFT elevation)
Bleeding: Clotting systems (Bleeding s/s, low hgb/hct, dizziness)
Neuro - Salicylism: Tinnitus, mental confusion, lethargy
Monitor: Temperature, CNS, GI, CV status, S/S bleeding, LFTs, stool guaiac, renal function
Teaching: Take with food, report bleeding, caution with smoking/alcohol/hx peptic ulcers, safe dosing, avoid in children under 16
Salicylate Toxicity
Toxic Doses: Can occur at 20-25 g in adults or 4 g in kids
Symptoms: Tinnitus (early symptom), tachypnea, hemorrhage, hyperactivity (agitation), confusion, hallucinations, seizures, metabolic acidosis, coma, CV/renal/respiratory collapse
Treatment: Gastric lavage, activated charcoal, reverse the alkalosis, IV fluids/electrolytes
Reye’s Syndrome
Most common in kids recovering from a viral illness (flu, chicken pox)
NO aspirin under age of 16
Causes hydrocephaly and fat accumulation in liver
Symptoms: Vomiting, diarrhea, tachypnea, severe fatigue, confusion, seizures, loss of consciousness
Treatment: Supportive care
Ibuprofen (NSAID)
Inhibits COX 1 and/or COX 2 blocking prostaglandin effects
Indications: Anti-inflammatory, analgesic, and antipyretic
Contraindications: Pregnancy, GI irritation/peptic ulcers/GI bleeding, renal disease, CV disease, Stevens-Johnson syndorme
Drug-drug: Medications that may cause bleeding or worsen renal function (nephrotoxic)
Monitor: S/S bleeding, weights, I&O, renal function labs, electrolytes
Teaching: Take with food, report bleeding, monitor BP/edema, caution with smoking/alcohol/hx peptic ulcers, plan to stop 7 days prior to surgery
Methotrexate (DMARD)
Dampen down the underlying disease process rather than simply treating symptoms; decreases inflammation and pain; slows further joint destruction
Indications: Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, ulcerative colitis, Crohn’s disease
Caution: Lowers the immune system response - risk for INFECTION
Adverse effects: Bone marrow suppression, GI upset (n/v), Mucositis, gastric ulcers, elevated uric acid levels, do not use in pregnancy
Infliximab - Tumor Necrosis Factor Inhibitors (DMARD)
Often first line treatment for progressing symptoms
Contraindications: Cannot be used in anyone with an acute infection, cancer, sepsis, TB, hepatitis, myelosuppression, demyelinating disorders, pregnancy, lactation, hepatic and renal disorders
Adverse effects: Black box warning - serious to fatal infections and development of lymphomas and other cancers
Report: Fever, symptoms of infection, extreme fatigue, rash, blurred vision, numbness/tingling of extremities
Drug-drug: Immune suppressant drugs and live vaccines
Monitor: Symptoms of infection, pain, injection site tissues, CBC, LFTs, liver function, HIV, hep B, TB, ESR
Teaching: S/S adverse reactions, check before getting a vaccine no live vaccines
Colchicine (Gout Medication)
Decreases inflammation related to Gout
Indications: Acute gout, used if NSAIDS or glucocorticoids are not effective
Caution: Renal or hepatic impairment, GI distress
NO Grapefruit
Adverse effects: n/v/d, abd pain, bleeding (check CBC), muscle pain/tenderness. Diarrhea = Toxic
Monitor: CBC, uric acid levels, resolution of gout symptoms
Education: Take with food, report s/s of adverse effects, avoid alcohol and high purine foods (red meat/shellfish), hydrate exercise
Allopurinol (Gout Medication)
Inhibits uric acid production (hyperuricemia can lead to gout flares)
Indication: Prevention of gout flares, chronic gout
Adverse effects: hypersensitivity reaction (fever/rash/kidney/liver damage), nephrotoxicity encourage fluids/monitor I&O/check renal labs, monitor LFTs, n/v, increase in gout attacks in first few months
Monitoring: Uric acid levels, liver and renal function, resolution of gout symptoms
Education: Take with food to decrease GI effects, report s/s adverse effects, avoid alcohol and high purine foods (red meat, shellfish), hydrate, exercise
Sumatriptan (Triptans)
Serotonin receptor agonist - releases serotonin helping with pain and nausea, vasoconstricts cerebral arteries
Adverse effects: Coronary artery vasospasm, dizziness, teratogenesis
Cautions: Hx of CAD/MI, HTN, pregnancy, liver dysfunction
Interactions: SSRIs (serotonin syndrome), MAOIs (toxicity), use with ergotamine (vasospasm)
Ergotamine (Ergot Alkaloids)
Peripheral and cerebral vasoconstriction
Adverse effects: n/v, chronic use toxicity (muscle pain, paresthesias), physical dependence
Cautions: Hx of CAD/MI, HTN, pregnancy, renal or liver dysfunction
Drug-drug: Triptans, grapefruit, HIV protease inhibitors, antifungals
Celecoxib (NSAID)
Cox-2 inhibitor
Black box warning: GI bleeding and CV risk
Adverse effects: Stevens-Johnson syndrome, avoid with sulfonamides, high BP, edema
