Pharm #5 Flashcards
(395 cards)
1
Q
Body’s Protective response to tissue injury and infection
A
Inflammation Patho
2
Q
A vascular reaction occurs causing fluid, blood, leukocytes, and chemical mediators to accumulate at the injured site
A
Inflammation Patho
3
Q
3 Chemical Mediators
A
Histamine, Kinins, and Prostaglandins
4
Q
Not all inflammations caused by ___
A
illness
5
Q
anti-inflammatory med goal is to-
A
decrease and inhibit mediators from occurring
6
Q
Cardinal signs of inflammation
A
Erythema, Edema, Heat, Pain, Loss of function
7
Q
Erythema-
A
Redness occurs in first phase of inflammation
8
Q
Edema-
A
Swelling, 2nd phase of inflammation.
Plasma is leaking into the tissues at the site of injury
9
Q
Heat-
A
resulting from increase blood at the site
10
Q
Pain-
A
resulting from swelling and chemical mediators
11
Q
Loss of function-
A
resulting from pain and swelling that occurs at the site.
12
Q
Inflammatory phases
A
Vascular phase
Delayed phase
13
Q
Occurs 10 to 15 minutes after injury
A
Vascular phase
14
Q
Associated with vasodilation and increased capillary permeability
A
Vascular phase
15
Q
Fluid and blood substances move to injured site
A
Vascular phase
16
Q
Leukocytes infiltrate inflamed tissue
A
Delayed phase
17
Q
Converts arachidonic acid into prostaglandins (causing vasodilation, papillary permeability, and sensation that causes pain)
A
Cyclooxygenase (COX) enzyme
18
Q
Cyclooxygenase (COX) enzyme has two forms:
A
COX-1
COX-2
19
Q
Protecting lining of the stomach and regulating platelets. Inducing clotting.
A
COX-1
20
Q
Trigger inflammation and pain.
A
COX-2
21
Q
Anti-inflammatory drug groups (4 major drug groups)
A
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Disease-modifying antirheumatic drugs (DMARDS)
Antigout drugs
22
Q
Inhibit COX enzyme which increases biosynthesis of prostaglandins- by inhibiting the enzyme it decreases pain.
A
Action of NSAIDs
23
Q
Analgesic effect- Primary use is to relieve inflammation and pain
A
Action of NSAIDs
24
Q
Antipyretic effect- can decrease fever
A
Action of NSAIDs
25
Inhibit platelet aggregation
Action of NSAIDs
26
Mimic effects of corticosteroids
Action of NSAIDs
27
Inhibit COX enzyme
Action of NSAIDs
28
First generation NSAIDS-
Aspirin- anticoagulant. Help prevent MI or stroke
29
Over the counter NSAIDS- ____
Other NSAIDs require prescription
aspirin, ibuprofen and naproxen
30
First-generation NSAIDs-
not selective.
When inhibit cox enzyme it inhibits 1 and 2.
Can cause GI upset and bleeding which is why it is required to be taken with food.
31
Second-generation NSAIDs-
not causing GI upset or bleeding.
Selective COX-2 inhibitors
32
Oldest anti-inflammatory drug. Goes back from 1899.
Aspirin (acetylsalicylic acid) (ASA)
33
Aspirin (acetylsalicylic acid) (ASA) action
Anti-inflammatory, antiplatelet, antipyretic effects
34
Aspirin (acetylsalicylic acid) (ASA) Therapeutic serum salicylate level
15 to 30 mg/dL
35
Aspirin (acetylsalicylic acid) (ASA) Toxic serum salicylate level Mild toxicity—
Greater than 30 mg/dL
36
Aspirin (acetylsalicylic acid) (ASA) Toxic serum salicylate level Severe toxicity—
Greater than 50 mg/dL
37
Inhibiting prostaglandins which decreasing inflammation.
Aspirin (acetylsalicylic acid) (ASA)
38
Inhibiting both cox 1- decreasing platelet aggregation, given with cardiac, causes.
Aspirin (acetylsalicylic acid) (ASA)
39
Downside- GI irritation,
Aspirin (acetylsalicylic acid) (ASA)
40
Upside- aspirin is a weak acid drug it will not cause as much GI upset as normal ibuprofen or cerebrovascular disorders to prevent clotting
Aspirin (acetylsalicylic acid) (ASA)
41
Prevents cox 2
Aspirin (acetylsalicylic acid) (ASA)
42
Gives 81 mg maintenance dose to prevent
Aspirin (acetylsalicylic acid) (ASA)
43
Decrease irritation- enteric coated
Aspirin (acetylsalicylic acid) (ASA)
44
Increased bleeding with anticoagulants and other NSAIDs
Salicylates drug interaction
45
Risk for hypoglycemia with oral antidiabetics (Metformin)
Salicylates drug interaction
46
Increased gastric ulcer risk with glucocorticoids
Salicylates drug interaction
47
Decreased effects of ACE inhibitors, loop diuretics, probenecid
Salicylates drug interaction
48
Salicylate (aspirin) effects are decreased by corticosteroids
Salicylates drug interaction
49
Increase PT, bleeding time, INR, uric acid
Salicylates Labs
50
Decrease cholesterol, T3 and T4 levels,
Salicylates Labs
51
Foods containing salicylates
Prunes, raisins, licorice
Certain spices such as curry and paprika
52
Do not take with other NSAIDs- it will increase risk for side effects
Aspirin Caution
53
Avoid during the last trimester of pregnancy- can cause premature closure of the ductus arteriosus (allows blood to bypass they lungs and closes right after birth)
Aspirin Caution
54
Do not give to children with flu or virus symptoms as it may lead to Reye syndrome- swelling of the liver and brain and can become fatal.
Aspirin Caution
55
Aspirin Side effects
Dizziness, drowsiness, headache, flushing, visual changes, tinnitus, hearing loss, GI distress, ulceration, bleeding, seizures, Reye syndrome
bronchospasm
56
Early signs of aspirin side effects
Dizziness, Tinnitus, Bronchospasm
57
Salicylates Assessment
Medical history- GI disorders, try not to increase risk for GI upset
58
Salicylates Nsg interventions
monitoring salicylate level.
Observe for s/sx of bleeding- dark tarry stools, bleeding gums, petechiae, ecchymosis and purpura
59
Do not to take aspirin with alcohol or other drugs that are highly protein bound specifically warfarin.
Salicylates Education
60
Tell dentist if they are on high doses of aspirin bc of increased bleeding, decrease risk of infection.
Salicylates Education
61
If someone has surgery they need to discontinued at least 7 days before.
Salicylates Education
62
If they have enteric coated aspirin it cannot be crushed- helps decrease breakdown in stomach.
Salicylates Education
63
Not administering this to children.
Salicylates Education
64
Talk to clients about taking aspirin for menstrual cycle.
Salicylates Education
65
Report changes is LOC, hearing, vision, potential side effect or toxicity at an early level
Salicylates Education
66
Para-Chlorobenzoic Acid Examples
Indomethacin, sulindac, tolmetin
67
First classification developed and can cause severe GI distress
Indomethacin
68
New drugs in classification, do have less adverse reactions.
Sulindac and Tolmetin
69
Para-Chlorobenzoic Acid Action
Inhibits prostaglandin synthesis
70
Para-Chlorobenzoic Acid Use
Rheumatoid arthritis, osteoarthritis, gouty arthritis
71
Para-Chlorobenzoic Acid Side effects/Adverse effects
Dizziness, headache, weakness
GI distress and bleeding
Sodium and water retention- increase in BP
Hypertension
72
Group of NSAIDS
Para-Chlorobenzoic Acid
73
First generation NSAIDs- cox 1 and 2 inhibitor
Para-Chlorobenzoic Acid
74
If Indomethacin does not work can switch to __
Sulindac and Tolmetin
75
Phenylacetic Acid Derivatives Examples
Ketorolac (Toradol)
76
Prototype drug.
Good analgesic effects.
Benefit vs opioid.
PO, intranasally, IM and, IV.
Similar side effects to NSAIDs- GI distress
Ketorolac (Toradol)
77
Phenylacetic Acid Derivatives Action
Inhibits prostaglandin synthesis
78
Phenylacetic Acid Derivatives Use
Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and pain
No antipyretic effect
Primary use is to relieve inflammation and pain
79
First generation NSAIDs
Phenylacetic Acid Derivatives
80
Reducing pain and inflammation in this drug
Phenylacetic Acid Derivatives
81
Often used for post op and post-partum pain
Phenylacetic Acid Derivatives
82
Short term pain reliever. Not longer than 5 day use
Phenylacetic Acid Derivatives
83
When used for postop or postpartum pain they are giving different NSAIDs such as ibuprofen
Phenylacetic Acid Derivatives
84
Phenylacetic Acid Derivatives Side effects/Adverse effects
Dizziness, drowsiness, Weakness, headache, GI distress, GI bleeding/perforation
85
Phenylacetic Acid Derivatives- Ketorolac
Is recommended for short-term management of pain
86
Propionic Acid Derivatives Examples
Ibuprofen (prototype and commonly used in the drug class) & Naproxen
87
Propionic Acid Derivatives Action
Inhibit prostaglandin synthesis
88
Propionic Acid Derivatives Use
Pain, osteoarthritis, rheumatoid arthritis
89
NSAIDs - New group
Propionic Acid Derivatives
90
Effects like aspirin but stronger and less GI irritability
Propionic Acid Derivatives
91
S/E similar to salysilates but less chance of GI distress and bleeding
Propionic Acid Derivatives
92
Give caution to give this with a blood disorder.
Propionic Acid Derivatives
93
Need to know drug history. ibuprofen and warfarin increases risks for bleeding
Propionic Acid Derivatives
94
Propionic Acid Derivatives Side effects
Drowsiness, dizziness, headache, confusion, Insomnia, dreams, blurred vision, tinnitus, gastric distress and bleeding, edema
95
Propionic Acid Derivatives Drug interactions
Increased bleeding with warfarin
Increased effects with phenytoin, sulfonamides, warfarin, cephalosporins
Hypoglycemia with oral hypoglycemics
96
Ibuprofen Assessment
Medical and drug history
Specific allergies to NSAIDs
Contraindicated with severe renal or liver disease and peptic ulcers. Caution with bleeding disorders.
S/E: GI distress and peripheral edema
97
Ibuprofen Nsg interventions
Monitor for bleeding, PT INR prolonged- removing NSAID.
Report if GI discomfort
98
Avoid alcohol, it will cause increase in GI distress.
Ibuprofen Education
99
Tell dentist about NSAIDs if taking frequently.
Ibuprofen Education
100
Menstruation- want females to avoid ibuprofen 1-2 days before menstruation.
Ibuprofen Education
101
To avoid increasing menstrual flow.
Ibuprofen Education
102
Should be avoided during pregnancy can cause congenital abnormalities and increase in bleeding at delivery.
Ibuprofen Education
103
For arthritis- it takes a few weeks for steady state to tx symptoms.
Ibuprofen Education
104
Take with food to decrease GI upset
Ibuprofen Education
105
Fenamates Examples
Meclofenamate sodium & mefenamic acid
106
Fenamates Action
Inhibits prostaglandin synthesis
107
Fenamates Use
Osteoarthritis, rheumatoid arthritis
108
Fenamates Side effects/Adverse effects
Dizziness, headache, tinnitus, pruritus
GI distress/bleeding, edema
109
First generation group most oftenly used to treat arthritis- cause GI distress
Fenamates
110
Oxicams Examples
Meloxicam
111
Oxicams Action
Inhibits prostaglandin synthesis
112
Oxicams Use
Osteoarthritis, rheumatoid arthritis
113
Oxicams Side effects/Adverse effects
Dizziness, headache
GI distress/bleeding, edema
Well-tolerated
114
Will or can cause GI distress but less severe
Oxicams
115
Has a long half life
Oxicams
116
Selective COX-2 Inhibitors Example
Celecoxib (Celebrex)
117
Selective COX-2 Inhibitors Action
Selectively inhibits COX-2 enzyme without inhibition of COX-1
118
Selective COX-2 Inhibitors Use
Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, pain, dysmenorrhea
119
Selective COX-2 Inhibitors S/E
Dizziness, headache, sinusitis
Peripheral edema, hypertension
120
2nd generation NSAIDs
Selective COX-2 Inhibitors
121
Most recently new to drugs
Selective COX-2 Inhibitors
122
Only one still left is Celebrex
Selective COX-2 Inhibitors
123
Drug interactions more common due to number of drugs taken
Selective COX-2 Inhibitors- NSAIDs in older adults
124
Greater incidence of GI distress, ulceration
Selective COX-2 Inhibitors- NSAIDs in older adults
125
Reduced dose decreases risk of side effects
Selective COX-2 Inhibitors- NSAIDs in older adults
126
Increase fluid intake for adequate hydration
Selective COX-2 Inhibitors- NSAIDs in older adults
127
Arthritis reason for older adults
Selective COX-2 Inhibitors- NSAIDs in older adults
128
Evaluate renal function bc can cause renal toxicity
Selective COX-2 Inhibitors- NSAIDs in older adults
129
Use the lowest most effective dose possible- go low start slow
Selective COX-2 Inhibitors- NSAIDs in older adults
130
NSAIDs- hepatotoxic
Selective COX-2 Inhibitors- NSAIDs in older adults
131
Corticosteroids examples
Prednisone, prednisolone, cortisone, methylprednisolone
132
Corticosteroids Action
Control inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site
133
Corticosteroids Use
Arthritic flare-ups
Not the drug of choice for arthritis because of their numerous side effects
134
Corticosteroids Discontinuation
Taper off over 5-10 days
135
Short term for arthritic flare ups
Corticosteroids
136
Avoiding long term use due to side effects- adrenal insufficiency, osteoporosis, infection, hyperglycaemia, fluid and electrolyte imbalance, growth delay in children and peptic ulcer disease.
Corticosteroids
137
Dose strength and duration is dependent on the pain
Corticosteroids
138
Disease-Modifying Antirheumatic Drugs Types
Immunosuppressive agents
Immunomodulators
Antimalarials
139
Disease-Modifying Antirheumatic Drugs Use
Refractory rheumatoid arthritis that does not respond to other tx- invasive way.
Osteoarthritis, ankylosing spondylitis
Psoriatic arthritis, severe psoriasis
Crohn disease, ulcerative colitis
140
DMARDs
Disease-Modifying Antirheumatic Drugs
141
Slow or stop inflammatory process associated with rheumatoid arthritis
Disease-Modifying Antirheumatic Drugs
142
Including drugs that suppress or regulate the immune system
Disease-Modifying Antirheumatic Drugs
143
Including antimalarial drugs
Disease-Modifying Antirheumatic Drugs
144
Disease-Modifying Antirheumatic Drugs Side effects
Infection, peripheral edema, hypertension, hypercholesterolemia, headache, fever, chills, insomnia, oral ulcerations, nasopharyngitis, Influenza, sinusitis, GI distress, fatigue, Injection site reaction, Increase risk for infection
145
Immunosuppressive Agents Example
Methotrexate
146
Immunosuppressive Agents Action
Suppress inflammatory process
147
Immunosuppressive Agents Use
Refractory rheumatoid arthritis that does not respond to other anti-inflammatory tx
148
First type of DMARDs used
Immunosuppressive Agents
149
Immunomodulators Classifications
Interleukin 1 (IL-1) receptor antagonists
Tumor necrosis factor (TNF) blockers
150
Immunomodulators Examples
Anakinra & infliximab (remicade)
151
(Interleukin 1 receptor antagonist)- sydopine that contributes to the inflammation in the synovial joint and destruction.
Antagonist blocks from occurring
Anakinra
152
TNF blocker tumor necrosis factor contributes to synovitis- inflammation of synovial joint. By blocking it, it blocks from occurring.
Infliximab (remicade)
153
Immunomodulators Action
Disrupt inflammatory process
Delay disease progression`
Neutralize TNF
154
Immunomodulators Use
Rheumatoid arthritis, psoriatic arthritis, psoriasis, spondylitis, ulcerative colitis, Crohn disease
155
Modulating
Immunomodulators
156
Disrupting inflammatory process and delaying progression of the inflammatory disease
Immunomodulators
157
Risk for infection
Immunomodulators
158
Need to have a negative TB test
Immunomodulators
159
Monitoring for early S/sx of infection
Immunomodulators
160
Monitoring for neutropenia, blood dyscrepancies
Immunomodulators
161
Monitoring liver and renal functions
Immunomodulators
162
Antimalarials Examples
Hydroxychloroquine
163
Antimalarials Action
Unclear
Effect may take 4 to 12 weeks to become apparent
164
Antimalarials Use
Refractory rheumatoid arthritis When other tx are not effective
165
Combing these with nsaid to be effective.
Antimalarials
166
Inflammatory disease of joints, tendons, and other tissues
Gout pathophysiology
167
Usually occurs in great (Big) toe
Gout pathophysiology
168
Defect in purine metabolism leads to uric acid accumulation due to ineffectiveness of purines in someone's body and insufficient extretion of them
Gout pathophysiology
169
Foods containing Purine should be avoided-
organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer)
170
Effects feet/toes
GOUT
171
When taking antigout meds-
Educating about increasing fluid intake to help excretion of med and uric acid that is being broken up into the body.
Helps prevent getting renal calculi.
172
Antigout Drugs
Colchicine, Uric acid inhibitors, Uricosurics
173
Colchicine Action
Inhibits migration of leukocytes to inflamed site
Alleviates gout symptoms
174
Colchicine Side effects
GI distress (nausea, vomiting, diarrhea, abdominal pain)
Taken with food to avoid GI distress
175
Colchicine Contraindications
Severe renal, cardiac, or GI problems
176
Decreases inflammation associated with gout
Colchicine
177
Used to treat an acute gout attack not to prevent
Colchicine
178
Uric acid inhibitors Examples
Allopurinol (common) & febuxostat-prototype for this class
179
Uric acid inhibitors Action
Decreases uric acid synthesis- lowering uric acid serum levels
Prevents gout attacks- prophylactically
180
Uric acid inhibitors Side effects
Dizziness, headache, GI distress
GI bleeding/perforation
Arthralgia, fatigue
Bradycardia, peripheral neuropathy
181
Not to be used for an acute attack
Uric acid inhibitors
182
Should be used w caution for someone with decreased renal function
Uric acid inhibitors
183
Allopurinol Assessment
Main labs- renal function labs. Serum uric acid levels.
If meds are effective.
Hx: kidney stone or renal calculi.
Record and monitor urine output.
184
Allopurinol Nsg Interventions
Reporting changes in urine output, monitoring intake and output, monitoring labs
185
Allopurinol Education
Need to have yearly eye exam.
Meds can decrease visual activity.
Prolonged use can cause decrease in vision
Increase fluid intake, eliminate or avoid caffeine and alcohol intake bc it can increase uric acid levels.
Vitamin C can cause kidney stone when taken with alopurinol.
List of food vitamin C reduce or eliminate from diet.
186
Uricosurics Action
Blocks reabsorption of uric acid which promotes its excretion
187
Uricosurics Example
Probenecid
188
Uricosurics Side effects
Flushed skin, fever
Dizziness, headache
GI distress, kidney stones(uric acid does not get excreted)
189
Increasing the excretion of uric acid
Uricosurics
190
Used for preventing a gout attack
Uricosurics
191
Can be taken with colchicine
Uricosurics
192
A 35-year-old woman diagnosed with rheumatoid arthritis has been prescribed infliximab. The nurse identifies infliximab as which type of medication?
Immunomodulator
193
The nurse identifies Infliximab as useful in the treatment of rheumatoid arthritis as well as
Crohn disease.
194
A patient has been advised to take ibuprofen. When teaching the patient about ibuprofen, which instruction should the nurse include? (Select all that apply.)
Avoid taking aspirin with ibuprofen.
Take with food to reduce GI upset.
Monitor for bleeding gums, nosebleeds, black tarry stools.
195
An older adult patient takes tolmetin for arthritis pain. Which statement made by the patient is of most concern to the nurse?
“My stomach aches and burns.” (GI upset)
196
A 65-year-old man has been diagnosed with chronic gout. The nurse anticipates that the patient will be treated with
allopurinol.
197
Level of stimulus needed to create painful sensation (differs)
Pain threshold
198
Affected by genetic makeup.
Pain threshold
199
May have different pain receptors with different sensitivities
Pain threshold
200
Amount of pain able to endure without interfering with normal functioning
Pain tolerance
201
Analgesics to relieve pain
Opioid and Nonopioid
202
Opioid-
moderate to severe pain- narcotics
203
Nonopioid-
mild to moderate pain
204
Reliving pain, subjective and objective pain-
Everybody’s pain tolerance is different.
205
Open-minded about pain towards
patients
206
5th vital sign-
pain.
207
Assess pain, manage pain and document
pain and interventions
208
0-10 scale typical or
faces scale
209
Sudden onset
Short duration (<3 months)
Acute pain
210
Gradual onset
Prolonged duration (>3 months) Ex: arthritis
Chronic pain
211
Results from injury to tissues
Nociceptor pain
212
Results from injury to peripheral or central nervous system
Neuropathic pain- nerve
213
Pain Classified by duration-
frequent, constant, sudden
214
Pain Classified by origin-
nociceptor or neuropathic
215
Tissue injury activates nociceptors (pain receptors) in the periphery
Gate control theory
216
Causes release of chemical mediators (Histamine, Kinins, and Prostaglandins)
Gate control theory
217
Mediators transmit pain signal along sensory nerve—sensitize pain receptors
Gate control theory
218
Pain signals begin in periphery—move to CNS
Gate control theory
219
Endorphins- Endogenous
Body naturally producing and
Naturally suppress pain conduction
220
Controlling pain sensation by blocking the signal that occurs.
Dependent on where it is address the pain
221
Opioids working on same receptors on endorphins to reduce pain-
exogenous pain control, opioids
222
Acute pain definition
Occurs suddenly, short duration, responds to treatment
223
Acute pain treatment
Mild: Nonopioid drugs
Mod: Combo
Severe: Potent opioids
224
Chronic pain definition
Pain persists for > 3 months, difficult to control
225
Chronic pain treatment
Nonopioids suggested first
Opioids should meet criteria*
226
Cancer pain definition
Pain occurs from pressure on organs and nerves, blocked blood flow, or metastasis to bone
227
Cancer pain treatment
NSAIDS and opioids may be given by any route
228
Somatic pain definition
Pain in skeletal muscle, ligaments, and joints
229
Somatic pain treatment
Nonopioids: NSAIDs and muscle relaxants
230
Superficial pain definition
Pain from surface – skin or mucous membranes
231
Superficial pain treatment
Mild: Nonopioids
Mod: combo
232
Vascular pain definition
Pain occurs from vascular tissues – headaches or migraines
233
Vascular pain Treatment
Non-opioids
234
Visceral pain definition
Pain is from smooth muscle and organs
235
Visceral pain treatment
Opioids
236
Drug Criteria-
Route: Orally or Transdermally?
Durations of action- Long or short?
Minimal respiratory depression
237
____ is a major issue in health car
Undertreatment of pain
238
Reasons for under-treatment-
not acknowledging pain
fear of addiction
nsg provider not assessing pain correctly or not offering pain meds, nurses not believing reports of pain, negative attitude of HC team against opioid use
239
Effects of unrelieved pain-
Increase RR, BP, Pulse, Stress response (hyperglycemia) increase in stress hormones, urinary retention, constipation, atelecesis and pneumonia, confusion, extended hospital stays, remissions, increased outpatient visits.
240
Balance between of underdosing and overdosing
Undertreatment of Pain
241
Bias vs actual issue
Undertreatment of Pain
242
__ of people in client population still have untreated pain
75%
243
Adds 200 billion dollars a year to HC costs just in pain relief alone
Undertreatment of Pain
244
Nonopioid Analgesics use
Mild to moderate pain
245
Dull, throbbing pain
Nonopioid Analgesics effective for
246
Headaches, dysmenorrhea, minor abrasions
Nonopioid Analgesics effective for
247
Inflammation, muscular aches, pain
Nonopioid Analgesics effective for
248
Mild to moderate arthritis
Nonopioid Analgesics effective for
248
Nonopioid Analgesics action site
Peripheral nervous system at pain receptor sites
249
Nonopioid Analgesics Examples
Acetaminophen, ibuprofen, aspirin, naproxen
250
Less potent than opioids
Nonopioid Analgesics
251
Antipyretic effect- reducing body temp
Nonopioid Analgesics
252
OTC NSAIDS available:
Aspirin
Ibuprofen
Naproxen
253
NSAIDs action
Analgesic
Antipyretic
Anti-inflammatory effects
254
prostaglandin synthesis- production of what signals body pain is present
NSAIDs
255
Aspirin—Nonopioid Analgesic Action
Inhibits biosynthesis of prostaglandins
Inhibits COX-1 & COX-2 (non-selective)
256
Aspirin—Nonopioid Analgesic Use
Drug of choice for pain and arthritic inflammation
Analgesic, antipyretic, anti-inflammatory
Decreases platelet aggregation
257
First generation NSAID-
Aspirin
258
Bleeding concern
Aspirin
259
High doses for pain= GI irritation, lead to gastric ulcers
Aspirin
259
Aspirin – Nonopioid Analgesic S/E/adverse reactions
GI distress
Excess bleeding due to decrease platelet aggrigation
Tinnitus(Common), vertigo, bronchospasm, possible metabolic acidosis, hyperventilation
Reye’s syndrome- do not give to children
260
Aspirin Therapeutic serum level:
15-30mg/dL
261
Take with food and/or full glass of water to help reduce GI upset
Applies to all NSAIDs
Aspirin
262
Avoid beginning of female menstrual cycle bc of increased bleeding
Aspirin
263
Acetaminophen—Nonopioid Analgesic action
Inhibits prostaglandin synthesis
264
Acetaminophen—Nonopioid Analgesic Uses
Muscular aches and pain
Fever
265
Acetaminophen—Nonopioid Analgesic Maximum dose
4g/day if taken infrequently
3g/day if taken frequently
2g/day for heavy drinkers
265
Acetaminophen—Nonopioid Analgesic Drug interactions
Caffeine- increased effect
Common ingredient in OTC combo meds- educate to pay attention for daily usage.
266
Acetaminophen—Nonopioid Analgesic Therapeutic Range
10-20 mcg/mL
267
Not an NSAID
Not an anti-inflammatory
Acetaminophen
268
1-3 hrs half life- can take every 4-6 hrs
Acetaminophen
269
Hepatotoxic- increase consumption of alcohol, liver failure risk
Acetaminophen
270
Headache pain- ephedrine- acetaminophen, caffeine, and aspirin
Acetaminophen
271
Safest OTC analgesic for children.
Acetaminophen
272
Monitor for pts taking prolonged time and renal function due to excretion
Acetaminophen
273
Acetaminophen S/E
Rash, headache, insomnia
Low incidence of GI distress
274
Acetaminophen Toxic effects/excess dosing
Hepatotoxicity(Liver function) if over use, renal failure
Thrombocytopenia
Hemolytic anemia
Agranulocytosis
Leukopenia, neutropenia
275
Acetaminophen Antidote
Acetylcysteine- smells and tastes like rotten eggs given inhalation, iv or oral. Orally dilute with flavored drink or coke to minimize bad taste.
276
Acetaminophen- Assessment
Monitor liver function, need baseline. Med and drug history, assessing severity of the pain. Ongoing pain assessments with documentation. Monitor liver enzymes and serum acetaminophen levels
277
Acetaminophen Nursing Interventions
teach parents to keep med out of reach and do not overdose.
278
Acetaminophen Education-
Direct parents to contat poision control if overdosed and if does not know how much they took. Adults should not self medicate for longer than 10 days consistently. If still requiring pain relief they must be presquibed. For children not be on longer than 5 days.
279
Opioid Analgesics examples
Morphine (prototype drug), hydromorphone (Dilaudid), codeine, hydrocodone, meperidine (Demerol), oxycodone, fentanyl, methadone
280
Opioid Analgesics uses
Moderate to severe pain
Many have antidiarrheal effects
Some used to help relieve cough
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Opioid Analgesics action
Act on the CNS to
Suppress pain impulses
Suppress respirations and coughing
Activating MEU receptors, effects resp and cough areas in the brain, suppressing respirations and cough
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All opioids are controlled substances bc likelihood of abuse, dependence, respiratory depression, worried about physical and psychological dependents of the medication.
Opioid Analgesics
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Can cause euphoria which leads to development of tolerance.
Opioid Analgesics
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Decreased analgesic effect and decreased euphoria-tolerance
Opioid Analgesics
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Opioid Analgesics Contraindications
Head injury- decreased respirations therefore causes CO2 to increase then causing intercranial pressure increase. And increased sedation. Assessing mental status.
Hypotension – use with caution
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Off label uses- coughs (codeine), over use of opioids (constipation)- antidiarrheal effect
Opioid Analgesics
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Opioid Analgesics Drug Interactions
St. John’s Wort- cause decreased effectiveness or morphine
Kava kava- for sleeping/decreased anxiety. Worried about oversedation (overdosing)
Valerian
All Causes increased sedation
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Morphine: side effects/adverse reactions
Drowsiness, dizziness, euphoria
Confusion, depression, miosis, blurred vision
GI distress, flatulence, constipation
Orthostatic hypotension, weakness
Urinary retention, pruritis(common) but does not indicating allergy to it
Psychological dependence
Respiratory depression
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Monitor for respiratory depression. 12-20
Morphine
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Antidote- Narcan (Naloxone)
Morphine (opioids)
289
Morphine Assessment-
assessing vital signs frequently and closely monitoring them(low BP and RR). If post op and BP is 90/60 no morphine for pain. Assessing vital signs related to pain- is effective.
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Morphine Nursing Interventions-
Older adult population- extremely high pain tolerances, watching vital signs. assessing bowel sounds and bowel movements (obstruction, constipation)- prophylactic tx- stool softener, fluids movement. pupils, urine output-S/E of urinary retention. Administer pain meds before peak pain level. Naloxone/Narcan available when pt on opioids should have standing order. Always double IV doses and prescriber orders related to morphine, hydromorphone and fentyl must give in small doses. Use safety precautions bc risk for falls (dizziness, drowsiness)- remind to call for help
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Morphine Education-
taking at home to avoid other cns depressants- alcohol can cause increase in sedation d rsp dep. Possibility of requiring substance use disorder. Identify symptoms early to relay to provider. Orthostatic hypotension- let feel touch the floor before getting out of bed. Increase fiber and fluids to decrease constipation
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Meperidine (Demerol) Uses
Primarily effective for GI procedures and pain
Generally, not given for more than 2-3 days
Preferred to morphine during pregnancy/Labor&Delivery
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Meperidine (Demerol) S/E/Adverse effects
Less constipation and urinary retention than morphine
Can cause neurotoxicity, especially in older adults- more sensitive. Looking at nervousness, agitation, irritability, tremors, and seizures- indicative of neurotoxicity.
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Less respiratory depression occurrence in newborns
Meperidine (Demerol)
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Hydromorphone (Dilaudid) Use
Analgesic effect is approximately 6 times more potent than morphine
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Hydromorphone (Dilaudid) Side effects/adverse effects
Drowsiness, dizziness, confusion, orthostatic hypotension, weakness
Constipation, but causes less GI distress than morphine
Urinary retention
Tolerance, dependence can easily occur
Miosis, respiratory depression(cardinal signs of toxicity)
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More potent than morphine
Fast onset and short duration
Do not give to pt w hypotension
Hydromorphone (Dilaudid)
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Fast onset and short duration
Hydromorphone (Dilaudid)
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Do not give to pt w hypotension
Hydromorphone (Dilaudid)
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Patient-Controlled Analgesia (PCA)- Medications used
Morphine most often used
Also – fentanyl, hydromorphone, & meperidine
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Loading dose-
basal dose, nurse set PRN limits
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Predetermined safety limits by providers orders
Patient-Controlled Analgesia (PCA)
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Lockout mechanism- once maximum limit is reaches it locks out
Patient-Controlled Analgesia (PCA)
303
Help provide Near-constant analgesic level- therapeutic level
Patient-Controlled Analgesia (PCA)
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IV analgesics set up with a pump with a time set system
Patient-Controlled Analgesia (PCA)
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Only the pt must push the button to administer self not significant other pushing just bc they think
they are in pain
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Pediatric pt the parent should not activate the pump while the child is sleeping. If the pt is pediatric they can help administer that with
proper education.
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Most common- fentynol, hydromorphone, and merperidine
On the pump it shows how many times they press, how much given. Controlled substance log.
Patient-Controlled Analgesia (PCA)
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Helpful for chronic pain
Transdermal Opioid Analgesics
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Provide continuous pain control
Transdermal Opioid Analgesics
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Fentanyl is most commonly used (Use gloves)
Transdermal Opioid Analgesics
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More potent than morphine
Available in various strengths
Fentanyl
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Not good for acute or post operative pain
Transdermal Opioid Analgesics
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Can be used for cancer pain, chronic back pain, and developed tolerance to other opioid meds orally
Transdermal Opioid Analgesics
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Can be used for breakthrough pain management, may already have a patch and need additional PRN meds.
Transdermal Opioid Analgesics
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Has different way of communication.
Crying, holding, guarding- different pain scales and document what pain scale used.
Analgesics in Children
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Older adults- decreased hepatic and renal function so decrease doses of analgesics.
Analgesics in older adults
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Polypharmacy- causes increased risk for adverse reactions.
Analgesics in older adults
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Pain is under reported.
Analgesics in older adults
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Observe for pain closelt-facial grimincing, guarding, refusing to do something.
Analgesics in older adults
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dementia, hearing loss, vision loss-can’t understand and report effectively.
Analgesics in Cognitively impaired individuals
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Oriented or not oriented.
Analgesics in Cognitively impaired individuals
317
Watch for physical signs of pain-faces scale.
Analgesics in Cognitively impaired individuals
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Caregivers w/ them may know normal (ask questions).
Analgesics in Cognitively impaired individuals
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dosages may need to be adjusted until the pain is controlled or risk vs benefit side effects become worse than the pain.
Analgesics in Oncology patients
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High dosages.
Analgesics in Oncology patients
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Less concerned about addiction and dependence as long as managing pain.
Analgesics in Oncology patients
321
Thorough pain assessment.
Analgesics in Individuals with substance abuse history
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Address pain issue but can still get opioids. .
Analgesics in Individuals with substance abuse history
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May need higher dose.
Analgesics in Individuals with substance abuse history
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Use different than fentanyl if they used it before
Analgesics in Individuals with substance abuse history
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Ask about past drugs used
Analgesics in Individuals with substance abuse history
325
Adjuvant Analgesics
Anticonvulsants
Antidepressants- TCAs
Corticosteroids
Antidysrhythmics
Local anesthetics
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Gabapentin-neropathy pain (decreases excitability of the nerve stimulant, blocking nerve transmission, decreasing neuropathic pain.
Prevents migraine headaches.
Anticonvulsants
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Amitriptyline- Helps with peripheral neuropathy used in lower dosages than in depression. Lots of side effects. Thorough med and drug history. Inhibiting reuptake of serotonin and norepinephrine.
Antidepressants- TCAs
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Reducing nociceptor stimuli. Inflammation
Corticosteroids
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- Mexiletine, blocks sodium channels to reduce pain
Antidysrhythmics
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Lidocaine- patches are used to provide analgesic effect by interrupting the transmission of pain signals to the brain. Numbs surface placed on.
Local anesthetics
331
Developed for other purpose than pain relief
Adjuvant Therapies
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May potentiate action of pain meds and can be used along side of them to allow for decreased use of opioid dosages. Less dosages of both drugs
Adjuvant Therapies
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Opioid Agonist-Antagonists Examples
Nalbuphine (Nubain), Buprenorphine, & Butorphanol
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Most often use for pts w hx of opioid abuse bc of lower potential for abuse bc causes less receptor activation than full agonists.- less intense analgesic effects.
Buprenorphine
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Opioid Agonist-Antagonists Uses
Moderate to severe pain
Decrease likelihood of substance abuse disorder
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Opioid Agonist-Antagonists Action
Agonists at kappa pain receptors
Antagonists at mu pain receptors
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Opioid Agonist-Antagonists Side effects/adverse effects
Constipation, urinary retention
Less Respiratory depression than regular opioids
Hallucinations or unusual dreams
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Psychiatric concerns- avoid this med
Opioid Agonist-Antagonists
338
Nalbuphine hydrochloride- Assessment
Assess vital sings, pain. Watch for changes significant o vital signs, bowel sounds, urinary output.
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Nalbuphine hydrochloride- Nsg interventions
Administering IV undiluted.
340
Nalbuphine hydrochloride- Education
avoid alcohol and other CNS depressant to decrease risk of adverse reaction or S/E
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Opioid Antagonists example
Naloxone (Narcan)- most commonly used OA
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Opioid Antagonists action
Blocks receptors and displaces opioids
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Opioid Antagonists Reverses effects of opioids
Sedation
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Opioid Antagonists uses
Antidote for opioid toxicity and overdose
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Opioid Antagonists Side effects/Adverse effects
Sweating, flushing, agitation, dyspnea
Hypo/hypertension, tachycardia- extreme pain, (vital signs)
Nausea, vomiting
Elevated PTT, bleeding
Reversal of analgesia
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Monitor vital signs and bleeding
Opioid Antagonists
347
Figure out if the med is effective when everything is reversed- figureout alternative method to reduce rebound pain
Opioid Antagonists
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Migraine Headaches Characteristics
Unilateral throbbing pain
Nausea, vomiting
Photophobia
Last hours to days
Occurs more in women
Can be preceded by an aura
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Migraine Headaches Triggers
Cheese, chocolate, red wine, aspartame, MSG
Fatigue, stress, missed meals
Odors, light
Hormonal changes
Drugs, weather
Too much or too little sleep
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Migraine Headaches Pathophysiology Theory
Due to neurovascular events in cerebral cortex
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Reason for analgesics
Migraine Headaches
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Due to neurovascular events in cerebrovascular
Migraine Headaches
353
Keep notebook/log to list symptoms and diet for day/experienced
Migraine Headaches
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Cluster Headaches Characteristics
Severe unilateral non-throbbing pain
Usually located around eye
Occur in a series of cluster attacks
One or more attacks every day for several weeks
Not associated with an aura
Do not cause nausea and vomiting
More common in males
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Migraine and Cluster Headaches Prevention
Avoid triggers
Prevent by Beta-adrenergic blockers
Anticonvulsants
Tricyclic antidepressants
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Propranolol
Atenolol (risk Nonselective, asthma)
Prevent by Beta-adrenergic blockers
357
Valproic acid
Gabapentin
Anticonvulsants
358
Keep log for diet/symptoms
Migraine and Cluster Headaches
359
Amitriptyline
Imipramine
Tricyclic antidepressants
360
Avoid triggers to those attacks
Migraine and Cluster Headaches
361
Migraine and Cluster Headaches management
Analgesics
Opioid analgesics
Ergot alkaloids
Selective serotonin1 receptor agonists
362
Aspirin with caffeine, acetaminophen (Excedrin)
NSAIDs: ibuprofen, naproxen
Analgesics
363
Meperidine, butorphanol nasal spray-opioid agonist antagonist
Opioid analgesics
364
Dihydroergotamine mesylate (Migranal)- tx migranes and cluster headaches
Ergot alkaloids
364
constricting the blood vessels to the brain. Prevents inflammation and blocks sensation
Selective serotonin1 receptor agonists
364
Sumatriptan (Imitrex)-prodotype for migrances and clusterheadaches, zolmitriptan
Selective serotonin1 receptor agonists
364
Most migraine combo Meds-
Excedrin
365
Sumatriptan (Imitrex) use
Treats migraine and cluster headaches
366
Sumatriptan (Imitrex) action
Causes vasoconstriction of cranial arteries
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Sumatriptan (Imitrex) Side effects/adverse effects
Dizziness, drowsiness, flushing, fatigue
Dysgeusia- altered taste, nausea, vomiting
Paresthesia, seizures
Hypertension, dysrhythmias, thromboembolism, MI, stroke
Suicidal ideation
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Sumatriptan (Imitrex) Drug Interactions
Dihydroergotamine or other ergot alkaloids- can cause vasoconstriction to bp to be dangerously high level. Wait full 24 hours before taking it
369
Sumatriptan (Imitrex) med class
Triptan
370
Contraindication, Hypertension- can cause stroke
Sumatriptan (Imitrex)
371
Monitoring BP and educate monitory bp at home
Sumatriptan (Imitrex)
372
Causes increase risk of blood clots
Sumatriptan (Imitrex)
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For the patient taking acetaminophen regularly, what should the nurse do? (Select all that apply)
Monitor routine liver enzyme tests
Encourage the patient to check packaging labels of other OTC meds
Report side effects immediately; toxicity can cause severe hepatic damage
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A patient’s pain medication is changed from morphine sulfate to hydromorphone. Which statement regarding hydromorphone does the nurse identify as being true?
Hydromorphone is more potent than morphine.
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The nurse assesses a patient receiving morphine via a PCA pump. The patient has a respiratory rate of 6 breaths/min. The nurse anticipates administration of which of the following drugs?
Naloxone
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The nurse identifies which of the following as a common side effect/adverse effect of morphine therapy?
Pruritis
377
A patient received morphine sulfate for severe pain. The nurse assesses the patient 20 minutes later. What is the best indication that the medication has been effective?
Patient verbalizes pain relief.
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