BHCLR-Pharmacology: Pain & Inflammation Management System: Exam 2

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Cyclooxygenase (COX)
Is an Enzyme that helps in the Synthesis of Prostaglandins. Prostaglandins cause Inflammation and Pain at the Injury Site

Is caused by Microorganisms and Results in Inflammation (but not all inflammations are caused by infections)

A Response to Tissue Injury and Infection. This process is a protective mechanism in which the body attempts to neutralize & destroy harmful agents at the site of injury and to establish conditions for tissue repair.

Nonsteroidal Antiinflammatory Drugs
Relieve Pain (Analgesic), Reduce Body Temperature (Antipyretic), and Inhibit Platelet Aggregation (Anticoagulant)

NSAIDS (Non-steriodal anti-inflammatory drugs)
-These drugs mimic the effects of Steroids but they are not Steroids
-Aspirin is the oldest Anti-inflammatory drug, it was first used for its Analgesic and Antipyretic effects
-Used to Treat Mild to Moderate Pain


*-Therapeutic Uses: Analgesic (reduce pain/inflammation), Antipyretic (decrease temperature) & Anticoagulant (inhibit platelet aggregation)

*-Contraindications: Do not give to Children (Reyes Disease), GI Bleed, Bone Marrow Suppression, Anticoagulant Therapy

*-Common Side Effects: N/V, Anorexia, Diarrhea, Hearing Loss, Abdominal Pain, Heartburn

*-Adverse Reaction: Tinnitus, Urticarial (Hives), Ulceration of Lining of Stomach (GI Bleed), Leukopenia

*-Drug/Lab/Food: Prothrombin Time

*-Nursing Interventions: Close observation during 1st dose; Asses for Side Effects/Adverse Reactions, Clotting Factor; Monitor Labs for Liver, Urine, C&S; Take med With Food; Monitor Liver & Kidney function, Non-compliance

*-Client Education: DO NOT take with Alcohol or with other anticoagulants; Possible Side Effects (GI Bleed really common); Increase Fluid Intake to help excretion; Discontinue 3-7 days before surgery; Report blood in Stool or other GI symptoms


*-Therapeutic Uses: To relieve Pain, Reduce Inflammatory Response, Anti-Arthritic, Anti-Pyretic

*-Contraindications: Renal or Hepatic Disease, Lactation

*-Common Side Effects: GI Disturbances, N/V, Rash, Fluid Retention (Edema)

*-Adverse Reactions: GI Bleed, Nephrotoxicity, Blood Dyscrasia, Cardiac Dysrhythmias

*-Nursing Interventions: Close Observation during 1st Dose; Assess for Allergies, GI Symptoms; Monitor Labs for Liver, Renal, C&S; Take med With Food; Monitor Liver & Kidney Function

*-Client Education: Possible Side Effects; Increase Fluid Intake to help Excretion; Report Blood in Stool or other GI Symptoms; Often chosen over Acetaminophen (Tylenol) r/t Liver Toxicity

*-Classification: NSAID, COX-2 Inhibitor

*-Therapeutic Uses: To treat Osteoarthritis, Rheumatoid Arthritis, to Relieve Dysmenorrhea (difficult menstrual cycle)

*-Contraindications: Advanced Renal Disease or Hepatic Failure, Hypertension

*-Side Effects: Headache, Dizziness, N/V, Rash

*-Adverse Reactions: Peripheral Edema

*-Nursing Interventions: Assess for Edema; Observe for GI Symptoms; Monitor Liver & Kidney Function

*-Client Education: Possible Side Effects; If it causes GI upset tell Patient to take with Food

*-Classification: Antigout

*-Therapeutic Uses: Reduces Uric Acid Synthesis; To treat Gout and Hyperuricemia, Prevents Urate Calculi

*-Contraindications: Hypertension, Decreased Renal or Hepatic Function

*-Side Effects: Headache, Sinusitis, N/V, Diarrhea, Rash

*-Adverse Reactions: Peripheral Edema

*-Nursing Interventions: Monitor Renal & Liver Profiles, VS, Urinary Output; Increase PO Fluids to Avoid Kidney Stones; Administer before or after Meals with Full Glass of Water

*-Client Education: Increase Fluid Intake; Limit Foods High in Purine (protein) Content (Meats, Salmon, Legumes)

Nonopioid and Opioid are Prescribed for the Relief of Pain

Pain Threshold
It Reflects the Level of Stimulus needed to Create a Painful Sensation in an Indiviual

Pain Tolerance
-The amount of Pain a Person can Tolerate without Interference of Functioning
-Influenced by Age, Gender, Culture, Ethnicity, Anxiety, Previous Experience

Neuropathic Pain
An Unusual Sensory Disturbance often Involving Neural Super Sensitivity, often due to Injury or Disease of the Peripheral or CNS

The Body Produces these Neurohormones, that naturally Suppress Pain Conduction although the Method is not completely understood

Opioid Agonists
Prescribed for Moderate and Severe Pain (Opioid Analgesics)

Withdrawal Syndrome
-Is caused by Physical Dependence
-If Chronic use of an Opioid is discontinued this happens usually within 24 to 48 hours after last dose

Opioid Agonist-Antagonist
Medications in which an Opioid Antagonist (Nalaxone) is Added to an Opioid Agonist, were developed in hopes of Decreasing Opioid Abuse

Opioid Antagonist
Blocks the Receptor and Displaces any Opioid that would Normally be at the Receptor, Inhibiting the Opioid Action

Cluster Headaches
Characterized by a Severe Unilateral Non-throbbing Pain usually Located Around the EYE

Acute Onset
-Pain is classified as Mild, Moderate or Severe
-Pain occurs suddenly and responds to treatment (Trauma, Tissue Injury, Inflammation, Surgery)

Chronic Pain
-Vague Origin and Onset, usually Prolonged Duration
-Pain persists for great than 6 months and is difficult to treat or control

-Pain from Pressure on Nerves and Organs
-Blockage to Blood Supply or Metastasis to Bone
-Pain of Skeletal Muscle, Ligaments, Joints

-Pain of Skeletal Muscle, Ligaments, Joints

-Pain from Surface Areas such as Skin and Mucous Membranes

-Pain from Vascular or Perivascular Tissues Contributing to Headaches or Migraines

-Pain from Smooth Muscle and Organs

Key Points about Pain:
1.Pain has become known as the 5th Vital Sign
2.Words to Describe Pain: Sharp, Stabbing, Dull, Aching, Pressure, Acute, Chronic
3.MUST Assess pain PRIOR to & 30 mins AFTER (Evaluate) administering pain meds (Document)
4.Pain is Subjective, Only the Patient can Accurately Rate their Level of Pain
5.Pain Assessment Tool: Scale of 1-10 or the Faces Chart
*6.Harmful Effects as the Result of Unrelieved Pain: Hypertension, Increased Respirations, Increased Blood Sugar, Paralytic Ileus (constipation), Confusion
7.Cognitively Impaired Individuals may not be able to Report Pain S/S include: Moans, Grimacing, Restless,Noisy Respirations, Clenched Teeth, Guarding

Schedule Drugs
-Opioid Analgesics are Addictive
-Schedule Drugs Indicate their Level of Abuse Potential
*I-HIGHEST: Minimal to No Accepted Medical Use in US
*II-HIGH: Morphine, Oxycodone
*III-MEDIUM: Potential for Leading to Low Physical or High Psychological Dependence
*IV-LOW: Ativan, Xanax
*V-LOWEST: Preparations containing Limited Quantities of Narcotics (Cough Syrup)

-Narcotic Antagonist
-Used for Emergencies
-It Reverses Respiratory and CNS Depression (Overdose of Narcotic)

-Opioid Antagonist
-Used for Withdrawal from Long Term Opioid Abuse

*-Classification: Analgesic

*-Therapeutic Uses: Used to Decrease Pain and Fever

*-Contraindications: Hepatic or Renal Dysfunction

*-Side Effects: Anorexia, N/V, Rash, Insomnia

*-Adverse Reactions: Hepatotoxicity, Agranulocytosis, Leukopenia, Oliguria

*-Drug/Lab/Food: Liver and Kidney Functions

*-Nursing Interventions: Check Liver Enzymes (High Doses can cause Hepatotoxicity); If no Relief of Symptoms within 5 days see Dr

*-Client Education: Only take as prescribed/indicated (85% is metabolized in the Liver)

Morphine Sulfate
*-Classification: Opioid

*-Therapeutic Uses: To Relieve Severe Pain

*-Contraindications: CNS or Respiratory Depression, Ileus, Apnea

*-Side Effects: Constipation, Ileus, Anorexia, N/V, Drowsiness, Sedation, Confusion, Blurred Vison

*-Adverse Reactions: Hypotension, Respiratory/CNS depression

*-Nursing Interventions: Monitor Renal & Liver Functions; Assess for need for Stool Softener; AVOID Alcohol; Assess for CNS or Respiratory Distress; Naxolone is an Agonist to Morphine; Methodone may be used for Long Term Withdrawal; Encourage Post-Op Patients to Turn, Cough, and Deep Breath

*-Client Education: Increase Fluids, Walking, And be Aware of Bowel Functions

*-Classification: Antimigraine

*-Therapeutic Uses: To Treat Migraine and Cluster Headaches

*-Contraindications: Coronary Artery Disease, Peripheral Vascular Disease, Diabetes, Smoking, Renal or Hepatic Dysfunction, Pregnancy

*-Side Effects: Dry Mouth, Dizziness, Fainting, Numbness, Abdominal Cramping

*-Adverse Reactions: Angina, Dyrythmias, Thrombolism, CNS Symptoms, Stroke

*-Nursing Interventions: Monitor Renal and Liver; Patient may need an Antiemetic before they can tolerate Sumatriptan

*-Client Education: Possible Side Effects; Increase Fluids; Quit Smoking; Report CNS or Cardiac S/S to Dr Immediately

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