pharmacology for pain

Are non opioid medications addicting?
Non opioid meds are non addicting

Which drug does NOT have anti inflammatory effects?
Acetaminophen (tylenol)

Which non NSAID medication is safe in children and elderly?
Acetaminophen (tylenol)

What is the MAJOR adverse effect of Acetaminophen (tylenol)?
liver toxicity

What is the maximum dose of tylenol?
4g/day

what is the #1 cause of liver failure in the US?
Acetaminophen (tylenol)

what is the antidote for a Acetaminophen (tylenol) overdose?
Acetylcysteine (Mucomyst) & must take within 8 hours for it to work

What s/s are associated with a drug overdose?
abdominal pain, n/v

How do NSAIDS work?
prevent COX enzymes from releasing prostaglandins that cause pain, fever, and inflammation

What does the COX-1 enzyme effect?
Kidneys-vasodilation
platlet-aggregation
stomach-protect mucosa

what does the COX-2 enzyme effect?
Site of injury-inflammation
Brain-pain sensation, fever

What NSAID blocks COX-1 and COX-2
Ibuprofen (Motrin, Advil)

* What are the side effects from NSAIDS?
Gastric irritation (ex. ulcers)
Decreased kidney function
Bleeding (decreased platelet aggregation which can be positive or negative

What drugs are part of the NSAID group?
Ibuprofen (Motrin, Alive)
Aspirin (ASA)
Celecoxib (Celebrex)

It is important to know the patient’s ______________ status because Ibuprofen is hard on this organ?
Kidneys

It is important to watch for this when taking Ibuprofen?
GI irritation and bleeding, hemoptysis (bloody sputum)

What is the maximum dose of Ibuprofen?
3200mg/24h

Ibuprofen should be taken with what to decrease GI bleeding and upset?
Food

COX-2 enzyme inhibitor selectively blocks what?
Site of injury-inflammation
Brain-sensation of pain, fever

COX-2 inhibitors have less what?
less GI irritation
less platelet effects

What drug is a COX-2 inhibitor?
Celecoxib (Celebrex)

What patient would be given Celecoxib (Celebrex)?
A patient at risk for GI toxicity and at low cardiovascular risk who requires NSAID therapy

What characteristic makes Aspirin (ASA) unique?
anti platelet

Must administer Aspirin (ASA) with food to decrease the chances of what?
GI upset, heartburn, bleeding, tinnitus (ringing in ears)

NSAIDS and ASA can cause what?
heartburn

why should children should NEVER take aspirin?
Reyes syndrome

what is Reye syndrome?
serious pathological condition associated with swelling of liver and brain

What was the 1st opioid?
heroin

Fentanyl and oxycodone are in what drug class?
opioids

What are the common side effects of opioids?
RESPIRATORY DEPRESSION
Constipation
N/V
Urticaria/Pruritus (Hives/Itching)
Sedation

What is the prototype for opioids?
Morphine

What are the side effects of Morphine?
Miosis (pin point pupils)
Orthostatic hypotension
Respiratory depression
Physical dependency
Histamine release
Increased ICP
Nausea
Euphoria (feeling unstoppable)
Sedation

What does morphine relieve pain from?
Heart attack, pulmonary edema, and left ventricular failure

What is the antidote for morphine and will usually be prescribed along with it?
Naloxone (Narcan)

When should Narcan be administered?
When RR < 8bpm

When should you be monitoring respirations?
<12bpm

How should Narcan be administered?
Slowly (unless an emergency)

What is an opioid antagonist?
Narcan

What are some nursing considerations when administering Morphine?
Know baseline respiratory rate
assess pupil size
constipation
risk for falls in the elderly

What are adjuvant pain medications?
Drugs that are used primarily for treating conditions other than pain, but may have analgesic effects

Anticonvulsants, antidepressants, and corticosteroids are all under what class?
Adjuvant Medications

What causes gout?
build of uric acid because it can’t excrete or are overproducing, arthritis like symptoms

What is the adjuvant medication taken for gout?
Allopurinol (Zyloprim)

What is the adjuvant medication taken for migraines and cluster headaches?
Sumatriptan (Imitrex)

What is the drug of choice in pediatric patients?
Acetaminophen (Tylenol)

What two drugs can be alternated between for fever and pain in a pediatric patient?
Acetaminophen (Tylenol) and Ibuprofen (Motrin, Advil)

What is the drug of choice in geriatric patients?
Acetaminophen (Tylenol), unless contraindicated such as liver disease/failure

Are narcotics more likely to cause side effects in the older adult?
true

The older adult may be afraid of addiction?
true

What is the list of potentially inappropriate medication use in older adults called?
Beers Critera

What is Celecoxib (Celebrex) used for?
rheumatoid arthritis, osteoarthritis

What is a common ingredient in OTC cold medicine?
Acetaminophen (Tylenol)

What drug shouldn’t you give if allergy to sulfonamides, NSAIDs, or ASA, don’t give in renal disease?
Celecoxib (Celebrex)

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Older adult patient about take prednisone for long-term treatment of rheumatoid arthritis. Monitor for what adverse effects? Bone loss prednisone (glucocorticoid) can cause osteoporosis esp with long-term use increase weight-bearing activity and report back pain. HCP must monitor bone density …

A health care professional should understand that naloxone can reverse the effects of an excessive dose of which of the following drugs? A) Aspirin B) Acetaminophen (Tylenol) C) Morphine D) Prednisone ANS: C Rationale: Naloxone, an opioid antagonist, reverses the …

A health care professional is caring for a patient who is opioid-dependent and is about to begin taking butorphanol (stadol). The health care professional should recognize the patient is at risk for developing a sundrome that causes which of the …

Pain Pain threshold does vary greatly in individuals. HOWEVER, this variation is because of widely different reactions to pain AND NOT because of different perceptions to pain Factors that DECREASE threshold and give a ____________________to pain. GREATER REACTION EG: Fear …

What is the prototype for the drug class salicylates? Aspirin (ASA) How do salicylates work? They relieve pain by acting both centrally and peripherally to block the transmission of pain impulses. They also are an antipyretic and reduce inflammation. WE …

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