Pharmacology Pain Management

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.

What is the action of salicylates?
Action: inhibit prostaglandins that produce the inflammatory effects needed for analgesia and antirhuematic effects. Acts on the hypothalmus by blocking pyrogens to reduce fever. Blocks the synthesis of thromboxane A2 to inhibit platelet aggregation.

What drugs are contained in the salicylates class?
Aspirin, Choline magnesium trisalicylate, Diflunisal, Salicylsalicylic acid.

What is the use of salicylates?
Analgesic, antipyretic, anti-inflammatory agent, antiplatelet.

What is the generic name of aspirin?
acetylsalicylic acid

What is the brand name for Choline magnesium trisalicylate?
Tricosal

What is the generic name for Salicylsalicylic?
salsalate

What is the side effects of salicylates?
nausea, dyspepsia, heartburn, epigastric discomfort, GI blood loss, hemorrhage, petechiae, bruising. In acute toxicity respiratory alkalosis, hyperpnea, tachypnea, confusion, pulmonary edema, seizures, tetany, metabolic acidosis, fever, coma, cardiovascular collapse.

What are the symptoms of salicylism (toxicity)?
dizziness, tinnitus, difficulty hearing, and mental confusion.

What are the contraindications of salicylates?
Patients with known sensitivity to ASA, those who are allergic to tartrazine, those who are at a risk for bleeding. People who have impaired renal function due to its nephrotoxic effects, and who are pregnant.

Whit is the black box warning on ASA?
Children and teenagers should not use aspirin due to treat chickenpox or flu like symptoms because of the risk of Reye’s syndrome.

What is Reye’s syndrome?
A potentially fatal disease characterized by encephalopathy and fatty liver accumulations. Associated with the use of aspirin and other NSAIDs in children and adolescents after viral infections.

What are the nursing implications of salicylates?
Take with food; assess for adverse affects; assess VS

What is the difference between Diflunisal and it’s prototype?
Has less of an antipyretic effect, causes less gastric irritation, and has a longer duration of action.

What is the difference between Salsalate and it’s prototype?
Has fewer GI adverse effects. Also is an antirheumatic.

What is the NSAIDs (Propionic Acid Derivatives prototype drug)?
Ibuprofen

What is the brand name of acetaminophen?
Tylenol

What is the action of acetaminophen?
Reduces fever by acting directly on the hypothalmus to increase vasodilation and sweating. Diminishes pain through an unknown mechanism.

What does NSAIDs stand for?
Nonsteroidal Anti-inflammatory Drugs

What is the use of acetaminophen?
To reduce fever and decrease minor pain.

What are the side effects of acetaminophen?
Hepatotoxicity and renal failure. Hypersensitivity reactions marked by rash and fever.

What are the contraindications of acetaminophen?
People with hypersensitivity to the drug. Caution in people with hepatic and renal impairment. Caution in pregnancy and lactation.

What are the nursing implications of acetaminophen?
To be given orally or by rectal suppository. Do not exceed 4 g for adults. Assess for adverse effects. Record patients temp every 2-4 hours. Assess for decreased pain.

What is the treatment for an acetaminophen OD?
Gastric lavage and activated charcoal within 4 hours. Use Mucomyst or Acetadote as the antidote.

What is the action of NSAIDs (propionic acid derivitives)?
Blocks prostaglandin synthesis and modulates T-cell production. Blocks Cox-1 and Cox-2. Destroys cells of inflammation.

What is the use of NSAIDs (propionic acid derivitives) ?
Used to relieve mild to moderate pain, inflammation, and is an antipyretic.

What are the side effects of NSAIDs (propionic acid derivitives) ?
dry mouth, gingival hyperplasia, dyspepsia, heartburn, nausea, epigastric pain, constipation, and GI ulceration with occult blood loss, nephrotoxicity, elevated BUN and creatinine, edema, dyspnea, bronchospasm, hemoptysis, pharyngitis, and anaphylactic reactions.

What are the contraindications of NSAIDs (propionic acid derivitives) ?
In patients with known allergies to NSAIDs and salicylates.

What are the nursing implications of NSAIDs (propionic acid derivitives)?
Administer PO. Do not exceed 3200mg . Assess for adverse effects and check for diminished pain levels. Assess temp every 2-4 hrs. Check for decreased inflammation.

What are the drugs in the Propionic Acid Derivatives class?
Ibuprofen, Flurbiprofen, Ketoprofen, Naproxen, Naproxen Sodium, and Oxaprozin.

What is the prototype drug for the NSAIDs Oxicam Derivatives?
Meloxicam (Mobic)

What are the brand names of Ibuprofen?
Motrin and Advil

What is the brand name for Flurbiprofen?
Ansaid

What is the brand name of Ketoprofen?
Oruvail

What is the brand name of Naproxen?
Naprosyn

What are the brand names of Naproxen Sodium?
Aleve, Anaprox, and Naprelan

What is the brand name of Oxaprozin?
Daypro

What is the action of oxicam derivatives?
COX-1 and COX-2 inhibitor, producing anti-inflammatory, analgesic, and antipyretic effects.

What is the use of oxicam derivatives?
Used in treatment of osteoarthritis and rheumatoid arthritis. Used in children 2 and up for relief of s/s of pauciarticular or polyarticular juvenile RA.

What are the adverse effects of oxicam derivatives?
dyspnea, hemoptysis, bronchospasm, pharyngitis, rhinitis, bleeding, platelet inhibition, decreased Hgb and Hct, bone marrow depression, edema, nausea, dyspepsia, diarrhea, vomiting, headache, dizziness, drowsiness, and insomnia.

What is the black box warning on oxicam derivative Meloxicam?
Risk for cardiovascular events and GI bleeding.

What are the contraindications of oxicam derivatives?
Patients with known ASA allergy, postoperatively in patients who have just undergone CABG.

What are the nursing implications of oxicam derivatives?
Alcohol, garlic, ginseng, and ginger increase risk of bleeding. Do not give with lithium due to risk of lithium toxicity. Administer with food and fluids. Shake oral suspension before use. Assess for pain level, adverse effects, decreased fever, reduced inflammation.

What are the drugs in the oxicam derivative class?
Meloxicam (Mobic) and Piroxicam (Feldene)

What is the prototype drug for the NSAID Acetic Acid Derivatives?
indomethacin (Indocin, Indocin SR)

What is the action of acetic acid derivatives?
Provides anti-inflammatory, analgesic, and antipyretic properties by inhibiting prostaglandin synthesis. Inhibits Cox-1 and Cox-2.

What is the use of acetic acid derivatives?
Relieve pain associated with RA, osteoarthritis, ankylosing spondylitis, bursitis, tendonitis, and gouty arthritis. Parenteral administration used to close patent ductus arteriosus in premature infants. Unlabled use in juvenile RA, premature labor, and macular edema.

Is indomethacin appropriate for use in geriatric patients?
No it is listed under the Beers Criteria

What are the adverse effects of acetic acid derivatives?
GI bleeding and bleeding ulcer, abdominal pain, distention, vomiting, transient ileus, headache, dizziness, somnolence, and insomnia. At risk for renal impairment and decreased clotting time. With IV use pulmonary hemorrhage.

What are the contraindications of acetic acid derivatives?
Known history of hypersensitivity of salicylates, past history of GI bleeding, post op CABG, infection, bleeding, thrombocytopenia, coagulation defects, necrotizing enterocolitis, and severe renal impairment.

What are the nursing implications of acetic acid derivatives?
Administer after meals or with antacids, store in light protected container, asses for adverse effects, assess for pain and inflammation improvement. Any abdominal pain complaints notify physician immediately.

What is the black box warning on acetic acid derivatives?
increased risk for adverse cardiovascular thrombotic effects such as MI and CVA.

What are the drugs in the acetic acid derivative class?
Indomethacin, Diclofenac potassium, Diclofenac sodium, Etodolac, Ketorolac (Toradol)

What is the QSEN safety alert regarding Ketorolac otherwise known as Toradol and Black Box warning?
Assessment for GI pain, rapid pulse, and diaphoresis is essential because these s/s indicate GI perforation.

What is the prototype drug in the treatment and prevention of gout?
Colchicine (Colcrys)

What is the prototype drug for the selective COX-2 inhibitor?
Celecoxib (Celebrex)

What is the action of Celecoxib?
Inhibits the Cox-2 enzyme to decrease inflammation. It does not affect the COX-1 enzyme protecting the lining of the GI tract and not inhibiting clotting factors.

What is the use of Celecoxib?
Administered for acute and long term treatment of juvenile RA, RA, osteoarthritis, ankylosing spondylitis, acute pain, dysmenorrhea, familial adenomatous polyposis. Unlabeled uses in treatment of preterm labor, prevention of colorectal cancer, and adjunctive therapy in schizophrenia.

What are the adverse effects of Celecoxib?
headache, dizziness, somnolence, insomnia, ophthalmic changes, rash, pruritus, sweating, dry mucous membranes, stomatitis, increased risk for MI and CVA. Black box warning due to cardiac and vascular risk.

What are the contraindications of Celecoxib?
Known allergy to sulfonamides, NSAIDs, and ASA. Renal impairment, perioperative pain, or patients who have just undergone CABG.

What are the nursing implications of Celecoxib?
Do not administer anticoagulants or ASA with Celecoxib, do not take lithium, alcohol, or smoke using this drug.
Administer antacid 2 hours before or after taking, assess for adverse reactions, assess for diminished pain and swelling. Keep in light protected container.

What is the action of Colchicine?
Inhibits the migration of WBCs into the body tissues containing urate crystals. The pahgocytic action of the drug decreases the inflammatory reaction of the urate crystals deposited in the tissues.

What is the use of Colchicine?
Treatment and prophylaxis of gout in adults.

What are the side effects of Colchicine?
Nausea, vomiting, abdominal pain, dyspepsia, bone marrow depression, aplastic anemia, hepatotoxicity, peripheral neuropathy, alopecia, rash, purpura, dermatoses, myopathy, muscle pain, and weakness.

What are the contraindications of Colchicine?
Known hypersensitivity, do not administer with cyclosporins or ranolazine or with CYP3A4 inhibitor in the presence of hepatic or renal impairment. Use caution in pregnancy and renal and hepatic impairment.

What are the nursing implications for Colchicine?
Be aware of adverse effects with medications due to the many medications that cause toxicity when mixed with colchicine. Do not combine with grapefruit juice and alcohol. Administer with food. Assess for adverse effects and decreases in inflammation.

What is the prototype drug for uricosuric acid medications?
Allopurinol (Zyloprim)

What is the action of Allopurinol?
Inhibits the enzyme that is responsible for the conversion of purines to uric acid.

What is the use of Allopurinol?
Used in the management and symptoms of primary and secondary gout. Also can be used in leukemia, lymphoma, and malignancies that raise uric acid levels.

What are the adverse effects of Allopurinol?
Drowsiness, headache, vertigo, bone marrow suppression, GI upset

What are the contraindications of Allopurinol?
Patients with a known hypersensitivity and a family history of idiopathic hemochromatosis.

What are the nursing implications of Allopurinol?
Several medications interact with allopurinol by increasing risk of uricoacid-associated toxicity. Anticoagulation effects are increased when combined with warfarin and asa. Administer after meals for absorption. Assess for adverse effects, decreased pain, serum uric acid levels (3.0-7.0 normal).

What are the other drugs in the uricosuric agents?
Allopurinol (Zyloprim), Febuxostat (Uloric), Probenecid, and Sulfinpyrazone (Anturane).

What is the Opioid Agonists prototype drug?
Morphine sulfate

What is the action of Morphine sulfate?
Relieves pain by binding to receptors in the brain, spinal cord, and peripheral tissues. They block or decrease the transmission of pain impulses from being transferred nerve cell to nerve cell.

What are the major types of pain receptors Morphine sulfate acts on?
mu, kappa, and delta

What is the use of Morphine sulfate?
Prevent or relieve acute or chronic pain, acute MI, biliary colic, renal colic, postoperative states, and cancer. Before and during surgery to promote sedation, during labor and delivery, GI disorders, pulmonary edema, and unproductive cough. Unlabeled uses are relief of dyspnea associated with left ventricular failure and pulmonary edema.

What are the adverse effects of Morphine sulfate?
CNS depression, drowsiness, loss of consciousness, decreased mental and physical activity, respiratory depression, nausea, vomiting, pupil constriction, sedation, constipation, and smooth muscle spasms in the bowel and biliary tract.

What are the contraindications of Morphine sulfate?
Respiratory depression, acute of chronic lung disease, live or kidney disease, prostatic hypertrophy, pregnancy, increased intracranial pressure and head injury, seizure disorders, hypersensitivity reactions, Addison’s disease, alcoholism, and toxic psychosis.

What are the nursing implications of Morphine sulfate?
Do not crush PO forms, monitor respiration closely, assess for pain every 1-2 hrs, and assess for adverse reactions.

What is the black box warning on all opioid analgesics?
Potential for respiratory depression, coma, and death. Risk of abuse and dependence.

What are the drugs in the Opioid Agonist class?
Morphine Sulfate, Codeine, Fentanyl, Hydrocodone, Hydrocodone w/ actetaminophen (lortab, vicoden), Hydrocodone w/ ibuprofen (Ibudone, Vicoprofen), Hydromorphone (Dilaudid), Meperidine (demerol), Methadone, Oxycodone, Oxymorphone, and Tramadol (ultram)

Codeine use?
analgesic and antitusive effects, weaker effects than morphine, often given with acetaminophen

Fentanyl use?
Potent opioid that is used for preanesthetic medication, post op analgesia, and chronic pain.

Hydrocodone use?
Similar to codeine, available with acetaminophen or ibuprofen.

Hydropmorphone (dilaudid)?
Same effects as morphine, but more potent.

Meperidine use?
Not ordered very often due to the neurotoxic metabolite it produces, but its effects are similar to morphine

Methadone use?
Similar to morphine but has a longer duration of action. Used for severe pain and detoxification of addicts. FDA issued an alert due to death, overdose, and cardiac dysrhythmias associated with the drug.

Oxycodone use?
derivative of codeine used to relieve moderate pain

Oxymorphone use?
derivative of morphine and has similar effects

Tramadol use?
Used to treat pain associated with fibromyalgia, back pain, osteoarthritis, and neuropathic pain. Low potential for tolerance.

What is the prototype drug for the opioid agonists/antagonists?
Pentazocine (Talwin)

What is the action of Pentazocine ?
Has a sedative effect, weakly antagonizes the analgesic effects of morphine and meperdine, incomplete reversal of cardiovascular, respiratory, and behavioral depression from morphine and meperdine.

What is the use of Pentazocine ?
Used to treat moderate of severe pain

What are the adverse effects of Pentazocine ?
confusion, respiratory depression, risk of dependence, hallucinations, increased BP, and systemic vascular resistance.

What are the contraindications of Pentazocine ?
Use caution in patients with hypothyroidism, adrenocortical insufficiency, prostate hypertrophy, inflammatory or obstructive bowel disease, acute abdominal syndromes, cholecystitis, pancreatitis, acute alcohol intoxication, and delirium tremens. Do not use during breast feeding.

What are the nursing implications of Pentazocine ?
Administer by IM and IV. Assess for pain relief and adverse effects.

What is the black box warning on Pentazocine ?
Same as morphine

What are the other drugs in the opioid agonists/antagonists class?
Pentazocine, Butorphanol, and Nalbuphine.

What is the prototype drug for opioid antagonist?
naloxone (Narcan)

What is the action of naloxone (Narcan)?
Antidote to opioid agonist. Competes with opioid receptor sites in the brain.

What is the use of naloxone (Narcan)?
Treat respiratory depression caused by overdose of opioids.

What are the adverse effects of naloxone (Narcan)?
tremors, drowsiness, sweating, decreased respirations, HTN, and nausea and vomiting.

What are the contraindications of naloxone (Narcan)?
Known hypersensitivity to the drug, presence of narcotic abuse, and pregnancy.

What are the nursing implications of naloxone (Narcan)?
Assess for reversal of opioid effects and adverse effects.

What is the other drug in the opioid antagonist class?
Naltrexone (Depade, ReVia)

How is Naltrexone used?
Use in treatment for substance abuse because it decreases the desire to use certain substances such as opioids and alcohol.

How is Naproxen and Naproxen sodium (aleve) used?
Used to treat headaches and migraines and are the prototypes in the treatment of headaches.

What is the other headache relieving drug in the class?
Ketorolac tromethamine

What is the action of Naproxen?
Cox-1 and Cox-2 inhibitor

What are the adverse effects of Naproxen?
bronchospasm, anaphylaxis, GI bleeding, nausea, dyspepsia, and GI pain.

What is the black box warning on Naproxen?
Increased risk of cardiovascular events and GI bleeding.

What are the contraindications of naproxen?
Known allergy to the drug and NSAIDs, pregnancy, and lactation. Use caution in patients with asthma, cardiovascular dysfunction, HTN, GI bleed, and peptic ulcers.

What are the nursing implications of Naproxen?
Do not administer with lithium do to lithium toxicity, assess for diminished pain and adverse effects.

What is the action of acetaminophen/aspirin/caffeine (excedrin)?
The combination causes constriction of the blood vessels and relieves migraines because they are caused by vasodilation. The caffeine increases the effects of acetaminophen and aspirin.

What is the use of acetaminophen/aspirin/caffeine (excedrin)?
Used to relieve symptoms of migraine or tension headaches.

What are the adverse effects of acetaminophen/aspirin/caffeine (excedrin)?
Acetaminophen: headache, CP, dyspnea, myocardial damage, and hepatic impairment.
ASA: dyspepsia, heartburn, epigastric discomfort, occult blood loss, hemostatic defects, hemorrhage, tachypnea, and cardiovascular collapse.
Caffeine: insomnia, restlessness, tremors, headache, lightheadedness, tachycardia, and palpitations.

What are the contraindications for acetaminophen/aspirin/caffeine (excedrin)?
Known allergies to the drug, hepatice impairment, chronic alcoholism, pregnancy, and lactation.

What are the nursing implications for acetaminophen/aspirin/caffeine (excedrin)?
Do not combine with antocoagulants, sulfonylureas, insulin, valproic acid, spironolactone, furosemide, theophylline, and clozapine due to drug on drug interactions. Monitor for therapeutic and adverse effects.

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Caring for opiode-dependant patient taking butorphanol (Stadol). Nurse should recognize that the patient is at risk for developing a syndrome that causes what symptoms? vomiting, abdominal cramps, and hypertension (The syndrome is abstinence syndrome, and may also cause fever and …

Codeine Codeine Classification: Narcotic (opiate agonist) analgesic, antitussive Dosages: Tablet-15, 30, 60 mg Oral-15 mg/5 mL Injectable- 30 & 60 mg Uses: 1) Symptomatic relief of mild to moderately severe pain 2) To suppress hyperactive or nonproductive cough Contraindications: 1) …

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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 …

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