Now Trending:
Home
NCLEX Test help – Pain Meds and Inflammation

NCLEX Test help – Pain Meds and Inflammation

Uncategorized No Comments

painPain and Inflammation

  • Analgesics relieve pain
  • Narcotics / NSAIDs / Antimigraine agents
  • Anti-inflammatory medications relieve inflammation
  • Salicylates / Glucocorticoids / Antigout / Disease-modifying antirheumatics drugs (DMARDs)
  • Some are antipyretic (salicylates, ibuprofen)
  • Salicylates and NSAIDs reduce platelet aggregation
  • Salicylates, NSAIDs, and glucocorticoids pose risk for ulceration
  • Acetaminophen has analgesic and antipyretic properties but not anti-inflammatory. It poses a risk for liver injury

 

NSAIDs

(Medication List)

  • Aspirin
  • Ketorolac (Toradol)
  • Celecoxib (Celebrex)
  • Valdecoxib (Bextra)
  • Ibuprofen
  • Indomethacin
  • Naproxen

 

NSAIDs

Expected Action:

Cyclooxygenase inhibition – COX 2 ’ òinflammation, COX 1 ’ ò platelet agg.

Examples: aspirin, ibuprofen, ketorolac, celecoxib

Therapeutic Uses:

Inflammation suppression / analgesia / ò fever

dysmenorrhea / suppression of platelet aggregation

Adverse Effects:

  • GI discomfort, aspirin induced ulceration and bleeding (use misoprostol as prophylaxis, and/or PPI and/or H2-receptor agonist ò risk of ulceration)
  • Renal dysfunction
  • Reye syndrome (in kids with viral illnesses)
  • Salicylism (tinnitus, resp. alkalosis, dizziness)

Contraindications/Precautions:

Peptic ulcers / bleeding disorders / hypersensitivity / pregnancy / kids ĉ viral inf.

Interactions:

  • Warfarin (ñ bleeding)
  • EtOH (ñ bleeding)
  • Glucocorticoids (ñ gastric bleeding) – use antiulcer prophylactic like
  • Ibuprofen (ò antiplatelet effects of low-dose aspirin)

Education:

  • Give with food or milk to reduce GI discomfort.
  • If can’t tolerate 1st generation, give 2nd generation (celecoxib)

 

Ketorolac (Toradol)

Expected Action:

ò pain without anti-inflammatory effect

Example: ketorolac (Toradol) – 1st generation NSAID

Therapeutic Uses:

  • Short-term treatment of moderate to severe pain (post-op)
  • Enhances opioid analgesia without opioid adverse effects

Adverse Effects:

  • Can occur when used with other NSAIDs.

GI bleeding / blood dyscrasias

Contraindications/Precautions:

Give no more than 5 days

Interactions:

Other NSAIDs / anticoagulants (ñ bleeding)

Education:

Usually started parenteral and then transition to oral dose

Acetaminophen

Expected Action:

Slows production of prostaglandins

Therapeutic Uses:

Analgesic and antipyretic

Adverse Effects:

  • Max 4 g daily
  • Acute liver toxicity
  • Antidote: acetylcysteine (Mucomyst)

Interactions: EtOH ’ ñ risk to liver / Warfarin ’ ñ levels of warfarin

 

Opioid Agonists

Therapeutic Uses:

Moderate to severe pain / Sedation / ò bowel motility / Cough suppression

Examples:

morphine, fentanyl, meperidine, methadone, codeine, oxycodone

Adverse Effects:

  • Constipation
  • Biliary colic
  • Respiratory depression
  • Orthostatic Hypotension
  • Cough suppression
  • Sedation
  • Urinary retention
  • Emesis

Contraindications/Precautions:

Increases cardiac workload

Meperidine metabolites are neurotoxic ’ (< 600 mg/24hr, < 48 hours)

Interactions:

CNS depressants (barbiturates, phenobarbital, benzodiazepines, EtOH)

Anticholinergics, antihistamines, tricyclic antidepressant ð anticholinergic effects

MAOIs (hyperpyrexia, seizures)

Antihypertensives

Education:

Withhold if RR<12

Have naloxone (Narcan) and resuscitation equipment available.

Infuse IV slowly over 4-5 minutes

Opioid Antagonists

Expected Action:   

  • Competitively interfere with opioid actions

Examples: Proto: naloxone (Narcan), naltrexone, nalmefene

Therapeutic Uses:

  • OD treatment
  • Reversal of opioid effects

Adverse Effects:    

  • Tachycardia / Tachypnea
  • Abstinence syndrome (cramping, hypertension)

Contraindications/Precautions:

  • Hypersensitivity
  • Dependency
  • Pregnancy: B

Education:  

  • Naloxone has extensive first-pass modification
  • Observe for w/d symptoms or abrupt onset of pain

 

Adjuvant Pain Medications

(Medication List)

  • Tricyclic Antidepressants — (TCA) Amitriptyline (Elavil)
  • Anticonvulsant Carbamazepine (Tegretol)
  • — Gabapentin (Neurontin)
  • —- Phenytoin (Dilantin)
  • CNS Stimulants Methylphenidate (Ritalin)
  • —- Dextroamphetamine (Dexedrine)
  • Antihistamines Hydroxyzine (Vistaril)
  • Glucocorticoids Dexamethasone (Decadron)
  • —- Prednisone (Deltasone)
  • Bisphosphonates Etidronate (Didronel)
  • — Pamidronate (Aredia)

 

Adjuvant Medications

Therapeutic Uses:

  • Enhance opioid effects thereby permitting lower opioid doses
  • Alleviate other symptoms that aggravate pain
  • Treat neuropathic pain

Examples:

TCAs, Anticonvulsants, CNS stimulants, Antihistamines, Glucocorticoids, Bisphosphonates

Adverse Effects:

TCAs (neuropathic pain) – Orthostatic hypotension, sedation, anticholinergic effects
Anticonvulsants (neuropathic pain) – Bone marrow suppression
CNS stimulants – Weight loss, insomnia
Antihistamines – Sedation
Glucocorticoids (ñ ICP, nerve compression)

  • Adrenal insufficiency
  • Hypokalemia
  • Glucose intolerance
  • Osteoporosis
  • GI Ulcers

Bisphosphonate (CA bone pain) – Flu-like symptoms, Injection site irritation

Antigout Medication

Expected Action:

  • Colchicine/Indomethacin: ò inflammation by preventing leukocyte infiltration
  • Allopurinol: Inhibits production of uric acid
  • Probenecid: Inhibits reabsorption of uric acid by renal tubules

 

Therapeutic Uses:

Colchicine/Indomethacin: Acute gout attacks

  • Allopurinol/Probenecid: Hyperuricemia

Probenecid: Prolongs effects of penicillins and cephalosporins

 

Adverse Effects:

Colchicine: GI toxicity

Probenecid: Renal injury (get 2-3L fluid/day)

Others: GI discomfort

Contraindications/Precautions:

Colchicine: Pregnancy (C/D), renal, cardiac, elderly

Interactions:

Salicylates: òη probenecid

Warfarin: ò warfarin metabolism in liver ð bleeding risk

Education:

Avoid EtOH, purines. Adequate hydration

 

Migraine Medications

(Medication List)

  • Ergot Alkaloids –> Ergotamine (Ergostat)
  • Serotonin Receptor Agonists –> Sumatriptan (Imitrex)
  • Beta-Blockers –> Propanolol, Atenolol
  • Anticonvulsants –> Divalproex (Depakote)
  • Tricyclic Antidepressants –> Amitriptyline (Elavil)
  • Calcium Channel Blockers –> Verapamil
  • Estrogens –> Alora, Climara
  • Triptans –> Almotriptan, Naratriptan, etc

 

Ergot Alkaloids

Expected Action:

Prevent inflammation and dilation of the intracranial blood vessels

Examples: Ergotamine, ergotamine + caffeine

Adverse Effects:

  • GI discomfort ’ administer metoclopramide (Reglan)
  • Ergotism (muscle pain, paresthesia) ’ stop medication
  • Physical dependence
  • Abortion

Contraindications/Precautions:

Renal or liver dysfunction / sepsis / CAD / pregnancy

Interactions:

Sumatriptan (Imitrex) ’ can lead to spastic rxn of blood vessels

 

Serotonin Receptor Antagonists

  • Expected Action:
  • Prevent inflammation and dilation of the intracranial blood vessels
  • Examples:
  • Sumatriptan (Imitrex), almotriptan (Axert)
  • Adverse Effects:
  • Chest symptoms (not dangerous, self-resolving)
  • Coronary vasospasm/angina
  • Teratogenic

Contraindications/Precautions:

  • Pregnancy, hypertension, cardiac disease, CAD
  • Interactions:
  • Triptans & Ergot Alkaloids ’ spastic reaction of blood vessels
  • MAOIs ’ Concurrent use leads to MAOI toxicity (space 2 weeks apart)

 

Beta-Blockers

  • Expected Action:…… Examples: Metoprolol, atenolol
  • Prevent inflammation and dilation of the intracranial blood vessels
  • Adverse Effects:
  • Tiredness, fatigue
  • Depression
  • Asthma exacerbation

 

Anticonvulsants

  • Expected Action:………… Example: Divalproex (Depakote)
  • Prevent inflammation and dilation of the intracranial blood vessels
  • Adverse Effects:
  • Neural tube defects

 

TCAs

  • Expected Action:……………. Example: Amitriptyline (Elavil)
  • Prevent inflammation and dilation of the intracranial blood vessels
  • Adverse Effects:……………………………………………………….
    • . Anticholinergic effects: dry mouth, constipation, urinary retention, tachycardia

 

Calcium Channel Blocker

Expected Action:     Example: Verapamil

  • Prevent inflammation and dilation of the intracranial blood vessels

Adverse Effects:  

  • Orthostatic hypotension
  • Constipation

 

Medications for Rheumatoid Arthritis (Medication List)

DMARDs

  • Cytotoxic medications methotrexate (Rheumatrex)
  • Gold salts aurothioglucose
  • Antimalarial agents hydroxychloroquine (Plaquenil)
  • Sulfasalazine Azulfidine
  • Biologic Response Modifiers etanercept (Enbrel), infliximab (Remicade)
  • Penicillamine Cuprimine, Depen

Others

  • Glucocorticoids -> prednisone
  • Immunosuppressants -> Cyclosporine
  • NSAIDs -> naproxen
  • celecoxib

Rheumatoid Arthritis Meds (Adverse Effects)

Cytotoxics: Hepatic fibrosis / Marrow suppression / GI ulceration / fetal death or abnormality

Gold salts: Toxicity, renal toxicity, blood dyscrasias, hepatitis, GI discomfort

Antimalarials: Retinal damage

Sulfasalazine: GI discomfort / hepatic dysfunction / marrow suppression

Bio Response Modifiers: Injection-site irritation

Penicillamine: Marrow suppression

Glucocorticoids: Osteoporosis (vit D, Ca2+, bisphosphonate), Adrenal suppression, GI discomfort

Related Posts

About The Author

admin

No Responses

Add a Comment