NU 221 L2

pain and inflam response; inc some meds

analgesia definition

pain relieving

prophylactic medication/therapy def

preventative

med class of naproxen (Aleve)

NSAID

PAINAD scale use, scoring, and criteria

pain scale for advanced dementia; rated 0-2; assess breathing, neg vocalizations (ex. groaning), facial expression, body language, consolability

agranulocytosis def

abnormally low neutrophils

anti-inflam med groups

NSAIDS, Analgesics, corticosteroids

what molecules may be released to vasodilate and increase cap perm (causing inflam)?

Histamines and Bradykinins

what molecule is released when allergies are triggered?

Histamines

what molecule release causes inc cap perm, pain, and fever?

prostaglandins

what floods to site of injury’s?

fluid (blood) and WBCs

Cyclooxygenase (COX) enzyme function

mediates inflam, pain, and fever

COX-1 enzyme function

protects GI, reg. platelets (keeps from clotting)

COX-2 enzyme function

inc during inflam, produces prostaglandins

what do first gen NSAIDs inhibit?

COX-1 &2

what do sec gen NSAIDS inhibit?

COX-2

which gen NSAIDs are safer on stomach?

2nd gen

adverse effects of first gen NSAIDS

renal impairment (more likely on high doses long term, inc BP and restrics BF)

Acetylsalicylic Acid (ASA)

Aspirin- first gen NSAID; dec inflam and fever; protects against stroke

Acetylsalicylic Acid adverse effects/warnings

toxicity, tinnitus, gastric ulcers, renal impairment; avoid with children and third tri pregnancy

Reye Syndrome

in children- decreased liver function from aspirin use; sxs encephalopathy (abnormal brain function)

Aspirin drug interactions

ACE inhibitors, warfarin, heparin, and anticoagulants

OTC and Rx ibuprofen limits

OTC 1200, Rx 3200

ibuprofen risks, adverse, interactions, gen

nephrotoxicity, GI and neurotoxicity, hematologic abnormalities; Steven-Johnson’s; Lithium (inhibit platelet function), SSRIs (inc risk GI bleed) (1st gen)

celecoxib (celebrex) (inc half-life and peak)

2nd gen NSAID- not recommended long term, contains sulfur, half-life 11hrs, peak 3hr

acetaminophen adverse, interactions, and toxicity antidote

HTN, Steven-J; inhibits warfarin metabolism; fasting inc toxicity risk, antidote acetylcysteine (Mucomyst)

corticosteroids overview

steroidal hormone- reduce inflam, suppress immune; reg NA/H2O balance

glucocorticoids (short, intermediate, and long acting)

corticosteroid- short: cortisone, hydrocortisone (8-12hr); inter: prednisone, prednisolone, triamcinolone, methylprednisolone; long: betamethasone, dexamethasone (>36 hr)

glucocorticoid adverse, interactions, warnings

adrenal suppression, osteoporosis, hyperglycemia, myopathy, growth delay, psych disturbances, cataracts, cushing syn (too much cortisol); digoxin, thiazide, loop diuretics, NSAIDs, hypoglycemics, live vaccines

Rhum Arth sxs

sym worse in morning; weight loss, weakness, fever, joint swelling, thinning of skin, nodules

methotrexate use and adverse

Rheumatrex- for RhA; GI ulcer, hepatotoxicity, folate suppression, bone marrow suppression (not for those with osteoporosis or blood related issues)

sulfasalazine use and adverse

Azulfidine- RhA; GI issues, folate deficiency, crystalluria, photosensitivity, skin and urine discoloration, agranulocytosis

Tumor Necrosis Factor Inhibitors drugs, warnings, adverse

etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira); black box for TB and Hep B; adverse: heart failure, lymphoma, hematologic disorders, liver failure

what causes gout? norm treatment med order?

hyperuricemia (uric acid in blood, joint inflam); 1. NSAIDS 2. Glucocorticoids 3. Colchicine

Colchicine

Colcrys, Mitigare, Lodoco- for gout; narrow therapeutic window; commonly causes GI toxicity

Colchicine adverse and interactions

adverse: Rhabdomyolysis; CCB, digoxin, antifungals, antivirals, grapefruit juice

allopurinol

zyloprim- first line for gout; initial dose may inc gout

allopurinol adverse interactions

bone marrow suppression, hepatotoxicity, cataracts, hypersensitivity syn (fatal), renal failure, kidney dysfunction; hepatic enzyme metabolizers, theophylline, ampicillin

what type of foods inc risk of migraines?

foods containing tyramine (ex. aged cheese, cured meat, fermented or pickled food)

patho of migraines

inflam and dilation of intracranial BV’s

best drug classes to treat migraines

triptans or ergot alkaloids (serotonin IB/ID receptor antagonists), or CGRP antagonists

sumatriptan

Imitrex- triptan, treats migraines, first-line

dihydroergotamine

Migergot- ergot alkaloid, for migraines

ergotamine

Mirgot, cafergot (with caffeine)- ergot alkaloid, treats migraines

Calcitonin Gene-Related Peptide (CGRP) Antagonists (names and use)

Rimgegepant (Nurtec ODT), Ubrogepant (UBrelvy)- for migraines

triptans adverse and warnings

coronary bronchospasm; 40% pple experience rebound headache; NOT for pple/w CAD, angina, or uncontrolled HTN

ergotamine adverse, warnings, and interactions

acute/chronic overdose; can build dependence; macrolide abx, protease inhib

codeine

pain reliever

papaverine

muscle relaxant

sign of overdose in eyes

pinpoint pupils

miosis

pupillary constriction to toxic dosage

senna

senokot- stimulant laxative

bisacodyl

dulcolax- stim laxative

polyethylene glycol

MiraLAX- osmotic

Fentanyl brand names and interactions

Sublimaze, Duragesic- ritonavir (protease inhibitor), ketoconazole (antifungal)

hydromorphone dosing frequency, and use

dilaudid- IV q 2-3 hrs, for severe pain, less likely to trigger allergic reaction

hydrocodone and acetaminophen brand names and risk

Norco, Vicodin, Lortab- hepatotoxicity

hydrocodone and ibuprofen brand names and risk

Vicoprofen, Reprexain- GI bleed, kidney inj

hydrocodone use

moderate pain and cough suppression

oxycodone

Roxicodone IR, Oxycontin ER- risk high abuse and dependency

Tramadol facts and adverse

ultram- synthetic opioid, works better with tylenol or motrin, may cause seizures, naloxone only partially stops its effects