PTH 622_Week 8 (Pharmacology for Orthopedic Injuries)

What do opioid analgesics do?

Inhibit perception of pain in CNS

When is morphine usually used?

Post surgery and for cancer patients

What are most opioid analgesics compared to?

Morphine

Adverse effects to opioid analgesics?

Nausea, constipation, respiratory depression

Basics to patient controlled analgesia?

Programmed dose, set lock-out interval, maximum amount in 4 hours

How long does it take for the patient to get help if they do not have patient controlled analgesic?

A lot longer. They have to call the nurse who responds and does a screening. They have to sign out of medications and prepare the injection before the injection is finally given

How long does it take if a patient has patient controlled anaglesic?

A lot shorter. They do not need to call the nurse and can give the injection themselves

Risks to know with opioid analgesics?

Abuse potential and addiction

Antidote for opioid analgesics?

Naloxone (Narcan)

How should naloxone be administered?

Nasal spray, auto injector, intravenous

Common forms of opioid analgesics?

Hydrocodone, acetaminophen, codeine

Use of opioid analgesics?

Acute and/or post-operative pain, chronic pain

What do NSAIDs do?

Inhibit production of prostaglandins that produce fever, pain, and inflammation

Typical NSAID?

Aspirin

What does aspirin inhibit?

Platelet aggregation, COX-1 and COX-2

Other typical types of NSAIDs?

Ibuprofen and naproxen

Adverse effects of NSAIDs?

All things GI, renal dysfunction, bleeding

Use of NSAIDs?

Acute and post-operative pain, chronic pain, anti-inflammatory, analgesic, antipyretic, anti-platelet

Definition of prostaglandins?

Group of lipids with hormone-like actions; made primarily at sites of tissue damage or infection

Function of prostaglandins?

Regulating bodily processes such as blood clot formation at injury site, healing, regulate inflammation, labor induction, uterine contractions (menstruation)

What do COX enzymes do?

Produce prostaglandins

What are COX-1 enzymes?

Produce baseline levels of prostaglandins that activate platelets and protect the lining of the gastrointestinal tract

What are COX-2 enzymes?

Release prostaglandins after infection or injury

Uses of COX-2 inhibitors?

Mild to moderate pain and inflammation, headaches and migraines, high blood pressure, osteoarthritis, spondylarthritis conditions (RA, JRA, AS), pain (acute or chronic)

Typical COX-2 inhibitors?

Celecoxib and meloxicam

Adverse effects to COX-2 inhibitors?

Reduced GI and renal adverse effects compared to traditional NSAIDs, associated with a higher risk of cardiovascular events, suppresses COX-1 enzymes to some extent at higher dosages

What system is constipation?

Sympathetic reaction

What else does the patient controlled analgesic machine do that helps clinicians?

Delivers information about the patient’s pain level and behavior over time with the lock-out interval

What is platelet aggregation?

Clotting

Adverse effect of too much prostaglandins?

Pain

Opioid analgesics can also produce these effects…?

Inhibit pain perception in the CNS, cause respiratory depression, and can cause constipation

Functions of prostaglandins include…?

Regulation of inflammation, blood clot formation, pain modulation, and healing processes

True or false: opioids primarily reduce inflammation at the injury site?

False

True or false: aspirin inhibits both COX-1 and COX-2 enzymes?

True

True or false: COX-2 inhibitors have lower GI risk compared to traditional NSAIDs?

True

True or false: COX-2 inhibitors have no cardiovascular risk?

False

NSAIDs work by inhibiting…?

Prostaglandins

A post-op patient is overly sedated with slow breathing after receiving opioids. What is the best immediate action?

Administer naloxone

What are appropriate uses of NSAIDs?

Acute pain, chronic pain, anti-inflammatory, and antipyretic

Biggest opioid danger?

Respiratory depression

COX-2 inhibitor risk?

Cardiovascular events

COX-1 enzymes produce baseline prostaglandins that activate platelets and protect the lining of the…tract?

Gastrointestinal

Difference between mechanism of action of opioids versus nonopioid analgesics?

Opioids inhibit CNS pain perception; NSAIDs inhibit peripheral prostaglandin production via COX enzymes