Unit 3 CNS and pain

What are common examples of NSAID medications used in the treatment of mild to moderate pain?

Ibuphrophen

Aspirin

Naproxen

Ketoprofen

Ketorolac

What is the main therapeutic outcome of medications that go through the COX-2 pathway with regards to pain management? (One word)

inflammation

What are the side effects of NSAID going through the COX-1 pathway?

GI upset

Nephrotoxicity

Decreased platelet count

What organ is an NSAID potentially toxic to if the maximum daily dose or chronic habitual use occurs?

Kidneys

What is the maximum daily allowance of ibuprofen in mg for an adult client?

2400 mg

What is the primary advantage of using a selective cox-2 inhibitors, like celecoxib (celebrex) for chronic pain management?

less GI upset

What is a specific ADR that the nurse must be concerned about when a client is talking celecoxib (celebrex)?

risk for thromboembolism

Is acetaminophen an NSAID?

No

What is the maximum amount of acetaminophen daily in mg or grams for adult for an adult client?

4000 mg

What organ is acetaminophen potentially toxic to if the maximum daily dose or chronic habitual use of the medication occurs?

liver

What is antidote to an acetaminophen overdose?

acetylcysteine

What is the therapeutic goal for treating gout?

Prevent attacks from occurring or reduce the pain during an attack through preventing the formation of uric acid

What vitamin (and amount of this vitamin) is especially helpful in the treatment or prevention of gout?

Vitamin C (1000mg/day)

Colchicine

KEY INFORMATION

SIDE EFFECTS

Key point: old drug used for acute flare up of gout '

side effect: diarrhea

Allopurinol

drug of choice for gout ---> helps lower the formation of uric acid

What classification of medication does allopurinol belong to?

Xanthine oxidase inhibitors

What are the primary nursing considerations or assessments needed when caring for a client receiving narcotic or opiate pain management?

MONITOR PATIENT'S RESP. DEPTH AND RATE BEFORE AND AFTER MEDICATION ADMINISTARTION

Are there any special considerations or risks associated with the medication tramadol?

Serotonin syndrome ---> especially if patient is taking SSRI

What is the antidote to an overdose of an opiate pain medication?

Naloxone

examples of antihistamines (centrally acting histamine 1 blocker) "- amine"

Diphenhydramine (Benadryl)

Chlorpheniramine

Hydroxyzine ---> may also be used to treat anxiety

Examples of Barbiturates (-tal)

pentobarbital --> hypnotic

phenobarbital---> anticonvulsant (popular in peds)

Examples of Benzodiazepines (-am)

- Midazolam (Versed)- Amnesia effect GREAT FOR CONSCIOUS SEDATION (SHORT HALF-LIFE)

-Diazepam (Valium) -- used for statis epliticus

-Lorazepam (Ativan) --> can be used as an anti-seizure med

-Alprazolam (Xanax) ---> sleep and anxiety can be sold as a "brick" on the street

What is the antidote to an overdose of benzodiazepine medications?

flumazenil

What are two specific non-benzo medications that are prescribed for sleep? List specific side effects

eszopiclone ---> same benefits as zolpidem lower risk of nocturnal behaviors

Zolpidem (Ambien) ---> may cause sleepwalking

What are benzodiazepines used for?

- conscious sedation

-anxiety

-seizures

-alcohol withdrawal

What is the most common or primary classification of medication for the treatment of ADHD? List some medications

1. Amphetamine

2. dextroamphetamine

3. methamphetamine

ex: dextroamphetamine/amphetamine combo (Adderall)

Methylphenidate (Ritalin)

What two neurotransmitters do these ADHD medications target?

Norepinephrine and dopamine

Side effect of ADHD medication

overstimulation, weight loss, insomnia, paranoia, confusion (elderly specifically), tachycardia, stroke, MI

What medication is commonly given to help with side effect of sleep disturbance but can also be given off- label in the treatment of ADHD in some cases?

clonidine

What is a "med holiday" from stimulants?

is when parents take their children off of stimulate medications to help children gain weight

Why is it important to assess a family history of drug abuse when starting a client on stimulant ADHD medication?

Many documented cases of misuse, such as:

- drug abuse

- using it to treat withdrawal

- selling the meds

What is the name of the non-stimulant medication commonly used in the treatment of ADHD?

Atomoxetine

What is the biggest safety implication or FDA warning about atomoxetine?

suicidal thoughts

What is the medication phenytoin (Dilantin) ?

Drug of choice for any seizure EXCEPT petit mal

What are two routes that phenytoin can given?

PO or IV

When giving phenytoin intravenously, what is the maximum rate of administration?

50 mg/ min

What intravenous solution MUST be avoided with an infusion of phenytoin?

dextrose

What is the therapeutic level of phenytoin?

10-20 mcg/mL

< 10 --> not therapeutic can cause a seizure to break through

> 20 ---> toxic and can cause ataxia, encephalopathy, nystagmus

What are some common side effects of phenytoin?

gingival hyperplasia

hyperglycemia

bone marrow suppression

Reddish urine

phenytoin vs fosphenytoin

- can give fosphenytoin faster (150 mg/min vs 50 mg/min)

- fosphenytoin not as irritating to the veins

- fosphenytoin can be given IM

How is fosphenytoin dosed?

phenytoin equivalents (PE)

What are two routes fosphenytoin can be given in?

IM or IV * no oral option available

if you give fosphenytoin intravenously what is the maximum rate of administration?

150 mg/min

What is the drug of choice for status epilepticus and why?

Diazepam

because it has a long half-life so the medication can stay in the pt. system for a longer time

What are two routes that diazepam can be given?

IV or rectal

What is a potentially serious adverse drug reaction of several seizure medications?

Steven Johnson Syndrome

What are the signs and symptoms of Steven Johnson Syndrome

starts off with flu like symptoms, followed by painful rash that spreads and blisters

Give two common examples of anti-seizure medications that are used "off-label" to treat pain

1. Gabapentin ---> used for chronic neuropathic pain, muscle cramps, and migraines

2. Lamotrigine----> BLACK BOX WARNING SJS

What is the drug of choice to treat migraines

" triptans"

example: sumatriptan

used to treat acute migraine

What are some prophylactic treatments for migraine headaches?

1) Beta-blockers

2) Anti- convulsants

3) Tricyclic antidepressants

4) Estrogen therapy

How do you know if treatment for migraines are working?

- migraine frequency is reduced

- migraine pain is less severe

- pain lasts for shorter period of time

- pt. no longer experiences pain

What are some considerations when using Botox to treat migraines

- pt. has to be over the age of 18

- approved for those who have more than 15 headaches per month

What are three types of medications are helpful with treating Bell's palsy?

1. Steroids ---> drug of choice ex: prednisone

2. Analgesics ---> if pt. is in pain

3. Anti- virials---> used only early diagnosis

What neurotransmitter is deficient in Parkinson's disease?

dopamine

What neurotransmitter is in excess in Parkinson's disease?

acetylcholine

What is the drug choice in the treatment of Parkinson's disease?

levodopa/carbidopa

Why is the combination drug levodopa/carbidopa used to treat Parkinson's disease?

Each drug individually is not enough to treat the disease. Carbidopa decreases GI breakdown of levodopa this allows levodopa more time to circulate and cross into the blood brain barrier.

What vitamin interaction do you have to be concerned about when a patient is taking levodopa/carbidopa?

Vitamin B6= Increases GI and hepatic breakdown of levodopa

What medication or class of medications would be potentially beneficial for physical manifestations of Parkinson's disease, like pill-rolling, shuffling gait, or tremors?

Class: Anticholinergic

Example: Benztropine

What is the primary neurotransmitter deficiency in Alzheimer's Disease?

acetylcholine

What drug classification can increase acetylcholine in Alzheimer patients?

Cholinesterase inhibitors

ex: Donepezil

What is a second line medication used used in the treatment of Alzheimer's disease?

memantine

What is the IV rate of administration for benzodiazepines?

No faster than 2 mg/min or 0.05 mg/kg

Why do you NEVER administer salicylates (aspirin) to children or teenagers with a viral illness?

risk of Reye's syndrome

abbreviation for aspirin

ASA (acetylsalicylic acid)

signs of aspirin overdose

tinnitus and hyperventilation

ALL NSAIDs are

nephrotoxic

What is the purpose of aspirin in cardiac patient's?

reduces platelet aggregation

misoprostol

protects the GI lining of the gut and is given to pt to prevent gastric ulcers

- given to pt. who take NSAIDs long-term

You can not give what medication to pregnant people?

misoprostol ---> it can cause spontaneous abortion

What medication is given to neonates to reduce apneic spells?

xanthine (caffeine)

What are examples of commonly prescribed muscle relaxers?

cyclobenzaprine and methocarbamol

CNS DEPRESSION RISK

Which medication is the only drug that acts directly on skeletal muscles?

dantrolene

Fentanyl

strongest opioid available 100X potency of morphine

Fentanyl (transdermal)

uses:

what should you warn pt.

chronic severe pain such as cancer

warn pts not to cut patch in half and to only throw it in toilet

- Also avoid sauna because it can increase the rate of absorption

Hydromorphone (Dilaudid)

synthetic morphine (IV, tab, liquid)

Why should children not use codeine mixed with cough syrup?

because they can rapid metabolize like IV morphine

* only should be given to individual OVER 18

Rate of administration of morphine

2.5-15mg over 5 minutes

What should you NEVER do with IV morphine?

GIVE IT IV PUSH WITHOUT DILUATION

Opiate side effects

respiratory depression, depth, and rate

Signs of acute opioid toxicity

coma, pinpoint pupils, respiratory depression