NUR 331 (Pharmacology) - Exam 3 Blueprint (NAU - Nursing)

What drug class is Acetylsalicylic Acid (Aspirin)?

NSAID: Salicylate

What is the generic name of Aspirin

Acetylsalicylic acid (Aspirin)

What are the common uses of Acetylsalicylic Acid (Aspirin)

Reduced inflammation, reduces platelet aggregation; a preventative treatment for clot reduction in cardiovascular disease

What are the common side effects of Acetylsalicylic Acid (Aspirin)?

Nausea and dyspepsia

What are the adverse reactions to Acetylsalicylic Acid (Aspirin)?

Tinnitus, hyperuricemia, GI bleeding and ulceration, and intracranial bleeding

What is the major contraindication of Acetylsalicylic Acid (Aspirin)?

Salicylate hypersensitivity

What are some cautions that are given with Acetylsalicylic Acid (Aspirin)?

It is metabolized in the liver and excreted by the kidneys. Cautions are renal disease, liver disease, alcoholism, trauma, and monitoring patients with asthma/respiratory diagnoses

What is the drug class of Ketorolac tromethamine (Toradol)?

NSAID: Phenylaceric acid

What is the generic name of Toradol

Ketorolac tromethamine

What is Ketorolac tromethamine (Toradol) used for?

Highly useful for short-term pain relief, minimal anti-inflammatory effects, commonly used as non-opioid pain relief

in multi-modal analgesia protocols and may

only be used for a maximum of 5 days, and should not be used for pain relief in patients with poor creatinine clearance or renal disease

What are the contraindications of Ketorolac tromethamine (Toradol)?

salicylate hypersensitivity, severe renal disease, concomitant use with epidural analgesia

What are the cautions of Ketorolac tromethamine (Toradol)?

renal impairment, liver impairment, alcoholism, trauma, monitor patients with asthma/respiratory diagnoses

How does Ketorolac tromethamine (Toradol) work?

Metabolized in the liver, excreted by the kidneys.

What are some drug-drug concerns with Ketorolac tromethamine (Toradol)?

Due to it being highly protein-bound, it interacts with Potassium-sparing diuretics (hyperkalemia); Methotrexate, lithium, cyclosporine, probenecid, cidofovir (toxicity); Increased bleeding risk when paired with other medications that also increase bleeding risk (examples: clopidogrel, anticoagulants

What are the major side effects of Ketorolac tromethamine (Toradol)?

nausea and dyspepsia

What are the adverse reactions to Ketorolac tromethamine (Toradol)?

Tinnitus, GI bleeding and ulceration, hepatotoxicity, and nephrotoxicity

What is the drug class of Ibuprofen (Advil)?

NSAID - Propionic Acid

What are the uses of Ibuprofen (Advil)?

OTC medication, fever, mild to moderate pain, arthritis

What are some drug-drug cautions with Ibuprofen (Advil)?

Note: Highly protein-bound; Methotrexate, lithium, cyclosporine, oral anticoagulants; increased bleeding risk when paired with other medications that also increase bleeding risk (examples: clopidogrel,

anticoagulants)

What are some contraindications of Ibuprofen (Advil)?

Salicylate hypersensitivity, Severe renal disease, Concomitant use with

epidural analgesia

What are some cautions with Ibuprofen (Advil)?

renal impairment, liver impairment, alcoholism, trauma, monitor patients with asthma/respiratory diagnosis; Ibuprofen may cause sodium and water retention and edema. Make sure the patient does not have underlying cardiovascular disease.

What are the major side effects of Ibuprofen (Advil)?

Nausea, dyspepsia, and edema

What are the adverse reactions of Ibuprofen (Advil)?

Tinnitus, GI bleeding and ulceration, hepatotoxicity, nephrotoxicity

What are some key points and nursing considerations with Aspitin?

• Enteric-coated ASA may reduce GI distress. Enteric-coated drug formulations should not be crushed or broken.

• Educate patients to take ASA with food.

• Educate parents not to administer ASA to children for viral of flu-like symptoms.

• ASA may need to be discontinued prior to surgical procedures. Some

procedures require discontinuation 7 days prior to surgery.

• ASA is highly protein-bound.

• Do not use ASA in patients with hypersensitivity/allergies to NSAIDS or actively GI bleeding.

Key Points & Nursing Considerations:

Non-Selective COX-1 and COX-2 Inhibitors

(Ibuprofen and Toradol)

• Highly protein-bound

• Increased risk of bleeding, especially when combined with other drugs that

increase bleeding time

• Increased risk of hepatic or renal toxicity with long-term use

• Not recommended for pain relief after CABG surgery or in patients with

cardiovascular disease—increased risk of thrombosis

• Monitor

• May cause GI discomfort and increase risk of gastric and duodenal

ulceration and bleeding

• Should be taken with food

• Many are useful as adjunct pain relief along with opioids for multimodal

analgesia

What drug class is Celecoxib (Celebrex)?

NSAID - COX-2 Inhibitor

What are the uses of Celecoxib (Celebrex)?

Reduces the risk of GI ulceration and bleeding, and is the drug of choice for patients with severe arthritis who need large doses of anti-inflammatory

drugs

What are the drug-drug cautions with Celecoxib (Celebrex)?

Decreased effectiveness of ACE-I, increased bleeding risk when paired with warfarin and SNRIs, increased toxicity with lithium, and fluoroquinolones may increase the risk of seizures

What are the contraindications of Celecoxib (Celebrex)?

Severe liver disease and renal disease

What are some cautions of Celecoxib (Celebrex)?

Renal impairment, liver impairment, alcoholism, heart failure

Where is Celecoxib (Celebrex) absorbed and excreted?

Metabolized in the liver, fecal excretion

What are the side effects of Celecoxib (Celebrex)?

Nausea and dyspepsia

What are the adverse reactions of Celecoxib (Celebrex)?

Tinnitus, hypertension, GI bleeding and ulceration, hepatotoxicity, and nephrotoxicity

What drugs are immunosuppressants and anti-gout medications?

Methotrexate (Otrexup) and Allopurinol (Zyloprim, Lopurin)

What drug class is Methotrexate (Otrexup)?

Immunosuppressive

What is the use of Methotrexate (Otrexup)?

Also known as a Disease-Modifying Anti-rheumatic Drug

(DMARD), may be used as first-line therapy for rheumatoid arthritis (RA), psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA), used for conditions that involve rapid cellular proliferation (e.g., cancer, ectopic pregnancy termination).

What are the cautions of Methotrexate (Otrexup)?

Renal impairment—do not use if the patient has kidney failure, liver impairment, or alcoholism; do not use in patients with AIDS, alcoholism, or severe hepatic disease.

What is required for the use of Methotrexate (Otrexup)?

Regular blood monitoring

What are some contraindications of Methotrexate (Otrexup)?

Severe liver disease and renal disease

What are the side effects of Methotrexate (Otrexup)?

GI upset and fatigue are common with the dosage used for RA

What are the adverse reactions of Methotrexate (Otrexup)?

May cause leukopenia and thrombocytopenia increasing risk of infection and aplastic anemia

What are some nursing considerations for Methotrexate (Otrexup)?

• Encourage fluid intake

• Monitor for abdominal pain, diarrhea.

• Assess patient for pain and range of motion during therapy.

• Monitor for bone marrow suppression, assess for bleeding gums, bruising, and urine.

• Monitor for symptoms of pulmonary effects, which may manifest early as a dry cough.

What is gout?

Deposition of urate crystals in joint and non-joint spaces

What is the most important risk factor for gout?

High serum urate level

What are some triggers for gout?

meals high in purine (meat, some shellfish), alcohol, joint trauma, and acute illness

What drug class is Allopurinol (Zyloprim, Lopurin)?

Uric acid biosynthesis inhibitor (anti-gout)

What is the use of Allopurinol (Zyloprim, Lopurin)?

Drug of choice for patients

Chronic gout, also used for patients with renal impairment who have gout to prevent kidney stones, may be used with NSAIDS during an acute gout attack.

What are some drug-lab cautions with Allopurinol (Zyloprim, Lopurin)?

Uric acid levels, Renal function tests, and Liver function tests

What are some contraindications of Allopurinol (Zyloprim, Lopurin)?

Rare: severe liver or renal disease

What are some cautions of Allopurinol (Zyloprim, Lopurin)?

Renal disease—do not use if the patient has severe renal failure, as it increases the risk of reactions, liver impairment, and alcoholism

How is Allopurinol (Zyloprim, Lopurin) absorbed and excreted?

Metabolized in the liver to an active metabolite; Excreted via the kidneys

What are the side effects of Allopurinol (Zyloprim, Lopurin)?

Nausea, vomiting, and diarrhea

What are the adverse effects of Allopurinol (Zyloprim, Lopurin)?

Anorexia, Rash/pruritis, Visual changes (annual eye exam

needed)

What are some nursing considerations of Allopurinol (Zyloprim, Lopurin)?

• Diet is very important when

a person has gout. Counsel

patient about avoiding

purine-rich foods.

• Increase water intake; fluid

increases uric acid and drug

excretion.

• Avoid large doses of Vitamin

C due to possible kidney

stone formation while on

allopurinol.

Key characteristics/signs of information?

Redness, heat, pain, swelling (edema), & loss of Function

How can nurses determine if someone is in pain?

Using a combination of self-report (the gold standard), behavioral observation, and physiological indicators. Key methods include using validated pain scales (0-10, Wong-Baker FACES), assessing pain characteristics using mnemonics like PQRST (Provocation, Quality, Region, Severity, Timing), and monitoring non-verbal cues such as guarding, grimacing, or moaning.

What drug class is Acetaminophen (Tylenol)?

Analgesic

What is the use of Acetaminophen (Tylenol)?

Mild pain, fever reducer, added to many pain and cold medications, adjuvant used with opioids to reduce dose and increase efficacy

What are the interactions of Acetaminophen (Tylenol)?

Note: Max adult dose is 4g in 24 hour period (some hospitals use 3g for the elderly), increased efficacy with caffeine, monitor liver function tests

What are the contraindications of Acetaminophen (Tylenol)?

Severe liver disease and renal disease

What are the cautions of Acetaminophen (Tylenol)?

Renal impairment, liver impairment, alcoholism, older adults (24-hour max dosage reduced)

What are the adverse reactions to Acetaminophen (Tylenol)?

Hearing loss and reduced urine output

What drus ig used for overdoses?

NAC - N-Acetyl Cysteine

Besides overdoses, what else is NAC - N-Acetyl Cysteine used for?

A supplement to protect the liver by creating antioxidants to

protect and repair cells from damage.

What drug class is Morphine (MS Contin)?

Opioid analgesic

What are some drug-drug interactions with Morphine(MS Contin)?

Avoid use with MAOIs, additive effects with other CNS depressants (opioids, sedatives, hypnotics, benzodiazepines, alcohol)

What is the antidote for morphine (MS Contin)?

Naloxone

What are some contraindications of Morphine?

Opioid hypersensitivity and do not abruptly discontinue id additin or dependence is noted

What are some cautions while taking Morphine?

Renal impairment, liver impairment, alcoholism, older adults, urinary retention

What are the side effects of Morphine (MS Contin)?

Sedation, confusion, and constipation

What are some adverse reactions of Morphine (MS Contin)?

Hypotension, respiratory depression, and increased intracranial pressure

What drug class is Meperidine (Demerol)

Opioid Analgesic - Synthetic

What are the common uses of Meperidine (Demerol)?

Reduces shivering threshold and is commonly administered post-anesthesia to

prevent or stop postoperative rigors and used during ERCP procedures to prevent

sphincter of Oddi spasm.

What are the drug-drug cautions with Meperidine (Demerol)?

Avoid use with MAOIs, serotonin syndrome risk when administered with SSRIs, SNRIs, and additive effects with other CNS depressants (opioids, sedatives, hypnotics, benzodiazepines, alcohol)

What are the contraindications of Meperidine (Demerol)?

Opioid hypersensitivity; do not abruptly discontinue if addiction or dependence is noted

What are the cautions of Meperidine (Demerol)?

Renal impairment, liver impairment, alcoholism, older adults, urinary retention, should not be prescribed for more than 72 hours.

What are the side effects of Meperidine (Demerol)?

Sedation, confusion, and constipation

What are the adverse reactions to Meperidine (Demerol)?

Hypotension, respiratory depression, and increased intracranial pressure

What is the drug class of Hydromorphone (Dilaudid)?

Semi-synthetic Opioid Analgesic

What is Hydromorphone (Dilaudid) used for?

Treat moderate to severe pain and suppression of cough

What are some drug-drug cautions with Hydromorphone (Dilaudid)?

Increased risk of overdose due to potency, avoid use of MAOIs (can increase serotonin concentrations, and additive effects with other CNS depressants (opioids, sedatives, hypnotics, benzodiazepines, alcohol)

What are some contraindications of Hydromorphone (Dilaudid)?

Opioid hypersensitivity: do not abruptly discontinue if addiction or dependence is noted.

What are some cautions of Hydromorphone (Dilaudid)?

Reduce does in renal or hepatic impairment, renal impairment, liver impairment, alcoholism, older adults, and urinary retention

What are the side effects of Hydromorphone (Dilaudid)?

constipation, sedation, and confusion

What are the adverse reactions of Hydromorphone (Dilaudid)?

Hypotension, respiratory depression, and delirium (especially in elderly patients)

What are the nursing considerations and key points with opioid analgesics?

• Stimulate the Mu receptor

• MAR and when administered. Avoid cumulative effects of opioids. For example, might have both of these orders: PO IR 3-5 hours; PO ER 8-24 hours.

• Overdose may result in respiratory depression, hypotension, and cardiovascular

collapse.

• Caution should be used in opioid naïve patients, starting with the smallest dose first when using range dosing.

• Naloxone is the antidote to opioid analgesics.

What symptoms are produced by the stimulation of the Mu receptor?

• Respiratory depression: Assess respiratory, BP, and pulse regularly.

• Euphoria

• Sedation

• Decreased GI motility: a laxative may need to be prescribed.

• Physical dependence: Assess pt. for pain management.

• Miosis (excessive constriction of the pupil)

What class of drug is Suboxone (Buprenorphine hydrochloride/Naloxone hydrochloride)?

Synthetic opioid agonist-antagonist

What are the uses of Suboxone (Buprenorphine hydrochloride/Naloxone hydrochloride)?

Relieves moderate to severe pain and decreases substance use disorder

Buprenorphine binds very tightly to ____ receptors to prevent ________ cravings and ______ symptoms.

Mu, opioid, withdrawal

By combinring _______ with _______, opoid cravings and withdrawl are ______ while blocking an opioid euphoria from other medications.

Buprenorphine, Naloxone, prevented

What are some drug-drug cautions with Suboxone?

• Note: Not responsive to Naloxone antidote due to tight binding of Buprenorphine

• Can depress respiration, but severe respiratory depression has not been observed; increased when

combined with other CNS Depressants

• MAOIs, SSRIs

What are some contraindications of Suboxone?

Naloxone component can induce opioid withdrawal, hypersensitivity, lieu's

What are some cautions with Suboxone?

Reduce dose in renal or hepatic impairment, renal impairment, liver impatient, alcoholism, psychosis, adrenal insufficiency; patients becomes addicted to Buprenorphine, but withdrawal symptoms are delayed -2 weeks after final dose and prevented with subsequent dosing

What are some side effects of Suboxone?

Drowsiness, dry mouth, and constipation

What are some adverse reactions to Suboxone?

Respiratory depression, opioid withdrawl if given with opioids already in system, tinnitus

Naloxone is...

A life saving drug that can reverse and opioid overdose

What class of drug is Naloxone (Narcan)?

Opioid antidote (antagonist)

What is the use of Naloxone (Narcan)?

Reverses CNS depression and respiratory depression because of suspected opioid overdose.

What is the emergency dosing of Naloxone (Narcan)?

0.4 mg IM or IV push. May repeat every 2 to 3 minutes for maximum dose of 2 mg.