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What are first-generation NSAIDs used for?

Inflammation, mild to moderate pain, fever, and dysmenorrhea.

What are the prototype first-generation NSAIDs?

Aspirin (ASA) and ibuprofen (Advil, Motrin).

What medications are first-generation NSAIDs?

Aspirin, ibuprofen, naproxen, indomethacin, ketorolac, meloxicam, and diclofenac.

What do first-generation NSAIDs block?

COX-1 and COX-2 enzymes.

What does COX-1 normally protect?

The stomach, platelets, and kidneys.

What does COX-2 cause?

Inflammation, pain, and fever.

What stomach problems can first-generation NSAIDs cause?

Gastric irritation, heartburn, nausea, and gastric ulcers.

Why can first-generation NSAIDs increase bleeding?

Blocking COX-1 decreases platelet aggregation.

What signs can show bleeding from an NSAID?

Black stools, abdominal pain, vomiting blood, petechiae, and easy bruising.

What kidney problems can NSAIDs cause?

Decreased kidney function and decreased urine output.

What should be monitored for NSAID-related kidney problems?

I&O, BUN, and creatinine. BUN and creatinine can increase.

What cardiovascular risk increases with non-aspirin NSAIDs?

Thromboembolic events, such as heart attack or stroke.

What serious symptoms should be reported with non-aspirin NSAIDs?

Chest pain, shortness of breath, severe headache, weakness, numbness, or confusion.

What is salicylism?

Aspirin toxicity.

What is an early sign of aspirin toxicity?

Tinnitus (ringing in the ears).

What other symptoms can occur with aspirin toxicity?

Headache, dizziness, sweating, nausea, vomiting, and diarrhea.

What should a client do if tinnitus develops while taking aspirin?

Stop taking aspirin and report it.

Why should aspirin be avoided in children with viral infections?

It can cause Reye’s syndrome.

What can be used instead of aspirin for a child with a viral infection?

Acetaminophen.

How should NSAIDs, including celecoxib, be taken to reduce stomach irritation?

With food, milk, or 8 oz of water.

What should clients avoid while taking NSAIDs, including celecoxib?

Alcohol.

What increases bleeding risk when combined with aspirin?

Anticoagulants, glucocorticoids, and alcohol.

How long before surgery should aspirin usually be stopped?

About 1 week before surgery, as directed by the provider.

What happens when ibuprofen is taken with low-dose aspirin?

It can decrease aspirin’s antiplatelet effect.

What are the major Pain & Inflammation medication groups?

NSAIDs, acetaminophen, tramadol, opioids, gout drugs, and glucocorticoids.

What type of medication is celecoxib?

The prototype second-generation COX-2 inhibitor.

What does celecoxib treat?

Pain, inflammation, fever, and dysmenorrhea.

Does celecoxib cause fewer stomach effects than first-generation NSAIDs?

Yes, but GI problems and ulcers can still occur.

What common GI effects can celecoxib cause?

Gastric upset, diarrhea, heartburn, nausea, and gastric ulceration.

What should be monitored for fluid retention with celecoxib?

Weight gain, edema, and bloating.

When should celecoxib be given around magnesium or aluminum antacids?

About 2 hours before or after the antacid, if instructed.

What allergy should be checked before giving celecoxib?

Celecoxib or sulfonamide (sulfa) allergy.

Why is celecoxib especially avoided during the third trimester?

It can cause premature closure of the ductus arteriosus.

What happens when celecoxib is taken with warfarin?

The anticoagulant effect and bleeding risk can increase.

What type of medication is acetaminophen?

A nonopioid analgesic.

What does acetaminophen treat?

Mild to moderate pain and fever.

Does acetaminophen decrease inflammation or have an anticoagulant effect?

No.

What major organ can be damaged by acetaminophen overdose?

The liver.

What are early signs of acetaminophen overdose?

Abdominal discomfort, nausea, vomiting, sweating, and diarrhea.

When can liver damage occur after a toxic acetaminophen dose?

Within about 48–72 hours.

What is the antidote for acetaminophen overdose?

Acetylcysteine (NAC).

Why should clients check cold-medicine labels when taking acetaminophen?

Many cold products contain acetaminophen and can increase overdose risk.

What happens when acetaminophen is combined with alcohol?

The risk of liver injury increases.

Who should use extra caution or avoid acetaminophen according to these notes?

Clients with alcohol use disorder.

What happens when acetaminophen is taken with warfarin?

The risk of bleeding can increase.

What medication can decrease acetaminophen absorption?

Cholestyramine.

What type of medication is tramadol?

A dual-mechanism analgesic.

What type of pain does tramadol treat?

Moderate to moderately severe pain.

How does tramadol work?

It binds opioid receptors and blocks norepinephrine and serotonin reuptake.

What are common adverse effects of tramadol?

Sedation, dizziness, headache, nausea, constipation, and urinary retention.

What serious neurological adverse effect can tramadol cause?

Seizures.

Who should use extra caution with tramadol because of seizure risk?

Clients with a seizure disorder.

What should be checked before giving tramadol?

Baseline vital signs, especially respirations.

How long does tramadol take to begin its therapeutic effect?

About 1 hour.

Why should tramadol be used cautiously with antidepressants?

SSRIs, SNRIs, TCAs, and MAOIs can increase serotonin syndrome risk.

What dangerous reaction can occur when tramadol is taken with an MAOI?

A hypertensive crisis and other serious reactions.

What is the prototype opioid agonist?

Morphine.

What medications are opioid agonists?

Morphine, fentanyl, meperidine, hydromorphone, methadone, codeine, oxycodone, hydrocodone, and tapentadol.

What type of pain do opioid agonists treat?

Moderate to severe pain.

What receptor do opioid agonists mainly stimulate?

Mu opioid receptors.

What effects occur when opioid agonists stimulate mu receptors?

Analgesia, sedation, euphoria, and respiratory depression.

What is the most serious adverse effect of opioid agonists?

Respiratory depression.

What should be monitored closely during opioid therapy?

Respiratory rate, oxygen saturation, and lung sounds.

What should the nurse do if respirations are below 12/min before tramadol or an opioid?

Hold the medication, assess the client, stimulate breathing, and prepare naloxone if indicated.

What medication reverses opioid respiratory depression?

Naloxone.

What should be available when IV opioids are administered?

Naloxone and resuscitation equipment.

How quickly should IV opioids be given according to these notes?

Slowly over about 4–5 minutes.

Why do opioids cause constipation?

They decrease intestinal motility.

What helps prevent constipation from tramadol or opioids?

Fluids, fiber, activity, and exercise.

What blood-pressure problem can opioids cause?

Orthostatic hypotension.

How can dizziness and falls from tramadol or opioids be reduced?

Change positions slowly and sit or lie down if lightheaded.

What urinary problem can opioids cause?

Urinary retention.

How often should clients taking opioid agonists be encouraged to urinate?

About every 4 hours.

Why should clients taking opioids be encouraged to cough?

To prevent retained respiratory secretions and pneumonia.

Which medication forms in these notes should not be crushed or chewed?

Enteric-coated/sustained-release NSAIDs, extended-release tramadol, and sustained-release opioids.

What activities should clients avoid after taking tramadol or opioids?

Driving and activities requiring mental alertness.

How should opioids be given for terminal cancer pain?

On a fixed around-the-clock schedule rather than only PRN.

Should long-term opioids be stopped suddenly?

No. They should be gradually tapered.

What are manifestations of opioid withdrawal?

Cramps, diarrhea, agitation, anxiety, hypertension, tachycardia, tremors, muscle pain, dilated pupils, runny nose, and insomnia.

What happens when opioids are combined with benzodiazepines or alcohol?

CNS and respiratory depression increase.

What can happen when opioids are combined with antihypertensives?

The hypotensive effect increases.

What dangerous reaction can occur when meperidine is combined with an MAOI?

Hyperpyrexia syndrome.

What type of medication is naloxone?

The prototype opioid antagonist.

What does naloxone do?

Reverses opioid effects and treats opioid overdose.

How does naloxone work?

It blocks opioid receptors.

Does naloxone reverse nonopioid medications?

No. It works on opioids.

What happens to respiratory rate after naloxone reverses an opioid?

The respiratory rate increases.

What should be monitored after giving naloxone?

Respirations, heart rate/rhythm, blood pressure, oxygen saturation, and consciousness.

How often should vital signs be monitored during naloxone administration?

Every 5–15 minutes.

How often can naloxone be repeated until opioid effects are reversed?

About every 2–3 minutes, as prescribed.

How long do naloxone's effects last according to the notes?

About 60–90 minutes.

Why might multiple naloxone doses be necessary?

The opioid can last longer than naloxone, so respiratory depression can return.

What can naloxone cause in an opioid-dependent client?

Acute opioid withdrawal.

What withdrawal findings can naloxone cause?

Hypertension, vomiting, and tremors.

What serious adverse reaction can opioid antagonists cause?

Ventricular arrhythmias.

What can happen to the client's pain after naloxone?

The pain can return.

What is the prototype antihyperuricemic medication?

Allopurinol.

What medications treat hyperuricemia/gout in these notes?

Allopurinol, febuxostat, probenecid, colchicine, pegloticase, and rasburicase.

What problem causes gout?

Hyperuricemia (high uric acid).

What happens when uric acid becomes too high?

Urate crystals can collect in the joints.