Pain and Inflammation simpler

What are first-generation NSAIDs used for and what are the prototypes?

Inflammation, mild to moderate pain, fever, and dysmenorrhea. Prototypes: aspirin and ibuprofen.

What other first-generation NSAIDs are listed?

Naproxen, indomethacin, ketorolac, meloxicam, and diclofenac.

What do COX-1 and COX-2 do, and how do first-generation NSAIDs work?

COX-1 protects the stomach, platelets, and kidneys. COX-2 causes pain, fever, and inflammation. First-generation NSAIDs inhibit both.

What stomach problems and signs of bleeding can NSAIDs cause?

NSAIDs can cause stomach upset and ulcers. Report black stools, bloody or coffee-ground vomit, stomach pain, or unusual bleeding.

What other bleeding findings should be monitored with NSAIDs?

Petechiae, easy bruising, and excessive bleeding.

How can NSAIDs affect the kidneys and what should be monitored?

They can cause renal dysfunction. so monitor urine output, intake and output (I&O), BUN, creatinine, swelling, and weight gain.

What serious cardiovascular risk can non-aspirin NSAIDs increase?

Heart attack and stroke.

What is salicylism and what should be done if tinnitus occurs?

Salicylism is aspirin toxicity. Tinnitus or decreased hearing is an early sign; stop aspirin and report it.

Why is aspirin avoided in children with viral infections?

Risk for Reye's syndrome.

What important teaching should you know when taking NSAIDs?

Take NSAIDs with food, milk, or water to reduce stomach irritation. Do not crush enteric-coated or sustained-release forms, avoid alcohol, and know that anticoagulants and glucocorticoids can increase bleeding risk.

What is celecoxib used for and what enzyme does it mainly inhibit?

Pain, inflammation, fever, and dysmenorrhea; it mainly inhibits COX-2.

What GI and kidney problems can celecoxib cause?

GI upset, ulcers, and renal dysfunction. Monitor urine output, BUN, creatinine, and fluid retention.

What celecoxib symptoms need immediate attention?

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

What important celecoxib interactions and precautions are listed?

Check for a sulfa allergy because celecoxib may cause an allergic reaction. Take magnesium/aluminum (Mg/Al) antacids at least 2 hours before or 2 hours after celecoxib. Warfarin, glucocorticoids, and alcohol can increase the risk of bleeding.

What is acetaminophen used for and what does it NOT do?

Mild to moderate pain and fever. It does not reduce inflammation or cause anticoagulation (does not prevent blood clots).

What are signs and timing of acetaminophen toxicity?

Abdominal discomfort, nausea, vomiting, sweating, and diarrhea; liver injury may appear 48–72 hours later.

What antidote and maximum dose are listed for acetaminophen?

Antidote: acetylcysteine (NAC). The notes list 4,000 mg/day for patients older than 12.

What acetaminophen teaching involves alcohol, warfarin, and cold medicines?

Alcohol increases liver risk; warfarin may increase bleeding; check cold and flu products because they may also contain acetaminophen.

What is tramadol used for and how does it work?

Moderate to moderately severe pain; it acts on opioid receptors and blocks norepinephrine and serotonin reuptake.

What common adverse effects can tramadol cause?

Sedation, dizziness, headache, nausea, and constipation.

What serious effects can tramadol cause and what if respirations are below 12/min?

Seizures and respiratory depression. Stimulate breathing and prepare naloxone.

What teaching is important with tramadol?

Food may reduce nausea; swallow extended-release tablets whole; avoid driving, rise slowly, and watch for serotonin syndrome.

What opioid agonists are listed and what do they treat?

Morphine, fentanyl, meperidine, hydromorphone, methadone, codeine, oxycodone, hydrocodone, and tapentadol; used for moderate to severe pain.

What major effects do opioid agonists cause?

Analgesia, sedation, euphoria, and respiratory depression.

(Opioids can relieve pain, cause sleepiness or a “high” feeling, and slow breathing.)

What should be monitored with opioids and what if respirations are below 12/min?

Monitor vital signs, breathing rate (RR), oxygen level, sedation, and pain relief. If breathing becomes too slow, hold the opioid, stimulate the patient to breathe, and prepare naloxone if needed.

What common side effects of opioids need nursing care?

Opioids can cause constipation, orthostatic hypotension (dizziness from low blood pressure when standing), and urinary retention (trouble emptying the bladder).

Why should postoperative clients taking opioids cough regularly?

Opioids suppress coughing and can cause retained respiratory secretions.

How are sustained-release and IV opioids given in these notes?

Swallow sustained-release forms whole. Dilute IV opioids as recommended and give slowly over 4–5 minutes.

What should be available with IV opioids and what increases CNS depression?

Keep naloxone and resuscitation equipment nearby. Alcohol, benzodiazepines, barbiturates, and other CNS depressants can cause more sedation and slower breathing.

What is naloxone used for and how does it work?

It reverses opioid effects or overdose by blocking the effects of opioids receptors.

What problems can naloxone cause in opioid-dependent clients?

Acute withdrawal: hypertension, vomiting, tremors, tachycardia, and sweating; ventricular dysrhythmias (abnormal heart rhythms) may also occur.

What monitoring is needed after naloxone?

Monitor breathing, heart rate, blood pressure, oxygen level, and alertness. Naloxone may wear off before the opioid, so slow breathing can return. Naloxone may be given again every 2–3 minutes if the patient is still not breathing well.

What is hyperuricemia and why does gout hurt?

Hyperuricemia is high blood uric acid; urate crystals deposit in joints and cause pain and inflammation.

What medications are used to lower uric acid (antihyperuricemics)?

Allopurinol, febuxostat, and probenecid.

How do allopurinol/febuxostat and probenecid lower uric acid?

Allopurinol and febuxostat lower uric acid production, while probenecid helps the kidneys remove uric acid.

Why is allopurinol given during chemotherapy?

It helps prevent or treat high uric acid levels (hyperuricemia) caused by rapid tumor cell breakdown.

What serious allopurinol reaction and labs should be monitored?

Fever and rash: stop the medication and notify the provider. Monitor uric acid, CBC, liver function, and kidney function.

What teaching is important with allopurinol?

Drink about 3 L/day if allowed, take with food if nauseated, and report bruising or sore throat.

What glucocorticoids are listed and what are they used for?

Prednisone is the prototype; others include prednisolone, hydrocortisone, methylprednisolone, and dexamethasone. Used to reduce inflammation and treat autoimmune, skin, and allergic conditions/ disorders.

What natural hormone do glucocorticoids act like, and what do they do?

They mimic cortisol, helping reduce inflammation and suppress the immune system.

Why should glucocorticoids be slowly decreased instead of stopped suddenly?

They suppress the adrenal glands' own cortisol production; sudden stopping can cause adrenal insufficiency.

What blood-glucose problem can glucocorticoids cause?

Hyperglycemia (high blood sugar) can cause polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased hunger).

What muscle problem can glucocorticoids cause?

Muscle weakness or myopathy (muscle damage or disease).

What GI problems can glucocorticoids cause and how should oral doses be taken?

Stomach irritation, ulcers, and GI bleeding, so take oral doses with food.

Why do glucocorticoids increase infection risk, and what symptoms should be reported?

They weaken the immune system, so infections may happen without a high fever. Report sore throat, fatigue, rapid heart rate, or abnormal wound drainage.

What fluid and electrolyte problems can glucocorticoids cause?

Cause sodium and water retention and low potassium (hypokalemia), so monitor for swelling, weight gain, and crackles in the lungs.

What long-term body changes can glucocorticoids cause?

can cause a round face (moon face), weight gain around the abdomen, a fat pad on the upper back (buffalo hump), weak bones (osteoporosis), and cataracts.

How can glucocorticoid-related bone loss be reduced?

Weight-bearing exercise plus adequate calcium and vitamin D.

What important safety precautions should you know with glucocorticoids?

Contact the provider during major illness or severe stress, and do not use them with a systemic fungal infection (a fungal infection throughout the body).

What medications can increase the side effects of glucocorticoids?

NSAIDs can increase the risk of GI bleeding, and furosemide can increase the risk of low potassium (hypokalemia).