Pain and Inflammation

tylenol, allopurinol, prednisone, aspirin, ibuprofen, morphine, naloxone

• Analgesia for mild to moderate pain

• Fever reduction

Acetaminophen

Acetaminophen ADVERSE drug reactions:

• ________(overdose)

• __________(w/ daily use, particularly Female pts.)

liver damage, hypertension

Early manifestations of Acetaminophen overdose/poisoning:

• nausea/vomiting, _____, ______, _______

Liver damage results in 48-72 hrs. following od

abd discomfort, sweating diarrhea

Acetaminophen overdose/liver injury reduction

counter:

acetylcysteine IV/oral

Acetaminophen ADMIN routes

oral, rectal

Acetaminophen adult max dose

4g/day

acetaminophen CONTRAIND.

alcohol use disorder

Acetaminophen PRECAUTIONS:

• _________

• __________

• hepatic or kidney disease

anemia, immunosuppression

Acetaminophen INTERACTIONS:

• _________ increases the risk of liver injury (w/ high doses of acetaminophen)

• __________ increases the risk of bleeding

Alcohol, warfarin

____________ reduces acetaminophen absorption

Cholestyramine

Allopurinol

drug class?

antihyperuricemics

treats hyperuricemia due to chronic tophaceous gout, cancer chemotherapy, and some blood dyscrasias

allopurinol

Allopurinol ADVERSE drug reactions:

• Hypersensitivity syndrome (_____, _____, _______, liver and kidney dysfuntion)

• GI disturbances (n/v/diarrhea)

• Drowsiness, headache, ________

• ___________, aplastic anemia, bone marrow depression

• metallic taste in the mouth

• cataracts (use 3+ yrs.)

fever, rash, eosinophilia,vertigo, agranulocytosis

Allopurinol INTERV.:

monitor _____

if GI disturbances; give med after meal

mild analgesic for headache

CBC

Allopurinol ADMIN Route

oral, iv

Allopurinol ADMIN:

• monitor _______ levels (initially then every 1-2 weeks)

• obtain baseline CBC and test liver and kidney function before therapy and periodically after

• tabs may be crushed and mixed w/ food or fluid

• IV; dilute and infuse over ____-_____ min.

• make sure clients drink at least ____ of fluid/day

Uric acid, 30-60, 3L

report bleeding, easy bruising, sore throat

minimize exposure of eyes to sunlight

report fever, rash, abd pain, swelling, or low urine output immediately and stop med

allopurinol instructions

_________ precautions:

• Bone marrow depression

• liver or kidney dysfunction

• peptic ulcer disease

• lower GI tract disease

allopurinol

Allopurinol INTERACTIONS:

• __________ requires lower dosages

• the risk of mercaptopurine, theophylline, and azathioprine toxicity increases

• Ampicillin increases the risk for rash

warfarin

• symptomatic relief of pain and inflammation for a wide variety of disorders

• many skin disorders

• delay progression of some disorders, such as rheumatoid arthritis

• prevention of organ rejection

• adjunctive therapy for some cancers

glucocorticoids

prednisone

drug class?

glucocorticoid

Prednisone ADVERSE drug reactions:

• suppression of adrenal function

• _________

• myopathy

• _______________, GI discomfort

• _________

• Fluid and Electrolyte imbalances

• Fat redistribution (long-term therapy)

• Bone loss

• Cataracts (long-term therapy)

hyperglycemia, peptic ulcer disease, Infection

Prednisone INTERV.:

• ______ doses during times of illness and stress

• observe for GI bleeding

• observe for manifestations of infection that may not include fever or inflammation (___________, fatigue, __________, and discharge from a wound)

• Monitor I&O (hypernatremia)

larger, sore throat, tachycardia

Prednisone must be ________ before discont.

• avoid taking _______

• consume adequate calcium and Vitamin D

tapered, NSAIDs

Prednisone CONTRAINDICATIONS:

recent live virus immunization, systemic fungal infection, cataracts

________Precautions:

• HF

• peptic ulcer disease

• DM

• HTN

• Kidney dysfunction

• myasthenia gravis

• osteoporosis

prednisone

Prenisone (glucocorticoid) INTERACTIONS:

• potassium-depleting diuretics, like furosemide, increase risk of hypokalemia

• risk of digoxin-induced dysrhythmias increases w/ digoxin

• NSAIDs increase the risk of GI bleeding and ulceration

• Effects of insulin and oral hypoglycemics decrease in clients who have diabetes

• prevents body from responding to ______

vaccines

Aspirin, Ibuprofen

Drug class?

first gen NSAIDs

• inflammation suppression

• analgesia for mild to moderate pain

• fever reduction

• dysmenorrhea

Ibuprofen

• inflammation suppression

• analgesia for mild to moderate pain

• fever reduction

• dysmenorrhea

• Inhibition of platelet aggregation

Aspirin

Ibuprofen ADVERSE drug reactions:

• Gastric upset, heartburn, nausea, gastric ulceration

• Bleeding

• kidney dysfunction

• ______________ events

thromboembolic

Aspirin ADVERSE drug reactions:

• Gastric upset, heartburn, nausea, gastric ulceration

• _________

• kidney dysfunction

• __________

• _____________

bleeding, salicylism, reye’s syndrome

manifestations of bleeding

easy bruising, petechiae, excessive bleeding

Aspirin and Ibuprofen INTERV:

• monitor rapid rise in _____ and ________

• monitor for tinnitus, diaphoresis, headache, dizziness, respiratory alkalosis (aspirin)

BUN, creatinine

Recommend Acetaminophen and not NSAIDs for children and adolescents under 18 who have _______, particularly ________ and __________

viral infections, chickenpox, influenza

Discontinue Aspirin: ___ week before surgery

1

Aspirin & Ibuprofen CONTRAINDICATIONS:

• _________

• peptic ulcer disease

• bleeding disorders (hemophilia, vitamin K deficiency)

teratogenic

Aspirin & ibuprofen (1st gen NSAIDs) Precautions:

• older adults

• cigarette smoking

• alcohol use disorder

• ___________

• HF

• HTN

• hypovolemia

• asthma

• chronic urticaria

• advanced kidney dysfunction

H. pylori infection

Aspirin, Ibuprofen INTERACTIONS:

• anticoagulants, _________, and _________ increase the risk of bleeding

• ACE inhibitors and angiotensin receptor blockers increase the risk of kidney failure

• Antihypertensive effects of ACE inhibitors decrease

glucocorticoids, alcohol

t/f?

the risk of lithium carbonate and methotrexate toxicity increases with first gen NSAIDs

t

t/f

Ibuprofen increases the antiplatelet effects of low-dose aspirin

f, decreases

morphine

drug class?

opioid agonist

• Analgesia for moderate to severe pain

• preop sedation and anxiety reduction

morphine

Morphine (opioid agonist) ADVERSE drug reactions:

• _____________

• sedation, dizziness, lightheadedness, drowsiness

• Constipation

• n/v

• _____

• urinary retention

• _____________

• potential for misuse along w/ tolerance and cross-tolerance w/ other opioids (larger dose req. for usual effect)

respiratory depression, OH, cough suppression

Encourage pt.’s on opioid agonists (i.e., morphine, fetanyl) to urinate every _____

4 hrs

Advise clients who have physical dependence not to discontinue opioids abruptly; taper the dose over ___ days

3

Morphine ADMIN:

• IV diluted and slowly given over 4-5min.

• monitor PCA use and pump settings carefully

• administer to clients who have cancer on a ______ dosing schedule, not PRN

ATC

Morphine CONTRAINDICATIONS:

• ________risk (long-term use, high doses, near term)

• kidney failure

• increased ______

• biliary colic

• preterm labor

pregnancy, ICP

__________ PRECAUTIONS:

• schedule II controlled substance

• older adults, infants

• reduced respiratory reserve

• head injury

• Inflammatory bowel disease

• prostatic enlargement

• hypotension

• hepatic or kidney disease

Opioid agonist

Morphine (opioid agonist) INTERACTIONS:

• CNS Depressants (barbiturates, phenobarbital, benzodiazepines, and alcohol) increase CNS depression

• Anticholinergic agents (i.e., antihistamines, and tricyclic antidepressants increase anticholinergic effects (constipation, urinary retention)

• Antihypertensives increase hypotensive effects

• __________ can increase sedation

St. John’s wort

Naloxone

drug class?

opioid antagonist

reversal of neonatal respiratory depression (from maternal analgesia)

reversal of opioid effects/overdose

naloxone

Opioid antagonists ADVERSE drug reactions:

ventricular arrhythmias, increased rr, bp, hr, abstinence syndrome

HTN, vomiting, cramping in opioid dependent clients

abstinence syndrome

Naloxone ADMIN routes

IM, IV, SC

Prepare to admin Naloxone every ___-___ min. until reversal of undesirable effects

2-3

____________________ precautions:

• cardiac irritability

• head injury, increased ICP

• brain tumor

• seizure disorders

Opioid antagonist