Pharm Week 4 - Anti-Inflammatories, steroids; analgesics

1st generation NSAIDS

examples: ibuprofen (Motrin/Advil); naproxen (Naprosyn); oxicam (Meloxicam)

mechanisms:

• inhibit BOTH COX-1 & -2 (i.e., don’t discriminate between them)

• reduces inflammation, therefore reduces pain (a cardinal sign of inflammation)

• decreases COX-1’s stomach lining protection → increase risk of GI bleed

uses: acute mild-moderate pain; musculoskeletal injury, OA, dysmenorrhea, pain

side effects:

• risk of GI s/s & bleed

• ibuprofen: acute kidney injury/dysfunction (check Cr)

nursing considerations/implications/interventions;

• assess Cr if increase in baseline

• cannot have within 3-5 days of surgery or procedure

• no herbal supplements with G’s

pt education:

• taking w food decreases n/v, GI discomfort

2nd generation NSAIDS

examples: celecoxib (Celebrex)

mechanisms: ONLY inhibits COX-2 (i.e., selective). reduces pain, fever, inflammation, but doesn’t cause gastric ulceration

uses: acute mild-moderate pain; musculoskeletal injury, OA, dysmenorrhea, pain

side effects: headache, HTN

nursing considerations/implications/interventions;

• assess if CR and LFT (ASP, ALT) levels increase from baseline (prior to starting)

pt education:

• can’t have within 3-5 days of surgery or procedure

• no herbal supplements w G’s

ketorolac

generic name: Toradol

class: misc NSAID (nasal spray; PO/IM/IV)

uses: treat modern to severe short-term pain

side effects: HTN, kidney and liver problems

nursing considerations/implications/interventions:

• don’t use w: severe kidney disease, bleeding/clotting disorders; GI ulcers/bleeding

• monitor Cr

pt education:

• only use for 5 days

• don’t use w other NSAIDS

other: can only take for a max of 5 days (rough on kidneys)

allopurinol

class: antigout

mechanisms: prevents UA production; excretes UA from kidneys

uses: treats chronic gout

side effects: n/v

nursing considerations/implications/interventions;

• monitor Cr trends

pt education:

• increase fluids

• take w food

• avoid alc

• avoid high purine foods

colchicine

class: antigout

mechanisms: decreases UA inflammation in joints

uses: acute gout

side effects: n/v, diarrhea

nursing considerations/implications/interventions;

• monitor CR trends, reduce dose w kidney disease

pt education:

• increase fluids

• take w food

glucorticoids (general)

examples: prednisone, methylprednisolone

mechanisms: systemic inhibition rather than enzyme-specific. Dr. Prochnow: “just know that it reduces inflammation”

uses:

• reduces inflammation

• treats respiratory conditions (PN, COPD, asthma)

• debilitating conditions (immune disorders (RA, SLE…)

side effects:

• hyperglycemia

• GI bleed/ulcer

• long-term use = immunosuppresant

• candidiasis (fungal infection; i.e., thrush

nursing considerations/implications/interventions;

• monitor glucose: even nondiabetic pts sometimes need sliding scale insulin PRN on this med

• must be tapered 5-10 days to allow adrenal gland produces cortisol again (otherwise: adrenal cortical insufficiency)

• monitor for s/s of GI bleed, prophylaxis (preventative) treatment w PPI (proton-pump inhibitors)

pt education:

• frequent oral hygiene to reduce candidiasis risk

• long-term use: risk of immunosuppression or neutropenia/leukemia

acetaminophen

generic name: Tylenol

class: nonopioid, non-NSAID analgesic

uses: mild to moderate pain, fever (NOT anti-inflammatory)

side effects: liver toxicity

nursing considerations/implications/interventions:u

• monitor LFT prior to administering

• don’t take or adjust dose w liver disease or hepatitis

pt education:

• no more than 2000 mg/day for liver pt (if at all). 4000 mg/day only under supervision

gabapentin

generic name: Neurontin

class: nonopioid, non-NSAID analgesic

mechanism: slows conduction of pain signals in nerve

uses:

• neuropathic pain (off-label, but most common use)

• seizure prophylaxis

side effects:

• drowsiness

• dizziness

nursing considerations/implications/interventions:

• watch for orthostatic hypotension

pt education:

• avoid activities requiring alertness

all opioids (AKA narcotics)

examples (least to most potent): hydrocodone (Norco/Vicodin); oxycodone (Percocet); morphine; hydromorphone (Dilaudid); fentanyl

uses:

• moderate to severe pain

• fentanyl: pain, but also for sedation for preop and/or conscious sedation

side effects:

• nausea

• drowsiness

• constipation

• confusion

• DANGER: may slow breathing!

• highly addictive

nursing considerations/implications/interventions:

• assess pain & RR prior to and after admin

• have naloxone available

• don’t give to head injury pts

pt education:

• don’t drive, operate machinery, or drink alc