2: pain medications

cardinal signs of inflammation

heat, redness, swelling, pain, loss of function

NSAIDs

non-steroidal anti-inflammatory drugs

salicylates (NSAID)

aspirin: bleeding/GI risk, Reye syndrome, avoid alcohol/warfarin, OTC

para-chlorobenzoic acid (indoles) (NSAID)

ketrolac (Toradol) potent prostaglandin inhibitor; protein bound, take w/ food, dizziness, N/V/D, RA/gout/OA, take with food

N/V/D

nausea, vomiting, diarrhea

propionic acids derivatives (NSAID)

ibuprofen: GI irritation/bleeding, no other NSAIDs, SJS risk (steven johnson syndrome), protein bound, OTC

fenamates (NSAID)

Potent (for chronic pain); high GI irritation; avoid if peptic ulcers disease

oxicams (NSAID)

Long half-life/once daily, RA/OA, may take 2 weeks to work, GI ulcers, avoid other NSAIDs

cox 2 inhibitors

celecoxib: chronic pain, increased MI/stroke risk, avoid other NSAIDs, take w/ food and water, less GI irritation, but GI bleeding risk

corticosteroids

Take AM + with food; taper (don't abruptly stop); monitor glucose & bleeding; avoid caffeine if jittery; monitor for adverse reactions

DMARDs (disease modifying anti-rheumatic drugs)

used to alleviate RA,OA, severe psoriasis, crohn’s, ulcerative colitis

immunosuppressive agents (DMARD)

azathioprine, cyclophosphamide, methotrexate: affect WBC count, administered in specialty units/trained individuals

immunomodulators (DMARD)

infliximab, adalimumab, leflunomide: affect WBC count, neutropenic (low neutrophils) precautions

antimalarials (DMARD)

hydroxychloroquine, used as last resort, may take 4-12 weeks for effects

anti-gout drugs: colchicine

first anti-inflammatory gout med, acute attacks, GI irritation, avoid if severe renal, cardiac, and GI dysfunction/high purine foods/alcohol

gout

uric acid build up, shows in big toe

xanthine oxidase inhibitors: allupurinol

reduce uric acid, given as prophylactic to prevent attack, for pt with renal obstruction

xanthine oxidase inhibitors: febuxostat

reduce uric acid, highly protein bound, may exacerbate (worsen) gout, risk of CV (cardiovascular) events

probenecid (anti-gout drugs)

uricosuric (increases uric acid excretion), chronic gout, can be used with other gout meds, protein bound, GI irritation

pain threshold

stimulus needed

pain tolerance

pain where tasks are affected

gate theory

how body feels pain following stimulus tissue injury

fifth vital sign

pain

undertreatment of pain

affects healing process

addiction

psychological and physical dependence upon a substance beyond normal voluntary control

acute pain

sudden

chronic pain

more than 3 months

cancer pain

pressure, blockage, metastasis (spread of cancer cells)

somatic pain

skeletal, muscles, joints

superficial pain

skin, mucous, membranes

vascular pain

vascular tissues, headaches

visceral pain

smooth muscle, organs

adjuvant therapy

complementary therapy; used in conjunction and may help reduce the dosing/risks associated with analgeisics

analgesics

pain relievers

antidote of aspirin/ibuprofen

sodium bicarbonate (ASA)

acetaminophen antidote

acetylcysteine

opiod analgesic antidote

naloxone (narcan)

opioid warnings

decreases respirations, constipation, nausea, drowsiness

migraine headaches

unilateral, throbbing head pain, nausea, vomiting, light sensitivity, women, hours to days

cluster headache

severe, non-throbbing around eye, no nausea, vomiting, light sensitivity, men, several weeks

sumatriptan

treats headaches like migraines and clusters

types of adjuvant therapies

Anticonvulsants (gabapentin), Antidepressants (amitriptyline), Corticosteroids (prednisone), Antidysrhythmics (mexiletine), Anesthetics (lidocaine)

PCA (patient controlled analgesics)

patient presses button to release meds

nociceptors

pain receptors that detect harmful/painful stimuli

prostaglandins

Chemicals involved in pain and inflammation

titration

adjusting a medication dose based on the patient's response

withdrawal syndrome

physical and psychological symptoms that occur when a substance is reduced or discontinued after prolonged use

WHO analgesic ladder

step 1: mild pain, step 2: moderate pain, step 3: moderate to severe pain

opioid agonist-antagonist: nalbuphine

surgery and labor/delivery; activates some receptors, blocks others

synthetic opioid: meperidine

preferred over morphine during labor/delivery; pain relief