Medications for Pain & Inflammation part 1

two types of pain

- acute

- chronic

acute pain

- rapid onset

- duration is short and well characterized

chronic pain

- slow, persistent, onset, ache

- >6 months or longer

- cause is often unknown

nonpharmacological techniques for pain management

- acupuncture

- massage

- physical therapy

- meditation

- ice

different types of pain management like to start with

- least invasive, then move to meds.

- if know they will be in pain will start w meds

Nonopioid analgesics:

- Non steroidal anti-inflammatory drugs (NSAIDS)

- 1st generation

- 2nd generation

1st generation NSAIDS

- asprin

- ibuprofen

Acetaminophen

- not an NSAID

- acetaminophen

Opioid analgesics

- opioid agonists

- morphine

Opioid reversals

- opioid antagonists

- naloxone

Aspirin prototype for

hematology

Asprin is

Affordable; commonly used to control pains and reduces fever and inflammation

Aspirin antiplatelet agent

= blocks formation of blood clots = prevents MI

Avoid using aspirin/salicylates to treat

- chicken pox or flu-like syndrome in children and teens (4-12 yrs)

- risk of reye's syndrome

- brain & liver swelling

Aspirin Toxicity - SALICYLISM

- Medical emergency

- Activated charcoal may be given to decrease absorption

- Can perform gastric lavage

- Cool the pt with tepid water

- damage to 8th cranial nerve

ASPRIN Toxicity S/S?

- sweating

- high fever

- acidosis

- dehydration

- electrolyte

- imbalance

- tinnitus

- respiratory depression

- confusion

- coma

asprin acute toxicity

- typically caused by a single overdose

asprin chronic toxicity

continuous use of an elevated dosage over long periods of time (built up over time)

opioid medications

- use for moderate to severe pain

- classified into 3 categories (agonists, antagonists, agonist-antagonist)

- metabolized extensively in the liver

opioid goal

reduction in pain

agonists

drugs that occupy receptors and activate them

agonist-antagonist

occupies receptors but do not activate them (partial activation)

antagonist

block receptor activation by agonists

COX 1

present in all tissues

role of COX-1

- reduces gastric acid in the stomach

- promotes renal blood flow

- inc mucus production

- platelet aggregation

- vasodilation

- bronchodilation

COX 1 when inhibited

- ↑ bleeding & GI upset

- ↓ kidney function (monitor BUN & creatinine lvls)

COX-2

- forms after tissue injury

- promotes inflammation which causes pain, fever, dec platelet aggregation

kidney labs

- BUN (blood urea nitrogen)

- Creatinine

BUN lab values

10-20 mg/dL

creatinine levels female

0.5-1.1 mg/dL

creatinine levels male

0.6-1.2 mg/dL

Ibuprofen therapeutic use

- suppression of inflammation

- analgesia for mild to moderate pain

- fever reduction

- dysmenorrhea (period cramps)

Ibuprofen mechanism of action

- act by inhibiting COX

- COX responsible for formation of prostaglandin

- reducing pain and inflammation

Ibuprofen complications

- GI bleeding (bleeding, ulceration, perforation)

- peptic ulcers

- impaired kidney function

- inc risk of heart attack & stroke

- Salicylates/Aspirin toxicity

Ibuprofen interferes w

normal blood clotting, potentially raising BP

Prostaglandin

responsible for regulating normal blood clotting

Ibuprofen Contraindications/Precautions

- peptic ulcer disease

- bleeding disorders

- pregnancy risk factor D

- children who have viral infections

- older adults

- smokers

ibuprofen drug-drug interactions

- Anticoagulants = ↑ risk of bleeding

- Glucocorticoids = inhibits mucous production = ↑ risk of GI bleeding

- Alcohol = ↑ risk of GI bleeding

- Be aware of all OTC meds

Ibuprofen Education

- take w food or milk

- stay hydrated to prevent kidney failure

- administer IV ibuprofen infusion over 30 min

Ibuprofen use smallest dose effective for pts w

heart diseases

Ibuprofen what to look for in pts

- abdominal pain: abdominal assesment

- nausea/vomiting black/dark colored stools: GI assessment

- inc use of antacids GERD

ibuprofen administered

- PO

- IV