Pharm Exam 3

NMNC:UNM NMNC 3230: Nursing Pharmacology

Analgesics

painkillers (do not make you lose consciousness)

Types: Non-opioids, Opioids, Adjuvant analgesics

NSAIDs (Non-steroidal Anti-Inflammatory Drugs)

Analgesic, anti-inflammatory, + antipyretic

1. Aspirin (antiplatelet)

2. Ibuprofen

Black Box Warning: Increased bleeding risk, increased risk of stroke/MI (not aspirin)

Nephrotoxicity: damage kidneys

Drug-drug interactions: ACE inhibitors & ARBs, lithium, methotrexate

Aspirin

Class: NSAID

Use: pain relief + inhibits platelet aggregation

Adverse effects: GI irritation, bleeding, Tinnitus with toxicity

Safety: Narrow therapeutic index, DO NOT GO OVER 4g/24hrs

Do not give to Peds → Reye’s syndrome

Give with full glass of water

Ibuprofen (Motrin, Advil)

Class: NSAID

Use: pain relief, reduces inflammation, and lowers fever.

Adverse effects: GI irritation - ulcers <1%, CV disorders - with IV

Black Box warning – risk for CV (stroke + MI)+ GI events

Give w/ food or milk

Acetaminophen (Tylenol)

analgesic and antipyretic

little to no anti-inflammatory effects

Adverse Effects: Overdose → Liver Failure

MAXIMUM DAILY DOSE: 4g/24 hours

Overdose treatment → Acetylcysteine

Opiods

Alleviate moderate/severe pain

Adverse Effects: respiratory depression, constipation, itching/pruritus, high risk of addiction, tolerance

Contraindications: allergy, Respiratory insufficiency (asthma, COPD), GI issues, obesity, intracranial pressure, pregnancy

MONITOR RESPIRATORY STATUS

• HOLD for respiratory rate < 10

• Fent fold = CNS depression leads to respiratory depression

Teach: ask for meds before pain is out of control, orthostatic precautions, fiber + walking + increase fluids,

Opiods: Morphine, fentanyl, hydromorphone (Dilaudid), oxycodone, methadone, and buprenorphine

Morphine

Class: opioid analgesic

Use: moderate/severe pain

Adverse Effects: respiratory depression, constipation, n/v, prutisis

Fentanyl

class: opioid analgesic (C-II)

• 100X more potent that morphine

Use: induction of anesthesia, analgesia

Adverse effects: respiratory depression, constipation, n/v, prutisis

• higher incidence than morphine, esp. muscle rigidity

Elders: high risk of confusion

Oxycodone

class: opioid analgesic (C-II)

PO only

Use: moderate/severe pain

Popular drug of abuse

Adverse Effects: respiratory depression, constipation, n/v, prutisis

Hydromorphone (Dilaudid)

class: opioid analgesic (C-II)

• 7X more potent than morphine

Use: analgesia

Adverse effects: miosis, orthostatic hypotension, respiratory depression, itching/pruritis, constipation, N/V

Methadone

Class: synthetic opioid analgesic (C-II)

Use: detoxification treatment of opioid addicts in methadone maintenance programs

Buprenorphine

Class: opioid agonist-antagonist

Use: acute pain, chronic pain, opioid use disorder (OUD)

• used to treat opioid addiction

adverse effects: similar to morphine with less respiratory depression, lower risk of abuse and addiction

can cause withdrawal in opioid dependent patients

Naloxone (Narcan)

Class: opioid antagonist

Use: partial or complete reversal of opioid induced respiratory depression, opioid overdose

Adverse effects: Headache, Hypertension, Immediate reversal of opioid induced effects (pain, seizures, death)

reverse respiratory depression induced by an opioid

respiratory assessment

Allopurinol

Class: Anti-hyperuricemic agent

Use: prevents gout and lowers uric acid levels.

Adverse effects: Pruritus, rash → discontinue, Bone marrow suppression

Asians at higher risk for severe skin reactions

Prednisone

Class: glucocorticoid (steroid)

Use: inflammatory diseases or conditions, allergies

Adverse effects: hypertension, psychosis, hyperglycemia, abdominal obesity

Take in the morning + DO NOT stop abruptly
*weakens immune system

*Adrenocortical insufficiency if stopped abruptly