Non-Opiod Anagesics

What is inflammation?

Inflammation is the body’s protective response to injury or pathogens that uses chemical mediators to destroy pathogens and promote healing.

What can happen if inflammation becomes chronic?

Chronic inflammation can damage the body.

What are the three major actions of non-opioid analgesics?

Anti-inflammatory, antipyretic, and analgesic effects.

What does anti-inflammatory mean?

Reduces swelling and inflammation.

What does antipyretic mean?

Lowers fever.

What does analgesic mean?

Relieves pain.

What are the two main types of non-opioid analgesics covered?

NSAIDs and acetaminophen.

What does NSAID stand for?

Nonsteroidal anti-inflammatory drug.

What are the benefits of NSAIDs?

They provide anti-inflammatory, antipyretic, and analgesic effects without corticosteroid-related adverse effects.

What major risks are linked to NSAIDs?

Increased cardiovascular events, death, and GI bleeding.

What are the first-generation NSAIDs?

Aspirin, ibuprofen, naproxen, diclofenac, meloxicam, ketorolac, and indomethacin.

What enzyme types do first-generation NSAIDs inhibit?

Both COX-1 and COX-2.

What is the second-generation NSAID listed?

Celecoxib.

What enzyme does celecoxib selectively inhibit?

COX-2.

What is the mnemonic for NSAIDs on the slide?

C-I-A-M-K-I-N-D: Celecoxib, Ibuprofen, Aspirin, Meloxicam, Ketorolac, Indomethacin, Naproxen, Diclofenac.

What is the mechanism of action of NSAIDs?

NSAIDs block cyclooxygenase, or COX, enzymes.

What does COX-1 inhibition cause?

Decreased platelet aggregation, antiplatelet effects, reduced clotting, and possible kidney damage.

What does COX-2 inhibition cause?

Decreased inflammation, fever, and pain.

Does COX-2 decrease platelet aggregation?

No. COX-2 does not decrease platelet aggregation.

Does COX-2 have antiplatelet effects?

No.

What are common therapeutic uses of NSAIDs?

Inflammation suppression, mild to moderate pain relief, fever reduction, and dysmenorrhea relief.

What is dysmenorrhea?

Painful menstrual cramping.

What special therapeutic use does aspirin have?

It inhibits platelet aggregation, helping protect against ischemic stroke and myocardial infarction.

What special therapeutic uses does celecoxib have?

It suppresses inflammation, relieves pain, decreases fever, and can protect against colorectal cancer.

What are the three major NSAID complications?

GI discomfort, impaired kidney function, and increased risk of heart attack and stroke.

ONLY EXCEPTION is ASPIRIN for fist generation NSAIDs

What are aspirin-related complications?

Salicylism

Reye syndrome

Aspirin toxicity.

What are symptoms of NSAID-related GI discomfort?

Dyspepsia (Indigestion)

abdominal pain

heartburn

nausea

Who has increased risk for NSAID GI complications?

Older adults, smokers, clients with alcohol use disorder, history of peptic ulcers, or NSAID intolerance.

What can long-term NSAID use cause?

GI bleeding.

What signs suggest GI bleeding?

Black or dark stools, severe abdominal pain, nausea, and vomiting.

What medications can reduce ulcer risk from NSAIDs?

Omeprazole (proton pump inhibitor)

cimetidine (H2 receptor antagonist)

misoprostol (Porphylaxis agents)

Why should misoprostol be used carefully?

It can cause uterine contractions and should not be used during pregnancy.

What should clients take NSAIDs with?

Food, milk, or an 8 oz glass of water.

What should clients avoid while taking NSAIDs?

Alcohol.

What are signs of impaired kidney function from NSAIDs?

Decreased urine output, weight gain from fluid retention, increased BUN, and increased creatinine.

Which clients need caution with NSAIDs due to kidney risk?

Older adults and clients with heart failure.

What is the normal creatinine range listed?

0.6–1.2 mg/dL.

What creatinine level is concerning?

Creatinine over 1.3 mg/dL can indicate poor kidney function.

Which lab is a better indicator of kidney function than BUN?

Creatinine.

What is the normal BUN range listed?

10–20 mg/dL.

What do elevated BUN and creatinine together suggest?

Renal dysfunction.

What should the nurse assess for nephrotoxicity?

Change in urinary pattern

Elevated BUN/creatinine

What should the nurse do if nephrotoxicity occurs?

Notify the provider; the medication may need to be stopped or decreased.

Which NSAIDs increase risk of heart attack and stroke?

Non-aspirin NSAIDs.

What dose should be used in clients with cardiovascular disease?

The smallest effective dose.

How is IV ibuprofen administered?

Infuse over 30 minutes.

What should be ensured before IV ibuprofen?

The client should be hydrated to help prevent kidney damage.

Who should not take ibuprofen?

Children younger than 6 months.

What is preferred for children younger than 6 months?

Acetaminophen.

What does high-dose ibuprofen do?

Decreases inflammation.

Is high-dose ibuprofen used to treat fever in cystic fibrosis?

No.

What is cystic fibrosis?

A genetic disorder affecting mainly the lungs, pancreas, and sweat glands.

What NSAID is first choice for acute gout attack relief?

Naproxen

Does naproxen interact with probenecid?

No.

What does probenecid treat?

Gout.

What can aspirin do to probenecid?

Aspirin can decrease probenecid’s effectiveness.

What are the 3 complications of Asiprin

Salicylism

Reyes Syndrome

Aspirin Toxity

What is salicylism?

A mild aspirin toxicity syndrome.

What are symptoms of salicylism?

Tinnitus (ringing in the ears)

sweating

headache

dizziness

respiratory alkalosis

What should a client do if salicylism occurs?

Stop aspirin and notify the provider.

What is Reye syndrome?

A rare pediatric condition but serious condition involving encephalopathy and liver failure.

Who is at risk for Reye syndrome?

Children or Adolescents taking aspirin during viral illnesses like influenza or chickenpox.

What symptoms can Reye syndrome cause?

Confusion, delirium, seizures, uncontrollable vomiting, brain swelling, and liver swelling.

What should children with viral illness receive instead of aspirin?

Acetaminophen.

What salicylate-containing products should children avoid during viral illness?

Aspirin and Pepto-Bismol.

What is aspirin toxicity?

A medical emergency where salicylism progresses to severe symptoms.

What are symptoms of aspirin toxicity?

Sweating, high fever, acidosis, dehydration, electrolyte imbalance, coma, and respiratory depression.

What medication can reduce aspirin absorption in toxicity?

Activated charcoal.

What antidote is listed for aspirin toxicity?

Sodium bicarbonate.

Why is sodium bicarbonate used in aspirin toxicity?

It reverses acidosis and promotes aspirin excretion.

What other treatments may be used for aspirin toxicity?

Gastric lavage, tepid water cooling, and correction of dehydration.

What is Gastric Lavage for aspirin toxicty

Stomach pumping, flushing with water

What is also a nursing action for aspirin toxicity

Cool client with tepid water

What pregnancy risk category is listed for first-generation NSAIDs?

Category D.

What does Category D mean?

There is evidence of human fetal risk, but benefits may sometimes outweigh risks.

What are contraindications for first-generation NSAIDs?

Pregnancy, peptic ulcer disease, scheduled surgery, bleeding disorders, and hypersensitivity to aspirin or NSAIDs.

What bleeding disorders are listed as contraindications?

Hemophilia and vitamin K deficiency.

Why are first-generation NSAIDs contraindicated in peptic ulcer disease?

They reduce platelet aggregation and increase GI irritation.

What is a special aspirin contraindication?

Children or adolescents with chickenpox or influenza.

What is a special ketorolac contraindication?

Advanced kidney disease.

How long can ketorolac be used?

No more than 5 days.

Why is ketorolac limited to 5 days?

Risk of GI, cardiovascular, and renal complications.

Who should use NSAIDs cautiously?

Older adults, smokers, clients with bleeding disorders, and clients taking ACE inhibitors or ARBs.

Why is celecoxib considered a last-choice medication for chronic pain?

Because it increases risk of MI and stroke.

What allergy is a contraindication for celecoxib?

Sulfonamide allergy.

What happens when NSAIDs are taken with anticoagulants?

Bleeding risk increases.

What anticoagulants are listed?

Heparin and warfarin.

What should clients report when taking NSAIDs with anticoagulants?

Signs of bleeding.

What happens when NSAIDs are taken with glucocorticoids?

Risk of gastric bleeding increases.

What can be used to reduce gastric ulcer risk with NSAIDs?

Antiulcer prophylaxis such as misoprostol.

What happens when alcohol is taken with NSAIDs?

Risk of bleeding and gastric ulceration increases.

What should clients avoid while taking NSAIDs?

Alcoholic beverages.

What does ibuprofen do to low-dose aspirin?

It decreases aspirin’s antiplatelet effect.

Why is low-dose aspirin used?

To help prevent myocardial infarction.

Should ibuprofen be taken at the same time as aspirin?

No.

What happens if ketorolac is taken with other NSAIDs?

Risk of adverse effects increases.

Should ketorolac be used with other NSAIDs?

No.

What can celecoxib decrease?

The diuretic effect of furosemide and antihypertensive effects of ACE inhibitors.

Why should clients on ACE inhibitors or ARBs avoid NSAIDs?

The combination increases risk for acute renal failure.

What supplements increase bleeding risk with NSAIDs?

Garlic, ginger, feverfew, and ginkgo biloba.