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What are first-generation NSAIDs used for?

They decrease inflammation, mild to moderate pain, fever, and painful periods (dysmenorrhea).

What are the prototype first-generation NSAIDs?

Aspirin (ASA) and ibuprofen (Advil, Motrin).

What medications are first-generation NSAIDs?

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

What do first-generation NSAIDs block?

They block COX-1 and COX-2 enzymes.

What does COX-1 normally protect?

The stomach, platelets, and kidneys.

What does COX-2 cause?

Inflammation, pain, and fever.

What stomach problems can first-generation NSAIDs cause?

Gastric irritation, heartburn, nausea, and gastric ulcers.

Why can first-generation NSAIDs increase bleeding?

Blocking COX-1 decreases platelet aggregation.

What signs can show bleeding from an NSAID?

Black stools, abdominal pain, vomiting blood, petechiae, and easy bruising.

What kidney problems can NSAIDs cause?

They can decrease kidney function and decrease urine output.

What should be monitored for kidney problems with NSAIDs?

Intake and output (I&O), BUN, and creatinine.

What can happen to BUN and creatinine with NSAID-related kidney problems?

They can increase.

What cardiovascular risk increases with non-aspirin NSAIDs?

Thromboembolic events, such as heart attack or stroke.

What symptoms should be reported immediately while taking a non-aspirin NSAID?

Chest pain, shortness of breath, severe headache, weakness, numbness, or confusion.

What is salicylism?

Aspirin toxicity.

What is an early sign of aspirin toxicity (salicylism)?

Tinnitus (ringing in the ears).

What other symptoms can occur with aspirin toxicity?

Headache, dizziness, sweating, nausea, vomiting, and diarrhea.

What should a client do if tinnitus develops while taking aspirin?

Stop taking aspirin and report it.

Why should aspirin be avoided in children with viral infections?

It can cause Reye’s syndrome.

What can be used instead of aspirin for a child with a viral infection?

Acetaminophen.

How should NSAIDs be taken to decrease stomach irritation?

With food, milk, or 8 oz of water.

What should clients avoid while taking NSAIDs?

Alcohol, because it can increase stomach irritation and bleeding risk.

What medications or substances increase bleeding risk when combined with aspirin?

Anticoagulants, glucocorticoids, and alcohol.

Should enteric-coated or sustained-release NSAIDs be crushed?

No. Swallow them whole.

How long before scheduled surgery should aspirin usually be stopped?

About 1 week before surgery, as directed by the provider.

What happens when ibuprofen is taken with low-dose aspirin?

Ibuprofen can decrease aspirin’s antiplatelet effect.

What are the major medication groups for Pain & Inflammation?

NSAIDs, acetaminophen, tramadol, opioids, gout drugs, and glucocorticoids.

What type of NSAID is celecoxib, and what is its role?

Celecoxib is the prototype second-generation COX-2 inhibitor.

What does celecoxib treat?

Pain, inflammation, fever, and dysmenorrhea.

Does celecoxib cause fewer stomach problems than first-generation NSAIDs?

Yes, but GI problems and ulcers can still occur.

What common GI effects can celecoxib cause?

Gastric upset, diarrhea, heartburn, nausea, and gastric ulceration.

What serious risks can occur with celecoxib?

Kidney problems, heart attack, and stroke.

What kidney labs should be monitored with celecoxib?

BUN and creatinine.

What should be monitored for fluid retention with celecoxib?

Weight gain, edema, and bloating.

How should celecoxib be taken to decrease stomach problems?

With food, milk, or 8 oz of water.

When should celecoxib be given around magnesium or aluminum antacids?

Give it 2 hours before or after the antacid, if instructed.

What should clients avoid while taking celecoxib?

Alcohol.

What serious GI bleeding signs should be reported with celecoxib?

Black tarry stools or coffee-ground vomit.

What allergy is important to check before giving celecoxib?

An allergy to celecoxib or sulfonamides (sulfa drugs).

When is celecoxib especially avoided during pregnancy, and why?

During the third trimester because it can cause premature closure of the ductus arteriosus.

What happens when celecoxib is taken with warfarin?

It can increase the anticoagulant effect and bleeding risk.

What type of medication is acetaminophen?

A nonopioid analgesic.

What does acetaminophen treat?

Mild to moderate pain and fever.

Does acetaminophen decrease inflammation or have an anticoagulant effect?

No. It does not reduce inflammation and does not have an anticoagulant effect.

What major organ can be damaged by acetaminophen overdose?

The liver.

What are early signs of acetaminophen overdose?

Abdominal discomfort, nausea, vomiting, sweating, and diarrhea.

When can liver damage occur after a toxic acetaminophen dose?

Within about 48–72 hours.

What is the antidote for acetaminophen overdose?

Acetylcysteine (NAC).

Why should clients check cold-medicine labels when taking acetaminophen?

Many combination cold medicines also contain acetaminophen, which increases the risk of overdose.

What happens when acetaminophen is combined with alcohol?

The risk of liver injury increases.

Who should use extra caution or avoid acetaminophen according to these notes?

Clients with alcohol use disorder.

What happens when acetaminophen is taken with warfarin?

The risk of bleeding can increase.

What medication can decrease acetaminophen absorption?

Cholestyramine.

What type of medication is tramadol?

A dual-mechanism analgesic.

What type of pain does tramadol treat?

Moderate to moderately severe pain.

How does tramadol work?

It binds to opioid receptors and blocks norepinephrine and serotonin reuptake.

What are common adverse effects of tramadol?

Sedation, dizziness, headache, nausea, constipation, and urinary retention.

What serious neurological adverse effect can tramadol cause?

Seizures.

Who should avoid or use extra caution with tramadol because of seizure risk?

Clients with a seizure disorder.

What should be monitored before giving tramadol?

Baseline vital signs, especially respirations.

What should the nurse do if respirations fall below 12/min with tramadol?

Hold the medication, assess and stimulate the client, and prepare to give naloxone if indicated.

How long does tramadol take to begin its therapeutic effect?

About 1 hour.

How should extended-release tramadol be taken?

Swallow it whole; do not crush or chew it.

What should clients avoid after taking tramadol?

Driving or activities requiring alertness until they know how the medication affects them.

How can dizziness from tramadol be reduced?

Change positions slowly and sit or lie down if lightheaded.

What should clients increase if tramadol causes constipation?

Fluids, fiber, activity, and exercise.

Why should tramadol be used cautiously with antidepressants?

SSRIs, SNRIs, TCAs, and MAOIs can increase the risk of serotonin syndrome.

What dangerous reaction can occur when tramadol is taken with an MAOI?

A hypertensive crisis and other serious reactions can occur.

What is the prototype opioid agonist?

Morphine.

What medications are opioid agonists?

Morphine, fentanyl, meperidine, hydromorphone, methadone, codeine, oxycodone, hydrocodone, and tapentadol.

What type of pain do opioid agonists treat?

Moderate to severe pain.

What receptor do opioid agonists mainly stimulate?

Mu opioid receptors.

What effects occur when opioid agonists stimulate mu receptors?

Analgesia, sedation, euphoria, and respiratory depression.

What is the most serious adverse effect of opioid agonists?

Respiratory depression.

What should be checked before administering an opioid agonist?

Baseline vital signs, especially respiratory status.

What should be monitored closely during opioid therapy?

Respiratory rate, oxygen saturation, and lung sounds.

What should the nurse do if respirations are below 12/min before giving an opioid?

Hold the opioid, assess the client, and stimulate breathing.

What medication reverses opioid respiratory depression?

Naloxone.

What should be available when IV opioids are administered?

Naloxone and resuscitation equipment.

How quickly should IV opioids be given according to these notes?

Slowly over about 4–5 minutes.

What common GI problem do opioids cause, and why?

Constipation because opioids decrease intestinal motility.

What should clients increase to prevent opioid constipation?

Fluids, fiber, activity, and exercise.

What blood-pressure problem can opioids cause?

Orthostatic hypotension.

What should the nurse monitor when a client taking opioids walks?

Dizziness and orthostatic hypotension.

How can clients prevent falls from opioid-related dizziness?

Rise slowly and sit or lie down if lightheaded.

What urinary problem can opioids cause?

Urinary retention.

How often should clients taking opioid agonists be encouraged to urinate?

About every 4 hours.

Why should clients taking opioids be encouraged to cough?

To prevent retained respiratory secretions and pneumonia.

Should sustained-release opioid tablets be crushed?

No. Swallow them whole.

What should clients avoid while taking opioids?

Driving and activities requiring mental alertness.

How should opioids be given for terminal cancer pain?

On a fixed around-the-clock schedule rather than only PRN.

Should long-term opioids be stopped suddenly?

No. They should be gradually tapered.

What are common manifestations of opioid withdrawal?

Cramps, diarrhea, agitation, anxiety, hypertension, tachycardia, tremors, muscle pain, dilated pupils, runny nose, and insomnia.

What happens when opioids are combined with benzodiazepines or alcohol?

CNS and respiratory depression increase.

What can happen when opioids are combined with antihypertensives?

The hypotensive effect increases.

What dangerous reaction can occur when meperidine is combined with an MAOI?

Hyperpyrexia syndrome.

What type of medication is naloxone?

An opioid antagonist.

What is the prototype opioid antagonist?

Naloxone.

What does naloxone do?

Reverses opioid effects and treats opioid overdose.

How does naloxone work?

It blocks opioid receptors.