NURS 321: Ch 33, Non-Opioid Analgesics (part one)

What is a NON-OPIOID?

not an opioid

What is a ANALGESIC?

pain reliever

What are NON-OPIOID ANALGESICS?

A pain-relieving medication that is not an opioid

What are NSAIDs?

"nonsteroidal anti-inflammatory drugs"; medication that can reduce pain, fever, and inflammation

What is ACETAMINOPHEN?

non-opioid analgesic and antipyretic used for pain and fever, but not inflammation

What is ASPIRIN?

salicylate medication used for pain, fever, inflammation, and anti-platelet effects

What is OTP medication?

medication available without a prescription but still capable of causing adverse effects or interactions

What is INFLAMMATION?

body's protective response to injury or pathogens

What occurs when there is TOO MUCH INFLAMMATION?

too much or chronic inflammation can damage the body

What are CHEMICAL MEDIATORS?

substances released by the body that help create the inflammatory response

What occurs when the body REACTS to CHEMICAL MEDIATORS?

produces signs and symptoms of disease

What are signs and symptoms of inflammatory disease?

Swelling

Pain

Redness

Heat

Fever

Increased blood flow

Immune cell movement to the injured area

What are the THREE potential effects of NON-OPIOID ANALGESICS?

anti-inflammatory, antipyretic, analgesics

What is a ANTI-INFLAMMATORY REACTION?

reduced swelling

What is a ANTI-PYRETIC REACTION?

lowered fever

What is a ANALGESIC REACTION?

eased pain

What are the TWO types of NON-OPIOID ANALGESICS?

NSAIDs and ACETAMINOPHEN

What is the EFFECT of NSAIDS?

Provide strong anti-inflammatory, antipyretic, and analgesic effects without adverse effects associated with corticosteroids

What are the TWO MAJOR RISKS of NSAIDS?

cardiovascular events and GI bleeding

Why can NSAIDs increase GI bleeding risk?

They can irritate the GI tract and reduce protective mechanisms in the stomach lining

Why should nurses ask about OTC NSAID use?

Patients may take OTC NSAIDs regularly without realizing they can interact with medications or cause complications.

How are NSAIDs GROUPED?

how they affect COX enzymes, especially COX-1 and COX-2

What are examples of FIRST GENERATION NSAIDs?

COX-1 and COX-2 inhibitors

What kinds of medications are FIRST GENERATION NSAIDs?

Aspirin

Ibuprofen

Naproxen

Diclofenac

Meloxicam

Ketorolac

Indomethacin

What is another name for KETOROLAC?

Toradol

What does COX stand for?

cyclooxygenase

What is the function of COX ENZYMES?

help the body make prostaglandins

What is the function of PROSTAGLANDINS?

trigger inflammation, swelling, pain, and fever

What is the EFFECT when NSAIDs block COX ENZYMES?

they can reduce pain, fever, and inflammation, but they can also cause side effects

What is the EFFECT of COX-1?

"housekeeping" enzyme; continuously active to protect the stomach lining, regulate kidney function, and support healthy blood clotting

What is the EFFECT of COX-2?

"inflammatory" enzyme; triggered by injury, infection, or disease to produce the prostaglandins that cause acute pain and inflammation

What if a medication BLOCKS both COX-1 and COX-2?

it can help symptoms but may also increase risk of stomach bleeding, kidney issues, and bleeding problems

What are SECOND GENERATION NSAIDs?

a class of pain-relief medications that selectively block the COX-2 enzyme, which triggers pain and inflammation

What is an example of a medication that is a SECOND-GENERATION NSAIDs?

celecoxib

What is an example of SECOND GENERATION NSAIDs?

selective COX-2 inhibitor

What SIX things should a NURSE KNOW about NSAIDs?

1.) purpose aka therapeutic uses

2.) complications

3.) contraindications and precautions

4.) interactions

5.) nursing administration

6.) nursing evaluation of medication effectiveness

What is the MNEMONIC to help remember the MAIN NSAIDs of this chapter?

CIAMKIND

What does CIAMKIND stand for?

aspirin, meloxicam, ketorolac, indomethacin, naproxen, diclofenac

What is CELECOXIB?

A second-generation NSAID and selective COX-2 inhibitor.

What is IBUPROFEN?

A common first-generation NSAID used for pain, fever, and inflammation.

What is ASPIRIN?

A salicylate NSAID with antiplatelet effects.

What is MELOXICAM?

An NSAID used for pain and inflammation.

What is KETOROLAC?

A strong NSAID used short-term for pain; should not be used longer than 5 days.

What is INDOMETHACIN?

A first-generation NSAID used for pain, fever, and inflammation.

What is NAPROXEN?

A first-generation NSAID used for pain and inflammation, including acute gout manifestations.

What is DICLOFENAC?

A first-generation NSAID used for pain and inflammation.

Why is ketorolac important to remember?

It is used short-term and should not be used for more than 5 days due to GI, cardiovascular, and renal complications.

What is the MECHANISM OF ACTION for NSAIDs?

NSAIDs block COX enzymes

What does it mean that first-generation NSAIDs are nonselective?

They inhibit both COX-1 and COX-2 enzymes

Why can first-generation NSAIDs cause side effects?

They block COX-1, which normally helps protect the stomach, kidneys, and platelet/clotting function

What is the result of COX-1 INHIBITION?

Decreased platelet aggregation, Kidney damage, Antiplatelet effects, Reduced clotting

What is the result of COX-2 INHIBITION?

inflammation, fever, pain

What is the NOT the result of COX-2 INHIBITION?

DOES NOT CAUSE decreased platelet aggregation, antiplatelet effects, reduce clotting

Why can NSAIDs increase bleeding risk?

Some NSAIDs inhibit COX-1, which can decrease platelet aggregation and reduce clotting.

Why can NSAIDs affect kidney function?

NSAIDs can reduce prostaglandins that help maintain kidney blood flow, increasing kidney injury risk.

What are FOUR therapeutic uses for NSAIDs?

• Inflammation suppression

• Analgesia for mild to moderate pain

• Fever reduction

• Dysmenorrhea

What diseases are NSAIDs typically used for for PAIN?

osteoarthritis and rheumatoid arthritis

What is DYSMENORRHEA?

painful menstrual cramps

How can the INHIBITED PLATELET AGGREGATION in the use of ASPIRIN help a patient?

reduces platelet aggregation, so it reduces clot formation; can protect against ischemic stroke or myocardial infarction

What is ISCHEMIC STROKE?

when blood flow to part of the brain is blocked

What is MYOCARDIAL INFARCTION?

heart attack

What does CELECOXIB do therapeutically?

suppresses inflammation, relieves pain, decreases fever, and may help protect against colorectal cancer

What are the THREE main NSAID COMPLICATIONS?

1. Gastrointestinal discomfort

2. Impaired kidney function

3. Increased risk of heart attack and stroke

What are THREE ASPIRIN-RELATED COMPLICATIONS?

1.) Salicylism

2.) Reye Syndrome

3.) Aspirin Toxicity

What is SAILCYLISM?

group of symptoms of aspirin/salicylate toxicity starting to develop

What are SIGNS of SALICYLISM?

tinnitus, sweating, headache, dizziness, and respiratory alkalosis

What is REYE SYNDROME?

rare but serious condition linked to giving aspirin to children or adolescents with viral illnesses like chickenpox or influenza

What is ASPIRIN TOXICITY?

severe toxicity that can progress to fever, acidosis, dehydration, electrolyte imbalance, coma, and respiratory depression

What are SYMPTOMS of GI DISCOMFORT?

Dyspepsia, Abdominal pain, Heartburn, Nausea

What is DYSPEPSIA?

indigestion or upset stomach

Why does GI DISCOMFORT occur?

NSAIDs can irritate the stomach lining and reduce protective prostaglandins that normally help protect the GI tract

Who is at HIGHER RISK for GI DISCOMFORT?

Older adults, Smokers, Clients who use alcohol, Clients with a history of peptic ulcers, Clients who cannot tolerate NSAIDs

What does LONG TERM NSAID USE lead to?

GI bleeding; dangerous because the client may lose blood slowly without realizing it at first

What are signs of GI BLEEDING?

Black or dark-colored stools, Severe abdominal pain, Nausea, Vomiting

What does BLACK/TARRY STOOL indicate?

digested blood from bleeding higher in the GI tract

What medications should be used to DECREASE ULCER RISK?

Omeprazole, Cimetidine, Misoprostol

Why should you be careful with MISOPROSTOL?

can cause uterine contractions, so it is especially important to consider pregnancy status and contraindications

What should NSAIDs be taken with? Why?

food or an 8 oz glass of water or milk to reduce gastric discomfort

Why should ALCOHOL be AVOIDED when taking NSAIDS?

the GI tract is under more stress, which raises the chance of ulcers or bleeding

How do NSAIDS cause IMPAIRED KIDNEY FUNCTION?

decrease kidney blood flow causing fluid retention and abnormal kidney labs

What is NEPHROTOXICITY?

impaired kidney function

What are SIGNS of IMPAIRED KIDNEY FUNCTION?

Decreased urine output

Weight gain from fluid retention

BUN increases

Creatinine increases

What is the NURSING ACTION to PREVENT IMPAIRED KIDNEY FUNCTION from NSAIDs?

Use cautiously with older adults and clients who have HEART FAILURE

Why are older adults at higher risk for NSAID kidney problems?

Older adults may have reduced kidney function and are more vulnerable to medication-related kidney injury.

What labs should the nurse monitor for kidney function?

BUN and creatinine

What is CREATININE?

a waste product that comes from normal muscle metabolism

What does HIGH CREATININE INDICATE?

kidneys are not filtering well because kidneys normally filter creatinine out of the blood

What is the RANGE for NORMAL CREATININE?

0.6-1.2 mg/dL

What is the RANGE for IMPAIRED KIDNEY FUNCTION?

greater than 1.3 mg/dL

Why is CREATININE a BETTER INDICATOR of kidney function than BUN?

creatinine is more directly related to kidney filtration while BUN can be affected by other things like hydration status, diet, protein intake, GI bleeding, or liver function

What is BUN?

Blood Urea Nitrogen

What is UREA NITROGEN?

a waste product made when the body breaks down protein

What is the NORMAL RANGE for BUN?

10-20 mg/dL

What does ELEVATED BUN AND CREATININE indicate?

renal dysfunction/nephrotoxicity

What should be ASSESSED to identify NEPHROTOXICITY?

change in urinary pattern and elevated BUN and creatinine

What INTERVENTIONS are necessary after a nurse discovers NEPHROTOXICITY in a patient?

Notify physician, may need to stop medication or decrease the dosage

How can NSAIDs INCREASE RISK of HEART ATTACK and STROKE?

Some NSAIDs can affect the balance between clotting, blood vessel function, blood pressure, and fluid retention

What should the nurse monitor for with NSAID cardiovascular risk?

Chest pain, shortness of breath, stroke symptoms, increased blood pressure, swelling, and worsening heart failure.

Why does "smallest effective dose" matter?

It limits medication exposure while still providing therapeutic benefit

How is IBUPROFEN IV infused?

over 30 minutes, not pushed rapidly