wk 4 pharm Dinali notes
Pain Medication Categories
Pain Type / Exam Clue
Best Medication Class
Pain + inflammation + fever
NSAIDs
Pain + fever, but no
inflammation
Acetaminophen
Moderate to severe pain
Opioid agonists
Opioid overdose
Naloxone
Burning, shooting, nerve pain
Amitriptyline or gabapentin
Migraine attack
Sumatriptan or ergotamine
Core Exam Rule
Pain medications are tested by asking:
1. What is the drug used for?
2. What is the mechanism of action?
3. What is the biggest adverse effect?
4. What patient should NOT receive this drug?
5. What patient teaching is required?
6. What finding requires the nurse/provider to hold or question the medication?
NSAIDs: Nonsteroidal Anti-Inflammatory Drugs
First-Generation NSAIDs
Class: First-generation NSAIDs
Mechanism: COX-1 and COX-2 inhibitors
Prototypes
Drug
Must-Know Point
Aspirin
NSAID + antiplatelet effect
Ibuprofen
Common NSAID for pain, fever,
inflammation
Naproxen
Longer-acting NSAID
Indomethacin
Strong NSAID
Ketorolac
Strong NSAID; short-term use only
NSAID Mechanism Step-by-Step
1. Tissue injury or inflammation occurs.
2. The body produces prostaglandins.
3. Prostaglandins cause pain, fever, and inflammation.
4. NSAIDs block cyclooxygenase enzymes, also called COX enzymes.
5. Less COX activity means fewer prostaglandins.
6. Result: decreased pain, decreased fever, and decreased inflammation.
COX-1 vs COX-2
Enzyme
Normal Function
What Happens When Blocked
COX-1
Protects stomach lining, supports kidney blood
flow, helps platelet function
GI bleeding, ulcers, kidney
injury, bleeding risk
COX-2
Produces inflammation, pain, and fever
Pain, fever, and inflammation
decrease
NSAID Therapeutic Uses
NSAIDs are used for:
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Mild to moderate pain
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Fever
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Inflammation
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Arthritis pain
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Muscle aches
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Menstrual cramps
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Dental pain
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Musculoskeletal injury painNSAID Major Adverse Effects
Adverse Effect Why It Happens
GI irritation Decreased stomach-protective prostaglandins
Gastric ulcer Loss of stomach lining protection
GI bleeding COX-1 inhibition and platelet effects
Kidney injury Decreased renal blood flow
Fluid retention Kidney prostaglandin effects
Hypertension Fluid retention and renal effects
Increased bleeding risk Platelet inhibition, especially with aspirin
Bronchospasm NSAID sensitivity in some patients
NSAID Contraindications / Use Caution
Use caution or avoid NSAIDs in patients with:
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Active GI bleeding
History of gastric ulcers
Kidney disease
Bleeding disorders
Anticoagulant use
Severe heart failure
Severe uncontrolled hypertension
Aspirin/NSAID allergy
Asthma with NSAID sensitivity
Heavy alcohol use
NSAID Patient Teaching
Teach the patient to:
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Take NSAIDs with food or milk.
Avoid alcohol because it increases GI bleeding risk.
Avoid taking multiple NSAIDs at the same time.●
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Aspirin
Report black stools.
Report vomiting blood.
Report severe stomach pain.
Report decreased urine output.
Tell the provider about anticoagulant use.
Avoid aspirin in children or teenagers with viral illness.
Class
First-generation NSAID
COX-1 and COX-2 inhibitor
Special Feature
Aspirin has an antiplatelet effect.
This means it decreases platelet aggregation and increases bleeding risk.
Aspirin Must-Know Uses
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Pain
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Fever
Inflammation
Antiplatelet therapy
Cardiovascular event prevention in selected patients
Aspirin Major Adverse Effects
Effect Exam Clue
GI bleeding Black tarry stools, vomiting blood
Bleeding risk Easy bruising, bleeding gums
Tinnitus Salicylate toxicity
Reye syndrome Child/teen with viral illness
Kidney injury Decreased urine outputAspirin Safety Alert
Do not give aspirin to children or teenagers with viral illness because of risk for Reye
syndrome.
Ketorolac
Class
First-generation NSAID
Must-Know Point
Ketorolac is a strong NSAID used for short-term pain management.
It has a higher risk of:
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GI bleeding
Kidney injury
Ulceration
Exam Rule
Ketorolac should not be used long term.
If an exam question shows prolonged ketorolac therapy, think:
unsafe due to GI and renal toxicity.Second-Generation NSAID: Celecoxib
Class
Selective COX-2 inhibitor
Prototype
Celecoxib
Celecoxib Mechanism Step-by-Step
1. Inflammation activates COX-2.
2. COX-2 increases prostaglandins.
3. Prostaglandins cause pain and inflammation.
4. Celecoxib selectively blocks COX-2.
5. Pain and inflammation decrease.
6. COX-1 is less affected, so GI protection is better preserved than with nonselective
NSAIDs.
Celecoxib Benefits
Celecoxib can reduce:
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Pain
Inflammation
Arthritis symptoms
It has less GI irritation than nonselective NSAIDs, but GI bleeding is still possible.
Celecoxib Major Risks
Risk Why It Matters
Cardiovascular events Increased risk of MI or stroke
Kidney injury Still affects renal prostaglandins
GI bleeding Lower risk than nonselective NSAIDs, but not zero
Sulfa allergy concern Celecoxib has sulfonamide structureCelecoxib Contraindications / Use Caution
Use caution or avoid in patients with:
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History of MI
History of stroke
Severe cardiovascular disease
Uncontrolled hypertension
Kidney disease
Sulfa allergy
Active GI bleeding
Celecoxib Exam Clue
A patient with arthritis and GI irritation may benefit from celecoxib.
But a patient with MI, stroke, severe cardiovascular disease, or sulfa allergy may not be a good
candidate.
Acetaminophen
Class
Non-opioid analgesic and antipyretic
Prototype
Acetaminophen
Acetaminophen Mechanism Step-by-Step
1. Pain or fever signals occur.
2. Acetaminophen works mainly in the central nervous system.
3. It decreases pain signaling.
4. It lowers fever.
5. It does not strongly reduce peripheral inflammation.
Acetaminophen Uses
Acetaminophen treats:
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Mild pain
Moderate pain●
Fever
Acetaminophen does not significantly treat inflammation.
Acetaminophen vs NSAIDs
Feature NSAIDs Acetaminophen
Pain relief Yes Yes
Fever reduction Yes Yes
Anti-inflammatory effect Yes No/minimal
GI bleeding risk Higher Lower
Platelet inhibition Yes, especially aspirin No
Main toxicity GI bleeding, kidney injury Liver toxicity
Acetaminophen Major Danger
The major toxicity is:
Hepatotoxicity
Too much acetaminophen can cause severe liver injury.
Acetaminophen Toxicity Exam Clues
Watch for:
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Right upper quadrant pain
Jaundice
Dark urine
Nausea/vomiting
Elevated AST/ALT
History of taking multiple cold, flu, or pain products
Alcohol use
Acetaminophen Antidote
The antidote for acetaminophen overdose is:
N-acetylcysteineMemory trick:
Acetaminophen attacks the liver. Acetylcysteine saves the liver.
Acetaminophen Patient Teaching
Teach the patient to:
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Avoid exceeding the recommended daily dose.
Avoid alcohol.
Check all medication labels.
Avoid taking multiple products containing acetaminophen.
Report jaundice.
Report dark urine.
Report right upper quadrant abdominal pain.
Opioid Agonists
Class
Opioid agonists
Prototypes
Drug Must-Know Point
Morphine Classic opioid agonist
Fentanyl Very potent opioid
Oxycodone Common oral opioid
Hydromorphone Potent opioid
Codeine Weaker opioid; pain/cough
Methadone Long-acting opioid
Opioid Mechanism Step-by-Step
1. Patient has moderate to severe pain.
2. Opioid agonist binds to opioid receptors, especially mu receptors.
3. Pain transmission decreases.4. Pain perception decreases.
5. The emotional response to pain decreases.
6. CNS activity slows.
7. Respiratory drive can slow.
8. GI motility slows.
Opioid Therapeutic Uses
Opioids are used for:
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Moderate to severe pain
Postoperative pain
Trauma pain
Cancer pain
Palliative pain control
Severe acute pain
Major Opioid Adverse Effects
Adverse Effect Exam Importance
Respiratory depression Most dangerous
Sedation Fall risk, CNS depression
Constipation Very common
Nausea/vomiting Common
Urinary retention Especially post-op or older adults
Orthostatic hypotension Fall risk
Miosis Pinpoint pupils
Tolerance Need for higher doses over time
Dependence Withdrawal riskOpioid Safety Rule
Opioids slow the body down.
Body System Effect
Brain Sedation
Lungs Respiratory depression
GI tract Constipation
Bladder Urinary retention
Blood vessels Orthostatic hypotension
Pupils Miosis/pinpoint pupils
Opioid Overdose Classic Triad
The classic opioid overdose triad is:
1. Respiratory depression
2. Pinpoint pupils
3. Decreased level of consciousness
Opioid Overdose Exam Clue
If the patient has:
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Respiratory rate 6/min
Unresponsiveness
Pinpoint pupils
Recent opioid use
Think:
Opioid overdose → support airway/breathing → naloxone.
When to Hold or Question an Opioid
Hold or question the opioid if the patient has:
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Very low respiratory rate●
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Severe sedation
Oxygen saturation dropping
Unstable hypotension
Concurrent alcohol use
Concurrent benzodiazepine use
Signs of opioid toxicity
Opioid Patient Teaching
Teach the patient to:
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Avoid alcohol.
Avoid benzodiazepines unless prescribed.
Do not drive until effects are known.
Change positions slowly.
Increase fiber and fluids if appropriate.
Use stool softeners or laxatives as prescribed.
Do not crush extended-release tablets.
Store opioids safely.
Keep opioids away from children.
Fentanyl
Class
Opioid agonist
Must-Know Point
Fentanyl is very potent.
Fentanyl Patch Safety
Teach the patient to:
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Do not apply heat over the patch.
Remove the old patch before applying a new one.
Apply only as prescribed.
Dispose of patches safely.
Avoid cutting the patch.
Avoid using in opioid-naive patients unless specifically prescribed.Why Heat Is Dangerous
Heat increases fentanyl absorption.
Increased absorption can cause overdose and respiratory depression.
Methadone
Class
Long-acting opioid agonist
Uses
Methadone may be used for:
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Chronic pain
Opioid use disorder treatment
Methadone Must-Know Risks
Risk Why It Matters
Respiratory depression Can be delayed/prolonged
Accumulation Long half-life
QT prolongation Dysrhythmia risk
Drug interactions Can increase toxicity
Agonist-Antagonist Opioids
Class
Agonist-antagonist opioids
Prototype
ButorphanolButorphanol Mechanism Step-by-Step
1. Butorphanol acts like an opioid at some receptors.
2. It blocks or partially blocks opioid effects at other receptors.
3. It can provide pain relief.
4. In opioid-dependent patients, it can displace full opioid agonists.
5. This can trigger withdrawal symptoms.
Butorphanol Uses
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Pain relief
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Sometimes migraine-related pain depending on setting
Butorphanol Major Adverse Effects
Effect Exam Meaning
Sedation Fall/CNS depression risk
Dizziness Safety risk
Nausea Common
Respiratory depression Possible
Withdrawal Can occur in opioid-dependent
patients
Butorphanol Exam Clue
If a patient chronically takes morphine, oxycodone, fentanyl, hydromorphone, or methadone and
receives butorphanol, monitor for withdrawal.
Withdrawal symptoms may include:
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Anxiety
Sweating
Cramping
Tachycardia
Nausea
RestlessnessOpioid Antagonist
Class
Opioid antagonist
Prototype
Naloxone
Naloxone Mechanism Step-by-Step
1. Patient has opioid toxicity.
2. Opioids are attached to opioid receptors.
3. Naloxone competes for those receptors.
4. Naloxone blocks the opioid effect.
5. Respiratory depression improves.
6. Sedation improves.
7. Pain may return.
8. Withdrawal may occur.
Naloxone Uses
Naloxone is used for:
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Opioid overdose
Opioid-induced respiratory depression
Emergency opioid reversal
Naloxone Major Exam Point
Naloxone may wear off before the opioid wears off.
Therefore, the patient can become sedated again.
This is called recurrent respiratory depression.After Naloxone, Monitor
Monitor:
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Respiratory rate
Oxygen saturation
Level of consciousness
Blood pressure
Heart rate
Return of sedation
Withdrawal symptoms
Naloxone Adverse Effects
Effect Why It Happens
Acute withdrawal Opioid effect is rapidly blocked
Agitation Sudden reversal
Nausea/vomiting Withdrawal response
Sweating Withdrawal response
Tachycardia Sympathetic activation
Pain returns Opioid analgesia is blocked
Adjuvant Pain Medications
Adjuvant medications are not traditional painkillers, but they help treat specific pain types.
They are especially useful for:
Neuropathic pain
Neuropathic Pain Exam Clues
Neuropathic pain is described as:
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Burning
Shooting
Tingling
Electric shock●
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Pins and needles
Numbness with pain
Examples include:
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Diabetic neuropathy
Postherpetic neuralgia
Nerve injury pain
Tricyclic Antidepressant
Class
Tricyclic antidepressant
Prototype
Amitriptyline
Amitriptyline Mechanism Step-by-Step
1. Patient has chronic or nerve-related pain.
2. Pain signals travel through the nervous system.
3. Amitriptyline increases norepinephrine and serotonin activity.
4. These neurotransmitters help suppress pain pathways.
5. Pain signaling decreases.
Amitriptyline Uses
Amitriptyline may be used for:
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Neuropathic pain
Chronic pain syndromes
Depression
Migraine prevention in some cases
Amitriptyline Major Adverse Effects
Category Symptoms
Anticholinergic effects Dry mouth, blurry vision, constipation, urinary retention
CNS effects Sedation, drowsinessCardiovascular effects Orthostatic hypotension, dysrhythmias
Other Weight gain
Safety concern Dangerous in overdose
Amitriptyline High-Risk Patients
Use caution in patients with:
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Older age
Fall risk
Glaucoma
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BPH
Urinary retention
Cardiac disease
Dysrhythmia history
Overdose risk
Other sedating medications
Amitriptyline Patient Teaching
Teach the patient to:
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Take at bedtime if sedating.
Change positions slowly.
Use sugar-free gum or candy for dry mouth.
Increase fiber and fluids if appropriate.
Report urinary retention.
Report palpitations or fainting.
Do not stop abruptly unless directed.
Understand that pain relief may take time.Anticonvulsants
Class
Anticonvulsants
Prototype
Gabapentin
Gabapentin Mechanism Step-by-Step
1. Nerves become overactive or irritated.
2. The patient feels burning, shooting, or electric pain.
3. Gabapentin decreases abnormal nerve firing.
4. Excitatory neurotransmitter release decreases.
5. Neuropathic pain decreases.
Simple memory:
Gabapentin calms overactive nerves.
Gabapentin Uses
Gabapentin is used for:
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Neuropathic pain
Diabetic neuropathy
Postherpetic neuralgia
Nerve injury pain
Seizure disorders
Gabapentin Major Adverse Effects
Effect Exam Meaning
Drowsiness CNS depression
Dizziness Fall risk
Ataxia Unsteady gait
Fatigue CommonPeripheral edema Swelling
Increased sedation with opioids/alcohol/benzodiazepines Safety concern
Gabapentin Patient Teaching
Teach the patient to:
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Avoid alcohol.
Avoid other CNS depressants unless prescribed.
Do not drive until effects are known.
Change positions slowly.
Report severe dizziness or unsteady gait.
Do not stop abruptly.
Taper if discontinuing.
Use caution with kidney disease.
Amitriptyline vs Gabapentin
Feature Amitriptyline Gabapentin
Class Tricyclic antidepressant Anticonvulsant
Main pain use Neuropathic pain Neuropathic pain
Major side effects Anticholinergic, sedation, cardiac toxicity Dizziness, drowsiness, ataxia
Dangerous issue Cardiac toxicity in overdose CNS depression and falls
Exam clue Dry mouth, constipation, urinary retention Nerve pain + dizziness/ataxia
Serotonin Receptor Agonists: Triptans
Class
Serotonin receptor agonists, also called triptans
Prototype
Sumatriptan
Sumatriptan Mechanism Step-by-Step1. Patient has a migraine.
2. Migraine pathways activate cranial blood vessels and trigeminal nerve signaling.
3. Sumatriptan stimulates serotonin receptors.
4. Cranial blood vessels constrict.
5. Migraine-associated inflammation decreases.
6. Pain signaling decreases.
7. Migraine symptoms improve.
Sumatriptan Uses
Sumatriptan is used for:
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Acute migraine attacks
Cluster headaches in some cases
It is not used for general pain.
Sumatriptan Major Adverse Effects
Effect Exam Meaning
Chest tightness/pressure May indicate cardiac concern
Tingling Common
Flushing Common
Dizziness Safety risk
Drowsiness Safety risk
Hypertension Vasoconstriction effect
Serotonin syndrome risk Especially with serotonergic meds
Coronary vasospasm Dangerous in heart disease
Sumatriptan Contraindications / Use Caution
Avoid or question sumatriptan in patients with:
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Coronary artery disease
History of myocardial infarction
History of stroke
History of TIA●
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Uncontrolled hypertension
Peripheral vascular disease
Hemiplegic migraine
Basilar migraine
Recent ergotamine use
Sumatriptan Patient Teaching
Teach the patient to:
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Take early during migraine symptoms.
Report chest pain or severe chest pressure.
Avoid taking with ergotamine within 24 hours.
Avoid overuse.
Tell the provider about heart disease, stroke history, or uncontrolled hypertension.
Report symptoms of serotonin syndrome, such as agitation, sweating, fever, tremor, or
confusion.
Ergot Alkaloids
Class
Ergot alkaloids
Prototype
Ergotamine
Ergotamine Mechanism Step-by-Step
1. Patient has a migraine.
2. Migraine-related blood vessel dilation and nerve signaling occur.
3. Ergotamine acts on serotonin and vascular receptors.
4. Blood vessels constrict strongly.
5. Migraine pain may decrease.
6. Excessive vasoconstriction can reduce blood flow too much.
Ergotamine Uses
Ergotamine is used for:
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Acute migraine treatmentIt is generally more toxic and less selective than triptans.
Ergotamine Major Adverse Effects
Effect Exam Meaning
Nausea/vomiting Common
Severe vasoconstriction Major danger
Numbness/tingling Possible poor blood flow
Cold extremities Possible ischemia
Hypertension Vascular constriction
Chest pain Emergency concern
Muscle pain Possible ischemia
Ergotamine Contraindications
Avoid ergotamine in patients with:
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Pregnancy
Coronary artery disease
Peripheral vascular disease
Uncontrolled hypertension
Stroke history
Severe kidney disease
Severe liver disease
Sepsis
Recent triptan use
Ergotamine Pregnancy Warning
Ergotamine is contraindicated in pregnancy because it can cause uterine contractions and reduce
fetal blood flow.Sumatriptan vs Ergotamine
Feature Sumatriptan Ergotamine
Class Triptan Ergot alkaloid
Main use Acute migraine Acute migraine
Mechanism Selective serotonin receptor agonist Less selective vasoconstrictor
Main danger Vasoconstriction/cardiac risk Severe
vasoconstriction/ischemia
Avoid in CAD/HTN Yes Yes
Avoid in pregnancy Use caution/usually avoid unless
directed
Contraindicated
Do not combine within
24 hr
Ergotamine Triptans
Rapid Exam Identification Table
Exam Clue Most Likely Answer
Pain + inflammation + fever NSAID
Blocks COX-1 and COX-2 First-generation NSAID
GI bleeding, ulcers, kidney injury NSAID toxicity
Antiplatelet effect Aspirin
Child with viral illness Avoid aspirin
Tinnitus after salicylate use Aspirin toxicity
Strong NSAID for short-term pain Ketorolac
Selective COX-2 inhibitor Celecoxib
Less GI risk but more cardiovascular risk CelecoxibPain + fever but no inflammation Acetaminophen
Liver toxicity Acetaminophen
Antidote is N-acetylcysteine Acetaminophen overdose
Moderate to severe pain Opioid agonist
Pinpoint pupils + respiratory depression Opioid overdose
Reversal agent for opioid overdose Naloxone
Can cause acute withdrawal Naloxone or butorphanol
Mixed opioid agonist-antagonist Butorphanol
Burning/shooting nerve pain Gabapentin or amitriptyline
Dry mouth, constipation, urinary retention Amitriptyline
Dizziness, drowsiness, ataxia Gabapentin
Acute migraine Sumatriptan or ergotamine
Migraine drug unsafe in CAD/HTN Sumatriptan or ergotamine
Migraine drug contraindicated in pregnancy Ergotamine
Severe vasoconstriction/ischemia ErgotamineMust-Know Safety Priorities
Most Dangerous Adverse Effects by Drug/Class
Drug/Class Most Dangerous Effect
NSAIDs GI bleeding, renal injury
Aspirin Bleeding, Reye syndrome in children with viral illness
Ketorolac GI bleeding and renal injury with prolonged use
Celecoxib Cardiovascular events
Acetaminophen Hepatotoxicity
Opioid agonists Respiratory depression
Butorphanol Withdrawal in opioid-dependent patient
Naloxone Recurrent respiratory depression after it wears off
Amitriptyline Cardiac toxicity, anticholinergic effects
Gabapentin CNS depression, falls
Sumatriptan Coronary vasospasm, hypertension
Ergotamine Severe vasoconstriction, ischemia, pregnancy risk
Must-Know Antidotes / Reversal Agents
Problem Antidote / Treatment
Opioid overdose Naloxone
Acetaminophen overdose N-acetylcysteine
Must-Know Patient Teaching Summary
NSAIDs
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Take with food.
Avoid alcohol.●
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Report black stools or vomiting blood.
Avoid taking multiple NSAIDs together.
Use caution with anticoagulants.
Report decreased urine output.
Acetaminophen
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Avoid alcohol.
Do not exceed the recommended dose.
Check labels for hidden acetaminophen.
Report jaundice, dark urine, or right upper quadrant pain.
Opioids
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Avoid alcohol and sedatives.
Do not drive until effects are known.
Take measures to prevent constipation.
Change positions slowly.
Do not crush extended-release forms.
Store safely.
Naloxone
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Emergency reversal of opioid overdose.
Patient must still be monitored after improvement.
Repeat doses may be needed.
Amitriptyline
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Take at bedtime if sedating.
Expect dry mouth, constipation, and drowsiness.
Change positions slowly.
Report urinary retention or palpitations.
Gabapentin
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May cause dizziness and drowsiness.
Fall precautions are important.
Avoid alcohol/CNS depressants.
Do not stop suddenly.Sumatriptan
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Take early during migraine.
Report chest pain or severe pressure.
Avoid if history of CAD, stroke, or uncontrolled HTN.
Do not combine with ergotamine within 24 hours.
Ergotamine
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Avoid in pregnancy.
Report chest pain, cold extremities, numbness, or severe muscle pain.
Avoid with triptans within 24 hours.
Avoid in cardiovascular or vascular disease.
Memory Tricks
NSAIDs
NSAIDs = No Stomach And Injured kidney Drugs
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Stomach bleeding
Kidney injury
Bleeding risk
Inflammation relief
Acetaminophen
A-CET = Affects Central pain/Fever, Endangers The liver
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Pain relief
Fever reduction
No major anti-inflammatory effect
Liver toxicity
Opioids
Opioids slow everything.
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Slow brain = sedation
Slow breathing = respiratory depression
Slow bowels = constipation
Slow bladder = urinary retention●
Slow blood pressure response = orthostatic hypotension
Naloxone
Naloxone knocks opioids off receptors.
But it can wear off before the opioid wears off.
Amitriptyline
Amitriptyline = Anti-cholinergic TCA
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Dry mouth
Blurry vision
Constipation
Urinary retention
Sedation
Cardiac risk
Gabapentin
Gabapentin calms nerve sparks.
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Helps burning/shooting nerve pain
Causes dizziness, drowsiness, and ataxia
Triptans and Ergots
Migraine meds squeeze vessels.
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Good: helps migraine
Bad: unsafe in CAD, stroke history, uncontrolled HTN, vascular diseaseExam Checklist
Before the exam, make sure you can answer these:
NSAIDs
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What do NSAIDs block?
What is the difference between COX-1 and COX-2?
Why do NSAIDs cause GI bleeding?
Why do NSAIDs harm the kidneys?
Why is aspirin avoided in children with viral illness?
Why is ketorolac short-term only?
Celecoxib
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Why does celecoxib have less GI toxicity?
Why can celecoxib increase cardiovascular risk?
What allergy matters with celecoxib?
Acetaminophen
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What does acetaminophen treat?
What does it not treat well?
What organ is damaged in overdose?
What is the antidote?
Opioids
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What is the biggest danger of opioids?
What are the signs of opioid overdose?
What should be monitored before giving opioids?
Why do opioids cause constipation?
Butorphanol
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Why can butorphanol cause withdrawal?
Which patients are at risk?
Naloxone
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What does naloxone reverse?●
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Why may repeated dosing be needed?
What symptoms can occur after naloxone?
Amitriptyline
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What type of pain does it help?
What are anticholinergic side effects?
Why is overdose dangerous?
Gabapentin
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What type of pain does it help?
What are the major CNS side effects?
Why are fall precautions important?
Sumatriptan
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What condition does it treat?
Why is it unsafe in CAD or uncontrolled HTN?
What should not be taken within 24 hours of sumatriptan?
Ergotamine
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What condition does it treat?
Why is it dangerous in pregnancy?
What are signs of excessive vasoconstriction?