210 pharm

Topical Anesthetics

  • Definition: Topical anesthetics are medications applied to the skin or mucous membranes to numb the area and decrease pain sensation.

  • Examples: Lidocaine is a common topical anesthetic.

  • Key Use: Provides no pain or decreases sensitivity to pain.

Inflammation

  • Key Characteristics of Inflammation:
      - Redness (alternatively referred to as Dreadness)
      - Swelling
      - Pain
      - Warmth

  • Page Reference: For more details, see Table 24.1 on page 279.

  • Inflammation Phases:
      - Vascular Phase: Occurs within 10 to 15 minutes after injury, characterized by vasodilation and leukocyte infiltration.
      - Delayed Phase: Following the vascular phase.

Chemical Mediators and Enzymes

  • Prostaglandins:
      - Chemical mediators involved in inflammation, isolated from exudate (drainage from an inflammatory site).

  • Cyclooxygenase (COX) Enzymes:
      - COX-1: Protects the stomach lining and regulates blood platelets.
      - COX-2: Triggers inflammation and pain.

  • Aspirin and Its Mechanisms:
      - Inhibits prostaglandin biosynthesis.
      - Affects hypothalamic temperature regulation and helps with platelet aggregation.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

  • NSAIDs Classifications:
      - Nonselective NSAIDs: Inhibit both COX-1 and COX-2 (e.g., Aspirin, Ibuprofen).
      - Selective NSAIDs: Primarily inhibit COX-2 (e.g., Celecoxib).

  • Common NSAID Use Cases:
      - Pain relief in inflammatory conditions (e.g., osteoarthritis, rheumatoid arthritis).
      - Antipyretic effect: used to reduce fever.
      - Analgesic properties: relieve pain.

  • Aspirin:
      - Oldest anti-inflammatory used for analgesia and antipyresis.
      - Commonly used nowadays for blood thinning rather than pain relief.

Side Effects and Precautions

  • Common Side Effects of Aspirin:
      - Dizziness, headache, nausea, abdominal pain, loss of appetite (anorexia), confusion, sweating (diaphoresis), agitation, lethargy, gastritis, vomiting, itching (pruritus), rash, dehydration.

  • Adverse Reactions:
      - Potentially life-threatening issues, e.g., hemolytic anemia, thrombocytopenia, renal or hepatic failure, pulmonary edema, Stevens-Johnson syndrome, GI bleeding, ulcers, and perforation.

  • Cautions:
      - Avoid use in children with flu-like symptoms due to the risk of Reye syndrome (brain and liver swelling).

Ibuprofen

  • Common Uses: Pain relief for headaches, menstrual pain, osteoarthritis, and rheumatoid arthritis.

  • Action Mechanism: Blocks COX-1 and COX-2, reducing inflammation and relieving pain.

  • Side Effects & Adverse Reactions: Similar to those of aspirin, including renal toxicity and risk for GI bleeding.

Gout and Medications

  • Gout Definition: An inflammatory condition characterized by deposits of uric acid crystals in joints, commonly affecting the big toe.

  • Causes: Urinary excretion deficits or overproduction of uric acid.

  • Medications for Gout:
      - Allopurinol: Inhibits xanthine oxidase to decrease uric acid production.
      - Dietary Recommendations: Increase fluid intake, avoid alcohol, organ meats, and high-purine foods.

  • Side Effects and Adverse Reactions: Gastrointestinal upset, renal impairment, and liver reactions.

Acetaminophen (Tylenol)

  • Use Cases: Reduces pain and fever but lacks anti-inflammatory properties of NSAIDs.

  • Dosage Information: Maximum recommended dose is 4000 mg per day, though limiting to 2000 mg is advised for frequent users to avoid hepatotoxicity.

  • Potential Side Effects: Nausea, constipation, and headache.

  • Life-Threatening Effects: Hepatic failure and renal toxicity.

Opioid Analgesics

  • Definition: Strong pain relievers derived from opium; used for moderate to severe pain.

  • Common Drugs: Morphine, codeine.

  • Mechanism of Action: Binds to opiate receptors in the CNS to modify pain perception.

  • Side Effects: Drowsiness, constipation, respiratory depression, hypotension, and potential for dependence.

  • Monitoring: Respiratory rate, consciousness level, and pain levels.

  • Antidotes: Naloxone (Narcan) is used to reverse opioid overdoses.

Patient Controlled Analgesia (PCA)

  • Definition: Allows patients to self-administer prescribed doses of pain medication via an IV or pump system.

  • Mechanism: A lockout mechanism prevents overdosing by limiting the frequency of administration.

Nursing Interventions & Patient Education

  • For NSAIDs:
      - Monitor for signs of GI distress, educate about potential interactions with other drugs (e.g., anticoagulants).
      - Ensure patients take medications with water or during meals to reduce gastric issues.

  • For Opioids:
      - Observe for respiratory function; assess for sedation, pain relief, vital signs.
      - Educate the patient on the importance of monitoring their substance use and use alternative pain control methods where possible.