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26 Cards in this Set
- Front
- Back
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Pain
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- the psychologic mechanisms involved in the pain response are complex
- the sensation of peripheral pain begins in afferent neurons called nociceptors - nociceptors are activated by chemical mediators such as prostaglandins, histamine, bradykinin, and serotonin |
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Drugs used to treat mild/mod pain, inflammation, fever
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- salicylates
- NSAIDs - para-aminphenol derivitave |
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NSAIDS
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- used as anti-inflammatory drugs
but also as analgesics - prototype drug: ibuprofen |
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Salicylates
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- used in managing simple headaches to acute myocardial infarction
- prototype drug: aspirin/acetylsalicylic acid |
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Aspirin: Core Drug Knowledge
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Pharmacotherapeutics
- Treat mild-to-moderate pain d/t inflammation, prevent platelet aggregation Pharmacokinetics ♣ Absorbed in the stomach & sm. Intestines ♣ highly protein bound Pharmacodynamics ♣ Fever: inhibited PGE2 synthesis in the hypothalamus ♣ Inflammation: peripheral inhibition of prostaglandin ♣ Antiplatelet: irreversible inhibition of thromboxane A2 ♣ Pain Contraindications and precautions ♣ Hypersensitivity, peptic ulcer disease/bleeding disorders, gout, renal & liver impairement, asthma, >60yrs. & children with illness ♣ Avoided by smokers ♣ Not to be given if on anticoagulation Drug interactions ♣ Other drugs that are highly protein bound ♣ Antiplt, Antacids, Corticosteroids, ibuprofen Adverse effects ♣ GI problems (N/V, ab. Pain, ulcerations), bleeds, hypersensitivity reactions, ototoxcitiy ♣ Salicylism ♣ HA, tinnitus, GI distress, paresthesias, increased R.R., drowsy, confused ♣ Reduce dose/stop drug therapy ♣ Salicylate poisoning: life threatening emergency ♣ Lethal dose=10-30g |
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Aspirin: Core Patient Variables
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Health status
♣ Assess for contraindications to therapy. ♣ Baseline hearing ♣ Hx of H. pylori infectionsGI complications ♣ CBC, plt. count, renal/hepatic func. Life span ♣ Caution in people >60yrs Lifestyle, diet, and habits ♣ Assess use of OTC medications. ♣ Alcohol/drug abuse ♣ smoking |
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Aspirin: Planning & Interventions
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Maximizing therapeutic effects
♣ Give with milk or food to decrease GI upset. ♣ When giving aspirin for its cardiovascular properties, use uncoated aspirin. Minimizing adverse effects ♣ Use of proton pump inhibitor ♣ Lab tests |
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Aspirin: Teaching, Assessment & Evaluations
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Patient and family education
♣ Teach proper administration of medication. ♣ Discuss side effects of therapy. Ongoing assessment and evaluation ♣ Monitor the patient who is taking aspirin for signs and symptoms of GI distress or bleeding, anemia, hepatotoxicity, and renal failure. |
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Drugs closely related to aspirin
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- diflunisal
- salsalate |
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NSAIDs
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♣ The NSAIDs are grouped by chemical classes.
♣ NSAIDs all inhibit COX and prostaglandin synthesis. ♣ All NSAIDs carry a Black Box warning stating that they increase the risk of MI and stroke. ♣ Prototype drug: ibuprofen. |
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Ibuprofen: Core Drug Knowledge
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Pharmacotherapeutics
♣ Arthritis, mild-to-moderate pain, primary dysmenorrhea, migraine headache, and fever. Pharmacokinetics ♣ Absorbed from the GI system. ♣ Absorption is slower with food. ♣ Highly protein bound Pharmacodynamics ♣ Inhibited synthesis or release of prostaglandins. ♣ Higher doses needed for anti-inflammatory effect ♣ Antipyretic action based on hypothalmus action Contraindications and precautions ♣ GI disease, anemia, fluid retention ♣ Smokers, regular consumers of alcohol ♣ Cardiac or cerebrovascular ♣ >60yrs Adverse effects ♣ GI problems: Stomach diseases ♣ PUD & gastritisGI bleeding ♣ GI upset & bleeding, hepatotoxicity, and acute renal failure. Increase risk of CVA or MI with prolonged use. ♣ Blurred vision, tinnitus ♣ Dizzy drowsy, N/V/D, heartburn Drug interactions ♣ Similar to those of salicylates. ♣ Not to be given with salicylates= increased risk of A. E. |
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Ibuprofen: Core Patient Variables
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Health status
♣ Hypersensitivty, MI/stroke, ulcers/bleeds, asthma, nasal polyps, baseline hearing Life span and gender ♣ >60 may have increased risk of A. E. esp. GI bleed ♣ men metabolized faster Lifestyle, diet, and habits ♣ OTC use, smoking Environment ♣ Keep in cool dry place to preserve potency |
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Ibuprofen: Planning and Interventions
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♣ Maximizing therapeutic effects
♣ Give with milk or food to decrease gastric distress. ♣ Minimizing adverse effects ♣ Closely monitor patients with pre-existing medical conditions or drug therapy that may interact with ibuprofen. |
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Ibuprofen: Teaching Assessment, Evaluations
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♣ Patient and family education
♣ Teach patient about cardiovascular risk from medication. ♣ Teach about side effects of drug therapy. ♣ Ongoing assessment and evaluation ♣ Monitor for side effects of therapy. ♣ Therapy is considered effective if the patient is free of fever, pain, or inflammation and is free from adverse effects. |
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Para-aminophenol derivative
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- an analgesic and antipyretic available in the United States.
- Prototype drug: acetaminophen (Tylenol). |
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Acetaminophen: Core Drug Knowledge
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Pharmacotherapeutics
♣ Used to treat fever or mild pain. ♣ Has NO anti-inflammatory effect ♣ Used in pt. w/ hypersen. to ASA or NSAIDs, intolerance to GI effects, or pts on anticoagulants Pharmacodynamics ♣ Analgesic & antipyretic effects from inhibiting prostaglandin synthesis in the CNS. ♣ No effect on plt aggregation Contraindications and precautions ♣ Hepatic disease, viral hepatitis, or alcoholism ♣ Cautious w/ preexisting anemia Adverse effects ♣ Generally well tolerated; overdose of medication can be fatal (acetylcysteine) ♣ Most common Adverse effects: ♣ Most serious A.E.: Drug interactions ♣ Activated charcoal, antacids, ethanol, warfarin |
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Acetaminophen: Core Patient Variables
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Health status
♣ Assess pain level and current medical conditions. Life span and gender ♣ Pregnancy drug of choice (no antiplt activity) ♣ Lifestyle, diet, and habits ♣ Ask about other OTC medication use. ♣ Alcohol/drug abuse (risk of hepatotoxicity) Environment ♣ Determine patient’s understanding of drug use. |
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Acetaminophen: Planning & Interventions
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Maximizing therapeutic effects
♣ Acetaminophen can be administered without regard to meals. Minimizing adverse effects ♣ Assess patients for medical conditions that contradict the use of acetaminophen. ♣ Coordinate periodic CBC, and liver and renal function tests for patients on long-term therapy. |
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Acetaminophen: Teaching, Assessment & Evaluations
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Patient and family education
♣ Teach patient to take medication as prescribed. ♣ Teach side effects of medication. ♣ Instruct that many OTC medications contain Tylenol. Ongoing assessment and evaluation ♣ Monitor patient for side effects from the medication. ♣ Therapy is considered effective if patient is free of fever and pain. |
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Migraine Headache
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♣ It is postulated that migraine begins when intracranial blood vessels dilate.
♣ This dilation stimulates the trigeminovascular system, resulting in abnormally excitable neurons that send pain impulses to the brain’s pain receptors. |
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Two major types of migraine headache
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♣ Migraine with aura
♣ Migraine without aura |
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Serotonin-Selective Drugs
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♣ Serotonin-selective drugs are used to relieve pain and inflammation related to migraine headache.
♣ They are not useful for other types of headache or inflammation that occur elsewhere in the body. ♣ These drugs are also known as “triptans” because the generic name of these drugs ends as such. ♣ The triptans are considered first-line drugs for the treatment of acute migraine headache. ♣ Prototype drug: sumatriptan (Imitrex). |
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Sumatriptan: Core Drug Knowledge
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Pharmacotherapeutics
♣ Acute migraine headache and cluster headache. Pharmacokinetics ♣ Administered orally, intranasally, or subcutaneously. Metabolized in the liver and excreted by the kidneys. Pharmacodynamics ♣ Selective for 5-HT1B/1D receptors located on cranial blood vessels and sensory nerves of the trigeminovascular system. ♣ Stimulation of these receptors results in vasoconstriction. Contraindications and precautions ♣ Coronary artery disease and ischemic cardiac diseases Adverse effects ♣ Coronary artery vasospasm, cardiac dysrhythmias angina, myocardial ischemia, and dizziness Drug interactions ♣ Selective serotonin reuptake inhibitors and monoamine oxidase inhibitors |
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Sumatriptan: Core Patient Variables
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Health status
♣ Assess the characteristics of the headache. Lifestyle, diet, and habits ♣ Identify trigger factors for headaches. Environment ♣ Given in the outpatient setting. |
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Sumatriptan: Planning & Interventions
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Maximizing therapeutic effects
♣ Confirm diagnosis of type of headache the patient is having. ♣ Administer drug as soon as headache begins. Minimizing adverse effects ♣ Assess the patient for a history of cardiovascular or cerebrovascular disorder. ♣ After administering sumatriptan, monitor for signs and symptoms of vasospasm and allergy. |
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Sumatriptan: Teaching, Assessment & Evaluations
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♣ Patient and family education
♣ Teach how to take medication properly. ♣ Teach side effects of medication. ♣ Teach patient to identify triggers. ♣ Ongoing assessment and evaluation ♣ Evaluate patients taking sumatriptan for the cessation of headache and for signs and symptoms of vasospastic events. |
