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69 Cards in this Set
- Front
- Back
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Nociocepters |
pain receptors found in joints, soft tissues, arteriole walls, skin and the periosteum |
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Action of Analgesic Antipyretic Anti-Inflammatory Drugs |
inhibit the formation of prostaglandins in inflamed tissues, preventing the stimulation of pain |
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acetylsalicylic acid (Aspirin) |
-Use: mild-moderate pain, fever, inflammation, -decrease risk of thrombus -Inhibts: COX 1 and 2 -Adverse Effects: stomach irritation and bleeding; increase risk of gastric ulceration |
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Nursing Implications of Aspirin |
-Toxicity -avoid OTC meds that contain ASA -must stop use 2 wks prior to invasive procedure -take w/ food and fluids -highly bound to albumin -DO NOT give to children -watch for sign of bleeding -Increase effects w/ ETOH, anticoags, opioids, steroids |
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acetaminophen (Tylenol) |
-Use: antipyretic and analgesic -may cause GI problems -additive effect w/ opioids -adverse effects: liver failure w/ high doses and nephrotoxcicity w/ overdose |
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Ofirmev |
IV form of aceaminophen given postop to decrease the use of opioids |
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Mucomyst |
given orally when someone is suspected of an acetaminophen overdose |
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Nursing Implications for acetaminophen (Tylenol) |
- widely used/over used so READ LABELS! - less than 4 g/d - DOC for children w/ fever, elderly w/ poor renal fx, and pregnant women - alternate acetaminophen w/ ibuprophen for children w/ fever - DO NOT use for >10/d - avoid ETOH consumption - hepatotoxic
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What two drugs are considered Nonsteriodal Anti-Inflammatory Drugs (NSAIDs)? |
- ibuprophen (Advil, Mortin) - naproxen (Aleve, Naprosyn) |
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ibuprophen (Advil, Motrin) |
- Use: fever, pain, inflammation, arthritis, menstrual cramps - less GI upset compared to Aspirin |
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indomethacin (Indocin) |
perscription strength ibuprophen -strong anti-inflammatory - higher risk of side effects |
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Nursing Implacations of ibuprophen |
-Toxicity -avoid OTC meds that contain ASA -must stop use 2 wks prior to invasive procedure -take w/ food and fluids -highly bound to albumin -DO NOT give to children -watch for sign of bleeding -Increase effects w/ ETOH, anticoags, opioids, steroids |
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naproxen (Aleve, Naprosyn) |
NSAIDS |
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ketorolac (Toradol) |
- Use: severe pain - Route: IV - Duration: 5 days - Side Effect: produces bleeding
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celecoxib (Celebrex) |
- Cox 2 inhibitor - block prostaglandins associated w/ pain & inflammation w/o GI upset or bleeding - BLACK BOX WARNING:increased risk of adverse cardiovascular event, GI bleeding w/ long term use |
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black box warnings |
- added after a significant number of serious adverse effects have been reported; often issued after several years on market |
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allopurinol (Zyloprim) |
- Anti-gout drug - Prevents uric acid formation
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What is Gout? |
- the body's inability to metabolize uric acid - S/S: hyperuricemia (>6mg/dl), severe pain, inflammation, edema in musculoskeletal system - Deposits usually in big toe or ear
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colchicine |
- gout drug prototype - anti-inflammatory that prevents gout attacks |
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Nursing Implications for anti-gout agents |
- obtain baseline serum levels - monitor uric acid levels - give w/ food - increase fluid to 3,000 mL/d to prevent stones - rest and immobilize effected area - avoid alcohol (ETOH) - eat a low purine diet |
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pregabalin (Lyrica) |
- decreases number of pain signals sent out by damaged nerves - Use: neuropathic pain, fibromyalgia, partial seizures - Adverse effects: tiredness, dizziness, nausea, vomitting |
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How do Opioid Analgesics work? |
- stimulate opiate receptors and bind to receptors in CNS to inhibit the ascending nerve pathway - Receptors: Mu, Kappa, Delta
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What are Opioid Analgesics used for? |
- Use: severe to moderate acute pain, terminal cancers, MI, burns, trauma, postop - mainly for acute pain - Schedule II: well absorbed orally - PO: significant 1st pass (high dosages) - Contraindications: allergy, increase ICP, resp problems, dependence, tolerance/addiction |
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Adverse effects of Opioids |
- sedation - respiratory depression - postural hypotesnsion - flushing - nausea/vomitting - constipation - urinary retention - pupil constriction |
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Morphine |
- opioid prototype - Route: Po, IM, IV, SQ, IT, epidural - Effects: 15-20 mins for IV and 60 mins for Po |
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What are the 2 oral forms of morphine? |
- Roxanal - MS Contin |
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What are the uses/routes for fentanyl? |
- anesthesia - transdermal (chronic/terminal pain) - epidural and IT drug of morphine - sucker form for young children |
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What is the half life for transdermal fentanyl? |
- long half life - works for 72 hours and 24 hours after patch removal - HIGHLY ABUSED! |
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oxycodone (OxyContin) |
-popular drug to abuse - Combined with ASA: Percodan - combined w/ acetaminophen: Percocett |
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hydromorphone (Dilaudid) |
- 10x more powerful than morphine - always given in small dosages |
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propoxyphene (Darvon) |
- another form of opioid - combined w/ acetaminophen: Darvocet; NO LONGER ON THE MARKET! |
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Codine |
- usually w/ acetaminophen - 3 drugs to know: - hyrdocodone (Vicodan, Norco) - meperidine (Demerol) - tramadol (Ultram)
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hydrocodone (Vicodan, Norco) |
- codine + acetaminophen - Viodan contains 500 mg of acetaminophen - Narco contains 325 mg of acetaminophen |
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meperidine (Demeral) |
- synthetic form of codine - not commonly used in acute care - may cause tremors, hallucinations and seizures (toxic amounts) |
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tramadol (Ultram) |
- synthetic form of codine - low potential for abuse - may use for chronic pain |
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Nursing implications for Opioids |
- MONITOR FOR SEDATION - alternate w/ non-narcotics - no alcohol - do NOT drive or operate machines, NO smoking - consitipation is common - IR vs SR - may use in PCA pumps -unlikely to cause addiction w/ acute pain |
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Opioid Antagonist Drugs |
- Use: reverse or block anesthesia, reverse CNS and resp depression from narcotics - Compete w/ opioids for receptor sites in brain - Adverse effects: Increase BP, HR, resp and return of pain |
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naloxone (Narcan) |
- Opioid Antagonsit Drug - produces withdrawal symptoms - repeated injections may be needed - small dosage may be ordered to reverse urinary retention but NOT reverse pain effects |
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butorphanol (Stadol) and nalbuphine (Nubain) |
- Opioid Agonist/Antagonist Drug - reduced potential for abuse - DO NOT give to someone who has taken opioid analgesics - may produce withdrawal symptoms in those that are opioid dependent |
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methadone (Dolophine) |
- Use: opioid addiction and cancer pain - longer acting than morphine - prolonged half life - 24 hour dosage - high potential for abuse - must wean off |
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octreotide (Sandostatin) |
- Hypothalmic/ Anterior Pituitary Hormone Drug - Action: inhibits growth hormone release - Use: acromegaly, carcinoid tumors, antidiarrheal - given prior to surgery or when surgery is not and option |
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cosyntropin (Cortrosyn) |
- Hypothalmic/ Anterior Pituitary Hormone Drug - Action: stimulates secretion of cortisol - Use: test for adrenal sufficiency (Addison's Disease) |
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somatropin (Humatrope) |
- Hypothalmic/ Anterior Pituitary Hormone Drug - Use: Promote growth in children - given 3x/wk IM |
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Nursing Implications for Hypothalmic/ Anterior Pituitary Hormone Drugs |
- Inappropriate use of growth hormones - use for anti-aging - link between growth hormone and tumor growth - monitor height growth |
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vasopressin (Pitressin) |
- Posterior Pituitary Drug - synthetic antidiuretic hormone - Use: severe hypotension, shock, diabetes insipidus - Monitor: water intoxication, chest pain, MI, high BP, abdominal craps |
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oxytocin (Pitocin) |
- posterior pituitary drug - use: induce labor, control postpartum bleeding, simulates milk production on mothers - Monitor: uterine rupture; HR & BP (mom and baby), contractions |
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What are corticosteroids? |
- Hormones that are produced by the adrenal glads - maintain homeostasis |
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What are the 3 corticosteroids drugs? |
- methylprednisolone (Solu-Medrol) - form: IV - prednisone (Deltasone) - form: po - dexamethasone (Decadron) - form: po, IV
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What are the uses of Corticosteroids? |
- anti-inflammatory - immunosuppressent - anti-allergic - anti- stress |
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Adverse effects of Corticosteroids |
- only controls symptoms - for short term treatment - many drug interactions - Adverse effects: moon face, obese trunk w/ thin extremities, hyperglycemia, psychosis, osteoporosis, paper thin skin, slow healing - Monitor: blood glucose in long term use |
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Nursing implications of corticosteroids |
- taper dose over several weeks - abrupt stoppage can cause acute adrenocortical insufficency - long term use: body image issues, osteoporosis - give w/ food - increase risk for infection
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What is the action and use of thyroid agents? |
- stimulate metabolism and cardiac function - replace what the thyroid can not produce - Use: hypothyroidism and myxedema coma |
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What are the 2 thyroid drugs? |
- levothyroxine (Synthroid) - lipthyronine (Cytomel) |
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What 2 routes can thyroid agents be given? |
- po - IV
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What are the adverse effects of thyroid agents? |
- NONE unless given in the inappropriate doses - use caution in elderly |
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Nursing implications for thyroid agents |
- monitor pulse and BP - withhold if HR > 100 bpm - take in AM prior to breakfast - monitor weight - life long treatment - DO NOT take w/ iron or calcium - DO NOT switch brands - monitor thyroid function
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What are antithyroid drugs used for? |
- hyperthyroidism - thyroid crisis |
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What are the actions of antithyroid drugs? |
- suppress thyroid hormone and prevent conversion of T4 and T3 |
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propythiouracil (PTU) |
- blocks thyroid hormone synthesis - long time until therapeutic effects (3-12 weeks) - 6 to 12 months before optimum levels are reached |
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Radioactive Iodine (sodium iodide 131) |
- emits beta and gamma rays to destroy the thyroid tissue - will have to start hormone replacement |
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Strong Iodine solution (Lugol's solution) and Potassium iodine (SSKI) |
- iodine solutions - non- radioactive iodine that stops thyroid hormone production - should NOT be taken with PTU or radioactive iodine - can reverse the effects of the solutions |
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What are the adverse effects of antithyroid drugs? |
- hypothyroidism - iodine toxicity - agranulocytosis |
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Nursing implications for antithyroid drugs |
- monitor pulse, BP and weight - mix iodine in full glass of liquid, drink w/ straw, metallic taste - iodine toxicity (S/S: abd pain, vomitting, diarrhea, glottis edema) - Radioactive iodine causes hypothyroidism and will require lifelong thyroid hormone replacement |
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What is the treatment for hypocalcemia? |
- calcium supplement + vitamin D - calcium carbonate (Os-Cal) - calcium gluconate (IV form) |
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What are the drugs used to treat osteoporosis? |
- alendronate (Fosamax) - raloxigene (Evista) - calcitonin |
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alendronate (Fosamax) |
-biophosphates - inhibits osteoclasts - must sit up for 30 mins after taking - monitor for swallowing issues - may cause cancer
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raloxigene (Evista) |
- selective estrogen receptor modulator - BLACK BOX WARNING: risk for PE/stroke, especially w/ cardiac history |
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calcitonin |
-injectable or nasal spray |
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phosphate salt (Neutra-Phos) |
- Used to treat hypercalcemia - inhibits intestinal absorption of calcium - increases deposition of calcium in the bones |
