Medications for Pain &   Inflammation        ATI 4.2      Senior Class
Learning Objectives•   Assess/monitor a need for pain med•   Plan and provide care to meet the client’s need for pain inte...
Key Points Analgesics are meds that relieve pain  Narcotics  NSAIDs  Anti-migraine agents Anti-inflammatory agents ar...
Key Points• Certain anti-inflammatory meds have properties that reduce fever  (antipyretic) such as salicylates and ibupro...
NSAIDsExpected Action:  Inhibition of cyclooxygenase: COX-2 inhibition   results in      inflammation, pain & fever  I...
NSAIDsTherapeutic Uses:  Inflammation suppression  Analgesia for mild to moderate pain  Fever reduction  Dysmenorrhea...
NSAID’s Selective Protoype:   1st generation NSAIDs (COX-1 & COX-2 Inhibitors):   aspirin ASA   2nd generation NSAIDs ...
NSAIDs Side/Adverse Effects:   GI (dyspepsia, abd pain, heartburn, N)   Aspirin-induced gastric ulcer, perforation & bl...
NSAIDs• Interventions & Education   – Stop aspirin 1 week before an elective surgery or expected date of     childbirth   ...
NSAIDsEvaluation of Effectiveness  Reduction in inflammation  Reduction of fever  Relief from mild to moderate pain or...
AcetaminophenSelective Prototype: TylenolExpected Action:  Slows the production of prostaglandins in the CNSTherapeuti...
Acetaminophen Side/Adverse Effects:  Acute toxicity—liver damage w/NVD, sweating, abd   discomfort progressing to liver ...
Acetaminophen Intervention & Education    Keep a running total of daily intake    Follow recommended dosage as prescrib...
Opioid AgonistSelective Prototype:  Morphine SulfateOther Meds:  fentanyl (Sublimaze, Duragesic)  meperidine (Demerol...
Opioid Agonist• Expected Action:• Act on mu receptors & to a lesser degree on  kappa receptors• Activation of mu produces ...
Opioid AgonistTherapeutic Uses  Relief of moderate to severe pain   (postop, MI, cancer)  Sedation  Reduction of bowel...
Opioid Agonist Side/Adverse Effects:  Respiratory depression  Constipation  Orthostatic hypotension  Urinary retentio...
Opioid Agonist• Contraindications:    Biliary tract surgery    Premature Infants    Asthma, Emphysema and/or head injur...
Opioid Agonists Interactions: Meds & Food  Barbiturates  Phenobarbital  Benzpdiazepine  Alcohol  Benadryl  TCA—Elav...
Opioid Agonists• Interventions & Education:       Assess pain regularly & document response       Baseline vitals if RR ...
Opioid Agonists• Evaluation & Effectiveness  Relief of moderate to severe pain  Cough suppression  Resolution of diarrhea
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
Medications for pain & inflammation
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Medications for pain & inflammation

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Medications for pain & inflammation

  1. 1. Medications for Pain & Inflammation ATI 4.2 Senior Class
  2. 2. Learning Objectives• Assess/monitor a need for pain med• Plan and provide care to meet the client’s need for pain interventions• Assess/monitor effectiveness of pain intervention• Advocate for the client’s needs• Provide appropriate client education• Reinforce client teachings regarding the purposes & possible effects of pain meds• Assess/monitor client for expected effects of meds• Assess/monitor client for side/adverse effects of meds• Assess/monitor client for actual/potential specific food & med interactions• Identify contraindications, actual/potential incompatibilities & interactions between meds---intervene appropriately• Identify symptoms/evidence of an allergic reaction---respond appropriately• Evaluate/monitor and document the therapeutic and adverse/side effects of meds• Assess/collect data regarding client’s med use over time
  3. 3. Key Points Analgesics are meds that relieve pain Narcotics NSAIDs Anti-migraine agents Anti-inflammatory agents are meds that reduce inflammation Salicylates Glucocorticoids Anti-gout meds Disease-modifying anti-rheumatic drugs (DMARDs)
  4. 4. Key Points• Certain anti-inflammatory meds have properties that reduce fever (antipyretic) such as salicylates and ibuprofen• Salicylates and NSAID’s reduce platelet aggregation and can be used to reduce a client’s risk of thrombosis. This anti-platelet effect can also pose a greater risk for bleeding and requires careful monitoring of clients• Salicylates, NSAIDs, glucocorticoids pose the risk for gastric ulceration• Acetaminophen (Tylenol) has analgesic and antipyretic effects, does not have anti-inflammatory effects, and does not reduce platelet aggregation• Tylenol overdose poses a risk for severe injury to the liver• Prolonged use of narcotic analgesic, such as morphine and/or meperidine (Demerol) may result in: – Tolerance – Physical dependence – Addiction
  5. 5. NSAIDsExpected Action: Inhibition of cyclooxygenase: COX-2 inhibition results in  inflammation, pain & fever Inhibition of COX-1 results in the  of platelet aggregation
  6. 6. NSAIDsTherapeutic Uses: Inflammation suppression Analgesia for mild to moderate pain Fever reduction Dysmenorrhea Low level suppression of platelet aggregation
  7. 7. NSAID’s Selective Protoype: 1st generation NSAIDs (COX-1 & COX-2 Inhibitors): aspirin ASA 2nd generation NSAIDs (selective COX-2 Inhibitors): celecoxib (Celebrex) Other Meds – 1st generation: ibuprofen (Motrin, Advil), naproxen (Naprosyn), ketorolac (Toradol) – 2nd generation: Valdecoxib (Bextra)
  8. 8. NSAIDs Side/Adverse Effects: GI (dyspepsia, abd pain, heartburn, N) Aspirin-induced gastric ulcer, perforation & bleeding Weight gain, urine output, BUN & creatinine levels Salicylism (tinnitus, sweating, headache & dizziness, resp. alkalosis Reye syndrome (occurs w/children in whom aspirin are used to reduce fever who have viral illness like chicken pox or influenza Interactions: Meds & Food Warfarin Glucocorticoids Alcohol Ibuprofen decrease anti-platelet effect of low-dose aspirin used to prevent MI
  9. 9. NSAIDs• Interventions & Education – Stop aspirin 1 week before an elective surgery or expected date of childbirth – Take aspirin w/food, mild or a full glass of H2O to reduce gastric discomfort – Don’t chew or crush enteric-coated or sustained-release aspirin tablets – Notify primary care provider if signs & symptoms of gastric discomfort or ulceration occur – Client unable to tolerate due to GI ulceration, risk of bleeding, or renal impairment: • Give Celebrex – Toradol is used for short-term treatment of moderate to severe pain like w/postoperative recovery • Provides analegisa w/o anti-inflammatory effect • Used concurrently w/opioids increased effects of opioids w/o occurrence of adverse effects • Used w/other NSAIDs serious adverse effects can occur use no more than 5 days usually start as parenteral administration & then progress to oral doses
  10. 10. NSAIDsEvaluation of Effectiveness Reduction in inflammation Reduction of fever Relief from mild to moderate pain or dysmenorrhea Platelet aggregation suppression
  11. 11. AcetaminophenSelective Prototype: TylenolExpected Action: Slows the production of prostaglandins in the CNSTherapeutic Uses: Analgesic effect Anti-pyretic effect
  12. 12. Acetaminophen Side/Adverse Effects: Acute toxicity—liver damage w/NVD, sweating, abd discomfort progressing to liver failure, coma & death Contraindicated: Use cautiously w/those who consume 3 or more alcoholic drinks/day & taking Warfarin Interactions: Meds & Food Alcohol Warfarin
  13. 13. Acetaminophen Intervention & Education  Keep a running total of daily intake  Follow recommended dosage as prescribed to prevent toxicity  Don’t exceed 4 g/day  If overdose, liver damage can be reduced by administering weight-based dosage of antidote:  Acetylcysteine (Mucomyst) diluted via oroduodenal tube Evaluation & Effectiveness:  Relief of pain  Reduction of fever
  14. 14. Opioid AgonistSelective Prototype: Morphine SulfateOther Meds: fentanyl (Sublimaze, Duragesic) meperidine (Demerol) methadone (Dolophine) codeine oxycodone (OxyContin)
  15. 15. Opioid Agonist• Expected Action:• Act on mu receptors & to a lesser degree on kappa receptors• Activation of mu produces analgesia resp. depression, euphoria & sedation• Activation of kappa produces analgesia, sedation & GI motility
  16. 16. Opioid AgonistTherapeutic Uses Relief of moderate to severe pain (postop, MI, cancer) Sedation Reduction of bowel motility Codeine: cough suppression
  17. 17. Opioid Agonist Side/Adverse Effects: Respiratory depression Constipation Orthostatic hypotension Urinary retention Cough suppression Sedation Emesis, Biliary colic Opioid overdose triad: coma, resp. depression, & pinpoint pupils
  18. 18. Opioid Agonist• Contraindications:  Biliary tract surgery  Premature Infants  Asthma, Emphysema and/or head injuries  Infants and older adults (risk of resp. depression)  Pregnant client risk of physical dependence of the fetus  In labor risk of resp. depression (newborn) & inhibition of labor by decreasing uterine contraction  Extremely Obese greater risk for prolonged side effects due to accumulation of med metabolized @ slower rate  IBD due to risk of megacolon or paralytic ileus  Enlarged prostate due to risk of Acute Urinary Retention  REPEATED USE OF DEMEROL results sin accumulation of normeperidine which can result in seizures and neurotoxicity  Don’t administer more than 600 mg/24 hr of Demerol & limit its use to less than 48 hr.
  19. 19. Opioid Agonists Interactions: Meds & Food Barbiturates Phenobarbital Benzpdiazepine Alcohol Benadryl TCA—Elavil amitriptyline Additive anticholinergic agents MAOI Anti-hypertensives
  20. 20. Opioid Agonists• Interventions & Education:  Assess pain regularly & document response  Baseline vitals if RR < 12/min notify PCP & withhold  Follow controlled substances procedures  Double check opioid doses w/another nurse 1st  Administer opioids IV slowly over a period of 4 to 5 mins have naloxone (Narcan) & resuscitation equip. available  Warn client not to dose w/o consulting PCP  Administer opioids on fixed regular schedule around the clock to cancer clients & supplemental doses PRN  Advise client w/physical dependence not to discontinue abruptly taper & withdraw slowly over 3 days  Closely monitor PCA settings & reassure client of its safety but mainly to use prior to activities  Switching to Oral Dose ensure client receive PCA up to the onset of oral med  Parenteral Duragesic is used primarily in surgery to induce anesthesia 100 x > potent than morphine  With 1st fentanyl will take many hours to achieve desired effect give short acting opioids prior to onset of therapeutic effect & for breakthrough pain
  21. 21. Opioid Agonists• Evaluation & Effectiveness Relief of moderate to severe pain Cough suppression Resolution of diarrhea

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