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Ati flash cards 04, medications for pain and inflammation

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Ati flash cards 04, medications for pain and inflammation

  1. 1. Pain and Inflammation (General Key Points) N203 ATI (Unit 4) Pain & Inflammation -
  2. 2. · Analgesics relieve pain · Narcotics / NSAIDs / Antimigraine agents · Anti-inflammatory medications relieve inflammation · Salicylates / Glucocorticoids / Antigout / Disease-modifying antirheumatics drugs (DMARDs) · Some are antipyretic (salicylates, ibuprofen) · Salicylates and NSAIDs reduce platelet aggregation · Salicylates, NSAIDs, and glucocorticoids pose risk for ulceration · Acetaminophen has analgesic and antipyretic properties but not anti-inflammatory. It poses a risk for liver injury
  3. 3. NSAIDs (Medication List) N203 ATI (Unit 4) Pain & Inflammation -
  4. 4. · Aspirin · Ketorolac (Toradol) · Celecoxib (Celebrex) · Valdecoxib (Bextra) · Ibuprofen · Indomethacin · Naproxen · · ·
  5. 5. NSAIDs N203 ATI (Unit 4) Pain & Inflammation -
  6. 6. Expected Action: Proto: aspirin, ibuprofen, ketorolac, celecoxib · Cyclooxygenase inhibition – COX 2  inflammation, COX 1   platelet agg. Therapeutic Uses: · Inflammation suppression / analgesia /  fever · dysmenorrhea / suppression of platelet aggregation Adverse Effects: · GI discomfort, aspirin induced ulceration and bleeding (use misoprostol as prophylaxis, and/or PPI and/or H2-receptor agonist  risk of ulceration) · Renal dysfunction · Reye syndrome (in kids with viral illnesses) · Salicylism (tinnitus, resp. alkalosis, dizziness) Contraindications/Precautions: · Peptic ulcers / bleeding disorders / hypersensitivity / pregnancy / kids ĉ viral inf. Interactions: · Glucocorticoids ( gastric bleeding) – use antiulcer · Warfarin ( bleeding) prophylactic like misoprostol (Cytotec) to prevent · EtOH ( bleeding) · Ibuprofen ( antiplatelet effects of low-dose aspirin) Education: · Give with food or milk to reduce GI discomfort. · If can’t tolerate 1st generation, give 2nd generation (celecoxib)
  7. 7. Ketorolac (Toradol) N203 ATI (Unit 4) Pain & Inflammation -
  8. 8. Expected Action: Proto: ketorolac (Toradol) – 1st generation NSAID ·  pain without anti-inflammatory effect Therapeutic Uses: · Short-term treatment of moderate to severe pain (post-op) · Enhances opioid analgesia without opioid adverse effects Adverse Effects: · Can occur when used with other NSAIDs. · GI bleeding / blood dyscrasias Contraindications/Precautions: · Give no more than 5 days Interactions: · Other NSAIDs / anticoagulants ( bleeding) Education: · Usually started parenteral and then transition to oral dose
  9. 9. Acetaminophen N203 ATI (Unit 4) Pain & Inflammation -
  10. 10. Expected Action: · Slows production of prostaglandins Therapeutic Uses: · Analgesic and antipyretic Adverse Effects: · Max 4 g daily · Acute liver toxicity · Antidote: acetylcysteine (Mucomyst) Contraindications/Precautions: · Interactions: · EtOH   risk to liver / Warfarin   levels of warfarin Education: ·
  11. 11. Opioid Agonists N203 ATI (Unit 4) Pain & Inflammation -
  12. 12. Therapeutic Uses: Proto: morphine, fentanyl, meperidine, methadone, codeine, oxycodone · Moderate to severe pain / Sedation /  bowel motility / Cough suppression Adverse Effects: · Respiratory depression · Sedation · Constipation · Orthostatic Hypotension · Urinary retention · Biliary colic · Cough suppression · Emesis Contraindications/Precautions: · Increases cardiac workload · Meperidine metabolites are neurotoxic  (< 600 mg/24hr, < 48 hours) Interactions: · CNS depressants (barbiturates, phenobarbital, benzodiazepines, EtOH) · Anticholinergics, antihistamines, tricyclic antidepressant  anticholinergic effects · MAOIs (hyperpyrexia, seizures) · Antihypertensives Education: · Withhold if RR<12 · Have naloxone (Narcan) and resuscitation · Infuse IV slowly over 4-5 minutes equipment available.
  13. 13. Opioid Antagonists N203 ATI (Unit 4) Pain & Inflammation -
  14. 14. Expected Action: Proto: naloxone (Narcan), naltrexone, nalmefene · Competitively interfere with opioid actions Therapeutic Uses: · OD treatment · Reversal of opioid effects Adverse Effects: · Tachycardia / Tachypnea · Abstinence syndrome (cramping, hypertension) Contraindications/Precautions: · Hypersensitivity · Dependency · Pregnancy: B Interactions: · Education: · Naloxone has extensive first-pass modification · Observe for w/d symptoms or abrupt onset of pain
  15. 15. Adjuvant Pain Medications (Medication List) N203 ATI (Unit 4) Pain & Inflammation -
  16. 16. · Tricyclic Antidepressants (TCA).........................Amitriptyline (Elavil) · Anticonvulsant..............................................Carbamazepine (Tegretol) · ............................................................................................................. Gabapentin (Neurontin) · ............................................................................................................. Phenytoin (Dilantin) · CNS Stimulants.............................................Methylphenidate (Ritalin) · ............................................................................................................. Dextroamphetamine (Dexedrine) · Antihistamines....................................................Hydroxyzine (Vistaril) · Glucocorticoids...........................................Dexamethasone (Decadron) · ............................................................................................................. Prednisone (Deltasone) · Bisphosphonates...................................................Etidronate (Didronel) · ............................................................................................................. Pamidronate (Aredia)
  17. 17. Adjuvant Medications N203 ATI (Unit 4) Pain & Inflammation -
  18. 18. Therapeutic Uses: Proto: TCAs, Anticonvulsants, CNS stimulants, Antihistamines, Glucocorticoids, Bisphosphonates · Enhance opioid effects thereby permitting lower opioid doses · Alleviate other symptoms that aggravate pain · Treat neuropathic pain Adverse Effects: · TCAs (neuropathic pain)  Orthostatic hypotension, sedation, anticholinergic effects · Anticonvulsants (neuropathic pain)  Bone marrow suppression · CNS stimulants  Weight loss, insomnia · Antihistamines  Sedation · Glucocorticoids ( ICP, nerve compression)  Adrenal insufficiency  Glucose intolerance  Hypokalemi a  Osteoporosi s  GI Ulcers · Bisphosphonate (CA bone pain)  Flu-like symptoms  Injection site irritation
  19. 19. Antigout Medication N203 ATI (Unit 4) Pain & Inflammation -
  20. 20. Expected Action: Proto: Colchicine, indomethacin, allopurinol, probenecid · Colchicine/Indomethacin:  inflammation by preventing leukocyte infiltration · Allopurinol: Inhibits production of uric acid · Probenecid: Inhibits reabsorption of uric acid by renal tubules Therapeutic Uses: · Colchicine/Indomethacin: Acute gout attacks · Allopurinol/Probenecid: Hyperuricemia · Probenecid: Prolongs effects of penicillins and cephalosporins Adverse Effects: · Colchicine: GI toxicity · Others: GI discomfort · Probenecid: Renal injury (get 2-3L fluid/day) Contraindications/Precautions: · Colchicine: Pregnancy (C/D), renal, cardiac, elderly Interactions: · Salicylates: η probenecid · Warfarin:  warfarin metabolism in liver  bleeding risk Education: Avoid EtOH, purines. Adequate hydration.
  21. 21. Migraine Medications (Medication List) N203 ATI (Unit 4) Pain & Inflammation -
  22. 22. · Ergot Alkaloids....................................................Ergotamine (Ergostat) · Serotonin Receptor Agonists................................Sumatriptan (Imitrex) · Beta-Blockers........................................................Propanolol, Atenolol · Anticonvulsants..................................................Divalproex (Depakote) · Tricyclic Antidepressants.....................................Amitriptyline (Elavil) · Calcium Channel Blockers.....................................................Verapamil · Estrogens.........................................................................Alora, Climara · Triptans.....................................................Almotriptan, Naratriptan, etc · · · · · · ·
  23. 23. Ergot Alkaloids N203 ATI (Unit 4) Pain & Inflammation -
  24. 24. Expected Action: Proto: Ergotamine, ergotamine + caffeine · Prevent inflammation and dilation of the intracranial blood vessels Adverse Effects: · GI discomfort  administer metoclopramide (Reglan) · Ergotism (muscle pain, paresthesia)  stop medication · Physical dependence · Abortion Contraindications/Precautions: · Renal or liver dysfunction / sepsis / CAD / pregnancy Interactions: · Sumatriptan (Imitrex)  can lead to spastic rxn of blood vessels Education: ·
  25. 25. Serotonin Receptor Antagonists N203 ATI (Unit 4) Pain & Inflammation -
  26. 26. Expected Action: Proto: Sumatriptan (Imitrex), almotriptan (Axert) · Prevent inflammation and dilation of the intracranial blood vessels Adverse Effects: · Chest symptoms (not dangerous, self-resolving) · Coronary vasospasm/angina · Teratogenic Contraindications/Precautions: · Pregnancy, hypertension, cardiac disease, CAD Interactions: · Triptans & Ergot Alkaloids  spastic reaction of blood vessels · MAOIs  Concurrent use leads to MAOI toxicity (space 2 weeks apart) Education: ·
  27. 27. Beta-Blockers N203 ATI (Unit 4) Pain & Inflammation -
  28. 28. Expected Action: Proto: Metoprolol, atenolol · Prevent inflammation and dilation of the intracranial blood vessels Adverse Effects: · Tiredness, fatigue · Depression · Asthma exacerbation · Contraindications/Precautions: · Interactions: · Education: ·
  29. 29. Anticonvulsants N203 ATI (Unit 4) Pain & Inflammation -
  30. 30. Expected Action: Proto: Divalproex (Depakote) · Prevent inflammation and dilation of the intracranial blood vessels Adverse Effects: · Neural tube defects Contraindications/Precautions: · Interactions: · Education: ·
  31. 31. TCAs N203 ATI (Unit 4) Pain & Inflammation -
  32. 32. Expected Action: Proto: Amitriptyline (Elavil) · Prevent inflammation and dilation of the intracranial blood vessels Adverse Effects: · Anticholinergic effects: dry mouth, constipation, urinary retention, tachycardia Contraindications/Precautions: · Interactions: · Education: ·
  33. 33. Calcium Channel Blocker N203 ATI (Unit 4) Pain & Inflammation -
  34. 34. Expected Action: Proto: Verapamil · Prevent inflammation and dilation of the intracranial blood vessels Adverse Effects: · Orthostatic hypotension · Constipation Contraindications/Precautions: · Interactions: · Education: ·
  35. 35. Medications for Rheumatoid Arthritis (Medication List) N203 ATI (Unit 4) Pain & Inflammation -
  36. 36. DMARDs · Cytotoxic medications.................................methotrexate (Rheumatrex) · Gold salts.......................................................................aurothioglucose · Antimalarial agents..............................hydroxychloroquine (Plaquenil) · Sulfasalazine..........................................................................Azulfidine · Biologic Response Modifiers...................................etanercept (Enbrel) · ............................................................................................................. infliximab (Remicade) · Penicillamine.............................................................Cuprimine, Depen Others · Glucocorticoids......................................................................prednisone · Immunosuppressants..........................................................Cyclosporine · NSAIDs....................................................................................naproxen · ............................................................................................................. celecoxib
  37. 37. Rheumatoid Arthritis Meds (Adverse Effects) N203 ATI (Unit 4) Pain & Inflammation -
  38. 38. · Cytotoxics:  Hepatic fibrosis / Marrow suppression / GI ulceration / fetal death or abnormality · Gold salts:  Toxicity, renal toxicity, blood dyscrasias, hepatitis, GI discomfort · Antimalarials:  Retinal damage · Sulfasalazine:  GI discomfort / hepatic dysfunction / marrow suppression · Bio Response Modifiers:  Injection-site irritation · Penicillamine:  Marrow suppression · Glucocorticoids:  Osteoporosis (vit D, Ca2+, bisphosphonate)  Adrenal suppression  GI discomfort

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