Ch. 14 Nonopioid Analgesics:Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Migraine Headache Medication
ecchymosis
bruise-like subcutaneous hemorrhage
Drugs used in the treatment of migraine headaches
Drugs used to treat migraine head-aches are given (1) prophylactically to prevent the spasms or (2) to treat the acute pain when a migraine occurs. The mecha-nism of action and classication of the drugs to prevent migraine headaches are different from those used to treat the acute pain of the migraine attack. Prophylactic treatment may include drugs from the following categories: beta (β) blockers (see Chapter 25), calcium channel blockers (see Chapter 35), antidepres-sant medications (see Chapter 22), or anticonvulsant drugs (see Chapter 29). The selective serotonin (5-HT) agonists used to relieve the acute pain are covered in this chapter and are listed in the Summary Drug Table: Nonsteroidal Anti-Inammatory Drugs and Migraine Medications.
NSAIDS(Adverse reactions G.I)
-Nausea,vomiting,dyspepsia -Anorexia,dry mouth -Diarrhea,constipation -Epigastric pain,indigestion,abdominal distress or discomfort,bloating -Intestinal ulceration ,stomatitis -Jaundice
NSAIDS(Actions)
Actions:Anti inflammatory effects,thought to inhibit prostaglandin synthesis by blocking the action of the enzyme cyclooxygenase,an enzyme responsible for prostaglandin synthesis.Also thought to inhibit the activity of two related enzymes cyclooxygenase-1 and cycloozygenase-2
Drugs used in the treatment of migraine headaches(Adverse Reactions Cardiovascular system)
Coronary artery vasospasm Cardiac Arrhythmias and tachycardia Myocardial infarction
Cyclooxygenase-1-an enzyme that helps to maintain the stomach lining (COX-1) Cyclooxygenase-2 an enzyme that triggers pain and inflammation (COX-2)
Cyclooxygenase-1-an enzyme that helps to maintain the stomach lining (COX-1) Cyclooxygenase-2 an enzyme that triggers pain and inflammation (COX-2)
NSAIDS(Metabolic/Endocrine System adverse Reactions)
Decreased appetite,weight increase or decrease,flushing sweating, menstrual disorders,vaginal bleeding,hyperglycemia or hypoglycemia(high or low blood sugar)
NSAIDS(Adverse reactions CNS )
Dizziness,anxiety,lightheadedness,vertigo,headache,drowsiness,somnolence,insomnia,confusion,depression,stroke,psychic disturbances
polyuria
increased urination
Stomatitis
infammation of a cavity opening such as the oral cavity
Pain assesment
location and intensity
referred pain
pain felt in an area remote from the site of origin possibly along the same dermatome
dymenorrhea
painful cramping during mestruation
dysuria
painful or difficult urination
Drugs used in the treatment of migraine headaches(Contraindications and Precautions)
patients with ischemic heart disease (such as angina or myocardial infarction), transient ischemic attacks (TIAs), or uncontrolled hypertension or those patients tak-ing monoamine oxidase inhibitor (MAOI) antidepressants. These drugs should be used cautiously in patients with hepatic or renal function impairment, such as the elderly or patients requiring dialysis. Because these are pregnancy category C drugs, they should only be used during preg-nancy when the benefit outweighs the risk to the fetus. Caution should be exercised when administering them to lactating mothers.
NSAIDS(Adverse reactions Integumentary system)
rash,erythema(redness),irritation,skin eruptions,ecchymosis(subcutaneous hemorrhage),purpura(excessive skin hemorrhage causing red-purple patches under the skin) Exfoliative dermatitis ,stevens johnson syndrome
oliguria
reduced urine output
Populations at higher risk for poor pain assesment
Infants and children,older adults especially cognitive impaired,developmentally disabled children and adults,those with communication problems such as limited english proficiency or limited health literacy,those unable to communicate due to the illness or treatment process
Drugs used in the treatment of migraine headaches(Interactions)
Interacting drug :Cimetidine used for decreased gastric secretions interacting w/serotonin will increase the effectiveness ofthe 5-HT agonist Interacting drug:oral contraceptives used for birth control increase the effectivness of the 5-HT agonist
NSAIDS (Hematologic System adverse reactions)
Pancytopenia(reduction in blood cell components),thrombocytopenia(reduced platelet count) Neutropenia(abnormally few neutrophils),eosinophilia(low eosinophil count ),leukopenia (reduced white blood cell count),agranulocytosis(reduced granulocyte count) Aplastic anemia
NSAIDS (Interactions)
Pg.153
NSAIDS(Adverse reactions renal system)
Polyuria,dysuria,oilguria ,hematuria(blood in urine),cystitis,elevated blood urea nitrogen (BUN),acute renal failure in those with impaired renal function
Drugs used in the treatment of migraine headaches(Actions and uses)
Selective serotonin drugs are used for the relief of moderate to severe pain and inammation related to migraine headaches. Because reduced GI motility can happen during a migraine event, delayed absorption of oral drugs may occur and alternative routes of administration are needed: rectal, internasal, or subcutaneous injection.
NSAIDS (Precautions)
The NSAIDs should be used cautiously during pregnancy (pregnancy category B), by older adults (increased risk of ulcer formation in patients older than 65 years), and by patients with bleeding disorders, renal disease, cardiovascu-lar disease, or hepatic impairment.
NSAIDS(Adverse reactions sensory and other reactions)
taste change,rhinitis(runny nose),tinnitus(ringing in the ears) Visual disturbances,blurred or diminished vision,diplopia(double vision),swollen or irritated eyes,photophobia(sensitivity to light), reversible loss of color vision,thirsty,fever,chills,vaginitis
Transient ischemic attack (TIA)
temporary interference with blood supply to the brain causing symptoms related to the portion of the brain affected (temporary blindness,aphasia,dizziness,numbness,difficulty swallowing,or paresthesias); may last a few moments to several hours after which no residual neurologic damage is violent.
Jaundice
yellow discoloration of the skin due to liver disease
Pain intensity Scales
*Look up figure 14.1 pg.152 ch,14
Pain Assessment Guidelines
*Patients subjective description of the pain(What does the pain feel like *location of the pain *Intensity,Severity and duration *Any factors that influence the pain *Quality of the pain *Patterns of coping *Effects ofprevious therapy(if applicable) *Nurses observations of patients behavior
Barriers to Assessment and Treatment
*Primary health care providers do not prescribe proper pain medicine doses *Nurses do not administer adequate medication for relief of pain *Patients do not report accurate levels of pain
NSAIDS(Contraindications)
*Cross-sensitivity to other NSAIDS, meaning if px. is allergic to one NSAID there is an increased risk of an allergic reaction with any other NSAID. in general, NSAIDs are contraindicated during the third trimester of pregnancy and during lactation. Some NSAIDs are not used to treat rheumatoid arthritis or osteoar-thritis; these include ketorolac, mefenamic, and meloxicam. Celecoxib is contraindicated in patients who are allergic to sulfonamides or have a history of cardiac disease or stroke. Ibuprofen is contraindicated in those who have hypertension, peptic ulceration, or GI bleeding.
NSAIDS(USES)
Uses:treatment of pain associated with musculoskeletal disorders such as osteoarthritis and rheumatoid arthritis -Mild to moderate pain -Primary dysmenorrhea(menstrual cramps) -Fever(reduction)
Phenylketonuria(PKU)
a genetic birth defect causing the amino acid phenylalanine to build up to toxic levels in the body
NSAIDS(Advers Reactions cardiovascular reactions)
decrease or increase in blood pressure congestive heart failure, cardiac arrhythmias,myocardial infarction
cyclooxygenase
enzyme responsible for prostaglandin synthesis; contributes to integrity of stomach lining,pain, and inlammation
purpura
excessive skin hemorrhage causing red-purple patches under the skin
5th vital sign
inclusion of pain inquiry when temperature pulse, respirations , and blood pressure readings are taken