NRSG 2100: Unit 6

Colchicine: Potential side effects/adverse

-GI: n/v, diarrhea, abdominal pain

Allopurinol: Nursing Considerations (2)

1. Monitor labs: Kidney & liver function, uric acid level 2. Monitor for symptoms of life-threatening toxicity syndrome -rash -malaise -fever -impaired kidney/liver function

Allopurinol: Side effects/adverse (3)

1. RASH* 2. Blood dyscrasias 2. Hepatotoxicity

Aspirin: Expected Therapeutic effects (5)

1. Reduce pain 2. Decrease inflammation 3. Decrease fever 4. Prevents platelet aggregation 5. Preventing colorectal caner

acetaminophen: Expected therapeutic effects (3)

1. Reduction of fever 2. Reduction of pain 3. Does not reduce inflammation

Ibuprofen: Teaching (4)

1. Report s/s of: -MI -stroke -GI bleeding 2. Do not take other NSAIDs 3. Take with food or milk 4. Do not take if pregnant

Ibuprofen: Contrainindications/caution (3)

1. Severe Renal or hepatic disease 2. PUD, history of GI bleeding, bleeding disorders 3. CAUTION with cardiac disease

Celecoxib: Contraindications (5)

1. Severe hepatic disease 2. chronic kidney disease 3. anemia 4. GI bleeding 5. PUD 6. Post CABG

Goals of anti-gout medications: (3)

1. Stop acute attacks 2. Prevent future attacks 3. Avoid complications (kidney stones)

Allopurinol: Teaching (4)

1. Stop med & notify the provider if you get a rash 2. Increase fluid intake 3. Report decreased urine output or pain w/ urination 4. Take daily to PREVENT gout attacks

Colchicine: Teaching (3)

1. Use this med for ACUTE gout attacks 2. Increase fluid intake 3-4 L/day 3. Avoid purine-rich foods (organ meat, mushrooms, oatmeal, legumes, sardines)

Colchicine: Expected therapeutic effects (2)

1. relieves swelling & associated pain in treatment of ACUTE gout attacks 2. May be used prophylactically

what is the max daily dose of Ibuprofen & ASA?

3200 mg

Allopurinol: MOA

Blocks the action of xanthine oxidase--> prevents formation of uric acid--> lowers serum uric acid levels

Sumatriptan: Potential Interactions

Use with antidepressants & other meds that alter serotonin levels may lead to serotonin syndrome (toxicity)

____________ pain: smooth muscles and organs dull, throbbing, aching

Visceral

Which of the following is NOT a contraindication of aspirin? an elderly woman with a GI bleed a child with a cold a middle-aged man with a fever a pregnant woman in her third trimester

a middle-aged man with a fever

What pain medication is a non-opioid analgesics & NOT a NSAID

acetaminophen

What is celecoxib commonly used for? migraines cancer pain arthritis tooth aches

arthritis

What medication is Nonanalgesic and Nonuricosuric for treatment of gout?

colchicine

Which are TWO drugs used in the treatment of gout? bethanechol colchicine allopurinol tramadol

colchicine allopurinol

Allopurinol: Contraindications/caution

genotype associated with severe cutaneous reactions

NSAIDs achieve their desired effect through....

inhibiting the production of prostaglandins

Which organ is acetaminophen intoxication most damaging to? kidneys heart brain liver

liver

What causes pain & inflammation in Gout?

uric acid and crystals

Persists for more than 6 months. Can be difficult to treat & and interferes with daily activities.

Chronic pain

Ibuprofen: MOA

NSADI; decreases prostaglandin synthesis by inhibiting COX-1 & COX-2

Celecoxib: MOA

NSAID; Inhibits COX-2

Aspirin: MOA

NSAID; Inhibits prostaglandin synthesis by inhibiting enzymes COX-1 & COX-2

Colchicine: Potential Interactions

NSAIDs increase risk of serious GI effects

____________ pain: Injury to nerves burning, shooting, numbing

Neuropathic

Sensory nerve receptors that initiate pain transmission.

Nociceptors

Inflammation: ______________ is prostaglandin irritation of nerve endings and pressure of edema.

Pain

Inflammation:_ ___________ is caused by vasodilation

Redness

Which of the following would NOT be included in the patient teaching about ibuprofen? Report black, tarry stools. Report coffee-ground emesis. Report blood in vomit. Report black hairy tongue.

Report black hairy tongue.

acetaminophen: CAUTION

Sever liver or kidney disease

Colchicine: Contraindications/caution

Severe GI disease

____________ pain: Skeletal muscles, ligaments, & joints. Sharp

Somatic

Sumatriptan: Expected therapeutic effects

Stop migraine at onset

What medication should be taken at onset for therapeutic effects/treatment of a headache?

Sumatriptan

Inflammation: ____________ is plasma leakage into extracellular space.

Swelling

With inflammation, ________ drugs should be used when appropriate to avoid systemic adverse effects.

Topical

A natural response that helps the body fight antigens and heal injuries. It is usually helpful and self-limiting. NOT A DISEASE.

Inflammation

NSAIDs include (5)

1. ASA 2. Ibuprofen 3. Advil 4. Meloxicam 5. Celebrex

acetaminophen: Potential side effects/Adverse (5)

1. Acute liver failure if doses exceed 4000 2. Hepatotoxicity/hepatic coma * 3. Renal failure * 4. Blood dyscrasias 5. Negligable with the recommended dose

Ibuprofen: Expected Therapeutic effects (3)

1. Anti-inflammatory 2. Analgesic 3. Antipyretic

Celecoxib: Expected Therapeutic Effects (2)

1. Anti-inflammatory 2. Analgesic 3. Treats Rheumatoid Arthritis

acetaminophen: Nursing considerations

1. Assess Renal & liver function 2. Be sure to account for all acetaminophen in all meds

Celecoxib: Nursing Considerations

1. Assess: -History of GI bleeding or PUD -Heart disease/stroke 2. Monitor: -CBC, LFTs., BUN, & HTN pts -PT/INR if on warfarin -for edema in CHF & HTN patients

Celecoxib: Teaching (5)

1. Avoid alcohol 2. Report s/s of: -liver dysfunction -GI bleeding -Stroke/MI 3. Do not take pregnant

Sumatriptan: Teaching (5)

1. Avoid triggers 2. Instruct on administration (intranasal, SQ, transdermal) 3. Report. s/s of hypersensitivity or s/s of CV distress 4. Caution with other serotonin meds 5. Do not use if pregnant

Sumatriptan: Contraindications/caution (2)

1. CAD, CV disease, HTN, & CV disease 2. Renal or hepatic disease

Sumatriptan: Potential side effects/adverse (3)

1. CNS:* dizziness, warm or cold sensation 2. CV: coronary artery vasospasm, cardiac arrest 3. Associated with increased risk of MI & CVA

Aspirin: Contraindications/Caution (5)

1. Children that have been exposed to viruses or have cold/flu (Reyes syndrome) 2. Pregnancy 3. Renal/hepatic failure 4. GI bleeding/ulcers 5. Vitamin K deficiency

acetaminophen: Education (4)

1. Contact care provider for fever lasting >3 days 2. Consult with doctor about other OTC meds 3. report s/s of liver dysfunction 4. Max dose: 4000 mg/day

Ibuprofen: Potential Interactions (2)

1. DO NOT TAKE WITH OTHER NSAIDs 2. Increased risk of bleeding when combined with other anticoagulants

Aspirin: Teaching (4)

1. DO NOT administor to children with fever/cold 2. Take with food or enteric coat to decrease gastric irritation 3. Do not crush or chew the enteric coat 4. Stop 7-14 days before surgery

Allopurinol: Expected therapeutic effects (2)

1. Decrease levels of uric acid 2. Gout prevention

Ibuprofen: Side/adverse effects (4)

1. GI effects 2. GI bleeding * ---> increased risk with older adults 3. Increased risk of potentially fatal CV thrombotic events (MI/stroke---BBW) 4. Blood dyscrasias

Aspirin: Side effects/adverse (4)

1. GI effects, heartburn, GI ulceration, or bleeding * 2. Tinnitus (hearing loss) * 3. Blood dyscrasias 4. Hepatotoxicity & nephrotoxicity (long term use)

Celecoxib: Side effects/adverse (3)

1. GI effects: Abdominal pain, heartburn 2. GI adverse: bleeding, ulceration, perforation (BBW) 3. Increased risk of potentially fatal CV thrombotic events (MI, Stroke)---BBW

Sumatriptan: Nursing Considerations (3)

1. Give at onset of. migraine symptoms 2. Provide a non-stimulating environment 3. Monitor for CV adverse effects, s/s of MI/CVA

Colchicine: Nursing Considerations

1. Give with food or milk to minimize GI upset 2. d/c if GI symptoms are severe (toxicity)

acetaminophen: Potential Interactions (2)

1. Increased effect with caffeine 2. Alcohol increases hepatotoxicity

Aspirin: Potential Interactions (2)

1. Increased risk of bleeding with anticoagulants 2. DO NOT TAKE WITH OTHER NSAIDs

Celecoxib: Potential interactions (2)

1. Increased risk of bleeding with oral anticagulants & anti-platelets 2. Increased GI affects with alcohol, steroids, & other NSAIDs

Aspirin: Nursing considerations (4)

1. Know appropriate dose and max daily 2. Assess for bleeding 3. Monitor PT/INR & blood sugar labs 4. Assess for aspirin toxicity or hypersensitivity

Ibuprofen: Nursing considerations

1. Know max daily dose--3200 2. Monitor & report s/s of MI or stroke 3. Assess for bleeding problems, GI bleeding, PUD 4. Monitor kidney function

Sumatriptan: MOA

Activates specific type of serotonin receptors (found intracranial & extracerebral). This causes vasoconstriction & reduced trigeminal pain transmission

Occurs suddenly, short-lived, and responds to treatment. Usually caused by Injury.

Acute pain

Colchicine: MOA

Anti-inflammatory; inhibits the response of leukocytes in inflammation

What is Acetylcysteine used for?

Antidote for acetaminophen OD

Drugs that have the ability to lower body temperature are _________.

Antipyretics

How does sumatriptan work to relieve headaches? It attaches to mu pain receptors. It decreases inflammation. It prevents the formation of prostaglandins. It causes intracranial vasoconstriction.

It causes intracranial vasoconstriction.

Which of the following includes the best description of chronic pain? It persists for more than 6 months. It is short-lived and responds easily to pain therapy. It occurs suddenly. It is always caused by an injury.

It persists for more than 6 months.

NSAIDSs

Drugs used in the treatment of pain, fever, and inflammation.

acetaminophen: MOA

Elevates pain threshold & inhibits pyrogens in the brain (Blocks formation of prostaglandins in the CNS

True or False: Acetaminophen treats inflammation.

False

A systemic response that activates body defenses and inhibits the growth of some microbes. It is a symptom and a sign.

Fever

Increased leukocytes, elevated erythrocyte sedimentation rate (ESR), fever, headache, loss of appetite, lethargy and weakness.

Generalized Inflammation

Caused by increased uric acid production and reduced uric acid secretion by the kidneys.

Gout