pharmacology test 2 Medications Used for Pain
deficiency of serum calcium levels Calcium supplements are used for treatment and prevention of calcium depletion when dietary measures are inadequate or as a result of hypoparathyroism, malabsorption syndromes.
Hypocalcemia-
Bisphosphonates Aldendronate/Fosamax Adverse effects
Hypophosphatemia, transient and mild Abdominal pain Headache Dyspepsia Nausea Constipation Diarrhea
what traditional medications block both cox 1 and 2 enzymes?
Ibuprofen and naproxen
brand name for Sumatriptin
Imitrex
DMARD's:major non biologic
Immunomodulator drugs that specifically or nonspecifically alter the client's immune response.
brand name for propanolol
Inderal
brand name for Indomethacin
Indocin
Generic name for Indocin
Indomethacin
Eletriptan/Relpax is administered via
(oral)
Rizatriptan/Maxalt is administered via
(oral)
Sumatriptin/Imitrex is administered via
(po, subq, nasal, transdermal)
give this agonist/ antagonist medication daily controlled doses in clinic setting Buprenorphine- suboxone, subutex- oral or sublinquil scheduled doses.
Methadone -Maintenance therapy is designed to prevent desire Dose and length of time vary depending on tolerance and length of opioid use. Patients on methadone maintenance need to continue therapy when hospitalized
used in conditions that arise from autoimmune disorders such as Rheumatoid Arthritis or RA. Known for having a slow onset of action and may take several weeks or months to achieve desired effect of reducing joint inflammation. may be used in combination with these or other drugs depending on the stage or severity of the disease. -are useful for their immunosuppressive ability Cancer therapy; Crohn disease and fibromyalgia
DMARDs
Opioid Analgesics have 3 Classifications are based on how they well they bind to receptor sites. these Classifications are?
- agonist -agonist/antagonist -antagonist
your patient sam is being prescribed Ecotrin 5mg PO BID for mild shoulder pain. what adverse affects would you notify Sam about when taking this medication?
-Gastrointestinal (GI) reactions: Gastric upset; heartburn; nausea; vomiting; anorexia; GI bleeding; allergy -Increased bleeding risk -Allergy to salicylates manifested by: Hives, rash, angioedema, bronchospasm, anaphylactic reactions -Monitor for bruising or increased bleeding -Monitor stool for dark tarry appearance or bright red blood
do not administer NSAIDS to patients that have? (contraindications)
-Hypersensitivity or allergy to Aspirin or other NSAID drugs -Peptic ulcer disease -Clients at risk for bleeding or have bleeding disorders -3rd trimester of pregnancy and lactation -Use in post-op pain following CABG -Use with caution during pregnancy, in elderly, clients with bleeding disorders, cardiovascular disease or renal impairment, smokers, clients with asthma, and H.pylori.
Asprin is used for?
-Lower body temperature -Used for mild to moderate pain; reducing elevated body temperature; treating inflammatory conditions; decreasing risk of myocardial infarction; reducing risk of transient ischemic attacks -Used in some OTC combination drugs such as pepto bismol
what to monitor/report for a client receiving opioid analgesics
-Monitoring and managing patient needs -Report significant decrease in the respiratory rate or a respiratory rate of 10 breaths/min or below -Report significant increase or decrease in the pulse rate or a change in the pulse quality -Report significant decrease in blood pressure (systolic or diastolic) or a systolic pressure below 100 mm Hg -Oral forms should be taken with food to minimize GI upset
administer Tylenol cautiously with
-Should avoid taking concurrently with salicylates or NSAID drugs. -Safe for short term use in pregnancy -Caution client that many OTC drugs such as cough and cold remedies contain acetaminophen. May cause blood glucose test to show a false low reading. -Prior to administering assess alcohol use to assess risk for hepatotoxicity recommended that clients who consume alcohol regularly limit use of acetaminophen to 1000-2000 mg daily.
-gout medications May be associated with rash, kidney or liver damage. -Increase fluid intake -Increased bleeding risk if taken with warfarin Long term use associated with Rhabdomyolosis
-gout medications May be associated with rash, kidney or liver damage. -Increase fluid intake -Increased bleeding risk if taken with warfarin Long term use associated with Rhabdomyolosis
this medication should not be used in patients with ischemic heart disease (such as angina or myocardial infarction), transient ischemic attacks (TIAs), or uncontrolled hypertension or those patients taking monoamine oxidase inhibitor (MAOI) antidepressants
5-HT agonists
Normal serum calcium levels
9-10.5 mg/dl
skeletal muscle relaxant contraindications
DO NOT ADMINISTER: Baclofen in muscle spasm caused by rheumatic disorders Cyclobenzaprine in recent MI, cardiac conduction disorders and hyperthyroidism, within 14 days of MAOI's MAOI's are used to manage depression and can cause fever and seizures if given with cyclobenazaprine.
this medication may be given in addition to the long acting forms to treat breakthrough pain for chronic pain management ( opioid analgesics)
A fast-acting form
synthetic opioids medications
Methadone, Meperidine
bind to receptor site and cause a response
Agonist
commonly used in to prevent MI and Stroke in at risk clients
Daily baby aspirin
Usually are synthetic opioids Have lower potential for abuse Less respiratory depression Less analgesia May be used for relief of labor pain Treatment for opioid dependence Can produce withdrawal in clients who are opioid dependent May be used for pain relief for clients with history of opioid dependence
Agonist-Antagonist specifics
or Partial agonist- binds to receptor site but has limited, or weaker response. Also called agonist-antagonist because it may possess properties of an agonist and antagonist.
Agonist/Antagonist
Gout and Anti-gout medications examples
Allopurinol/Zyloprim and Febuxostat/Uloric Colchicine Probenecid -Used to treat and manage acute attacks of gout or in prevention of gout. -Drugs used to treat gout may be used with NSAID's and glucocorticoids to control pain and inflammation.
(Nonopioid Analgesic) Analgesic and antipyretic activity: exact method of action is unknown.No anti-inflammatory action, does not effect platelets aggregation.Used to treat mild to moderate pain; reduce elevated body temperature; manage pain and discomfort—arthritic disorders
Acetaminophen/Tylenol
Non-salicylate Analgesics
Acetaminophen/Tylenol
medication examples of Non-opioid Analgesics
Acetylsalicylic acid/ASA/Aspirin Salicylates
DMARDs (disease modifying anti-rheumatic drugs)
Act by producing immunosuppression and decreases the body's autoimmune response. Slow the progression and preserve joint function. -Have a slow onset and make take weeks to take effect. Each DMARD works differently restricting precise pathways that activate specific immune cells, therefore suppressing the immune response of the body creating and preserving the joint from the damage that occurs in RA. Treatment with these drugs slows or delays the disease process. -They are used in other autoimmune disorders such as Crones disease, lupus, and fibromyalgia -These drugs act by inhibiting the movement of various cells that participate in the inflammatory process from accumulating in the diseased joint decreasing inflammation and altering the progression of the disease.
Bisphosphonates Aldendronate/Fosamax
Act primarily on bone by inhibiting bone resorption. Results in increased bone mineral density and reverses progression of osteoporosis uses: Treatment and prevention Osteoporosis in women , Glucocorticoid-Induced Osteoporosis in men Paget Disease -Take tablet with full glass of water (6-8 oz) at least 30 minutes before first food or drink of day, in upright position -Administer oral solution with at least 2 ounces of water Swallow with plain water only; mineral water, coffee, juice or other beverages severely reduces -bioavailability -Given weekly po
Contraindications, Precautions and Interactions of opioid antagonist medications
Acute hepatitis or liver failure Hypersensitivity, pregnancy category B (caution) infants of opioid-dependent mothers patients with opioid dependency cardiovascular disease Lactation Withdrawal symptoms: opioid dependent
are specific in the fact that they alter the body's response to the disease process. They may have higher risk of toxic effects and extensive adverse reactions. Used for RA when Methotrexate and DMARD's I nonbiologics ineffective.
DMARD's Biologic modifying drugs
is used for surgery as anesthesia.
Anectine
skeletal muscle relaxant used with general anesthesia.
Anectine/ succinylcholine-
is the loss of feeling or sensation. may be induced by various drugs and can induce a partial or complete loss of sensation
Anesthesia
Calcium carbonate or Carbonate: adverse effects
Anorexia Constipation Flatulence Nausea Vomiting Hypercalcemia Hypophosphatemia
Bind to a receptor and causes no response. Used to reverse effects of agonists because it competes for the receptor cites
Antagonist
may be given to decrease secretions of the oral and upper respiratory tract. This decreases aspiration risk and excessive mucous production from anesthesia gases or intubation. Can reduce complications such as pneumonia.
Anticholinergic drugs
medication interactions with aspirin
Anticoagulants- Plavix or warfarin NSAID drugs Antacids -Avoid 1 week - 10 days prior to surgery and not use until healing process complete. -May be given in low dose 85 mg or baby aspirin -GI bleeding, ulceration or perforation may occur with long term therapy even if the client has no history of bleeding or previous GI bleed or ulcerations. -Do not take concurrently with Ibuprophen.
control nausea and vomiting during the immediate post-op period. Robinul, Vistaril, scopolamine.
Antiemetic drugs
what interaction happens with the medications: Alcohol Benzodiazepines Antihypertensive drug when taken with Opioid Analgesics
Any substance that effects or produces CNS depression, results in sedation or may increase GI side effects.
inhibits prostaglandin synthesis and has greater anti-inflammatory effects than most OTC products. prolongs bleeding time by inhibiting platelet aggregation
Asprin
what to assess, monitor and educate before administering NSAIDS. ( nursing care)
Assess for history of allergy to aspirin Assess for history of GI bleed Educate client to take with food, milk or antacids Monitor elderly clients closely for complications Review client history for current meds and allergies, alcohol intake.
DMARD's are listed under subcategories relating to each specific drugs potential effects. Treatment guidelines differentiate DMARDS into non Biologic and Biologic
DMARD's are listed under subcategories relating to each specific drugs potential effects. Treatment guidelines differentiate DMARDS into non Biologic and Biologic
your patient has been given Levomethadyl how long do the you have to wait before administering the first dose of methadone or other narcotics?
Wait 48 hours after the last dose of levomethadyl
your patient is being prescribed Baclofen for muscle spasms, what adverse affects will you need to educate the patient on before administering?
Baclofen is a Skeletal muscle relaxant. when taking Skeletal muscle relaxants you can have: Drowsiness Sedation Constipation Brady or tachycardia
trade names for: Acetylsalicylic acid/ASA/Aspirin Salicylates
Bayer, Ecotrin (enteric coated), Ascriptin, St. Joseph, BC powder
medication examples of Agonist-Antagonist specifics
Bupenorphine/Buprenex Butophanol/ stadol Methadone
Drugs used for general anesthesia
Have rapid onset and short duration Depress CNS and used with inhalant for of anesthesia Propfol/Diprivan (barbiturate) Midazolam/Versed (benzodiazepine)- Nitrous Oxide- Anectine/ succinylcholine-
DMARD's are not use in clients with active bacterial infection, herpes zoster, active or latent TB, acute or chronic hepatitis B or C Clients taking these drugs should be monitored closely for infections. Even minor infections such as a cold sore can be life threatening.
DMARD's are not use in clients with active bacterial infection, herpes zoster, active or latent TB, acute or chronic hepatitis B or C Clients taking these drugs should be monitored closely for infections. Even minor infections such as a cold sore can be life threatening.
Methotrexate-immunomodulator/folic acid antagonist/cytotoxic medication -Sulfasalazine/Azulfidine (antinflamatory)
DMARD's:major non biologic MEDICATION EXAMPLES
Calcium can decrease absorption of thyroid hormones and tetracycline if taken concurrently; give 1 hour apart.
Calcium can decrease absorption of thyroid hormones and tetracycline if taken concurrently; give 1 hour apart.
calcium citrate
Calcium supplement found in caltrate, citrical usually contains vitamin D
Calcium Citrate-
Calcium supplement. primary form for osteoporosis
are contraindicated for clients with hypercalcemia, and history
Calcium supplements
brand name for celecoxib
Celebrex
this medication is contraindicated in clients with history of sulfa allergy and cardiac disease or stroke. Currently remains on the market but is monitored by FDA.
Celexicoxib
what clients are the greatest risk for Respiratory depression when administered opioids
Clients who seldom use opioid pain relievers are termed opioid naïve.
Clients with suppressed immune systems may not exhibit classic signs of infection such as fever Etanercept, infliximab, and adalimumab are not to be used in patients with heart failure, lymphoma, or MS.
Clients with suppressed immune systems may not exhibit classic signs of infection such as fever Etanercept, infliximab, and adalimumab are not to be used in patients with heart failure, lymphoma, or MS.
what medication is indicated for the management of pain when a continuous analgesic is needed for an extended time for chronic pain management (opioid analgesics)
Controlled-released forms:
promotes synthesis of prostaglandins that specifically initiate the inflammation process.
Cox-2 cyclooxygenase-2
responsible for synthesis of beneficial prostaglandins that protect the gastric mucosa This is the reason adverse effects include GI irritation, stomach upset, and ulcers.
Cox1 cyclooxygenase-1
Evista/Raloxifene Adverse effects
Hot Flashes Flu symptoms Cramps /muscle spasms Arthralgia Infection
calcium Complications and adverse effects are rare but include
Hypocalcemia hypercalcemia
Disease-Modifying Anti-rheumatic Drugs
DMARD's
Raloxifene/Evista
Decreases bone resorption and slows bone loss preserving bone density. Stimulates estrogen receptors on bone and increases bone density in the same fashion as estrogen. -Given as a nasal spray Used in prevention of osteoporosis in postmenopausal women and prevention of spinal fractures in women
this medication is contraindicated in clients with renal failure due to decreased renal excretion of the drug that can result in neurotoxicity and seizures.
Demerol/meperidine
Drugs that combine a nonopioid and an opioid analgesic provide good pain relief.
Drugs that combine a nonopioid and an opioid analgesic provide good pain relief.
-Medications and supplements used to prevent and treat osteoporosis and promote bone health and healing of fractures. -Calcium specific formulations and administration -Estrogen receptor modulators used to prevent osteoporosis -Bisphosphonates -Calcitonin
Drugs used to Treat Osteoporosis
Apply to intact skin 1 hour prior to superficial puncture to smallest surface area necessary. Avoid wrapping or heating the area.
EMLA topical cream
generic name for Relpax
Eletriptan
DMARD's Biologic Drugs medications examples
Etanercept/Embrel, -Infliximab/ Remicade- Adalimumab/Humira
complications when taking Sulfasalazine/Azulfidine (antinflamatory)
GI discomfort-nausea, vomiting, diarrhea, abdominal pain hepatic dysfunction and bone marrow depression. May be given in an enteric coated preparation to prevent GI upset Used instead of methotrexate for clients with liver disease
generic name for neurontin
Gabapentin
Pre anesthesia drugs are used prior. Produces a loss of consciousness. Requires the use of one or more drugs Choice of drugs are considered based on operative area, client physical condition, and length of procedure. Most commonly achieved with inhalation drugs such as nitrous oxide. Process is divided in to 4 stages. Ranging from sedation to respiratory paralysis requiring entubation. Requires IV access See box 17.1
General Anesthesia
Adalimumab/Humira
Given subq, monitor injection site for irritation Increase risk for infection -With concerns of infection, as with many of the biologic response−modifying drugs, monitor the patient's vital signs with attention to temperature and also for the occurrence of chills and headache, sorethroat. Biologic drugs should not be used in clients with congestive heart failure or neurologic demyelinating diseases.
Uric Acid Inhibitors
Gout is a type of inflammatory arthritis caused by excess uric acid in the body. Uric acid accumulates in the blood and is often deposited in the joints usually in feet such as heels or big toe. The affected joint becomes red hot swollen and tender. Drugs used to treat gout may include anti-inflammatory agents and some specific to the condition classified as Uric Acid inhibitors.
Probenecid
Inhibits reabsorption and increases excretion of uric acid -Also used as adjunct treatment with some antibiotics to prolong plasma levels of the drugs. -Along with regular side effects of uric acid inhibitors may cause flushing or dizziness -Contraindicated in clients with blood dyscrasia's or renal calculi as the result of uric acid levels. -Use cautiously in clients who are sensitive sulfa drugs or have PUD
local anesthetic anesthesia is injected into tissues and absorbed by infiltration such as for dental procedures or suturing small wounds, obtaining a biopsy or prior to a diagnostic procedure.
Injection anesthesia -
Intact structure of bones and joints is vital to mobility and usual daily activities. Calcium is needed for bone development and hardness. It is also required to maintain bone strength as well as vital neurological and cardiovascular functions. Calcium is the most abundant mineral in the human body with its highest concentration in bones and teeth. It is obtained from dietary sources and required vitamin D for absorption. Calcium is also present in the blood in small amounts and needed for clotting, nerve transmission, and muscle contraction. Inadequate calcium intake can result in increased risk for fractures and the development of osteoporosis.
Intact structure of bones and joints is vital to mobility and usual daily activities. Calcium is needed for bone development and hardness. It is also required to maintain bone strength as well as vital neurological and cardiovascular functions. Calcium is the most abundant mineral in the human body with its highest concentration in bones and teeth. It is obtained from dietary sources and required vitamin D for absorption. Calcium is also present in the blood in small amounts and needed for clotting, nerve transmission, and muscle contraction. Inadequate calcium intake can result in increased risk for fractures and the development of osteoporosis.
Bisphosphonates Aldendronate/Fosamax medication interactions
Interactions can occur with calcium supplements and aspirin
are significant in pain relief, sedation and decreased GI motility.
Kappa receptors
this is contraindicated in severe renal disease and risk for renal impairment. Should only be used for 5 days. 1st dose usually given IM then followed by po. Used in adjunct with some pain meds to control post op pain from joint or bone surgery.
Ketorolac/Toradol
the only NSAID that can be given po IM or IV- Only used for up to 5 days due to risk for renal complications
Ketorolac/toradol-
aspirin is contraindicated in patients with?
Known hypersensitivity; bleeding disorders; children or teenagers with chickenpox or influenza History of GI bleed Clients on anticoagulants -Children with specific viral infection such as flu or chickenpox aspirin increases risk for Reyes Syndrome. Reye's Syndrome is an acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and liver damage. Triggered by viral illness and and salicylate therapy.
this medication is a agonist/ antagonist classification & is given in a clinic setting 3 days a week and used when there is no response to other treatments.
Levomethadyl-
with this medication following oral administration keep client NPO for at least 1 hour or until gag reflex returns.
Lidocaine Topical or oral spray or garbles
Tylenol is contraindicated in patients with
Liver disease Heavy alcohol use
Opioid Agonist-Antagonists may be used for
Management of opioid dependence
brand name for Rizatriptan
Maxalt
indomethacin/Indocin meloxicam/Mobic celecoxib/Celebrex ketorolac/Toradol
Medication examples of NSAID's
A variety of drugs are used to treat musculoskeletal injuries and disorders; they include DMARDs, bone resorption inhibitors, skeletal muscle relaxants, and uric acid inhibitors.
Medications for Musculoskeletal Disorders
generic name for mobic
Meloxicam
your patient is prescribed Methotrexate for Rheumatoid Arthritis what adverse affects will you educate your patient before administering?
Methotrexate is a disease Modifying anti- rheumatoid drugs that is also and immunomodulator/folic acid/antagonist/cytotoxic medication. when taking this medication you could experience: nausea, vomiting, alopecia, stomatitis or GI ulcerations (early finding with toxicity).
Most commonly used DMARD in Rheumatoid Arthritis. -Inhibits lymphocyte multiplication Main adverse effect is bone marrow suppression. Also used as anticancer drug
Methotrexate-immunomodulator/folic acid antagonist/cytotoxic medication
Activation of the 5-HT receptors causes vasoconstriction and reduces the neurotransmission, which in turn produces pain relief Act on specific vascular receptor sites causing vasoconstriction in large intracranial arteries.
Migraine Specific Drugs
These drugs are contraindicated in patients with a known hypersensitivity to selective serotonin agonists and should only be used when a clear diagnosis of migraine headache has been established Pregnancy Use cautiously in patients with hepatic or renal function impairment, such as the elderly or patients requiring dialysis
Migraine Specific MedicationsSelective Serotonin Medications
Medications that may be used as preventative agents for migraine headache. also prevents avoiding triggers and some food items
Migraine prevention treatment
CALCIUM
Mineral obtained from specific foods and is the most abundant mineral in the body. Essential for development of bones and teeth and found in small amounts in the blood. Requires vitamin D to facilitate the absorption Calcium in the blood contributes to regulation of muscle contractions, nerve conduction, serves as a component for blood coagulation. -Calcium is available in numerous preparations of oral and parenteral form.
brand name for Meloxicam
Mobic
Nursing care includes: Post-op-(General Anesthesia)
Monitor for complications, respiratory status, level of pain assessed, Turn, cough deep breath, Airway maintenance, O2 saturation,
opiates medication
Morphine and Codeine.
Most widely used opioid and considered the model drug for pain management. It is used as the standard which other opioid analgesics are compared.
Morphine sulfate
what medication is used usually extended release form and should be scheduled around the clock for chronic pain management ( opioid analgesic)
Morphine sulfate:
are significant in physical dependence of opioids
Mu receptors
NSAID drugs due effect platelets and pose an increased risk for bleeding but not to the extent of aspirin which inhibits platelet aggregation.
NSAID drugs due effect platelets and pose an increased risk for bleeding but not to the extent of aspirin which inhibits platelet aggregation.
(Inhibit prostaglandin synthesis by blocking the enzyme cyclooxygenase.) inhibit two related enzymes Inhibit activity of cyclooxygenase-1 (COX-1): Enzyme helps to maintain the stomach lining Inhibit activity of cyclooxygenase-2 (COX-2): Enzyme triggers pain and inflammation
NSAID's
may be given to control pain and inflammation for the short term while DMARDS are taking effect.
NSAID's and glucocorticoids
what three classes of drugs are typically used to treat RA
NSAID's, corticosteroids, and DMARD drugs. DMARD's will Produce Immunosupression in advanced stages when in advanced stages pain from RA cannot be controlled with analgesics or NSAID treatment.
Used for Osteoarthritis, rheumatoid arthritis, and other musculoskeletal disorders; Mild to moderate pain; primary dysmenorrhea; fever reduction.
NSAIDS
what medications can be taken for Arthritis inflammation and pain, musculoskeletal disorders and mild to moderate pain , fever and primary dismenorrhea.
NSAIDS: OTC ibuprofen/Advil naproxen/Aleve or naprosyn
examples of antagonists
Naloxone, naltrexone
what are medication examples of opioid antagonists
Naloxone/Narcan
medication used to reverse effects of respiratory arrest from overdose
Naloxone/narcan
what are adverse effects of antagonists medications?
Nausea Vomiting Sweating Tachycardia Increased blood pressure Tremors
Gout and Anti-gout medications Adverse reactions include:
Nausea, vomiting, abdominal pain, urinary frequency and headache
brand name for gabapentin
Neurontin
most commonly used anesthetic gas. Used in combination with other drugs.
Nitrous Oxide-
these medications are used to treat pain and inflammatory conditions such as osteoarthritis, and rheumatoid arthritis.Derived from salicylic acid.Useful in pain management due to analgesic, antipyretic, and anti-inflammatory effects. Also, inhibits platelet aggregation prolonging bleeding time (Anti-platelet).
Non-opioid Analgesics
Use for people With aspirin allergy; bleeding disorders; receiving anticoagulant therapy; who had recent minor surgical procedures. Does not possess the anti-inflammatory effects as salicylates and does not have effect on platelets that aspirin does.Given orally or rectally.Available OTC or in combination with opioid analgesics.
Non-salicylate Analgesics
are named for their anti-inflammatory effects but do not belong to the steroid class of drugs, thus do not produce all of the adverse effects as steroids. Some also possess antipyretic and analgesic properties.Produce: analgesic, anti-inflammatory, antipyretic effects. Aspirin is also in this category
Nonsteroidal Anti-inflammatory Drugs (NSAID)
are natural substances derived from the opium plant.
Opiates
Act on opiate receptor sites in the CNS specifically Mu and kappa receptors. Results in analgesic/pain relief, sedation, euphoria and respiratory depression.
Opioid Analgesics
reverse opioid effects by competing or displacing the opioid drug at receptor sites. Have no effect in the absence of opioids Interfere with action of opioids reversing the effects, not just side effects but all effects including pain relief.
Opioid Antagonists
are the general term used for opium-derived or synthetic analgesics used to treat moderate to severe pain.
Opioids
may be given to older adults, adolescents, postmenopausal women and women who are pregnant or breast feeding.
Oral Calcium supplements
protocol that is used as a guideline for treating pain with analgesics of opioid and non-opioid medications. This method is based on pain intensity.
Pain ladder 3 step protocol
what is pain?
Pain warns the body of potential danger or illness; It is a protective sensation, alerting our body of injury or potential injury. Pain that lingers can affect client outcomes. Pain management is often complex.
Palliative care for pain unrelieved by other methods. Make sure client has sensation return prior to ambulation.
Palliative care for pain unrelieved by other methods. Make sure client has sensation return prior to ambulation.
Other medications may be used such a antidepressants or NSAID, or medications that treat nerve pain in conjunction
Patch forms
do not administer Opioid analgesics to patients that have (contraindications)
Patients with hypersensitivity to drugs Acute bronchial asthma, emphysema, or upper airway obstruction Patients with head injury or increased intracranial pressure, Convulsive disorders; severe renal or hepatic dysfunction; acute ulcerative colitis Paralytic ileus Not recommended in pregnancy or labor
Post menopausal women have a decrease in the hormone estrogen which decreases calcium reabsorption in the bone and results in decrease in bone density or hardness that results in osteoporosis.
Post menopausal women have a decrease in the hormone estrogen which decreases calcium reabsorption in the bone and results in decrease in bone density or hardness that results in osteoporosis.
opioid antagonists medications are used for
Postoperative respiratory sedation and respiratory depression Reversal of opioid adverse effects Suspected or known opioid overdose
Given prior to anesthesia to relax or sedate the client such as: opioid/ Fentanyl or antianxiety/ valium
Preanesthetic Drugs
preop, post op, and nursing education for analgesics
Preop assessment for allergies Educate client on post-op care and what to expect. Turn cough, deep breath, Educate on pain control post op
Colchicine
Prevents uric acid from being deposited in tissues. -Used alone or in combination therapy for prevention of gout attacks -Side effects are same as zyloprim except this drug may also cause severe diarrhea and bone marrow suppression. -Should be used cautiously in debilitated clients, clients with blood disorders or liver damage Grapefruit juice can increase adverse effects Client's should increase fluid intake and avoid alcohol.
Gout Medications
Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim)
administer Asprin cautiously in patients with
With hepatic and/or renal disease; during pregnancy and lactation; with pre-existing hypoprothrombinemia; vitamin K deficiency; GI irritation or peptic ulcer disease
Pain associated with migraine headaches is believed to be caused by cranial vascular dilation and inflammation of specific cranial nerves. Drugs used to treat migraine headaches are given:
Prophylactically to prevent the migraine headaches are different than those used for acute onset. To treat the acute pain when a migraine occurs Medications to prevent migraine headaches work to prevent the inflammation and dilation intracranial blood vessels.
what medication can be given with NSAIDS to decrease adverse GI affects?
Proton pump inhibitors such as omeprazole/Prilosec
is a chronic systemic disease that produces inflammatory changes effecting joint structure, function and mobility. Joint destruction in a progressive manner when white blood cells mobilize against the tissue and lodge in joints causing swelling pain and inflammation.
RA
Selective estrogen receptor modulator medication example
Raloxifene/Evista-
Regional blocks require needle placement and insertion of a catheter for medication delivery is performed using strict aseptic technique by a trained physician or Certified Nurse Anesthetist. For extended use a catheter may be used for repeat injections to maintain the level of pain control. Used for labor and delivery or immediate postoperative periods.
Regional blocks require needle placement and insertion of a catheter for medication delivery is performed using strict aseptic technique by a trained physician or Certified Nurse Anesthetist. For extended use a catheter may be used for repeat injections to maintain the level of pain control. Used for labor and delivery or immediate postoperative periods.
brand name for Eletriptan
Relpax
what precautions must a nurse monitor when administering opioid analgesics?
Respiratory insufficiency Head injury sleep apnea History of bowel obstruction Elderly clients Opioid naïve clients Clients undergoing biliary surgery Lactating women prostatic hypertrophy, and renal/hepatic impairment Risk for physical dependency in long term use
Calcitonin adverse reactions
Rhinitis Epitaxis Headache Injection site reaction -Rotate nares and injection site Monitor for signs of hypocalciemia- Serious hypersensitivity reactions, including fatal anaphylaxis, reported; consider skin testing prior to treatment Hypocalcemia associated with tetany has been reported; ensure adequate intake of calcium and vitamin D
Conditions associated with calcium deficiency include:
Rickets in children Osteomalasia Muscle cramps Osteoporosis in older adults
Selective estrogen receptor modulator that produce estrogen-like effects on bone (decreases bone resorption; incr````rt 5`trease bone density) and may decrease serum lipid levels (decrease in LDL) May increase risk for breast cancer -Increased risk of deep vein thrombosis and pulmonary embolism has been reported with this drug Women with active or past history of venous thromboembolism should not take this drug Discontinue 72 hours prior to and during prolonged immobilization Increased risk of stroke, deep vein thrombosis/pulmonary embolism Pregnancy, lactation Active history of thromboembolic disorders Women who could become pregnant
Selective estrogen receptor modulator that produce estrogen-like effects on bone (decreases bone resorption; incr````rt 5`trease bone density) and may decrease serum lipid levels (decrease in LDL) May increase risk for breast cancer -Increased risk of deep vein thrombosis and pulmonary embolism has been reported with this drug Women with active or past history of venous thromboembolism should not take this drug Discontinue 72 hours prior to and during prolonged immobilization Increased risk of stroke, deep vein thrombosis/pulmonary embolism Pregnancy, lactation Active history of thromboembolic disorders Women who could become pregnant
this medication is (Migraine Specific Medications Selective Serotonin Medications) are used for the relief of moderate to severe pain and inflammation related to migraine headaches.
Selective serotonin drugs (5-HT)
are drugs extracted from raw opium and chemically
Semisynthetic opioids
DO NO ADMINISTER METHOTREXATE TO PATIENTS WITH THE FOLLOWING: (contraindications)
Should be avoided in pregnancy(can cause fetal death); Pregancy Risk Category X -clients with liver failure/ disfunction,alcohol use disorder, hematologic disorder, infections, bonemarrow suppression, peptic ulcer disease, and impaired nutritional status. -When used with salicylates, NSAIDs, sulfonamides, penicillin, and tetracycline pose an increase risk for toxicity -Folic Acid may decrease medications effects due to medications action as folic acid antagonist
Used in addition to pain relievers for muscle strains, sprains, and back pain. Assist in relaxing certain muscle groups as some repair themselves from injury or in addition to other medications for chronic pain conditions. For some of these drugs the exact mode of action is not clearly understood. Some act indirectly to relax muscles by producing a sedative effect.
Skeletal Muscle Relaxants
topical anesthesia examples
Solarcaine, Hurricane spray, Anusol, Emla Cream is a the drug lidocaine and prilocane applied to a small area of the skin
Some anesthesia drugs used for general anesthesia, opioid analgesics and drugs used to reverse anesthesia may cause nausea and vomiting. Some preanesthesia may control nausea as well as produce a mild sedative effect
Some anesthesia drugs used for general anesthesia, opioid analgesics and drugs used to reverse anesthesia may cause nausea and vomiting. Some preanesthesia may control nausea as well as produce a mild sedative effect
Generic name for Imitrex
Sumatriptan
these medications are administered at the onset of symptoms and may be repeated in 2 hours.
Sumatriptin and eletriptan
medication examples of Selective Serotonin drugs (5-HT)
Sumatriptin/Imitrex (po, subq, nasal, transdermal) Eletriptan/Relpax (oral) Rizatriptan/Maxalt (oral)
are manufactured analgesics with chemical structure and actions similar to natural opioid drugs.
Synthetic opioids
brand name for ketorolac
Toradol
Amitryptyline is a
Tricyclic antidepressants
brand name for acetaminophen
Tylenol
Allopurinol/Zyloprim
Uric Acid inhibitors -Reduces production of uric acid thereby decreasing uric acid levels and the deposit of the crystals in joints. -May be given orally or IV -Client may experience increased attacks in first months of treatment
your patient lil'tittie has a fever of 104.2F* the DR. prescribed Tylenol 10 mg PO QID for fever.what adverse affects would you notify Lil'tittie about when taking this medication?
Urticaria/Hives Hemolytic Anemia Pancytopenia (reduction in all cellular components of the blood) Hypoglycemia Jaundice -Adverse reactions are rare when used as directed. -Hepatotoxic drug. -Excessive doses and chronic use can cause damage or death to liver cells resulting in liver failure. -for hepatotoxicity increased for clients that drink alcohol. -Maximum does should not exceed 3 GM/day. -Acute toxicity can occur with excessive doses includes nausea, vomiting, diaphoresis.
may be prescribed orally for the client prior to dental or outpatient minor procedures.
Valium
what nursing actions/care will be provided when administering Opioid analgesics
With hold for respiratory rate 12 or below Maintain Airway Monitor for hypotensive effects Assess Level of pain and sedation Increase fluid intake Monitor for s/s constipation and urinary retention Clients who are receiving medications for cough suppression should be encouraged to cough, assess lung sounds, airway etc.
Generic name for Tylenol
acetaminophen
generic name for aspirin
acetylsalicylic acid
Etanercept/Embrel,
administered subcutaneously side effect; headache rhinitis, irritation of injection site Increased infection risk especially with TB or hepatitis B -use with live vaccine increases risk of getting or transmitting infection clients should not get live vaccine during therapy -contraindicated in clients with malignancies, active infection, hematologic disorders, lactation. Use with caution in heart failure, CNS disorders such as MS or hematologic disorders
medications used to treat pain are?
analgesics. They are classified as opioid and nonopioid. Anti-inflammatory medications are non- opioid medications that also reduce inflammation.
Hypercalciemia-
anorexia, nausea,vomiting, muscle weakness, hypotonia, abdominal pain, cardiac irregularities Contraindicated Documented hypersensitivity, hypercalciuria, renal calculi, hypophosphatemia, hypercalcemia, ventricular fibrillation and digoxin toxicity Caution in kidney disease, decrease in GI functions Monitor serum calcium levels Bone density studies
GABA is a
anticonvulsant
Azulfidine-Sulfa drug Methotrexate Adalimumab/Humira Etenercept/ Enbrel Infliximab/Remicade
are medication examples of DMARD's
IV calcium
are utilized for critically low levels of calcium in renal failure clients and may be administered as an antedote for magnesium sulfate toxicity. IV calcium preparations if infused too rapidly can cause cardiac arrythmias.
brand name for acetylsalicylic acid
aspirin
Nursing care includes: Preop (General Anesthesia)
assessing for allergies, make sure operative consents signed prior to any pre anesthesia drugs administered, pertinent lab results reviewed, maintain NPO status.
application of an anesthetic to the surface of the skin, open area or mucous membrane. This may be spray, cream or patch. Also can be used to desensitize skin prior to injection of deeper anesthetic such as epidural or prior to an IV stick. prior to a diagnostic procedure to inhibit gag reflex prior to endoscopy
topical anesthesia -
migraine prevention medication examples
beta blockers(propranolol/Inderal) anticonvulsants(gabapentin/Neurontin) Tricyclic antidepressants (amitriptyline) Estrogen preparations.
propanolol is
betablocker
what medical disorders do you administer Skeletal muscle relaxant with CAUTION
use Precaution with Clients: with history of CVA, cerebral palsy, Parkinson's, seizure disorders, pregnancy and lactation.
local anesthesia can be administered by injection or topical
local anesthesia can be administered by injection or topical
Calcium Acitate
calcium supplement
generic name for Celebrex
celecoxib
an NSAID that only inhibits cox 2 enzyme specifically and gets the same therapeutic effects without potential GI effects. but is associated with increased risk for MI and stroke that can be fatal.
celecoxib (Celebrex)
Angie was prescribed Celebrex for back inflammation. She c/o of constant urination and thirst when taking the medication. what will you observe and monitor ?
celecoxib/Celebrex ADVERSE REACTION Elevations in BUN and Creatinine,
Enteric coated form of asprin may be used for
clients who take long term low dose to prevent stomach upset and GI complications.
Propfol/Diprivan (barbiturate) -
commonly used to induce anesthesia and maintain anesthesia.
what interaction happens with the medication antihistamines when taken with opioid Analgesics
contribute to sedation, increased dry mouth and constipation.
Spinal- injection
local anesthesia into the subarachnoid space in the spinal cord. Usually at specific lumbar level. This includes conduction blocks such as epidural and caudal blocks
what interaction happens with the medication mepederine when taken with opioid analgesics
when given concurrently with MAO inhibitors can cause coma or seizures
what interaction occur with NSAIDS and Hypertensive drugs?
decrease effectiveness of antihypertensive
what interaction occur with NSAIDS and Diuretics?
decrease effectiveness of diuretic increased risk for renal toxicity.
Local Anesthesia-
decreases pain by blocking conduction of pain impulses to a specific area resulting in numbness or lack of sensation
Calcium carbonate
found in oral tums
tylenol toxicity or overdose is treated with
gastric lavage, and acetylcysteine/Mucomist
an illegal narcotic substance that is not used in medicine, is illegal and considered a narcotic.
heroin
your patient Lizzo is prescribed Hydrocodone for severe cough and chest pains. before administering the medication to the patient what adverse reactions will you educate Lizzo on?
hydrocodone is an opioid analgesic when taking this medication you can have : CNS: sedation, headache, miosis, lightheadedness, dizziness, agitation, insomnia, impaired mental and physical tasks Respiratory: depressed breathing rate/depth(most serious) GI: constipation, anorexia, dry mouth, nausea, vomiting, biliary tract spasms(Morphine) Cardiovascular: tachycardia, bradycardia Genitourinary: urinary retention/hesitancy Allergic reactions: pruritus, rash, urticaria Other reactions: sweating, pain at injection site, local tissue irritation -Some of the body systems will adapt to the secondary or side effects but the GI system does not. This is the reason Slow gastric motility and constipation are always an issue for clients on pain management using opioid drugs. -These effects are more common with Agonists due to the bond on receptors.
semisynthetic opioids medications
hydromorphone(dilaudid), oxycodone, heroin. Hydrocodone is a semisynthetic drug made from codeine.
Infliximab/ Remicade-
iV and may cause site irritation. -Monitor for skin reactions including stevens-johnsons syndrome Risk for heart failure and hematologic disorders. side effect; headache, rhinitis, irritation of injection site, fever chills
this medication is contraindicated in hypertension, peptic ulcer disease, or GI bleed.
ibuprophen
Bisphosphonates Aldendronate/Fosamax Contraindicated in
in Abnormalities of the esophagus, delayed esophageal emptying such as stricture or achalasia Inability to stand or sit upright for 30 minutes May cause local irritation of upper GI mucosa
Calcium chloride
in liquid form may be given IV or found in electrolyte replacement drinks
what interaction occur with NSAIDS and anticoagulants?
increase bleeding risk
what interaction occur with NSAIDS and the use of herbal / dietary supplement such as vitamin E, garlic, or gingko?
increase risk for bleeding.
what complications can occur when taking Methotrexate ?
increase risk of infection, hepatic toxicity, bone marrow suppression. Each drug may alter the clients immune response by targeting specific cells in the or a group of cells suppressing the inflammation process.
what interaction occur with NSAIDS and the use of Aspirin, glucocorticoids, and alcohol?
increase risks for GI bleed.
Salicylism - toxicity =
increased pulse, tinnitus, dimness of vision, sweating thirst, hyperventilation. Is a medical emergency and can result in serous renal failure. -toxicity in adults who take increased amounts or large doses. If signs or symptoms present may order serum salicylate level.
what interaction occurs when given Tizanidine with Hypertensive medication?
increased risk for hypotenstion
what interaction occur with NSAIDS and the use of ACE inhibitors ?
increased risk for renal toxicity.
what interaction occurs when given CNS depressants with Skeletal Muscle relaxants?
increased sedation
Blocking cyclooxygenase
inhibits the inflammation process.
nerve block
injection into or near a nerve truck or space surrounding the area that is affected.
Calcium metabolism modifier Calcitonin
is a hormonal substitute derived from salmon; calcium metabolism modifier Inhibits osteoclast activity; decreases bone resorption Given subcutaneously or nasal spray every other day Use only in treatment of osteoporosis not prevention
brachial plexus
is a nerve block medication used on surgeries such as carpal tunnel release.
generic name for Toradol
ketorolac
local injection
may be done in conjunction with conscious sedation with IV sedatives administered as well such as Oral surgery or cataract surgery. Client may be NPO. Local injection drugs can be mixed with epinephrine to cause local vasoconstriction to limit area effected and for anesthetic to last longer. Effects on distal areas should be monitored closely due to the risk of tissue damage related to vasoconstriction. Complication gangrene.
carisoprodol/Soma Lioresal/Baclofen Cyclobenzaprine/Flexaril Diazepam/Valium tizanidine/zanaflex Methocarbamol/Robaxin
medication examples of Skeletal Muscle Relaxants
this medication is contraindicated in biliary colic due to it increasing spasms in the biliary ducts. Also during delivery especially in premature infants due to the risk of respiratory depression in the infant.
morphine
examples of agonists
morphine, heroine
Arthritis Degenerative Joint Disease Rheumatoid Arthritis Gout Osteoporosis Synovitis Disorders involving calcium deficiency
musculoskeletal disorders
Regional Anesthesia-
numbing sensation of an area by applying anesthesia to the nerves that supply the area resulting in a larger area of anesthesia.
Used to treat moderate to severe pain Controlled substances/Scheduled Drugs Alter pain perception by binding to pain receptors in the brain and changing the client's perception of pain.
opioid Analgesics
this medication Main use is to alleviate moderate to severe acute and chronic pain. Post-op pain, cancer pain or pain from MI. its also used forTreat pain acute or chronic Manage opiate dependence Decrease anxiety Support anesthesia as adjunct Promote obstetric analgesia Treats severe diarrhea; intestinal cramping; severe, persistent cough
opioid analgesics
why are clients that are have nausea and vomiting at risk when taking Opioid analgesics?
opioid analgesics can cause sedative effects which put nausea and vomiting clients at an increase risk of aspiration.
what interaction happens with the medication Opioid agonist-antagonist when taken with opioid analgesics
opioid withdrawal symptoms
Hydroxychloroquine/Plaquinil-
originally used as an antimalarial agent- Along with the same side effects of Methotrexate it may cause retinal damage or corneal changes that can result in blindness. is a slow-acting drug. People may begin to notice improvement after one or two months. It may take up to six months before the full benefits are realized. -Clients should have a baseline opthamology exam prior to starting the drug and q 6 months while taking this medication -interferes with communication between cells within the immune system. Ultimately, it is thought to block proinflammatory pathways.
generic name for inderal
propanolol
Injection of a local anesthetic around nerves that transmit sensation in a specific area to block sensation and transmission.
regional anesthesia
what interaction happens with the medication Barbiturates when taken with opioid Analgesics
respiratory depression, hypotension, and/or sedation
Spinal/Epidural
results in a loss of feeling and movement in the lower abdomen, lower extremities, perineum area. Used for delivery, C/Section, Total knee or hip. Is a lower risk for complication than General for high risk clients.
generic name for Maxalt
rizatriptan
General Anesthesia-
sensation free state for the entire body, produces loss of consciousness, reflex control and absence of pain.
Midazolam/Versed (benzodiazepine)-
short acting used to induce anesthesia, relieve anxiety, and for conscious sedation. Produces amnesic effect
your patient Bob is being prescribed Indocin for mild pain due to arthritis before administering the medication what adverse affects will educate Bob on when taking NSAIDS?
taking this medication can cause: GI distress: nausea, vomiting, dyspepsia, epigastric pain, bloading. Increased risk for GI bleed, mucosal ulcerations Somnolence, dysuria, reduced platelet count Ecchymosis, purpura. Increased risk for cardiovasular events with
your patient Karen is being prescribed Imitrex for severe migraines. before administering what adverse reactions do you want to educate karen on ?
this medication can cause The most common are dizziness, nausea, fatigue, pain, dry mouth, and flushing Cardiovascular system Coronary artery vasospasm/angina, tightness or heaviness in chest. Cardiac arrhythmias and tachycardia Myocardial infarction
