Drugs to Manage Pain
Drug Action Uses Adverse/SE Implications
-inhibits PG synthesis in -DOC for mild pain & fever -no anti-inflammatory -MUCOMYST=Antidote
acetaminophen CNS -tension HA, muscle/joint pain properties -avoid use of ASA &
-may block pain impulse -used w/codeine for analgesia -fewer side effects than NSAIDs at same time
TYLENOL generation in periphery aspirin -seek medical care if:
fever > 3days
pain > 10d/adult; 5d/child
-inhibits cyclooxygenase Prophylaxis dose: (80 mg/d) to -protein bound so can -give w/food
(COX 1 & 2) prevent MI displace other meds -avoid alcohol; incr. effects
-blocks formation of -antiplatelet action (COX 1
Aspirin inhibition)-irreversible
-GI irritation -take w/ 8 oz. water
NON
PGs in periphery -Reye’s syndrome- -DC before surgery
(acetylsalicylic acid)
Low dose: (1-2 325 g/tab)=60 mg children -observe for bleeding
codeine -tinnitus, ototoxicity -assess for tinnitus
-mild fever, pain, HA -respiratory alkalosis -do not give to children
STEROIDAL
-pregnancy category D
High dose: (3-8 Gm/d) -hepatoxic
-DOC for rheumatoid arthritis
-pain and inflammation
-hypersensitivity
-inhibits cyclooxygenase -pain relief: menstrual, -GI irritation -same as for ASA
(COX 1 & 2) and blocks strains/sprains, dental -inhibition of platelet -monitor lab (CBC, BUN,
NSAIDs
ANTI-INFLAMMARORY
PG in periphery postpartum, rheumatoid/osteo
arthritis
aggregation (reversible) LFT)
ibuprofen (ADVIL, MOTRIN) -aka 1stgeneration -rash, peripheral edema -check for allergies
-fever relief in children
naproxen (ALEVE) -acute gout attacks -if one NSAID not effective
indomethacin (INDOCIN) -minimal anti-inflammatory try another
properties -warn about photosensitivity
ketorolac -inhibits COX 1 & 2 -moderate to severe pain -ulcerogenic -OK for impaired renal
pathway in periphery -not addicting
TORADOL -no ventilatory depression
-analgesic efficacy
DRUGS
comparable to morphine
-blocks proinflammatory -chronic pain & inflammation
COX-2 PGs management -GI problems -assess for sulfonamide
Inhibitors -guards the GI tract by allergies (CELEBREX)
leaving COX-1 intact
CELEBREX,VIOXX -aka 2nd generation
Drugs to Manage Pain
Drug Action Uses Adverse/SE Implications
-encourage fluid intake 2-3L/day
-inhibits phagocytosis of urate -for acute gout -GI upset to prevent kidney stones
colchicine crystals by neutrophils attacks -allopurinol is P450 inhibitor -avoid high purine diet
GOUT
-interferes w/ inflammatory -avoid salicylates
process -caution w/ diuretics
-avoid alcohol
-may take w/ meals if GI upset
allopurinol -inhibits uric acid formation -for chronic gout
MEDICATIONS
treatment -avoid vitamin supplements
-CBC alert for agranulocytosis
-stress compliance w/ tx
-inhibits reabsorption or uric acid by -for chronic gout
-probenecid incr. plasma & tissue
kidneys treatment concentration of PCN and
probenecid
cephalosporins
BENEMID
-respiratory depression Antidote: NARCAN or naltrexone
Medullary actions: -for control of -sedation (ReVIA)
Opiates -CNS-drowsiness, euphoria, moderate to severe -nausea/vomiting
N/V, respiration depression, pain -constipation/urinary retention Contraindicated/precaution in:
morphine, DEMEROL, cough suppression -hypotension
fentanyl, codeine -closed head injury;shock
-dizziness, lightheadedness -respiratory impaired—asthma,
Peripheral actions: -mental clouding/drowsiness COPD
-CV-hypotension -undiagnosed abdominal
-GI-constipation, ↓GI motility conditions
-GU-spasm, urinary retention -pregnancy
-ocular-pinpoint pupils -hx of addiction to opiates
-assess pain w/ scale
-instruct to ask before pain is
severe
-assess respiratory status and
VS—hold med if R < 12/min
-monitor bowel elimination
•monitor I & O
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