Anti-inflammation
*inhibits the inflammatory process
Classified as
* antipyretics
*analgesics
*anticoagulants
(prototype drug:aspirin)
Aspirin
*anti-inflammatory
*anti-pain (mild, to moderate)
*anti-pyrrhic
*anti-platelet aggregation
Aspirin
-prostaglandin inhibitor
-decrease platelet aggregation
-inhibits hypothalamic heat regulator center
Aspirin use
-antipyretic, analgesic, inhibitor of platelet aggregation, anti-inflammatory
(CAUTION : history of GI bleeding, liver or renal disorders, allergies)
Aspirin (ASA) side effects
GI, confusion, dizziness
Aspirin adverse reactions
GI bleeding, or ulceration, tinnitus, anemia, hepatotoxicity
Aspirin nursing considerations
Assess for allergies, monitor for adverse reactions
* assess for s/s of hearing loss
* observe for signs of bleeding
Aspirin patient teaching
*Beware of risk of bleeding, particularly if having procedures, taking other meds, alcohol
* take with food
*report side effects
* not for administration with children
NAIDS ( non steroidal anti-inflammatory drug agents)
Prototype 1st generation : ibuprofen
NSAIDs. Action
Inhibits prostaglandin synthesis
NSAIDs Uses
-anti-inflammatory
-antipyretic
-analgesic
NSAIDs. Caution
- drug interactions
- bleeding disorders
- pregnancy
-lupus
NSAIDs. First generation
-Dali glares
-para- chlorobenzoic acid
- phenylacetic acid derivatives
-propionic acid derivatives
-fenamates
-oxicams
NSAIDs secondary generation
Selective Cox-2 inhibitors
NSAIDs prototype: ibuprofen
Contraindication
Hepatic or renal disease, asthma, ulcers
NSAIDs. Prototype: ibuprofen
side effects
GI, dizziness, peripheral edema, petechia
NSAIDs (ibuprofen)
Adverse effects
GI bleeding, nephrotoxicity
NSAIDs (ibuprofen)
Nursing considerations
-Observe for bleeding, edema
-give with food, particularly if GI discomfort
NSAIDs (ibuprofen)
Patient teaching
- beware of drug (including herbal) interactions, alcohol
-inform dentists/ other healthcare providers of use prior to procedures
-don't use with pregnancy
-take with meals
- use cautiously in elderly patients
NSAIDSs. (ibuprofen)
Decreased liver function take with food may cause GI irritation, edema antipyretic for fever
NSAIDs (ibuprofen)
Cause bleeding and make sure herbal products don't affect them
* pregnancy caution use Tylenol
*elderly, decrease kidney function
NSAIDS second generation
Celecoxib
Drug of choice with severe arthritis
NSAIDs. Celecoxib
Action
Inhibits Cox2 only
NSAIDs. Celecoxib
Use
Osteoarthritis, rheumatoid arthritis, relief of dysmenorrhea
NSAIDs celecoxib
Caution
Renal or hepatic dysfunction, fluid retention, heart failure, history of GI bleeding
NSAIDs Celecoxib
Info
Coumarin drug interaction and ace inhibitors, due to fluid retention
NSAIDs Celecoxib
Contraindications
-renal or hepatic failure
-use of diuretics and ace inhibitors
NSAIDs Celecoxib
Side effects
Headaches, GI, rash
NSAIDs Celecoxib
Adverse reaction
Peripheral edema
NSAIDs celecoxib
Nursing considerations
-be aware of drug interactions
- monitor for edema
NSAIDs Celecoxib
pt education
-report side effects; unexplained weight gain, edema, skin rash
- do not use in third trimester of pregnancy
Corticosteroids
-use as anti-inflammatory
-used for arthritis but not DOC
-administer daily
- must taper when discontinued
Corticosteroids
Very useful, used for respiratory disorders, lupus inflammation and rheumatoid arthritis,
Pt must be tapered off due to rebound effect
Drug modifying anti rheumatic drugs (DMARDs)
-used with arthritic disease
-prototype drug gold (Cyrus therapy)iv
DMARDs
Action
Inhibits prostaglandin synthesis, decreasing phagocytosis
DMARDs
Use
Alleviation of inflammation and plan in rheumatoid arthritis
DMARDs
Contraindications
-renal or hepatic dysfunction
-lupus
-blood dyscrasias
DMARDs
Info
Kidney and renal dysfunction 1/2 life up to a month ( last resort med) not first line of treatment
Rheumatoid arthritis
Becomes, deformed, joint eroded, autoimmune, body doesn't recognize self
DMARDs
Caution use
Heart failure, diabetes
DMARDs
Side effects
GI, pruritis, headache, dermatitis, photosensitivity, gingivitis,
DMARDs
Adverse reactions
Blood dyscrasias, nephrotoxicity
DMARDs
Nursing considerations
-assess vital signs
- monitor urine output
-monitor lab tests
-monitor for side effects
DMARDs
Pt teaching
- frequent dental hygiene
- desired effects take months
- report side effects, adverse effects
-avoid direct sunlight
- high fiber diet
Immune agents
Use
Immnosuppressive drugs
- used for refractory rheumatoid arthritis
- after 1st and 2nd line drugs
Immunomodulators
-treat moderate to severe rheumatoid arthritis
-prototype drug: infliximab
Immunosuppressive drugs
No active infection can be present, deplete immune system ( elderly usually doesn't get it, young healthy pt are good candidates)
Immunomodulators (infiximab)
Action
Delay of imflammatory process through binding to TNF and blocking attachments to receptors
Immunomodulators
Use
Moderate to severe rheumatoid arthritis, Crohn's disease
Immunomodulators
Contraindications
Heart failure
Immunomodulators
Caution use
Renal, or hepatic dysfunction, immunosuppression, heart problems, liver disease, infection or existing immunosuppression
Immunomodulators (infiximab)
Side effects
Insomnia, depression, GI, rash, alopecia, dizziness, headache
Immunomodulators ( infiximab)
Adverse reaction
Severe infection, liver dysfunction
Immunomodulators
Nursing considerations
- monitor vital signs and lab studies
-assess patient for signs of infection
Immunomodulators
Patient teaching
Report signs of infection
Immunomodulators
Constant monitor LFT's monthly or every 3 months, check for infection and report to an physician ( photosensitivity)
Antigout drugs
- inflammatory
- primarily affects joints, tendons, other tissues
- disorders of uric acid and purine metabolism
- characterized by tophi
Gout (prototype allopurinol)
Strikes larger joints, usually great toe, accumulation of uric acid, nodules on knuckles and toes
Antigout ( allopurinol)
Action
Reduces synthesis of uric acid
Antigout ( allopurinol)
Use
Treatment of gout, hyperuricemia
Antigout ( allopurinol)
Contraindications
Severe renal diseae
Antigout (allopurinol)
Caution
Renal or hepatic disorders; bone marrow depression
Antigout (allopurinol)
Side effects
GI, dizziness, headache, rash, metallic taste
Anti gout ( allopurinol)
Adverse reaction
Bone marrow depression, hepatoxicity
Anti gout ( allopurinol)
Nursing considerations
- give with food
-monitor intake and output
-monitor lab tests
-report GI symptoms
Anti gout ( allopurinol)
Patient teaching
- diet teaching
- increased fluids
-no alcohol, caffeine
-limit high- purine foods
- monitor for side effects
( monitor I & O's foods high in puritine, gravies, wines, dark beers, no alcohol or caffeine
What is pain
Unpleasant sensory and emotional experience
Classifications of pain
- acute, surgical pain, self limiting , get pt up and pain should subside
- chronic pain, 6 months or longer
Pain ( origin)
Noncieptor pain- sensory receptor to pain
Somatic - tissues, bones, muscle
Visceral-organ pain
Neuropathic - originates in nerve, diabetic nephropathy disorder, numbness and tingling in feet
Pain scale
5th vital sign
0-4 mild
5-7 moderate
8-10 severe
Nonopioid analgesic prototype
(acetaminphen)
Actions
Inhibits prostaglandin synthesis, inhibits hypothalamus heat regulator center
Nonopioid analgesic ( acetaminophen)
Use
Decrease pain and fever
Nonopioid analgesic (acetaminophen)
Contraindications
- alcoholism
- severe hepatic or renal disease
No opioid analgesic ( acetaminophen)
Side effects
GI, rash
Tylenol use for mild pain, menstral, muscle aches, fever, drinking alcohol can cause toxic effects, can kill liver, watch with respiratory and asthma
...
Nonopioid analgesics
- less potent
- use for mild to moderate pain
-include in this category
- acetaminophen
- ibuprofen
- aspirin
( prototype drug: acetaminophen)
Nonopioid analgesic ( acetaminophen)
Adverse reactions
Hepatotoxcity, hypoglycemia, leukopenia,
Nonopioid analgesic
( acetaminophen)
Nursing interventions
- monitor liver enzymes
- check pain level before and after meds
Non opioid analgesic
( acetaminophen)
Client teaching
- length of self- medication
- keep out of children reach
-report side effects
Nonopioid analgesic
(acetaminophen) OTC
-less potent mild to moderate pain
-monitor liver enzymes
- if elevated do not give
- assess pain level
-excess 2400 mg
- keep out of reach of children
Opioid analgesics act on CNS receptors
...
Opioid analgesics produce
- analgesics
- respiratory depression
- euphoria
-sedation
-antitussive and antidiarreal effects
prototype: morphine sulfate
Opioid analgesics are
- percocet
-vicodin
-Demerol, pt have neural toxicity
Opioid analgesic ( morphine)
Action
Depresses CNS, pain impulses
Opioid analgesics ( morphine)
Use
Relief of severe pain
Opiod analgesic ( morphine)
Contraindications
Asthma, with respiratory depression, increased intracranial pressure
Opioid analgesic ( morphine)
Caution use
Respiratory, renal, hepatic diseases
Opioid analgesics (morphine)
Side effects
Dizziness, sedation, confusion, GI, constipation, urinary retention, decrease respiratory, bradycardia, rash
Opioid analgesic ( morphine)
Adverse effects
Hypotension, respiratory depression, increased intracranial pressure
Opioid analgesic ( morphine)
Nursing interventions
- check pain level before and after meds
- monitor v/s and urine output
- check bowel sounds
- have antidote ready
- remember safe precautions
- check pupil changes, check older adults for confusion
Opioid analgesic ( morphine)
Pt teaching
- be aware of side effects
- no alcohol or CNS depressants
-cultural considerations
Synthetic opioid analgesics
Mederidine ( demerol)
- shorter duration, no antitussive qualities
-analgesia through CNS effects
- used during pregnancy( not labor ) GI procedures
Synthetic opioid analgesic ( Demerol )
Contraindications
-MAOI therapy
- convulsive disorders
Synthetic opioid analgesic( demerol)
Caution use
- impaired liver or kidney function
Synthetic opioid analgesics
Nursing interventions
- assess pain before and after meds
- monitor v/s
Synthetic opioid analgesic
Pt education
- safety needs
- not for long term use
Synthetic opioid analgesic
- orally meds assess 1 hr later
-IV 30 mins reassess normally every 3 to 4 hrs.
- Demerol 25 to 100 mg
- watch v/s and age, before elevating to higher dose
Synthetic opioid analgesic
( hydromorphine) is
- more potent analgesic than morphine sulfate
- shorter duration than morphine sulfate
Synthetic opioid analgesic
( hydromorphine)
Contraindications
- respiratory depression, asthma, head injuries
Synthetic opioid analgesic
( hydromorphine)
Side effects
Drowsiness, constipation, withdrawal syndrome
Synthetic opioid analgesic (hydromorphine)
Adverse reaction
Respiratory depression, orthostatic hypotension,
Opioid antagonist
Reverse opioid toxicity or overdose
Naloxone ( narcan)
Narcotic antagonist
Reverse slow hand when pt returns stop
Opioid antagonist
- naloxone (narcan) (IM or IV), or naltrexone hydrochloride (ReVia), nalmefene (Revex) (oral)
- reverse CNS and respiratory depression
- monitor for analgesic reversal
-observe for bleeding
Opioid agonists - antagonist
Prototype drug :nalbuphine (nubain )
Developed to decrease opioid abuse
Opioid agonists- antagonist
Use
Moderate to severe pain
Opioid agonists- antagonist
Action
Binds with opiate receptor and increase pain threshold
Opioid agonists- antagonist
Caution
Impaired respirations, head injury, renal and hepatic dysfunction
Opioid agonists- antagonist
Side effects
Dizziness, confusion, headache,dry mouth, GI
Opioid agonists- antagonist
Adverse reaction
Hypotension, respiratory depression
Opiod agonists- antagonist
Nursing interventions
- monitor v/s urine output
- check bowel sounds, monitor for constipation
Opioid agonists- antagonist
Pt teaching
- safety
- side effects
PCA ( pt controlled analgesia)
- use for self medication
- predetermined limits for pt with pain meds
-used with an IV line
-maintain a near constant analgesic effect
-usually use morphine sulfate but may use hydromorphine or fentanyl
PCA
-you are unable to push button for pt
- once locked out no med is available
- teach before surgery
- connected to IV line and pt cannot overdose themselves
Methadone treatment
- used for severe addiction
-sickle cell pt more so than morphine
- must screen for TB, hepatitis, HIV