Pain & Inflammation

• stimulation of mu receptors causes what?

  suppression of respiratory and cough center, suppression of CNS, inhibition of baroreceptor function, release of histamine, increased tone of bladder sphincter, suppression of GI function, stimulation of CTZ, pupillary constriction
• withdrawal symptoms from opioids

  anxiety, irritability, chills, hot flashes, joint pain, runny eyes and nose, sweating, nausea, vomiting, abdominal cramps, diarrhea
• which drugs are used for pain & inflammation?

  first gen NSAIDs (COX1 and COX2 inhibitors) - aspirin, ibuprofen

  second gen NSAIDs (COX2 inhibitor) - celecoxib

  acetaminophen

  opioid agonists - morphine

  opioid agonist-antagonists - buprenorphine

  opioid antagonists - naloxone
• adverse effects of aspirin & ibuprofen

  gastric erosion and ulceration, bleeding, renal impairment, tinnitus, Reye's syndrome, salicylism
• key monitoring parameters of aspirin & ibuprofen

  GI effects, I&O, bleeding, salicylism s/s
• patient education for aspirin & ibuprofen

  take with food, milk, or water, avoid alcohol, report bleeding, chest pain, shortness of breath
• adverse effects of celecoxib

  GI upset, heartburn, diarrhea, gastric ulceration, kidney dysfunction, cardiovascular or cerebrovascular events
• key monitoring parameters of celecoxib

  give antacids 2 hours before or after, monitor I&O, kidney function
• patient education for celecoxib

  take with food, milk, or water, avoid alcohol, report GI irritation, bleeding, I&O changes, chest pain, shortness of breath
• adverse effects of acetaminophen

  hepatotoxicity (overdose), hypertension (with daily use)
• key monitoring parameters of acetaminophen

  overdose, antidote is acetylcysteine, BP
• patient education for acetaminophen

  no other hepatotoxic drugs or alcohol, 4g max daily dose, be careful with other OTC drugs
• s/s of salicylism

  mild - nausea, vomiting, dizziness, tinnitus, headache

  moderate - confusion, hyperventilation, tachycardia, fever

  severe - delirium, hallucinations, seizures, coma, respiratory arrest
• adverse effects of morphine

  tolerance, physical dependence, overdose, respiratory depression, sedation, constipation, nausea or vomiting, orthostatic hypotension, urinary retention, cough suppression
• key monitoring parameters of morphine

  antidote is naloxone, monitor vitals, bowel function, I&O, have patient cough frequently
• patient education for morphine

  take drug PRN and short term, change positions slowly, increase fluids, fiber, and exercise, take with food or milk, report difficulty urinating
• adverse effects of buprenorphine

  respiratory depression, sedation, dizziness, headache, nausea, increased cardiac workload, abstinence syndrome
• key monitoring parameters of buprenorphine

  vitals, ask about opioid use, do not give if MI history or cardiac insufficiency
• patient education for buprenorphine

  short term use only, change positions slowly, do not use for anginal pain
• adverse effects of naloxone

  ventricular arrhythmias, increased RR, BP, HR, abstinence syndrome (hypertension, vomiting, cramping)
• key monitoring parameters of naloxone

  give every 2-3 minutes until reversal of overdose, observe for nausea, vomiting, tachycardia, diaphoresis
• which drug is used for gout?

  allopurinol
• adverse effects of allopurinol

  hypersensitivity, GI effects, CNS effects, agranulocytosis, aplastic anemia, bone marrow depression, cataracts, metallic taste
• key monitoring parameters of allopurinol

  hypersensitivity syndrome, give after meals, CBC
• patient education for allopurinol

  increase fluids, candy or gum for metallic taste, minimize sun exposure to eyes, obtain regular eye exams