Week 4 Pain, Inflammation, fever Drug Therapy
this is the sensation of discomfort, hurt, or distress
pain occurs generally due to these 2 things:
tissue injury and inflammation
these sensitize pain receptors and increase pain associated with other chemical mediators of inflammation and immunity
This is the elevation of body temp above normal range
what controls the body temp?
this occurs when set point of hypothalamus is raised in response to presence of pyrogens
this is inflammation or fever causing agents inside of the body:
this is inflammation or fever causing agents outside of the body:
what is inflammation?
local reaction of the body to injury or invasion from a foreign substance
the activation of neutrophils and chemicals that lead to cell injury and destruction is called:
clinical signs of inflammation include:
warmth, redness, swelling, pain
this inhibits prostaglandins produced in inflammation, acts on hypothalamus for antipyretic effects, and low doses block thromboxane A2 to inhibit PLT aggregation
salicylates [such as aspirin] use:
analgesic agent [pain], antipyretic, anti-inflammatory, antiplatelet effects
salicylate adverse effects:
nausea, vomiting, heartburn, epigastric pain, occult blood loss, dizziness, tinnitus, acidosis
salicylates like aspirin is ______ in high doses
contraindications for salicylates like aspirin:
known sensitivity, high risk for bleeding, impaired renal function, children and adolescents may get Reye Syndrome
salicylates are some times a preventative for this condition[s]:
TIA or MI [transient ischemic attack] or heart attack] ex-aspirin
do not give salicylates to these people:
should salicylates be taken with food?
bleeding, ringing in the ears, or diminished hearing is sometimes associated with this type of drug:
avoid this drug for 2 weeks before and after major surgery including dental procedures:
aspirin and other salicylates should be used with CAUTION with these people:
people on low sodium diet
what is the therapeutic serum level of salicylates for treatment of arthritis and rheumatic fever?
100 to 300 mcg/ ML
when does salicylate toxicity occur?
when therapeutic serum level is above 300 mcg/mL
how to treat MILD salicylate toxicity?
stop the drug or reduce the dose
how to treat SEVERE salicylate toxicity?
gastric lavage, activated charcoal, IV sodium bicarbonate, iv fluids and hemodialysis
This drug is a Non-narcotic analgesic antipyretic drug:
acetaminophen, aka tylenol
what does acetaminophen do?
reduces fever acting on hypothalamus,
increases vasodilation and sweating,
diminishes pain somehow,
has NO anti-inflammatory effects
What is the drug of choice [DOC] t ogive children with fever or pain?
give this drug prior to DTAP in those at risk for a seizure:
can you alternate ibuprofen and acetaminophen every 4 hours over 3 days to control a fever?
name 3 contraindications for acetaminophen?
hypersensitivity, hepatic dysfunction, alcoholism
why shouldn't you give acetaminophen to an alcoholic?
it causes liver enlargement and liver failure
acetaminphen can have drug-drug interactions with these 2 :
alcohol ingestion and anticoagulants like rifampin
when does myocardial damage occur when taking tylenol?
ingesting 5-6 grams a day for several weeks
what should a nurse assess for when giving acetaminophen?
look for jaundice, decrease pain, checking temp every 2-4 hours for fever, rash, history of myocardial damage/ chest pain
this drug produces a toxic metabolite that is normally inactivated by combining with glutathione:
it is important to obtain this in the blood work when acetaminophen overdose is known or suspected:
plasma acetaminophen levels
what is another drug you can give to help with acetaminophen toxicity that is a mucolytic agent given by inhalation in respiratory disorders?
acetylcysteine [mucomyst or acetadote] helps by synthesizing glutathione
this is what NSAIDs stands for:
Non- Steroidal Anti-inflammatory Drugs
How do NSAIDS work?
they block COX-1 and COX-2 enzymes
2nd generation NSAIDS only block this enzymes:
Both 1st and 2nd generation Nsaids have the ability to cause this serious event:
cardiovascular thrombotic events
if your patient has had coronary artery bypass graft surgery, DO NOT GIVE THIS or you will get FIRED [probably].
name 4 NSAIDS
ibuprofen, indomethacin, celecoxib, meloxicam
Ibuprofen is a ___ generation Nsaid:
this is a propionic acid derivative:
use this NSAID to relieve mild pain including dysmenorrhea, inflammation, rheumatoid arthritis and osteoarthritis , initial attacks of gout
ibuprofen can be given to children older than __ _____.
some side effects of ibuprofen include:
dry mouth, sores, dyspepsia, heartburn, nausea, epigastric pain, constipation, GI ulcers w/ occult blood loss
on bloodwork, some bad effects of ibuprofen can be shown here:
elevated BUN, creatinine, edema, cbc and signs of anticoagulation
ibuprofen also goes by these 2 names:
motrin or Advil
allergic reactions occur more to patients with these pre-existing issues:
rhinitis, asthma, chronic urticaria, nasal polyps
naproxen [aleve] is similar to ibuprofen, but naproxen has this:
a longer half life
drug -drug interactions with ibuprofen include:
loop diuretics, beta blockers [lessens effect on HTN], and lithium
when taking this drug, take it with food or water and drink 2-3 quarts of fluid daily when taking regularly.
indomethacin goes by these 2 names:
indocin and Tivorbex
this drug is an acetic acid derivative:
what action does indomethacin take on the body?
anti-inflammatory, analgesic, antipyretic by inhibiting prostaglandin synthesis. inhibits COX1 and COX2
rheumatoid arthritis, osteoarthritis, bursitis, gouty arthritis and acute gout attacks is when patients use this drug:
this drug can produce closure of patent ductus arteriosus in preterm infants:
GI bleeding/ ulcers, abdominal pain and distention, transient ileus, headaches, renal impairment, decrease clotting time and severe respiratory effects can be seen with this drug:
dont use indomethacin in patients with a history of:
salicylate hypersensitivity, past GI bleeding, severe renal impairment or patients who had coronary bypass
name an injectable NSAID:
this is a selective COX2 inhibitor that is activated with inflammation and does not affect COX1 enzymes:
what sre some uses for celecoxib?
acute or long term tx of juvenile rheumatoid arthritis, osteoarthritis, acute pain and primary dysmenorrhea, and familial adenomatous polyposis
adverse effects of celecoxib include:
headaches, dizzy, insomnia, increase for MI and CVA, rash, pruritus, sweating, dry MM, stomatitis, GI bleeding
contraindications for celebrex include:
allergy to sulfonamides, NSAIDS/ aspirin, renal impairment, perioperative pain, post- coronary artery bypass sx, or pregnancy
to prevent gastric upset, give this med with food, try not to operate machinery, and report a sore throat, rash, itching, weight gain, swelling or vision changes:
celecoxib [ celebrex]
this is a disease- modifying antirheumatic drug that is given SQ:
what does etanercept do?
genetically engineered tumor necrosis factor TNF receptors react with and deactivate TNF, released by active leukocytes- decreasing inflammation.
etanercept is used in these patients:
patients with rheumatoid arthritis, polyarticular idiopathic arthritis, psoriatic arthritis, ankylosis spondylitis, plaque psoriasis [to decreased signs/ symptoms]
adverse reactions of etanercept:
fatal infections, lymphoma, demyelinating disorders like MS, MI, heart failure, injection site reactions.
dont use etanercept in these patients:
acute infection, cancer, tuberculosis, sepsis, hepatitis, myelosuppression or demyelinating disorders, and pregnancy
do not use these drugs when using etanercept:
immunosuppressant drugs, or live vaccines
is blurred vision, tingling, numbness, and extreme fatigue side effects of etanercept?
this narcotic/ opioid agonist binds to receptors in brain, spinal cord, and peripheral tissue to produce analgesia, euphoria, and sedation:
morphine [roxanol, astramorph]
what is the unlabeled use of morphine?
relief of dyspnea, acute left ventricular failure and pulmonary edema
side effects of morphine:
pupil constriction, CNS & respiratory depression, slow GI, decrease mental activity, constipation, nausea and vomiting
don't use morphine under these circumstances:
patient has respiratory depression, lung, liver, kidney disease, prostatic hypertrophy, pregnant, ICP, seizure disorder, addison's disease, toxic psychosis
morphine can interact poorly with these drugs:
antihistamines, alcohols, antidepressants, antipsychotics, barbiturates, sedatives, MAOIs, benzodiazepines, kava, valerian, st johns wort.
reversal for morphine is:
codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, oxycodone, oxymorphine, tramadol are all from this group of drugs:
duragesic, sublimaze is the trade name for this:
Hysingla is the trade name for this drug:
Dilaudid and Exalgo is the trade name for this drug:
Demerol is the trade name for this drug:
Dolophine is the trade name for this drug:
OxyContin is the trade name for this drug:
Opana or Opana ER is the trade name for this drug:
Ultram or ConZip is the trade name for this drug:
how is PCA, or patient controlled Analgesia, defined?
any method that allows a person in pain admin their own pain relief
a kappa agonist drug does this:
causes dysphoria and hallucinations
Talwin is AKA :
why would one use Talwin?
moderate to severe pain - generally perioperative or for labor pains.
side effects of pentazocine [talwin]:
headache, dizzy, drowsy, vertigo, euphoria, nausea vomiting and constipation.
contraindication for pentazocine:
acute asthma who are unmonitored or if resuscitative equipment is not available
Nubain is also called this:
nalbuphine- most often seen in labor and delivery
after stopping opiods after continuous use, you will see this happen in patients:
name the opioid Antagonist:
patients may need more than one dose of naloxone due to this:
it has a short half-life
side effects of naloxone:
tremors, drowsiness, sweating, HTN, nausea vomiting d/t, narcotic abstinence syndrome, decreased respirations
dont use naloxone in these people:
known hypersensitivity, narcotic abuse, pregnancy
name another drug in the opioid antagonist group other than narcon:
Naltrexone [ Vivitrol]
A seizure is defined as:
not a disease but a symptom of underlying CNS dysfunction characterized by spontaneous nerve firing
these things can provoke seizures:
fever, electrolyte imbalance, hypoglycemia, CNS infection or damage
the cause for unprovoked seizures is:
there are over __ different things that can cause seizures
these are generalized seizure:
tonic- clonic, absence, myoclonic, febrile, status epilepticus
these are partial seizures:
simple [one part of the brain] and complex [ multiple parts of the brain]
there are 5 drug CLASSES for treating generalized seizures:
inhibitory neurotransmitter gamma-amino-butyric acid
name 5 drugs that treat generalized seizures:
Dilantin, Solfoton, Valium, Zarontin, Depakene
this drug treats generalized seizures by stabilizing neuronal membrane, control tonic- clonic seizures, psychomotor seizures, non-epileptic seizures:
Dilantin- or phenytoin
ataxia, nause, vomiting, lethargy, gingival hyperplasia, steven johnson syndrome are adverse effects for:
do not use phenytoin [dilantin] if:
there is known hypersensitivity, sinus bradycardia, pregnant, hypoglycemia
alcohol, chloramphenicol, omeprazole, ticlopidine, amiodarone can cause drug-drug interactions with:
phenobarbitol is a
this drug depresses CNS by inhibiting conduction of impulses in ascending reticular activating system:
this is a sedative and anti-epileptic agent in the treatment of generalized tonic- clonic and partial seizures
some adverse side effects of phenobarbital include:
somnolence, agitation, confusion, vertigo, NightMares, steven-johnson syndrome, suicidal thoughts
sudden withdrawal from phenobarbital places patient at risk for:
this drug has interactions with this list of drugs:
opioids, corticosteroids, doxycycline, estrogens, contraceptives, anticoagulants, antidepressants, vitamin D, alcohol, chloramphenicol, diazepam, monoamine oxidase inhibitors
Diazepam is also called:
valium or diazepam is this class of drug:
this drug primarily works on the limbic system and reticular formation and potentiates GABA by increasing attraction of medication to receptor sites:
adverse effects of diazepam include:
CNS depression, confusion, restlessness, paradoxical excitatory reaction, CVS collapse w/ bradycardia and hypotension, BBS [combining this w/ opioid]
the benzodiazepine Klonopin is aka:
alcohol, omeprazole, cimetidine, disulfiram, hormonal contraceptives, herbs and food like grapefruit juice increase the effect of this drug group:
theophylline, ranitidine are drugs that _____[increase or decrease]?] effects of benzodiazepines
Depakene is the trade name for this drug:
what does valproic acid do?
increase GABA in the brain
adverse effects of valproic acid [ depakene]:
hepatotoxicity, birth defects, pancreatitis, GI effects, tinnitus, blurred vision, ataxia, infection
what is depakene [valproic acid] used to treat?
to treat absence or partial seizures
dont use depakene [valproic acid] if:
hypersensitivity, acute narrow angle glaucoma, shock, coma, alcohol intoxication, pregnant
valproic acid [depakene] can have drug interactions with these4:
phenobarbital, diazepam, primidone, zidovudine
important things to teach patients when taking depakene [valproic acid]?
take with food, dont stop abruptly taking, dont take with OTC sleep agents, medical alert bracelet, report bruising or bleeding, and use contraceptives is sexually active
Gabapentin is also called this:
action of gabapentin is to?
antiepileptic action; ability to inhibit postsynaptic neuralgia
why would you use gabapentin [neurontin]?
adjunctive therapy for partial seizures and postherpetic neuralgia
adverse effects of gabapentin [neurontin]?
CNS depression, dizzy, insomnia, ataxia, pruritus, dry mouth, dyspepsia, suicidal ideation
gabapentin interacts with these other drugs:
antacids and ginkgo biloba [decrease effects]
when teaching patients about taking gabapentin, it is important to note these things:
take with food, do not stop abruptly, report any mal-effects , do not crush or cut pills, do not drive if cns depression occurs
name another drug in the same class as gabapentin/ neurontin:
Keppra is aslo known as:
levetiracetam is used for:
adjunctive therapy for partial onset and generalize tonic- clonic seizures
true or false- levetiracetam inhibits normal firing and does not affect normal neuronal excitability or function?
Adverse effect of levetiracetam [keppra] are:
fatigue, double vision, amnesia, hostility, rhinitis, anxiety, pharyngitis, decrease in RBS, WBC
contraindications for keppra[ levetiracetam] are:
pregnant, lactating, hypersensitivity, suicidal ideation
Topamax is the trade name for the drug:
increased GABA activity, antiepileptic action and blockage of sodium channels in neurons are associated with this drug:
adverse effects of topiramate [topamax] include:
increase intraocular pressure, CNS, GI, metabolic issues such as weight gain and glucose, oligohydrosis, fatigue
do not take topiramate if:
hypersensitive, ,metabolic acidosis, or taking anticholinergic medications
in teaching patients about topiramate, it is important to tell them to:
take 2 forms of contraceptive, drink 6-8 8oz glasses of H2O a day to decrease renal stone development. dont stop taking abruptly.