Non-Opiate Analegesics

non-steroidal anti-inflammatory drug

Reversibly inhibit COX-1 & COX-2
Block prostaglandin synthesis

-reduce inflammation and pain

Adjunctive therapy; this allows us polong effects of the narcotics thus lowering the use of narcotics

Homestatic functions

side effects:
-GI distress
-Renal tract (nephrotoxic)
-platelet function (Bruising and bleeding)
-Macrophage differential (Prone to infections)

Gives us the desired outcomes:
-Reduces inflammation

OTC and RX prescribed for larger doses

GI irritation

Misoprostol

Pregnant patients; causes abortion

OTC drugs

Aspirin

GI distress and bleeding

NEVER administer to children or teenagers with viral illnesses; can cause Reyes syndrome

Syndrome which is an acute encephalopathy (inflammation of the brain). Usually follows a viral illness & linked to intake of aspirin. Use acetaminophen (not aspirin) to reduce fever with child with a communicable disease (virus) to prevent this.

Tinnitus, hyperventilation, acid-base imbalances, seizures

Anti-thrombotic to prevent blood clots and strokes

Propionic acid derivatives, Indoles, and Oxicams

2400 mg in 24 hrs (NEPHROTOXIC)

celecoxib; newer drug

Less GI problems

Increases risk of thromboembolism (MI, Stroke)

Tylenol. Can be OTC or combination

have anti-inflammatory effect

hepatoxicity

4000 mg/day

Acetylcysteine (Mucosmyst PO; Acetadote IV)

reducing agent that can help save the liver

inflammation of the bone and joint

1st line= NSAID in large dosages

-More ADE due to high dosage (1)

-More clotting disorders (2)

NSAID COX-2

Pain but not inflammation

-Steroids short-term

-Intraarticular injection

a dietary supplement used in the treatment of joint pain

-Should not be used in pts. withshellfish allergy.

- May increase glucose levels, pt. with DM should monitor bloodsugars

-SAMe (May can seratonin syndrome)

-Flexium (expensive)

painful form of arthritis caused by a buildup of uric acid in the joints, which forms urate crystals

1. Asymptomatic hyperuricemia (Uric acid build up in blood)

2. Acute gouty arthritis

3. Intercritical gout

4. Chronic tophaceous gout

-Weight control
-Regular exercise
-Limiting alcohol, especially beer
-Eating a heart-healthy diet
-Avoiding foods high in purine (meat, poultry, and seafood)
-Vitamin C

-NSAIDs
-Colchicine (Acute episode, short term)
-Steroids (short term)

May use: Narcotics and non-medicinal

-Uricosurics (Increases excretion of Uric Acid)

-Xanthine oxidase inhibitors (e.g., allopurinol, febuxostat) *Black box warning*

-Low purine diet
-Vitamin C
-Force fluids
-Assess meds OTC

substance derived from the opium poppy from which all narcotic drugs are derived

Agonist, partial agonist, antagonist

Mimic the action of endorphins on opiate receptorsin brain

PO, IV & IM, transdermal, parenteral

Oxycodone

A treatment that activates opiate receptors slowly than other opiates, dampening the high that addicts get. Eases withdrawal. Used for pain

Longer

narcotic drug derived from opium, used to treat severe pain

-High abuse potential
-Should not be combined with any other sedative or"downer" medication (ie. sleeping pills, tranquilizer

Opioid Analgesic; Strongest avail. 100x potency of morphine

-IV
-transdermal patch

-Teach pt. that heat can increase absorption.
- Warn pts not to cut patch in half and do not dispose of patch in trash(flush instead).

Dilaudid

Oxycontin

Vicodin

-Demerol
-Renal toxic, not recommended for more than 48 hours

A narcotic drug that is commonly used for suppressing coughs.

*Black Box warning for pts younger than 18*

Synthetic opiod

Potentially life-threatening condition from excess serotonin.

Serotonin syndrome

-respiratory depression,
-orthostatic hypotension,
-tachycardia
-drowsiness
-mental clouding, *constipation*
-urinary retention.

Respiratory depression, come, pinpoint pupils

PRN

-Tolerance
-Pain is out of control
-neuropathic pain
-genetic factors (metabolism)

-Follow-up assessments to evaluate effectiveness
-Monitor vital signs, especially respiratory rate & depth, prior to and after administration
-Safety measures
-Don't forget to document

-Often given combined with anti-emetics (5HT3 blockers, promethazine, hydroxyzine)
-Constipation is a problem with long-term therapy; diet, fluids, activity, and stimulant laxatives help.

-DO NOT PUSH MORPHINE WITHOUT DILUTION; Administered is 2.5-15mg over 5 minutes.

Sever vomiting

-Naloxone (Narcan)
-Naltrexone

Opiate dependent pt. may have serious withdrawal symptoms if given the antidote

PO as maintenance

Naloxone

-Tolerance
-Dependence
-Addiction

The phenomenon where an increased dose is required to produce the same effects.

The dosage is increased as the body adjusts.

When patients uses opioids 10 days or longer, when treatment stops, it causes withdrawal symptoms.

A physical or psychological need for higher and higher doses of a drug. Interrupts their daily lives

Risk Evaluation and Mitigation Strategy
FDA requirement for drug manufacturers to develop strategies to assure safe use of a specific drug

opioid antagonist

Like any opioid, they are dose dependent, dizzy, drowsy, diaphoresis, respiratory depression, coma → DEATH!

methadone, reduce dose over time, the Relapse rate is sadly high