Term
| What are the roles of Prostaglandins? |
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Definition
GI Protection
Renal Protection
Uterine Contractions
Pain
Inflammation at Tissue Level |
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Term
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Definition
| inhibits cyclooxygenase and blocks prostaglandins |
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Term
| Whats the difference between nonselective NSAIDS and COX2 inhibitors? |
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Definition
| Nonselective NSAIDS are the first generation NSAIDS that inhibit BOTH COX 1 and COX 2 while COX2 inhibitors are the second generation NSAIDS that only inhibit COX2 |
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Term
| What are the effects of blocking COX 2? |
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Definition
| prevention sensitization of pain receptors, Lower body temperature and prevention of inflammation |
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Term
| What are the effects when you block COX 1? |
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Definition
| Prevent platelet aggregation |
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Term
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Definition
| Moderate pain, sunburn, fever, arthritis pain, menstrual cramping, headach, orthopedic injuries (fractures, sprains, tendonitis), dental pain, postpartum pain |
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Term
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Definition
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Expected Action:
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Proto: aspirin, ibuprofen, ketorolac, celecoxib
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· Cyclooxygenase inhibition – COX 2 decrease’ inflammation, COX 1 ’decrease platelet agg.
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Therapeutic Uses:
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· Inflammation suppression / analgesia / decrease fever
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· dysmenorrhea / suppression of platelet aggregation
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Adverse Effects:
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· GI discomfort, aspirin induced ulceration and bleeding (use misoprostol as prophylaxis, and/or PPI and/or H2-receptor agonist decrease risk of ulceration)
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· Renal dysfunction
· Reye syndrome (in kids with viral illnesses)
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· Salicylism (tinnitus, resp. alkalosis, dizziness)
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Contraindications/Precautions:
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· Peptic ulcers / bleeding disorders / hypersensitivity / pregnancy / kids ĉ viral inf.
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Interactions:
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· Glucocorticoids (increase gastric bleeding) – use antiulcer prophylactic like misoprostol (Cytotec) to prevent
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· Warfarin (increase bleeding)
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· EtOH (increase bleeding)
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· Ibuprofen (decrease antiplatelet effects of low-dose aspirin)
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Education:
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· Give with food or milk to reduce GI discomfort.
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· If can’t tolerate 1st generation, give 2nd generation (celecoxib)
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Term
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Definition
first generation NSAIDs (COX-1 and COX-2 inhibitors)
aspirin
ibuprofen (motrin, advil)
naproxen
indomethacin (indocin)
diclofenac (voltaren)
keorolc (toradol)
meloxicam (mobic)
2nd generation NSAIDs (COX-2 inhibitor)
celecoxib (celebrex) |
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Term
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Definition
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Expected Action:
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Proto: ketorolac (Toradol) – 1st generation NSAID
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· decrease pain without anti-inflammatory effect
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Therapeutic Uses:
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· Short-term treatment of moderate to severe pain (post-op)
· Enhances opioid analgesia without opioid adverse effects
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Adverse Effects:
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· Can occur when used with other NSAIDs.
· GI bleeding / blood dyscrasias
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Contraindications/Precautions:
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· Give no more than 5 days
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Interactions:
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· Other NSAIDs / anticoagulants (increase bleeding)
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Education:
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· Usually started parenteral and then transition to oral dose
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Term
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Definition
· Analgesics relieve pain
· Narcotics / NSAIDs / Antimigraine agents
· Anti-inflammatory medications relieve inflammation
· Salicylates / Glucocorticoids / Antigout / Disease-modifying antirheumatics drugs (DMARDs)
· Some are antipyretic (salicylates, ibuprofen)
· Salicylates and NSAIDs reduce platelet aggregation
· Salicylates, NSAIDs, and glucocorticoids pose risk for ulceration
· Acetaminophen has analgesic and antipyretic properties but not anti-inflammatory. It poses a risk for liver injury |
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Term
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Definition
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Expected Action:
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· Slows production of prostaglandins
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Therapeutic Uses:
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· Analgesic and antipyretic
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Adverse Effects:
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· Max 4 g daily
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· Acute liver toxicity
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· Antidote: acetylcysteine (Mucomyst)
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Contraindications/Precautions:
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·
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Interactions:
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· EtOH ’- increase risk to liver / Warfarin -’ increase levels of warfarin
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Education:
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·
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Term
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Definition
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Therapeutic Uses:
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Proto: morphine, fentanyl, meperidine, methadone, codeine, oxycodone
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· Moderate to severe pain / Sedation / decrease bowel motility / Cough suppression
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Adverse Effects:
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· Respiratory depression
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· Sedation
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· Constipation
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· Orthostatic Hypotension
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· Urinary retention
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· Biliary colic
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· Cough suppression
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· Emesis
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Contraindications/Precautions:
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· Increases cardiac workload
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· Meperidine metabolites are neurotoxic ’- (< 600 mg/24hr, < 48 hours)
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Interactions:
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· CNS depressants (barbiturates, phenobarbital, benzodiazepines, EtOH)
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· Anticholinergics, antihistamines, tricyclic antidepressant -anticholinergic effects
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· MAOIs (hyperpyrexia, seizures)
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· Antihypertensives
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Education:
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· Withhold if RR<12
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· Have naloxone (Narcan) and resuscitation equipment available.
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· Infuse IV slowly over 4-5 minutes
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Term
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Definition
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Expected Action:
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Proto: naloxone (Narcan), naltrexone, nalmefene
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· Competitively interfere with opioid actions
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Therapeutic Uses:
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· OD treatment
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· Reversal of opioid effects
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Adverse Effects:
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· Tachycardia / Tachypnea
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· Abstinence syndrome (cramping, hypertension)
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Contraindications/Precautions:
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· Hypersensitivity
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· Dependency
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· Pregnancy: B
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Interactions:
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·
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Education:
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· Naloxone has extensive first-pass modification
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· Observe for w/d symptoms or abrupt onset of pain
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Term
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Definition
· Tricyclic Antidepressants (TCA)............... Amitriptyline (Elavil)
· Anticonvulsant......................... Carbamazepine (Tegretol)
Gabapentin (Neurontin)
Phenytoin (Dilantin)
· CNS Stimulants...................... Methylphenidate (Ritalin)
Dextroamphetamine (Dexedrine)
· Antihistamines.................. Hydroxyzine (Vistaril)
· Glucocorticoids................... Dexamethasone (Decadron)
........................... Prednisone (Deltasone)
· Bisphosphonates..................... Etidronate (Didronel)
· .......................................Pamidronate (Aredia) |
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Term
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Definition
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Therapeutic Uses:
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Proto: TCAs, Anticonvulsants, CNS stimulants, Antihistamines, Glucocorticoids, Bisphosphonates
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· Enhance opioid effects thereby permitting lower opioid doses
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· Alleviate other symptoms that aggravate pain
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· Treat neuropathic pain
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Adverse Effects:
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· TCAs (neuropathic pain)
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FOrthostatic hypotension, sedation, anticholinergic effects
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· Anticonvulsants (neuropathic pain)
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FBone marrow suppression
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· CNS stimulants
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FWeight loss, insomnia
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· Antihistamines
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FSedation
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· Glucocorticoids (inc. ICP, nerve compression)
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FAdrenal insufficiency
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FGlucose intolerance
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FHypokalemia
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FOsteoporosis
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FGI Ulcers
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· Bisphosphonate (CA bone pain)
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FFlu-like symptoms
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FInjection site irritation
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Term
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Definition
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Expected Action:
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Proto: Colchicine, indomethacin, allopurinol, probenecid
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· Colchicine/Indomethacin: ò inflammation by preventing leukocyte infiltration
· Allopurinol: Inhibits production of uric acid
· Probenecid: Inhibits reabsorption of uric acid by renal tubules
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Therapeutic Uses:
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· Colchicine/Indomethacin: Acute gout attacks
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· Allopurinol/Probenecid: Hyperuricemia
· Probenecid: Prolongs effects of penicillins and cephalosporins
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Adverse Effects:
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· Colchicine: GI toxicity
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· Others: GI discomfort
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· Probenecid: Renal injury (get 2-3L fluid/day)
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Contraindications/Precautions:
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· Colchicine: Pregnancy (C/D), renal, cardiac, elderly
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Interactions:
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· Salicylates: dec. η probenecid
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· Warfarin: dec. warfarin metabolism in liver - bleeding risk
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Education:
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Avoid EtOH, purines. Adequate hydration.
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Term
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Definition
· Ergot Alkaloids.............................. Ergotamine (Ergostat)
· Serotonin Receptor Agonists............. Sumatriptan (Imitrex)
· Beta-Blockers............................... Propanolol, Atenolol
· Anticonvulsants.......................... Divalproex (Depakote)
· Tricyclic Antidepressants.................. Amitriptyline (Elavil)
· Calcium Channel Blockers............................. Verapamil
· Estrogens........................................ Alora, Climara
TriptansAlmotriptan, Naratriptan, etc |
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Term
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Definition
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Expected Action:
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Proto: Ergotamine, ergotamine + caffeine
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· Prevent inflammation and dilation of the intracranial blood vessels
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Adverse Effects:
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· GI discomfort ’ administer metoclopramide (Reglan)
· Ergotism (muscle pain, paresthesia) ’ stop medication
· Physical dependence
· Abortion
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Contraindications/Precautions:
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· Renal or liver dysfunction / sepsis / CAD / pregnancy
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Interactions:
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· Sumatriptan (Imitrex) can lead to spastic rxn of blood vessels
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Education:
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·
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Term
| Serotonin Recoptor Antagonists |
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Definition
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Expected Action:
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Proto: Sumatriptan (Imitrex), almotriptan (Axert)
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· Prevent inflammation and dilation of the intracranial blood vessels
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Adverse Effects:
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· Chest symptoms (not dangerous, self-resolving)
· Coronary vasospasm/angina
· Teratogenic
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Contraindications/Precautions:
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· Pregnancy, hypertension, cardiac disease, CAD
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Interactions:
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· Triptans & Ergot Alkaloids - spastic reaction of blood vessels
· MAOIs - Concurrent use leads to MAOI toxicity (space 2 weeks apart)
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Education:
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·
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Term
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Definition
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Expected Action:
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Proto: Metoprolol, atenolol
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· Prevent inflammation and dilation of the intracranial blood vessels
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Adverse Effects:
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· Tiredness, fatigue
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· Depression
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· Asthma exacerbation
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·
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Contraindications/Precautions:
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·
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Interactions:
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·
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Education:
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·
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Term
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Definition
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Expected Action:
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Proto: Divalproex (Depakote)
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· Prevent inflammation and dilation of the intracranial blood vessels
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Adverse Effects:
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· Neural tube defects
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Contraindications/Precautions:
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·
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Interactions:
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·
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Education:
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·
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Term
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Definition
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Expected Action:
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Proto: Amitriptyline (Elavil)
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· Prevent inflammation and dilation of the intracranial blood vessels
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Adverse Effects:
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· Anticholinergic effects: dry mouth, constipation, urinary retention, tachycardia
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Contraindications/Precautions:
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·
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Interactions:
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·
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Education:
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·
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