pharm exam 4 Pain

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pharm exam 4 Pain
2012-12-01 15:51:27
pain mgt

pain mgt drugs
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  1. Cox inhibitors
    • NSAIDs-1st & 2nd gen
    • Acetaminophen
    • initial drug of choice for mild-moderate pain
    • pain relief-limited
    • all tx fever, all but acetaminophin < inflam.
  2. Cox 1
    • Good- stomach lining, kidney, platelets, most other tissues
    • protects stomach lining, promotes renal blood flow/function, promotes platelet aggregation
  3. Cox 2
    • Bad-injured tissue & CNS
    • promotes; inflamation, painful sensation, fever
  4. 1st gen NSAIDs
    • Aspirin, Ibprofen, Naproxen, & others
    • inhibits both Cox 1 & 2
    • inhibit cox 2=<inflam., pain, & fever
    • inhibit cox 1= GI ulcer/ bleeding, renal failure, > bleeding
  5. Aspirin
    • prototype
    • inhibits platelet aggregation irreversibly tx/prevent HA & stroke
    • stop 5-7 d prior to surg
    • Reyes syndrome-associated w/viral illness, do not admin to <16yo
    • ADR: GI ulcer/bleed, renal fx, salicylism (od-tinnitus), reyes, preg cat D, hypersensitive reaction
    • toxicity= acute emergency-resp dep, hyper therm, dehyd, acidosis
    • DD= anticoagulants, steroids, alcohol, ibuprofen
  6. Non-aspirin NSAIDs
    • ibuprofen (advil), Indomethacin (indocin), Naproxen Sodium (alieve), Ketorolac (toradol)
    • torodol- <5d use, great analgesic
    • Inhibit Cox 1&2 reversibly
    • benefit: anti inf, anti pyretic, analgesic
    • ADR:not as bad as aspirin- gastric ulceration, bleeding, renal impairment
    • *take w/ food
  7. Second Gen NSAID
    • Celecoxib (celebrex)
    • inhibits Cox 2 only: <pain & inflam.
    • ADRs: <1st gen nsaids, ab pain/ dyspepsia, rarely renal tox &edema, less bleeding
    • caution w/ sulfonimide allergy
  8. Acetaminophen
    • inhibits cox 1&2 but only in CNS (not peripheral tissue)
    • mild-moderate pain relief not inflam reducer
    • 1st choice in osteoarthritis, can admin to kids
    • ADR- severe liver dmg w/ OD
    • DD- alcohol, lrg dose warfarin (>inr)
    • OD= >4000 mg/24hr tx=acetylcysteine (mucomist/acetadote) 17 dose liquid, rotten egg (removes toxic metabolite)
    • Nomogram- helps determine how much taken but must know time of admin
  9. Opioids
    • opioid- any drug w/ similar action to morphine
    • opiate- drugs derrived from opium (poppy)
    • narcotics- opioids
    • opioid receptors- mu, kappa, delta
    • Agonist- stimulates mu (euphoria)
    •     morphine, methadone
    • Agonist/ Antagonist- stimulates Kappa relieves pain/ blocks mu: no euphoria/ sedation, <dependency
    •     butorphanol (stadol), nalbuphine (nubain)
    • Antagonist-block access of agonist to mu receptor. antidote to morphine
    •     naloxone (narcan)
  10. Morphine Sulfate
    • prototype: agonist @ mu- moderate-severe p
    • schedule II- abuse potential
    • ADR: resp distress, constipation, N/V
    • DD: alcohol, barb, benz, <BP, agonist-antagonist opioids
    • toxicity: coma, resp dep, pinpoint pupils
    • OD: Narcan
    • Monitor: RR, BP, pulse (get baseline)
  11. Other strong opioid agonists
    • Fentanyl- patch (100x more powerful than morphine)
    • Meperidine (demerol)- caution in renal impairment
    • Methadone (Dolophine)- tx heroin addiction
    • hydromorphine (dilaudid)- 7x more powerful than morphine
    • Heroin- illegal in US (cat I)
  12. Moderate to strong opioid agonist
    • Hydrocodone (vicodin, lortab)- sch 3 available only in combo w/ ASA, acetaminophine, ibprofen
    • Oxycodone (oxycontin, percocet, percodin)- sch 2 available alone or in combo
    • Codeine (robitussin AC, Tylenol #3)
  13. Drugs for muscle spasm (relaxants)
    • mechanism-sedation (not direct relaxation of muscle)
    • use-spasm, injury, <pain/ tenderness, >ROM
    • ADR-sedation
    • Ex)Cycobenzaprine (flexeril), Carisoprodol (Soma), Metaxalone (skelaxin), Benzodiazepines-Diazepam (valium)