Clindamycin
afaibor
painmeds.pptxDolor Sit Amet
Pain Medicines-Pharm1/2
Pain medications
NSAIDS Opiates IV MEDS inflammation Migraine
Chronic Pain meds
Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
Aspirin (ASA)
Ibuprofen –Motrin/Advil First generation - Cox1/Cox2 inhibitors
Naproxen- Naprosyn/Aleve Drugs can cause decreased platelet aggregation
Indomethacin- Indocin Kidney Damage
Diclofenac- Voltaren
Ketorolac- Toradol
Meloxicam- Mobic
Selective Cox 2 inhibitor
Celecoxib- Celebrex
Uses for NSAIDS
Inflammation suppression Complications
Used for mild to moderate pain Gi discomfort- give with food
Osteoarthritis/ Rheumatoid arthritis GI Bleeding due to low plat
Fever reduction ( Give PPI –Omeprazole)
Dysmenorrhea
Inhibition of platelet Impaired Kidney Function
Protects against CVA/MI Decreased urine output
Increased Bun/Creatinine
Use with caution in elderly/CHF
Drug Interactions
Anticoagulants- Coumadin/ Heparin causes increased risk of bleeding
Monitor PTT, PT/INR
Instruct PT to report indications of bleeding
Black , tarry stools, bleeding from gums, nose bleeds, hematuria
Alcohol increases risk of bleeding
Dehydration from fever can lead to kidney impairment –
Drinks lots of water
Aspirin (ASA)
Uses- Fever reduction
Prevent platelet aggregation
Used to prevent stroke/ MI
Used in ER MONA- Morphine, O2, NTG,ASA
Side effects = Gastric distress bleeding
Use enteric coated to prevent bleeding
Have Pt report signs of bleeding- black, tarry stools, Hematuria
Bleeding from mouth, gums, or nose
Avoid use in children due to REYES syndrome-rare –CNS, Liver damage
Don’t give with viral illness –flu, varicella
Action- slows production of prostaglandins in CNS
Uses-Analgesic, Antipyretic
Used in pain relief, fever reduction
Effectiveness-
Pain relief of mild to moderate pain
Fever reduction especially effective in children
Acute Toxicity- nausea ,Diarrhea , vomiting, sweating
Hepatic failure, coma ,death
Dosage < = 4 GMs /24 hours
Antidote- Acetylcysteine- Mucomyst
Avoid alcohol, increases risk of bleeding with warfarin( metabolism)
Acetaminophen
Opioid Agonist
Opioid agonist
Morphine class
Fentanyl
Meperidine- rigors after epidural
Methadone-cocaine & heroin addiction /cancer pain relief/less sedation and side effects
Codeine
Hydromorphone
Oxycodone
Tramadol HI Acting NSAID
Uses and actions
Pain relief- opioid receptor
Relief of moderate to severe pain
Used in childbirth,
Post-operative pain
M/I
Renal colic
Chronic pain
Cancer pain relief
Routes /Actions
Opiate receptor- blocks or occupies
Routes-
IM ,Po,sublingual
IV/epidural
Intrathecal
Rectal, oral
Subq/transdermal
Side Effects
Contraindications/Precautions
Don’t use in neonates resp depression
Morphine- don’t use after biliary surgery causes spasm(ODI sphincter)
Hepatic /Renal Disease
Use in caution with elderly
CNS depression – no alcohol
Give Lax of Choice (LOC)
Interactions with TCA, MAOI,-Malignant hyperthermia
For Cancer Patients- give ATC with prn doses for effective pain management
Pain Contract to avoid addition / dependence
Recheck pain level with pt after administration for effectivenessr
Respiratory Depression
Orthostatic Hypotension
Constipation
Urinary Retention
Nausea/Vomiting
Sedation
Biliary Colic
Opioid Overdose
Opioid Agonist / Antagonist
Actions- Blocks opiate receptor sites/ occupies other receptor site
Blocks pain but reduces side effects
Low potential for abuse
Less sedation
Less analgesic effect
Uses –
Moderate to severe pain
Treatment of opioid dependence-Suboxone
Adjunct to balanced anesthesia
Relief of labor pain
Nalbuphine –Nubain
Butophanol- Stadol
Buprenorphine- Suboxone
Pentazocine- Talwin
Opioid Antagonist
Naloxone- Narcan- IV IM Subq
Blocks and competes for opioid receptors
Reverses effects
Resp depression
Overdose
Half life of opioid can exceed half life of Narcan
Monitor for 2 hours after to assess for further resp depression
Titrate dosage to get full effect
Rapid infusion can cause hypertension, nausea and vomiting tachycardai
Adjunct Pain Medications
Tricyclics- ( Amytriptyline)used to treat fibromyalgia, depression, neuropathic pain –burning, cramping, sharp stabbing pain.
Anticonvulsants-(Carbamazepine, Gabapentin)-neuropathic pain, neuralgia
CNS stimulants- (Methylphenidate)- oral, transdermal)
Glucocorticoids-Prednisone (oral), Dexamethasone- oral, IV.IM
Bisphosphonates-Etidronate (Oral) Pamadronate-IV
NSAIDS-Ibuprophen (oral, IV)
Acetaminophen- Used as adjunct in pain and cold meds-oral, IV
CNS effects, Increased bleeding, Grapefruit juice, steroids can cause superinfection or fungal infection, ulcerative colitis, Ibuprophen- ASA allergy can cause bronchospasm
Migraines
ASA like meds- Ibuprofen, NSAIDS
Serotonin Receptor agonist
Sumatriptan-oral subcutanous transdermal
Betablockers-propranolol Oral’
Anticonvulsants-Divalproex oral-Topiramate
Tricyclic Antidepressants
Many drug interactions/ side effects on these medications
Use sumatriptan as prophylaxis
Watch for cont/severe chest pain
CNS excitation – seizures, serotonin syndrome
Beta blockers –can mask hypoglycemia
CNS depression- increases with alcohol
Orthostatic hypotension =amitriptyline, propanolol
