ATI Pharm Ch 35 Nonopioid Analgesics

  1. Nonopioid analgesics may have what 3 actions?
    • anti-inflammatory
    • antipyretic
    • analgesic
  2. Nonopioid analgesics include what to classes of meds?
    • NSAIDs
    • acetaminophen
  3. 1st generation (COX 1, COX 2 inhibitors):
    ibuprofen (Motrin, Advil)
    naproxen (Naprosyn)
    indomethacin (Indocin)
    diclofenac (voltaren)
    ketorolac (Toradol)
    2nd generation (selective COX 2 inhibitor):
    meloxicam (Mobic)
    celecoxib (Celebrex)
    What are these?
  4. What's the expected pharm action of NSAIDs?
    Inhibition of cyclooxygenase (COX)
  5. Inhibition of ___ in NSAIDs may result in decreased platelet aggregation and kidney damage, whereas inhibition of ___ results in decreased inflammation, fever, pain.
    • COX1
    • COX2
  6. This nonopioid analgesic is used for inflammation suppression, analgesia for mild to moderate pain, fever reduction, dysmenorrhea, and inhibition of platelet aggregation.
  7. What 2 things do inhibition of platelet aggregation protect against?
    • stroke
    • MI
  8. To decrease the risk of ulcer formation with NSAIDs, whta might you administer?
    • proton pump inhibitor (omeprazole)
    • h2 receptor antagonist (ranitidine)
  9. What med may be used prophylactically to combat possible GI damage?
  10. Besides GI discomfort/damage, what are other side effects of NSAIDs?
    • renal dysfunction
    • increased risk of MI and stroke
    • salicylism
    • Reye syndrome
    • aspirin toxicity
  11. T/F Increased risk of MI and stroke is generally associated with nonaspirin NSAIDs.
  12. This ADR may occur with aspirin and s/s include tinnitus, sweating, headach, dizziness, respiratory alkalosis.
  13. Children and teenagers recovering from chickenpox and flu-like symptoms should never take this med. Why?
    • aspirin
    • Aspirin has been linked with Reye's syndrome, which is a rare but serious condition that causes swelling in the liver and brain
  14. What might aspirin toxicity therapy include?
    • cooling w/ tepid water
    • correction of dehydration & elecrolyte imbalance
    • reversal of acidosis & promotion of salicylate excretion w/ bicarbonate
    • gastric lavage
  15. PUD, bleeding disorders (hemophilia, vitamin K deficiency), children with chickenpox/influenza are contraindications for what med class?
  16. This med class should be used cautiously in older adults, smokers, pts with H. pylori infection, hypovolemia, asthma, chronic uticaria, hx of alcoholism.
  17. What NSAID is contraindicated in pts w/ allergy to sulfonamides?
  18. Which NSAID is contraindicated in pts w/ advanced renal dysfunction?
  19. ___ generation NSAIDs should be used cautiously in pts w/ known cardiovascular disease.
  20. There is a potential risk of bleeding when a NSAID is combined with an ___.
    anticoagulant (heparin, warfarin)
  21. When taken with NSAIDs ___ increase risk of gastric bleeding; antiulcer prophylaxis (misoprostol) should be taken to decrease risk of gastric ulcer.
  22. T/F Alcohol does not affect bleeding in pts taking NSAIDs.
    F; alcohol increases risk of bleeding
  23. Which NSAID decreases the antiplatelet effects of low-dose aspirin used to prevent MI?
  24. Concurrent use of other NSAIDs, especially ___, increase the risk of known side effects.
  25. How long before surgery, childbirth should aspirin be d/c?
    1 week
  26. T/F NSAIDs should be taken without food.
    F; with food
  27. Use of what NSAID should not be longer than 5 days due to risk for kidney damage?
  28. What's the trade name for acetaminophen?
  29. What's the expected pharm action for acetaminophen?
    Slows production of prostaglandins in CNS
  30. This nonopioid analgesic is used for analgesic and antipyretic effects.
  31. Why should pts not exceed 4g/day of acetaminophen?
    May cause acute toxicity that results in liver damage (s/s: n/v/d, sweating, abdominal discomfort), progressing to hepatic failure, coma, death
  32. What's the antidote for acetaminophen?
    acetylcysteine (Mucomyst)
  33. This nonopioid analgesic should be used cautiously in pts that drink 3+ alcoholic drinks/day and those taking warfarin.
  34. With acetaminophen, ___ increases risk for liver damage.
  35. Acetaminophen slows the metabolism of ___, placing the pt at risk for bleeding.
  36. How is acetylcysteine (acetaminophen antidote) administered?
    oroduodenal tube to prevent emesis/aspiration
  37. ___ may be used for short term treatment of moderate to severe pain such as that associated with postop recovery. Concurrent use with opioids allows for lower dosages of opioids and thus minimizes adverse effects (constipation, resp depression).
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ATI Pharm Ch 35 Nonopioid Analgesics