ATI Flash Cards 04, Medications For Pain and Inflammation

Pain and Inflammation
(General Key Points)

N203
ATI (Unit 4)
Pain & Inflammation -
Analgesics relieve pain
Narcotics / NSAIDs / Antimigraine agents
Anti-inflammatory medications relieve inflammation
Salicylates / Glucocorticoids / Antigout / Disease-modifying
antirheumatics drugs (DMARDs
Some are antipyretic (salicylates! i"uprofen
Salicylates and NSAIDs reduce platelet aggregation
Salicylates! NSAIDs! and glucocorticoids pose ris# for ulceration
Acetaminophen has analgesic and antipyretic properties "ut not anti-
inflammatory$ It poses a ris# for liver in%ury
NSAIs
(!edi"ation #ist)
N203
ATI (Unit 4)
Aspirin &etorolac ('oradol
(eleco)i" ((ele"re) *aldeco)i" (+e)tra
I"uprofen Indomethacin
Napro)en

NSAIs
N203
ATI (Unit 4)
Expected Action:
Proto: aspirin! i"uprofen! #etorolac! celeco)i"
(ycloo)ygenase inhi"ition , (-. / inflammation! (-. 0 platelet agg$
Therapeutic Uses:
Inflammation suppression / analgesia / fever
dysmenorrhea / suppression of platelet aggregation
Adverse Effects:
GI discomfort! aspirin induced ulceration and "leeding (use misoprostol as
prophyla)is! and/or 11I and/or 2
/
-receptor agonist ris# of ulceration
Renal dysfunction
Reye syndrome (in #ids 3ith viral illnesses
Salicylism (tinnitus! resp$
al#alosis! di44iness
Contraindications/Precautions:
1eptic ulcers / "leeding disorders / hypersensitivity / pregnancy / #ids 5 viral inf$
Interactions: Glucocorticoids ( gastric "leeding , use antiulcer
prophylactic li#e misoprostol ((ytotec to prevent 6arfarin ( "leeding
7t-2 ( "leeding I"uprofen ( antiplatelet effects of lo3-dose aspirin
Education:
Give 3ith food or mil# to reduce GI discomfort$
If can8t tolerate 0
st
generation! give /
nd
generation (celeco)i"
Ketorola" (Toradol)
N203
ATI (Unit 4)
Expected Action:
Proto: #etorolac ('oradol , 0
st
generation NSAID
pain 3ithout anti-inflammatory effect
Therapeutic Uses:
Short-term treatment of moderate to severe pain (post-op
7nhances opioid analgesia 3ithout opioid adverse effects
Adverse Effects:
(an occur 3hen used 3ith other NSAIDs$
GI "leeding / "lood dyscrasias
Give no more than 9 days
Interactions:
-ther NSAIDs / anticoagulants ( "leeding
Education:
:sually started parenteral and then transition to oral dose
A"etamino$%en
N203
ATI (Unit 4)
Expected Action:
Slo3s production of prostaglandins
Therapeutic Uses:
Analgesic and antipyretic
Adverse Effects:
Ma) ; g daily
Acute liver to)icity Antidote< acetylcysteine (Mucomyst
Interactions:
7t-2 ris# to liver / 6arfarin levels of 3arfarin
Education:
&$ioid A'onists
N203
ATI (Unit 4)
Therapeutic Uses:
Proto: morphine! fentanyl! meperidine! methadone! codeine!
o)ycodone
Moderate to severe pain / Sedation / "o3el motility / (ough suppression
Adverse Effects:
Respiratory
depression
Sedation
(onstipation -rthostatic 2ypotension :rinary retention
+iliary colic (ough suppression 7mesis
Increases cardiac 3or#load
Meperidine meta"olites are neuroto)ic (= >?? mg//;hr! = ;@ hours
Interactions:
(NS depressants ("ar"iturates! pheno"ar"ital! "en4odia4epines! 7t-2
Anticholinergics! antihistamines! tricyclic antidepressant anticholinergic effects
MA-Is (hyperpyre)ia! sei4ures Antihypertensives
Education:
6ithhold if RR=0/
2ave nalo)one (Narcan and resuscitation
eAuipment availa"le$ Infuse I* slo3ly over ;-9 minutes
&$ioid Anta'onists
N203
ATI (Unit 4)
Expected Action: Proto: nalo)one (Narcan! naltre)one! nalmefene
(ompetitively interfere 3ith opioid actions
Therapeutic Uses:
-D treatment Reversal of opioid effects
Adverse Effects:
'achycardia / 'achypnea A"stinence syndrome (cramping! hypertension
2ypersensitivity Dependency 1regnancy< +
Interactions:
Education:
Nalo)one has e)tensive first-pass modification
-"serve for 3/d symptoms or a"rupt onset of pain
Ad()*ant Pain !edi"ations
(!edi"ation #ist)
N203
ATI (Unit 4)
'ricyclic Antidepressants ('(A$$$$$$$$$$$$$$$$$$$$$$$$$Amitriptyline (7lavil
Anticonvulsant$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$(ar"ama4epine ('egretol
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Ga"apentin (Neurontin
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
1henytoin (Dilantin
(NS Stimulants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Methylphenidate (Ritalin
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
De)troamphetamine (De)edrine
Antihistamines$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$2ydro)y4ine (*istaril
Glucocorticoids$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$De)amethasone (Decadron
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
1rednisone (Deltasone
+isphosphonates$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$7tidronate (Didronel
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
1amidronate (Aredia
Ad()*ant !edi"ations
N203
ATI (Unit 4)
Therapeutic Uses:
Proto: '(As! Anticonvulsants! (NS stimulants! Antihistamines!
Glucocorticoids! +isphosphonates
7nhance opioid effects there"y permitting lo3er opioid doses
Alleviate other symptoms that aggravate pain 'reat neuropathic pain
Adverse Effects:
'(As (neuropathic pain
-rthostatic hypotension! sedation! anticholinergic
effects
Anticonvulsants (neuropathic pain
+one marro3 suppression
(NS stimulants
6eight loss! insomnia
Antihistamines
Sedation
Glucocorticoids ( I(1!
nerve compression
Adrenal insufficiency Glucose intolerance
2ypo#alemi
a
-steoporosi
s
GI :lcers
+isphosphonate ((A "one
pain
Blu-li#e symptoms In%ection site irritation
Anti'o)t !edi"ation
N203
ATI (Unit 4)
Expected Action:
Proto: (olchicine! indomethacin! allopurinol! pro"enecid
(olchicine/Indomethacin< inflammation "y preventing leu#ocyte infiltration
Allopurinol< Inhi"its production of uric acid
1ro"enecid< Inhi"its rea"sorption of uric acid "y renal tu"ules
Therapeutic Uses:
(olchicine/Indomethacin< Acute gout attac#s
Allopurinol/1ro"enecid< 2yperuricemia
1ro"enecid< 1rolongs effects of penicillins and cephalosporins
Adverse Effects: (olchicine< GI to)icity
-thers< GI discomfort
1ro"enecid< Renal in%ury (get /-CD fluid/day
(olchicine< 1regnancy ((/D! renal! cardiac! elderly
Interactions: Salicylates< E pro"enecid
6arfarin< 3arfarin meta"olism in liver "leeding ris#
Education:
Avoid 7t-2! purines$ AdeAuate hydration$
!i'raine !edi"ations
(!edi"ation #ist)
N203
ATI (Unit 4)
7rgot Al#aloids$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$7rgotamine (7rgostat
Serotonin Receptor Agonists$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Sumatriptan (Imitre)
+eta-+loc#ers$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$1ropanolol! Atenolol
Anticonvulsants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Divalproe) (Depa#ote
'ricyclic Antidepressants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Amitriptyline (7lavil
(alcium (hannel +loc#ers$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$*erapamil
7strogens$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Alora! (limara
'riptans$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Almotriptan! Naratriptan! etc

+r'ot Al,aloids
N203
ATI (Unit 4)
Expected Action:
Proto: 7rgotamine! ergotamine F caffeine
1revent inflammation and dilation of the intracranial "lood vessels
Adverse Effects:
GI discomfort administer metoclopramide (Reglan
7rgotism (muscle pain! paresthesia stop medication
1hysical dependence
A"ortion
Renal or liver dysfunction / sepsis / (AD / pregnancy
Interactions:
Sumatriptan (Imitre) can lead to spastic r)n of "lood vessels
Education:
Serotonin -e"e$tor
Anta'onists
N203
ATI (Unit 4)
Expected Action:
Proto: Sumatriptan (Imitre)! almotriptan (A)ert
Adverse Effects:
(hest symptoms (not dangerous! self-resolving
(oronary vasospasm/angina
'eratogenic
1regnancy! hypertension! cardiac disease! (AD
Interactions:
'riptans G 7rgot Al#aloids spastic reaction of "lood vessels
MA-Is (oncurrent use leads to MA-I to)icity (space / 3ee#s apart
Education:
.eta-.lo",ers
N203
ATI (Unit 4)
Expected Action:
Proto: Metoprolol! atenolol
Adverse Effects:
'iredness! fatigue Depression
Asthma e)acer"ation
Interactions:
Education:
Anti"on*)lsants
N203
ATI (Unit 4)
Expected Action:
Proto: Divalproe) (Depa#ote
Adverse Effects:
Neural tu"e defects
Interactions:
Education:
T/As
N203
ATI (Unit 4)
Expected Action:
Proto: Amitriptyline (7lavil
Adverse Effects:
Anticholinergic effects< dry mouth! constipation! urinary retention! tachycardia
Interactions:
Education:
/al"i)m /%annel .lo",er

N203
ATI (Unit 4)
Expected Action:
Proto: *erapamil
Adverse Effects:
-rthostatic hypotension
(onstipation
Interactions:
Education:
!edi"ations for -%e)matoid

Art%ritis
(!edi"ation #ist)
N203
ATI (Unit 4)
!A"s
(ytoto)ic medications$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$methotre)ate (Rheumatre)
Gold salts$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$aurothioglucose
Antimalarial agents$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$hydro)ychloroAuine (1laAuenil
Sulfasala4ine$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$A4ulfidine
+iologic Response Modifiers$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$etanercept (7n"rel
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
infli)ima" (Remicade
1enicillamine$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$(uprimine! Depen
#thers
Glucocorticoids$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$prednisone
Immunosuppressants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$(yclosporine
NSAIDs$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$napro)en
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
celeco)i"
-%e)matoid Art%ritis !eds
(Ad*erse +ffe"ts)
N203
ATI (Unit 4)
Cytotoxics:
2epatic fi"rosis / Marro3 suppression / GI ulceration / fetal
death or a"normality
$old salts:
'o)icity! renal to)icity! "lood dyscrasias! hepatitis! GI
discomfort
Antimalarials:
Retinal damage
%ulfasala&ine:
GI discomfort / hepatic dysfunction / marro3 suppression
'io "esponse !odifiers:
In%ection-site irritation
Penicillamine:
Marro3 suppression
$lucocorticoids:
-steoporosis (vit D! (a
/F
! "isphosphonate
Adrenal suppression GI discomfort

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Pain and Inflammation

(General Key Points)

/al"i)m /%annel .lo",er

!edi"ations for -%e)matoid

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