pain pharmacology
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| Acetaminophen (Tylenol) | •relieve pain primarily by action at the peripheral nervous system level at the site of injury. •antipyresis •No significant anti-inflammatory effects | liver toxicity with overdoses | use cautiously in patients with liver disease
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| Acetylsalicylic acid (Aspirin) | •inhibits COX-1 and COX-2 enzymes that produce prostaglandins •effective anti-inflammatory agent •works primarily at the peripheral nervous system level at the site of injury •decrease platelets aggregation •antipyresis | •GI irritation and bleeding •Bleeding •Tinnitus with overdosing | •Oral doses should be taken with food
or milk
•Do not give to patients on anticoagulant
therapy, with a history of ulcer disease,
or on glucocorticoids
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| Nonsteroidal anti-inflammatory (Ibuprofen (Motrin) Naproxen (Naprosyn) Ketorolac (Toradol)) | = aspirin •inhibits COX-1 and COX-2 enzymes that produce prostaglandins •effective anti-inflammatory agent •works primarily at the peripheral nervous system level at the site of injury •decrease platelets aggregation •antipyresis | •GI irritation •Bleeding •Allergic reactions | •Take with food
•May need to be taken with antacids or
cytotec
•Use cautiously in patients with history of
ulcers
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| Non-Steroidal Anti-inflammatory Cyclooxygenase-2 or COX-2) | Inhibits only COX-2 prostaglandins | (blank) | (blank)
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| Opioids--Agonist Codeine sulfate Fentanyl Hydrocodone (Lortab & Vicodin) Hydromorphone (Dilaudid) Meperidine (Demerol) Morphine sulfate Oxycodone Propoxyphene (Darvon) | •works on mu receptor site •Relieve pain mainly by action at the CNS and decreasing the perception of pain | •Sedation •Constipation •N/V •Respiratory depression •Urinary retention •Pruritis | There is no ceiling on the
analgesia of mu agonists. However propoxyphene and meperidine have
active metabolites that limit their doses
Sedation effect(2-3d), constipation, N/V, RR<10-23: withhold, admi Naloxnone(narcan), urinary retention, pruritis
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| Opioids--Agonist-Antagonists Opioids--Agonist-Antagonists | •Binds to Kappa receptor sites for pain relief •Antagonizes the effects of pure agonist at the mu site | •Less side effect that with agonists but has higher incidences of anxiety responses, nightmares, and hallucinations | •Monitor for side effects.
•Take non-judgmental history to ascertain
if taking any other opioid medications
•There is a ceiling effect on these
medications
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