Welcome to Week 6 Chapters: 16, 24, and 8: p. 146-150
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Transcript Welcome to Week 6 Chapters: 16, 24, and 8: p. 146-150
Welcome to Week 6
Chapters: 16, 24, and 8: p. 146-150
1
Analgesics/Antipyretics
Musculoskeletal System and
Disorders/Converting Between
Measurement Systems
Drug Classes
2
ANALGESICS
Clinical Case
3
Marcus has been prescribed a transdermal
patch to manage pain associated with a
rotator cuff injury. Halfway into his course
of treatment, he calls the physician’s office
to report that he has a bad cold with a fever
and chills and would like to know what OTC
medications he can use to relieve his
symptoms. What is the physician likely to
tell Marcus?
Analgesics and Pain
4
What does “pain” look like?
Evaluate pain based on:
Where pain is felt
Duration
Intensity (1-10 scale)
Precipitating factors
Pain may be Acute or Chronic:
Acute-short duration, responds to analgesics
Chronic-over time, less responsive to analgesics,
tolerance
Types of Analgesics
5
Three Classes
Opioid
Nonopioids
Adjuvant
Opioid (Narcotic) and Opiate Analgesics
6
Strong and capable of reducing pain from any origin
Derivatives of opium or synthetic chemicals that
produce effect similar to opium.
Examples: codeine, morphine, oxycodone, fentanyl,
meperidine
Vary in potency, onset and action
Tolerance and potential for dependence are
important concerns
Many are schedule II
Narcotic Analgesics Side Effects
7
Respiratory depression
Constipation
Itching (may subside in 4-5 days)
Nausea (may subside in 4-5 days)
Confusion
Euphoria
Idiosyncratic (restlessness and agitation)
Sedation
Drug Interactions with Narcotics
8
Alcohol –leads to CNS and Respiratory depression
Other medications that have CNS depression
What can we give to treat narcotic overdose?
Nonopioid Analgesics
9
For mild to moderate pain
Differ from narcotic analgesics
1. Not related to morphine
2. Work on peripheral nervous system
rather than CNS (outside brain and
spinal cord)
3. Do not produce physical dependency
and tolerance
4. Do not alter consciousness or mental
function
Characteristics of Nonopioid Analgesics
10
Relieve low-intensity pain of inflammation and dull
aches and vague pain
Reduce Fever
Uses are -anti-inflammatory
-analgesic
-antipyretic
Not every drug in this class has all three
More Characteristics on Nonopioid Analgesics
11
Usually first step in pain control
Can be OTC or Rx
Less expensive that Narcotics
May be combined with narcotics to become Rx items:
Hydrocodone and APAP, Hydrocodone and ibuprofen,
Oxycodone and APAP
May be combined with non-narcotics to become Rx
or OTC items:
ASA and caffeine, APAP and caffeine and butalbital
Salicylate Analgesics, ie. ASA (aspirin)
12
Oldest of nonopioid analgesics; not for children
Four distinct therapeutic actions of ASA:
1. Analgesic – inhibits prostaglandin release from
damaged tissues
2. Anti-inflammatory—reducing prostaglandin synthesis
3. Anti-pyretic—reduces fever by causing vasodilation and
sweatin, resets temperature control in brain
4. Anti-coagulant—prevents platelets from aggregating
(clump) to decrease clot formation
Beware GI effects, bleeding out
Acetaminophen (APAP)
13
Has analgesic and antipyretic actions; No anti-
inflammatory action
Reasons to use APAP over ASA:
Can be used in all ages including children
Good choice for people allergic to ASA or ASA-like
compounds
Rarely causes GI upset and bleeding
Can take with anticoagulation medications
Main disadvantage –liver damage with long term or
high doseages or concurrent heavy alcohol use
NMT (no more than) 4 grams in 24 hours for adults
with normal liver function!
Nonsteroidal Anti-inflammatory (NSAID’s)
14
Examples: ibuprofen (Advil®, Motrin®), naproxen
(Aleve®)
Treat mild to moderate pain
Normally used for inflammatory conditions,
dysmenorrhea, dental pain
Inhibits cyclooxygenase (COX) which results in
decreased formation of prostaglandin precursors
SE- GI
Do not take with ASA, APAP or other NSAID’s.
Time limits 10 days for pain, 3 days for fever or as
directed by MD
World Health Organization (WHO) Pain Ladder
15
•Mild Pain-APAP, ASA, other NSAIDS
around the clock
•Moderate Pain- add mild opioid
(codeine or hydrocodone)
•Severe Pain-DC Mild Opioid, give strong
opioid (Demerol or morphine). The
nonopioid should be continued.
Adjuvant Analgesic
16
Used to enhance analgesic efficiency and prolong effects of
opioid medications
Typically not prescribed alone for pain
Goal=Decrease amount of pain medication with increase in
pain control
Help to reduce side effects of analgesics (ex: nausea)
Examples of adjuvants:
Tricyclic Antidepressants (amitriptyline) *treat dull aches
Corticosteroids (prednisone) *treat edema
Anti-Convulsants (lorazepam, phenytoin) *treat sharp,
shooting, or burning pain
Antihistamine (hydroxyzine) *treat anxiety/nausea
Review
17
Name the three types of Analgesics
Answer
18
Opioid
Nonopioids
Adjuvant
Musculoskeletal System – Chapter 24
19
(2) Different systems working closely together
Muscular System made up of
Muscles
Connective Tissue … ligaments, tendons
Skeletal System made up of
Bones -- osteoporosis
Joints – arthritis, bursitis
Osteoporosis and Rx Therapy
20
Osteoporosis = Bone resorption (Bone loss)
Most patients are Not Aware it is occuring!
-as we age, resorption begins to exceed formation
-common causes: *decreasing Estrogen (women)
*low/insufficient Calcium intake
*decreased Physical-activity (exercise)
Biphosphonates -(Fosamax, Actonel, Boniva)
Evista – for both prevention and treatment!
Calcitonin-salmon –treatment only! (Miacalcin)
Forteo – stimulates new bone growth
Osteoporosis – Patient Education
21
Increase load-bearing exercise –walking, stairs
Calcium supplement + Vitamin-D – don’t forget the
natural sources! – dairy products, etc.
Biphosphonates: important guidelines … always take on
empty-stomach 30-60 minutes before breakfast with a full glass of
water to make sure the tab doesn’t stick in the throat (may cause
esophageal erosion!), and patient should remain upright 30-60 minutes
after swallowing (to prevent reflux, erosion).
Miacalcin(nasal calcitonin-salmon) – alternate
nostril every other day (apply in 1 nostril per day)
Joint Diseases and Rx Therapy
22
Osteoarthritis – most common, generative
noninflammatory, caused by ‘wear-and-tear’
Rheumatoid arthritis – autoimmune, various forms,
all ages, progressive, pain/swelling/limits movement
Bursitis – inflammed ‘fluid-sacks’ in the joints
Common Antiarthritis Medications:
Salicylates – ASA(aspirin), salsalate
NSAIDs – ibuprofen, naproxen, Celebrex
DMARDs – methotrexate **dangerous drug!!
Gluco-corticosteroids – prednisone, dexamethasone
General Characteristics of Arthritis meds
23
Salicylates – fast-acting, inexpensive, GI s/e(enteric-coated)
NSAIDs – potency, duration, $, less GI side-effects, blocks both
COX1 and COX2 enzymes (GI danger in long-term use)
COX2 Inhibitors – much greater potency and duration, much
less GI side-effects(only block COX2), indicated for both Osteo and
Rheumatoid arthritis (only one available is Celebrex)
Glucocorticosteroids – powerful in reducing inflammation,
preferably only used for a limited time (specific courses of therapy)
DMARDs(immunosuppressants) – reduces the body’s
own immune-response (autoimmune) to provide relief
These only produce short-term remission, disease will worsen!
Gout
24
Hyperuricemia (excess uric acid accumulation)
Uric acid accumulates, then crystalizes (ouch!)
Symptoms: *acute pain *swelling *redness *tenderness
(usually the big-toe, ankle, knee, elbow)
Medications:
Acute attack – colchicine
Prophylaxis – allopurinol, probenecid
Muscle Relaxants
25
Treat Muscle spasms and muscle spasticity
Most spasm caused by local injury, seizure-disorders
Muscle-relaxants *decrease local pain/tenderness,
*increase range-of-motion, *cause sedation
Soma (carisoprodol)
Flexeril (cyclobenzaprine)
Skelaxin (metaxalone)
Robaxin (methocarbamol)
CNS agents: diazepam, Lioresal (baclofen)
Questions
26
Time Conversions: 24-Hour Clock
Figure 7-1.
Most countries don’t recognize AM or PM
Remember that 12am (midnight) is either 0000 or
2400
Converting AM to 24-hr clock is relatively easy
◦
◦
4AM = 0400
7:45AM = 0745
All other PM times, add 12 to convert to 24 hour clock
For example:
◦
◦
6PM (+12) = 1800
10:20PM (+12) = 2200
Hints for Time Conversions
1.
2.
3.
4.
5.
6.
11:02 AM = 1102
2:56 AM = ?
10:45 PM = 2245
8:10 PM = ?
12:00 PM (noon)=
12:01 AM (1 minute after midnight) =
Changing to the 24hour clock
1.
2.
3.
4.
5.
6.
0421 = 4:21AM
0258 = ?
1357 = 1:57PM
1234 = ?
2400 = ?
0045 = ?
Convert from 24-hr to 12-hr clock