1
, o Corticosteroids: If someone is on oral steroids, it cannot be stopped right away. Tell pts
to withdraw slowly/taper steroids because they can go into adrenal insufficiency.
Homeostasis! Wean off!
o SABA: use bronchodilator first
NSAIDS: metabolized in kidneys
o Anti-inflammatory used to pain and fever reducer
o Contraindicated: do not use in conjunction with anticoagulants, antiplatelet,
stjohns wort, ginko, or history of gastric ulcer disease
o Someone orders 200mg ibuprofen for someone with ESRF= call physician and clarify
order
o Creatinine: 0.6-1.2 mg/dL
o High creatinine and low GFR indicate renal failure
o Big risk factors for NSAIDS: GI bleeding (ulcers)
Cannot be on Aspirin or anticoagulants (Coumadin)
Tylenol: liver failure
o Max dose: 3g per day
o If pt is liver compromised or old: max 2g per day
o If pt is vomiting and has high fever, give suppository rectally
o Antagonist: Acetylcysteine
Tolerance with narcotics: body has higher threshold
o Dose is not relieving pain anymore
Pt has pain and is getting morphine 4mg Q6H and is still in pain= call DR and change the
med
, o Normal dose of morphine: 2-10 mg
o Dilaudid or fentanyl may be used instead of morphine
o Fentanyl is 10X stronger than morphine
Dr will order a lower dose for pt on fentanyl than on morphine
Narcotic Demerol for post op= not indicated for long term treatment of pain
o Just immediately post op or for endoscopy or pre-procedure for pain
o Contraindications: severe asthma or breathing problems, constipation
o Pt comes in ER and has an MI, put pt on morphine!! Why? Because it reduced pre-
load/workload of the heart (Demerol does not do that!)
Muscle relaxants (flexeril) = drowsiness
Narcotics= assess resp rate
o Antagonist: Narcan
Morphine is metabolized in the liver but can affect kidney function
o Assess for respiratory distress; hold if respirations less than 12
If pt takes aspirin, we are worried about salicylate intoxication
o Worry about Reye syndrome with salicylate poisoning in children
o Salicylate toxicity: ototoxicity, hyperventilation, tinnitus
Salicylates: Found in hundreds of OTC medications and in many prescription drugs!
o Salicylate toxicity: important cause of morbidity and mortality! Common cause of
poisoning in children and adolescents!
o Available for ingestion as tablets, capsules, and liquids; topical in creams or lotions
o Used as an analgesic agent for the treatment of mild to moderate pain
, o Corticosteroids: If someone is on oral steroids, it cannot be stopped right away. Tell pts
to withdraw slowly/taper steroids because they can go into adrenal insufficiency.
Homeostasis! Wean off!
o SABA: use bronchodilator first
NSAIDS: metabolized in kidneys
o Anti-inflammatory used to pain and fever reducer
o Contraindicated: do not use in conjunction with anticoagulants, antiplatelet,
stjohns wort, ginko, or history of gastric ulcer disease
o Someone orders 200mg ibuprofen for someone with ESRF= call physician and clarify
order
o Creatinine: 0.6-1.2 mg/dL
o High creatinine and low GFR indicate renal failure
o Big risk factors for NSAIDS: GI bleeding (ulcers)
Cannot be on Aspirin or anticoagulants (Coumadin)
Tylenol: liver failure
o Max dose: 3g per day
o If pt is liver compromised or old: max 2g per day
o If pt is vomiting and has high fever, give suppository rectally
o Antagonist: Acetylcysteine
Tolerance with narcotics: body has higher threshold
o Dose is not relieving pain anymore
Pt has pain and is getting morphine 4mg Q6H and is still in pain= call DR and change the
med
, o Normal dose of morphine: 2-10 mg
o Dilaudid or fentanyl may be used instead of morphine
o Fentanyl is 10X stronger than morphine
Dr will order a lower dose for pt on fentanyl than on morphine
Narcotic Demerol for post op= not indicated for long term treatment of pain
o Just immediately post op or for endoscopy or pre-procedure for pain
o Contraindications: severe asthma or breathing problems, constipation
o Pt comes in ER and has an MI, put pt on morphine!! Why? Because it reduced pre-
load/workload of the heart (Demerol does not do that!)
Muscle relaxants (flexeril) = drowsiness
Narcotics= assess resp rate
o Antagonist: Narcan
Morphine is metabolized in the liver but can affect kidney function
o Assess for respiratory distress; hold if respirations less than 12
If pt takes aspirin, we are worried about salicylate intoxication
o Worry about Reye syndrome with salicylate poisoning in children
o Salicylate toxicity: ototoxicity, hyperventilation, tinnitus
Salicylates: Found in hundreds of OTC medications and in many prescription drugs!
o Salicylate toxicity: important cause of morbidity and mortality! Common cause of
poisoning in children and adolescents!
o Available for ingestion as tablets, capsules, and liquids; topical in creams or lotions
o Used as an analgesic agent for the treatment of mild to moderate pain
