NURS 615
Exam 3 Review
Study Guide
Week 8 Content
Pain Management
o Know the treatment of acute pain – what medications are first-line?
NSAIDs, anticonvulsants, acetaminophen, and muscle relaxants
Non-pharmacological recs: exercise programs, physical therapy,
acupuncture, massage, TENs, chiropractic treatment, and
biofeedback therapy
What would you prescribe first when treating acute mild
musculoskeletal pain?
Topical NSAIDs w/ or w/o menthol gel
Think of the guidelines and the Shadow Health assignment
NSAIDS – Ibuprofen, Naproxen, Aspirin, Toradol, Mobic
exert analgesic, antipyretic, and anti-inflammatory effects (don’t get anti-
inflammatory relief with acetaminophen)
o Adverse effects –
GI – nausea, heartburn
Mild headaches
Dizziness
o Contraindications –
History of ulcers, Crohns, GI bleeding
Liver or Kidney disease
Heart disease
Bleeding or platelet disorders
Unmanaged HTN
Pregnancy
o Drug interactions –
Antihypertensives
Warfarin
Digoxin
o Symptoms of salicylate toxicity (aspirin-based) – which one would
you see first;
N/V
Diaphoresis
Tinnitus
Hyperventilation – this is the physical sign
Respiratory alkalosis – earliest signs
o Why do NSAIDS have a black box warning?
2005: FDA issued warning on all prescription and OTC NSAIDs
Increased risk of cardiovascular events and serious GI bleeding,
NON-ASPIRIN
Salicylates
, o Uses:
o Mechanism of action
o Toxicity
Signs and symptoms of toxicity
Toxicity versus adverse effects at usual doses (these are
different) - what is first seen with toxicity, i.e. what is the
cascade of events?
Acetaminophen – non-opioid, non-NSAID analgesic
- used in treatment of mild pain and fever
- no anti-inflammatory properties
o Contraindications –
Alcohol abuse
Liver or kidney disease
Malnutrition
o Acetaminophen toxicity –
What are the signs and symptoms of liver damage/failure?
Abdominal pain
N/V
dark urine
jaundice
Opioids –
o Know the difference between agonists, partial agonists and
antagonists
What are some examples of each –
Morphine – prototypical opioid agonist
Full Agonists – Activate opioid receptor fully
o Morphine, codeine, methadone, hydromorphone
o Affinity plus efficacy (affinity = it attaches, efficacy =
it’s effective)
Partial Agonists – Activate opioid receptor to a lesser
degree
o Buprenorphine, tramadol
o Affinity but low efficacy
Antagonists – Bind to opioid receptors without activating
them
o Naloxone (Narcan)
o Affinity but no efficacy
Gout –
- goals of therapy: management of pain associated with acute attacks
o Lowering uric acid levels
Lifestyle management
o Allopurinol is the first-line agent for lowering urate levels – Xanthine
oxidase inhibitor
MOA: Inhibit the enzyme responsible for conversion of hypoxanthine
and xanthine to uric acid
Adverse Effects
Exam 3 Review
Study Guide
Week 8 Content
Pain Management
o Know the treatment of acute pain – what medications are first-line?
NSAIDs, anticonvulsants, acetaminophen, and muscle relaxants
Non-pharmacological recs: exercise programs, physical therapy,
acupuncture, massage, TENs, chiropractic treatment, and
biofeedback therapy
What would you prescribe first when treating acute mild
musculoskeletal pain?
Topical NSAIDs w/ or w/o menthol gel
Think of the guidelines and the Shadow Health assignment
NSAIDS – Ibuprofen, Naproxen, Aspirin, Toradol, Mobic
exert analgesic, antipyretic, and anti-inflammatory effects (don’t get anti-
inflammatory relief with acetaminophen)
o Adverse effects –
GI – nausea, heartburn
Mild headaches
Dizziness
o Contraindications –
History of ulcers, Crohns, GI bleeding
Liver or Kidney disease
Heart disease
Bleeding or platelet disorders
Unmanaged HTN
Pregnancy
o Drug interactions –
Antihypertensives
Warfarin
Digoxin
o Symptoms of salicylate toxicity (aspirin-based) – which one would
you see first;
N/V
Diaphoresis
Tinnitus
Hyperventilation – this is the physical sign
Respiratory alkalosis – earliest signs
o Why do NSAIDS have a black box warning?
2005: FDA issued warning on all prescription and OTC NSAIDs
Increased risk of cardiovascular events and serious GI bleeding,
NON-ASPIRIN
Salicylates
, o Uses:
o Mechanism of action
o Toxicity
Signs and symptoms of toxicity
Toxicity versus adverse effects at usual doses (these are
different) - what is first seen with toxicity, i.e. what is the
cascade of events?
Acetaminophen – non-opioid, non-NSAID analgesic
- used in treatment of mild pain and fever
- no anti-inflammatory properties
o Contraindications –
Alcohol abuse
Liver or kidney disease
Malnutrition
o Acetaminophen toxicity –
What are the signs and symptoms of liver damage/failure?
Abdominal pain
N/V
dark urine
jaundice
Opioids –
o Know the difference between agonists, partial agonists and
antagonists
What are some examples of each –
Morphine – prototypical opioid agonist
Full Agonists – Activate opioid receptor fully
o Morphine, codeine, methadone, hydromorphone
o Affinity plus efficacy (affinity = it attaches, efficacy =
it’s effective)
Partial Agonists – Activate opioid receptor to a lesser
degree
o Buprenorphine, tramadol
o Affinity but low efficacy
Antagonists – Bind to opioid receptors without activating
them
o Naloxone (Narcan)
o Affinity but no efficacy
Gout –
- goals of therapy: management of pain associated with acute attacks
o Lowering uric acid levels
Lifestyle management
o Allopurinol is the first-line agent for lowering urate levels – Xanthine
oxidase inhibitor
MOA: Inhibit the enzyme responsible for conversion of hypoxanthine
and xanthine to uric acid
Adverse Effects
