NR565 ADVANCED PHARMACOLOGY PAIN DRUGS MAIN EXAM 2025

NR565 ADVANCED PHARMACOLOGY PAIN DRUGS MAIN EXAM 2025 Acute Pain - Occurs for less than three months and is often precipitated by trauma, acute medical conditions, surgery, or treatment. - Subacute pain has a duration of 1-3 months. - Categorized as referred pain, acute somatic pain, or acute visceral pain. - Rated by severity. - The focus is on immediate relief and prevention of transition to chronic pain, utilizing a variety of drugs. Acute Pain and Opioids - Short-acting opioids should be used exclusively as the treatment of acute pain in opioid-naive clients (as opposed to opioid-tolerant clients). - Titration to optimal therapeutic effects is faster, safer, and easier with immediate-release opioids (as opposed to extended-release opioids). - Unintentional overdose may be more likely when opioid therapy begins with long-acting opioids in opioid-naive clients. Chronic Pain - Persists beyond three months or the expected time of healing. - Treatment aims to alleviate pain and improve function and quality of life over the long term. - Agents used to manage chronic pain are often the same ones used to manage acute pain. However, due to the extended duration of use and increased potential for serious risks, including misuse and abuse, addiction, overdose, and death, these agents must be used judiciously to avoid harm. - Chronic pain is ideally treated without opioids. Nonpharmacological Treatments NR 565 NR 565 Examples: physical therapy, complementary therapies like acupuncture, rest, ice, heat, etc. - Crucial in a holistic pain management plan. Essential Considerations for Safe Pain Management 1. Opioids are not first-line therapy 2. Establish goals for pain and function 3. Discuss risks and benefits 4. Use immediate-release opioids when starting 5. Use the lowest effective dose 6. Prescribe short durations for acute pain 7. Evaluate benefits and harms frequently 8. Use strategies to mitigate risk 9. Review PDMP data 10. Use urine drug testing 11. Avoid concurrent opioid and benzodiazepine prescribing 12. Offer treatment for opioid disorder Management of Pain with Non-Opioids The CDC clinical practice guideline (CPG) for prescribing non-opioids strongly recommends considering non-opioid medications and nonpharmacologic treatments for pain management before prescribing opioids. This approach prioritizes the prescription of non-opioid medications that can effectively manage pain with a lower risk of addiction and side effects. Non-opioid treatments encompass a wide range of pharmacologic options (including acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) and nonpharmacologic options (including physical therapy, exercise, and cognitive behavioral strategies) to address pain comprehensively. Acetaminophen (Tylenol): Category, Primary Function, Unique Features Category: Cyclooxygenase Inhibitors (Drugs that Lack Anti-inflammatory Actions) Primary Function: Acetaminophen reduces prostaglandin synthesis in the CNS to reduce pain and fever. Unique Features: Acetaminophen is used more than any other analgesic. NR 565 NR 565 Acetaminophen (Tylenol): MOA Acetaminophen reduces prostaglandin synthesis in the CNS to reduce pain and fever. While acetaminophen is mostly transformed into safe metabolites after metabolism, liver enzymes convert a small part into a harmful substance. Normally, this dangerous byproduct is quickly neutralized, but in cases of overdose, it accumulates and can severely damage the liver due to the depletion of protective glutathione. Acetaminophen (Tylenol): Indications and Therapeutic Uses - Pain Relief: Acetaminophen is used when mild pain relief is needed across a range of indications. - Fever: Acetaminophen can be used to reduce fever. Acetaminophen (Tylenol): Side Effects and Adverse Reactions - Hypertension - Hepatotoxicity - Rash: Stevens-Johnson Syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), or toxic epidermal necrolysis (TEN) Acetaminophen (Tylenol): Precautions, Contraindications, Black Box Warning Precautions - Monitor for hepatic dysfunction. - Caution with clients who consume three or more alcoholic drinks daily. - Administering acetylcysteine (Mucomyst) for overdose can reduce liver injury. Contraindications - Contraindicated in clients with hepatic impairment. - Contraindicated in clients who consume high amounts of alcohol. Black Box Warning - Serious liver injury can result from acetaminophen. Acetaminophen (Tylenol): Drug Interactions - Alcohol consumption - Warfarin - Vaccines (blunt response) NR 565 NR 565 Acetaminophen (Tylenol): Dosing - Dosing varies based on the condition, severity, and client response. - Check drug dosing guidelines for individualized dosing. - Oral (tablet or solution) or rectal dosing. - Do not use in clients with liver impairment due to the risk for hepatotoxicity. - Monitor daily dose of acetaminophen as many other products (cold and flu medications, other pain medication combination drugs, etc.) also contain acetaminophen. The maximum daily dose is 3900mg/day. - Administering acetylcysteine (Mucomyst) for overdose can reduce liver injury. Acetaminophen (Tylenol): Administration and Client Teaching Administration - Administer orally or rectally. Client Teaching - Advise clients to assess over-the-counter medications for acetaminophen and monitor the daily amount. 3900mg/day is the maximum amount. - Advise clients to avoid alcohol. - Advise clients to only consume 2000mg/day if they drink more than 3 alcoholic beverages per day. Acetaminophen (Tylenol): Labs to Monitor Liver Function Tests (LFTs) Regular liver function tests may be required for certain clients due to the potential for liver injury. NSAIDs: Ibuprofen (Motrin): Category, Primary Function, Unique Features Category: Cyclooxygenase Inhibitors, Propionic Acid Derivative (Nonsteroidal Anti-inflammatory Drugs (NSAIDs)) Primary Function: NSAIDs can treat fever, inflammation, and pain. Unique Features: There are first and second-generation NSAIDs. First-generation NSAIDs are covered here, with second-generation NSAIDs covered later. NSAIDs: Ibuprofen (Motrin): MOA NR 565 NR 565 NSAIDs temporarily inhibit cyclooxygenase (COX-1 and COX-2), key enzymes in pain, inflammation, and fever processes. Unlike aspirin, NSAIDs cause reversible inhibition of COX-1 and COX-2 (unlike aspirin, which is irreversible). This contributes to antipyretic, anti inflammatory, and pain-relieving qualities. NSAIDs: Ibuprofen (Motrin): Indications and Therapeutic Uses - Pain Relief: NSAIDs are used when mild pain relief is needed across a range of indications. - Fever: NSAIDs can be used to reduce fever. - Inflammation: NSAIDs can reduce inflammatory processes throughout the body. NSAIDs: Ibuprofen (Motrin): Side Effects and Adverse Reactions - Hemorrhage: can occur anywhere in the body but often in the GI system. - Renal impairment - Rash: Stevens-Johnson Syndrome (SJS) - Increased risk for thrombotic events: MI and stroke - Gastric ulcer NSAIDs: Ibuprofen (Motrin): Black Box Warning, Precautions, Contraindications Black Box Warning - All first-generation NSAIDs have a black box warning for an increased risk of GI bleeding and thrombotic events (e.g., MI and stroke). Precautions - Should be used carefully in clients taking anticoagulants like warfarin due to increased bleeding risk. - Should be avoided or used with caution in clients with a history of peptic ulcer disease or gastrointestinal bleeding. - Use cautiously in renal impairment. - Use caution with clients at risk for thrombotic events, as NSAIDs can increase those risks. Contraindications - Avoid in heart failure, severe heart disease, GI bleeding, and severe renal disease. - Avoid in the last 3 months of pregnancy due to the effect on prostaglandins. NSAIDs: Ibuprofen (Motrin): Drug Interactions