NR565 Advanced Pharmacology- Pain Drugs
Study online at https://quizlet.com/_fl16bi
1. 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.
2. 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.
3. 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.
4. Nonpharmacological Treatments: Examples: physical therapy, complementary therapies like
acupuncture, rest, ice, heat, etc.
- Crucial in a holistic pain management plan.
5. 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
, NR565 Advanced Pharmacology- Pain Drugs
Study online at https://quizlet.com/_fl16bi
11. Avoid concurrent opioid and benzodiazepine prescribing
12. Offer treatment for opioid disorder
6. 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.
7. Acetaminophen (Tylenol): Category, Primary Function, Unique Features: Cate-
gory: 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.
8. 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.
9. Acetaminophen (Tylenol): Indications and Therapeutic Uses: - Pain Relief: Aceta-
minophen is used when mild pain relief is needed across a range of indications.
- Fever: Acetaminophen can be used to reduce fever.
10. Acetaminophen (Tylenol): Side Effects and Adverse Reactions: - Hypertension
- Hepatotoxicity
- Rash: Stevens-Johnson Syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), or toxic epidermal
necrolysis (TEN)
11. Acetaminophen (Tylenol): Precautions, Contraindications, Black Box Warn-
ing: 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.
, NR565 Advanced Pharmacology- Pain Drugs
Study online at https://quizlet.com/_fl16bi
Black Box Warning
- Serious liver injury can result from acetaminophen.
12. Acetaminophen (Tylenol): Drug Interactions: - Alcohol consumption
- Warfarin
- Vaccines (blunt response)
13. 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.
14. 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.
15. 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.
16. 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.
17. NSAIDs: Ibuprofen (Motrin): MOA: 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.
Study online at https://quizlet.com/_fl16bi
1. 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.
2. 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.
3. 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.
4. Nonpharmacological Treatments: Examples: physical therapy, complementary therapies like
acupuncture, rest, ice, heat, etc.
- Crucial in a holistic pain management plan.
5. 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
, NR565 Advanced Pharmacology- Pain Drugs
Study online at https://quizlet.com/_fl16bi
11. Avoid concurrent opioid and benzodiazepine prescribing
12. Offer treatment for opioid disorder
6. 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.
7. Acetaminophen (Tylenol): Category, Primary Function, Unique Features: Cate-
gory: 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.
8. 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.
9. Acetaminophen (Tylenol): Indications and Therapeutic Uses: - Pain Relief: Aceta-
minophen is used when mild pain relief is needed across a range of indications.
- Fever: Acetaminophen can be used to reduce fever.
10. Acetaminophen (Tylenol): Side Effects and Adverse Reactions: - Hypertension
- Hepatotoxicity
- Rash: Stevens-Johnson Syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), or toxic epidermal
necrolysis (TEN)
11. Acetaminophen (Tylenol): Precautions, Contraindications, Black Box Warn-
ing: 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.
, NR565 Advanced Pharmacology- Pain Drugs
Study online at https://quizlet.com/_fl16bi
Black Box Warning
- Serious liver injury can result from acetaminophen.
12. Acetaminophen (Tylenol): Drug Interactions: - Alcohol consumption
- Warfarin
- Vaccines (blunt response)
13. 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.
14. 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.
15. 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.
16. 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.
17. NSAIDs: Ibuprofen (Motrin): MOA: 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.
