Post on 08-Apr-2018
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PAINWhen tissue damage occurs, injured cells release chemicalmediators, such as bradykinin, serotonin and prostaglandin, thataffects the exposed nerve endings of nocireceptor.
Classification of Pain are:
1. Acute Pain
2. Cancer Pain
3. Chronic Pain
4. Somatic Pain5. Superficial Pain
6. Vascular Pain
7. Visceral Pain
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Non Narcotic AnalgesicyAspirin
yAcetaminopen
y Ibufropeny Naproxen
* use to treat mild to moderate pain
* may be purchased over the counter
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SalicylatesyAspirin comes from the family of salicylates
derived from salicylic acidy
Also called ASA (acetylsalicylic acid)y Developed in 1899 by Adolph BayeryAlso called Prostaglandin inhibitoryAnti-platelet drugy
Should not be taken with other NSAIDs because itdecreases blood level and effectiveness of NSAIDsyAspirin inhibits COX-1 and COX-2y Never use in children below 12 years old
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Side effect and adverse
reactiony Gastric irritation
y Should be taken with food or full glass of fluid
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Acetaminopheny For infants children and adults
y Not NSAID
y Safe and effective analgesic and antipyretic drugs usedfor muscular aches and pain and for fever caused by
viral infection.
y Large dose can be toxic to the hepatic cells
y It weakly inhibits prostaglandin synthesis, whichdecrease pain sensation.
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NARCOTIC ANALGESICy Narcotic agonist, are prescribed for moderate and
severe pain.
y Opium was used as early as 350BC to relieved painyActs mostly on CNS, while Non narcotic acts in the
Peripheral Nervous system.
y Morphine and Codeine are derivatives of opiod
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MorphineyA potent narcotic analgesic effective against acute pain
resulting from AMI.
y May also be used as pre operative medicationy Can cause respiratory depression, orthostatic
hypertension, urinary retention, constipation.
yAntidote is Naxolone(Narcar) narcotic antagonist
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y Narcotic antagonist must be available whenadministering morphine IV
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Meperidiney Synthetic Narcotic
y Prepared during pregnancy because iit does not
diminished uterine contractions and cause lessneonatal respiratory depression.
y Not indicated for clients with chronic pain, severe liverdysfuction, sickle cell disease, history of seisure,
Coronary Artery Disease and Cardiac Dysrythmia.y Not prescribed for long term.
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NursingManagementSome can cause allergic reaction
Store at room temperature and protect it from light band
freezingNote that meperedine is incompatible with
aminophylline, heparin, phenobarbital, phenytoin,and Sodium Bicarbonates
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NalbuphineyA narcotic agonist and antagonist
y Effective in alleviating moderate to severe pain.
y Side effect- dizziness, confusion, hallicination, blurredvision, headache, depression
yAdverse effect Bradycardia, tachycardia
y Life threatening respiratory depression
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ANTIINFLAMMATORY AGENTy Inflammation is a response to tissue injury and
infection. When the inflammation process occurs, a
vascular reaction takes place in which fluids, elementsof blood , leukocytes and chemical , mediatorsaccumulate at the injured tissue on infection sites.
y The process of inflammation is a protective
mechanism
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Cardinal Sign of Inflammation1. Redness
2. Swelling
3. Heat4. Pain
5. Loss of Function
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Non-Steroidal Anti-inflammatory DrugsI. Salicylates
II. Para- ChlorobenzoicAcid Derivatives
III. Phenylacetic Acids
IV. Propionic acidDerivatives
V. FenamatesVI.Oxicams
VII.Selective COX-2Inhibitors
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Parachlorbenzoic Acidy Used for the treatment of Rheumatoid Arthritis,Gouty Arthritis and Osteoarthritis
y Highly protein bound 90%
y
This group of NSAIDs may cause sodium andwater retention as well as increased blood pressure
y indomethacin, sulindac, tolmetin
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Phenylacetic Acid Derivatives
y Used for the treatment of Rheumatoid Arthritis,Osteoarthritis, Ankylosing Spondylitis
y diclofenac sodium (Voltaren)
y ketorolac- first injectible NSAID-short termmanagement of pain
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Propionic Acid Derivatives
y New group of NSAIDs
yAspirin-like but have stronger effects and lessGI irritation
y Better tolerated than other NSAIDsy ibupfropen (Motrin) is the most widely used
NSAIDs which can be purchased OTC.
y ketoprofen (Orodis)
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Fenamates
y Includes potent NSAIDs used for acute andchronic arthritic conditions
y mefenamic Acid
y
meclofen-amate sodium monohydrate(Meclomen)
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Oxicams
y Indicated for long-term arthritic condition
y Longer half-life
y piroxicam (Feldene)
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Selective COX-2 Inhibitors
y Drug of choice forclients with severe
arthritic conditionswho need high doses ofanti-inflammatorydrug.
y Celecoxib is anexample.
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CorticosteroidyWidely prescribed for arthritic conditionsy Numerous side-effects
y Half-life greater than 24 hours
y Discontinouing steroids
Examples:
Prednisone
PrednisiloneDexamethasone
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Disease-Modifying Antirheumatic
Drugs
y Gold Drug Therapy
y
Immunosuppresive Agentsy Immunomodulators
yAnti-malarials
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Gold Drug Therapyy
Most frequently used DMARDsy Used to arrest progression of rheumatoid
Arthritis and prevent deformities
y Depresses migration of leukocytes and suppresses
prostaglandin activity.y Not used in the early stages of arthritis unless
the illness is progressing rapidly and isunresponsive to other therapy, nor used in far-
advanced arthritis.y Palliative and not curative
y Response in alleviating symptoms is slow.
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y Injectible-2 monthsy Oral-3-6 monthsy Half-life-7-25 daysy Gold Salt Auranofin (Ridaura) oraly Sodium aurothiomalate, aurothioglucose - injection
Side Effects:y Dermatitis Gastritis
y Urticaria(hives) Pharyngitisy Erythema StomatitisyAlopecia
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Immunosuppressive Agentsy To treat refractory arthritis
y In low doses, have been effective
Example:y azathioprine (Imuran)
y cyclophosphamide (Cytoxan)
ymethotrexate (Mexate)
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Immunomodulatorsy To treat moderate to severe rheumatoid arthritis
bydisrupting the inflammatory process
delaying disease progression.y Interleukin (IL-1) receptor antagonist and Tumor
Necrosis Factor (TNF) Blockers
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y anakinra- subcutaneously
y etanercept(Enbrel) Subcutaneously
y Signs and symptoms are suppressed rapidly but
reappears if discontinuedy Both IL1 and TNF inhibitors predisposes a client to
severe infections
yVery expensive approximately $14,000-$37,000 peryear
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Antimalarials
y Mechanism is unclear
y 4-12 weeks before effects to become apparent
y Plaquenil
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Anti- Gout Drugs
y Gout disease of Kings
y Unwalkable Disease
y Podagra according to Hippocrates
or Foot SeizureyJoints of the large toe, elbows, hand,
knee and shoulder are affected.
y Hippocrates recommended use of
purgatives(Strong laxatives)
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Colchicine
y 1st drug for GoutyAlleviating acute symptoms of gout
y Not effective in decreasing inflammationoccurring in other inflammatory disorders
y Should not be used in clients with severe renal,cardiac or GI problem (GI irritation)
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Uric Acid Inhibitory allopurinol (Zyloprim)
y InhibitsUric Acid Biosynthesis
y Lowers uric acid level
y Prevents precipitation of an attack
yDrug of choice for Chronic tophaceous gout
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