Quizlet

Overview

This lecture covers the mechanisms, indications, adverse effects, drug interactions, administration, and nursing implications of NSAIDs, corticosteroids, opioids, and related drugs used for pain and inflammation management.

NSAIDs: Mechanisms, Uses, and Adverse Effects

• NSAIDs inhibit cyclooxygenase (COX) enzymes, decreasing prostaglandin synthesis to reduce pain, fever, and inflammation.
• Ibuprofen is a propionic acid NSAID that inhibits COX-1 and COX-2.
• Aspirin irreversibly inhibits COX-1/COX-2, also inhibiting platelet aggregation.
• Celecoxib selectively inhibits COX-2, lowering pain but sparing gastric protection.
• Keterolac is a strong analgesic NSAID for short-term use in moderate-severe pain.
• Common adverse effects: GI upset, ulcers, bleeding risk, tinnitus, renal effects (especially with ibuprofen, keterolac, aspirin).
• Aspirin can cause Reye's syndrome in children with viral illness.
• Celecoxib has less GI risk but higher cardiac event risk.

Opioids and Related Agents

• Morphine is an opioid agonist at mu and kappa receptors, producing analgesia, euphoria, and sedation.
• Nalbuphine is a kappa agonist and mu antagonist, offering analgesia with less risk of dependence and respiratory depression.
• Naloxone is an opioid antagonist used to reverse opioid overdose.
• Adverse effects of morphine: respiratory depression, sedation, constipation, nausea, hypotension, addiction risk.
• Nalbuphine can cause sedation and mild respiratory depression; naloxone can cause withdrawal symptoms.

Non-Opioid Analgesics and Steroids

• Acetaminophen acts centrally to reduce pain and fever with little anti-inflammatory effect.
• Prednisone is a corticosteroid that suppresses inflammation and immune response.
• Acetaminophen overdose leads to hepatotoxicity; prednisone can cause hyperglycemia, osteoporosis, immunosuppression, and mood changes.

Interactions and Nursing Implications

• NSAIDs: increased bleeding with anticoagulants or other NSAIDs; monitor renal and GI function.
• Aspirin: interacts with hypoglycemics, anticoagulants, and increases ulcer risk with steroids.
• Morphine: sedation risk with alcohol/CNS depressants; caution with MAOIs.
• Acetaminophen: avoid alcohol, monitor for liver toxicity, check OTC products for duplicate dosing.
• Prednisone: do not stop abruptly, monitor blood glucose and infection risk, taper gradually.
• Naloxone may induce withdrawal in opioid-dependent patients.

Administration Guidelines

• Ibuprofen, aspirin, prednisone: give with food to minimize GI upset.
• Celecoxib: oral, individualize dosing; monitor for cardiac risk.
• Morphine: IV, PO, IM, subQ, titrate to effect, monitor respiration.
• Keterolac: IM, IV, PO, nasal; use for no more than 5 days.
• Acetaminophen: PO, IV, rectal; max 4g/day.
• Naloxone: IV, IM, subQ, intranasal; may need repeat doses due to short duration.

Key Terms & Definitions

• NSAID — Non-steroidal anti-inflammatory drug: reduces inflammation, pain, and fever.
• COX-1/COX-2 — Cyclooxygenase enzymes involved in prostaglandin synthesis.
• Opioid Agonist — Drug that activates opioid receptors to provide pain relief.
• Opioid Antagonist — Drug that blocks opioid receptors, reversing opioid effects.
• Analgesic — Drug that relieves pain.
• Antipyretic — Drug that reduces fever.
• Corticosteroid — Hormone that reduces inflammation and immune response.

Action Items / Next Steps

• Review drug indications, adverse effects, and interactions.
• Practice safe administration guidelines for each medication.
• Complete assigned readings on pharmacology of analgesics and anti-inflammatory drugs.