NURS3415 Pharmacological Concepts: Module 1B PDF

**NURS3415 Pharmacological Concepts** **Module 1B** **Didactic Learning Guide** ***[Comfort]*** *[ATI RN Pharmacology for Nursing Text - Unit 9 Medications for Pain and Inflammation]* *[Chapter 33 Non-Opioid Analgesics]* - **Aspirin** Be sure to list other first-generation NSAIDs, address...

**NURS3415 Pharmacological Concepts** **Module 1B** **Didactic Learning Guide** ***[Comfort]*** *[ATI RN Pharmacology for Nursing Text - Unit 9 Medications for Pain and Inflammation]* *[Chapter 33 Non-Opioid Analgesics]* - **Aspirin** Be sure to list other first-generation NSAIDs, address client education, and address toxicity. - Purpose: It is used for [inflammation suppression], [analgesia] (relief of pain) for mild to moderate pain (with osteoarthritis and rheumatoid arthritis), [fever reduction], [dysmenorrhea] (moderate to severe menstrual pain), and [inhibition of platelet aggregation] (aspirin). - Complications: - Gastric upset, heartburn, nausea, and gastric ulceration. - Bleeding (less with non-aspirin NSAIDs) - Kidney Dysfunction - Salicylism (aspirin): if a client takes in more aspirin than they excrete. - Reyes syndrome (aspirin): giving aspirin to a child with a viral infection. - Contraindications/precautions: - Teratogenic - Hypersensitivity to aspirin and other NSAIDs - Peptic ulcer disease - Bleeding disorders (hemophilia, vitamin K deficiency) - Children or adolescents with chicken pox or influenza - Perioperative use prior to coronary artery bypass grafting (non-aspirin NSAIDs) - Discontinue within 1 week before any elective surgery - Interactions: - Anticoagulants, glucocorticoids, and alcohol increase the risk of bleeding. - Ibuprofen decreases the antiplatelet effect of low-dose aspirin. - ACE inhibitors and angiotensin receptor blockers increase the risk of kidney failure. - Antihypertensive effects of ACE inhibitors decrease the risk of lithium carbonate and methotrexate toxicity increase. - Nursing Administrations: - Ensure clients swallow enteric-coated or sustained-release forms whole and do not crush or chew them. - Discontinue 1 week before scheduled surgery. - Monitor for initial and continued therapeutic effects. - PO, - Nursing Evaluation of Medical Effectiveness: fever is reduced, client reports a lower level of pain, and inflammation has decreased. Monitor for initial and continued therapeutic effects. - Other first gen NSAIDs: - Naproxen, indomethacin, ketorolac, meloxicam, and diclofenac - Client Education: - Take with food, milk, or 8oz of water to minimize gastrointestinal effects - Avoid alcohol - Report gastric irritation and manifestations of bleeding - Report prolonged bleeding - Report changes in output, weight gain, or manifestations of fluid retention such as edema or bloating. - Report ringing or buzzing in the ears, sweating, headache, and dizziness. - Do not give aspirin or NSAIDs to children under 19 with a viral infection (particularly chickenpox or influenza). Use acetaminophen instead. - Report chest pain, heaviness, shortness of breath, sudden and severe headache, numbness, weakness, visual disturbances, or confusion. - Take aspirin once daily to reduce the risk of heart attack and stroke if prescribed. - Aspirin toxicity: Salicylism, for aspirin, if a client takes in more aspirin than they excrete. Salicylism will present with tinnitus, sweating, headache, dizziness, and respiratory alkalosis. - What information stands out about **Ketorolac**? Hint: This medication has unique administration principles. - What information stands out about **Celecoxib**? Hint: This medication is a unique type of NSAID and has a unique and life-threatening adverse effect and contraindication. - **Acetaminophen** (Be sure to address toxicity, antidote, and client education.) - Purpose: It is a COX inhibitor, BUT its effects are limited to CNS (no anti-inflammatory or anticoagulant effects. It Does not affect the gastric mucosa or platelets, decreasing the risk for gastric ulcers and cardiovascular events.) - Complications: Rare but acute toxicity can happen; details below. - Contraindications/precautions: Anemia, Immunosuppression, hepatic or kidney disease. - Interactions: - Nursing Administrations: Oral or rectal. Advise clients that many combination products exist and to read labels carefully. No more than 4g a day. - Nursing Evaluation of Medical Effectiveness: reduced fever and client reports reduced pain. - Acetaminophen antidote: Use antidote, acetylcysteine via duodenal tube to prevent emesis and subsequent aspiration. - Client Education: Teach the client to read med labels carefully to determine proper doses. And take only one product at a time that contains acetaminophen. - Acetaminophen toxicity: Rare but acute toxicity can happen, resulting in liver damage with manifestations of nausea, vomiting, diarrhea, sweating, and abdominal discomfort, progressing to hepatic failure, coma, and death. *[Chapter 34 Opioid Agonists and Antagonists]* - **Morphine** (Be sure to list other opioid agonists, how to minimize the risk of adverse effects, and patient-controlled analgesia (PCA) pump.) Opioid agonist - Purpose: Analgesic for moderate to severe pain. Pre-op sedation, anxiety reduction, cough suppression (codeine), and reduction of bowel motility relief of diarrhea. - Complications: Have naloxone present in the client's room in case it is needed. - Contraindications/precautions: Pregnant women, renal failure, increased cranial pressure, biliary colic (pain caused by gallstones blocking the cystic duct), biliary surgery, and clients in preterm labor. - Interactions: Opioid agonists interact with CNS depressants, such as barbiturates, phenobarbital, benzodiazepines, and alcohol, by increasing their CNS depressant effects. When given medications with anticholinergic agents such as antihistamines and tricyclic antidepressants, their anticholinergic effects increase, causing constipation and urinary retention. Other antihypertensive medications increase hypotensive effects. St. John's wort can increase sedation. - Nursing Administrations: PO, IM, IV, subcutaneous, rectally, or epidurally. When ordered intravenously, give slowly over 4 to 5 minutes. - Nursing Evaluation of Medical Effectiveness: Ask the client to rate pain and wait 30-60 minutes after giving it orally to assess. Cough suppression Resolution of diarrhea - Client Education: - Other opioid agonists: Fentanyl, meperidine, methadone, codeine, oxycodone, hydromorphone - How to minimize the risk of adverse effects: - Patient-controlled analgesia (PCA) pump: closely monitor pump settings (dose, lockout, interval, 4-hr limit). Inform the client that safeguards are there to reduce the risk of excessive doses. - What information stands out about **Fentanyl**? Hint: This medication has unique routes of administration. - **Naloxone** (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) - Purpose: it interferes with the action of opioids by competing for opioid receptors. Opioid antagonists have no effect in the absence of opioids. It will temporarily reverse euphoria and respiratory depression. - Complications: Tachycardia and tachypnea. Abstinence syndrome (cramping, hypertension, vomiting, and reversal of analgesia). This happens when physically dependent clients are suddenly withdrawn the medication. Have oxygen and resuscitation equipment ready - Contraindications/precautions: - Interactions: reverses effects of opioids. - Nursing Administrations: IV, IM, subcutaneous, NO ORAL Rapid infusion can cause hypertension, tachycardia, nausea, and vomiting. The half-life of opioid analgesic can exceed the half-life of naloxone (60 to 90 min); give until crisis has passed. - Nursing Evaluation of Medical Effectiveness: *[Chapter 35 Adjuvant Medications for Pain]* - **Ibuprofen** (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) Be sure to address client education. Used with another primary pain medication, usually an opioid agonist, to increase pain relief while reducing the dosage of opioid agonists. Reduced dosage of opioids results in reduced adverse effects, and targeting the pain stimulus using different types of pain medications often provides improved pain reduction. - Purpose: Used to treat inflammation and fever and relieve mild to moderate pain and dysmenorrhea. - Complications: bone marrow suppression, GI distress (presenting as abdominal pain, elceration, nausea, vomiting, diarrhea, or constipation),and MI or stroke - Contraindications/precautions: Avoid after 30 weeks of gestation, use cautiously with lactation. It is contraindicated with clients who have a history of bronchospasms with aspirin or other NSAIDs and those who have severe kidney/hepatic disease. Use caution with clients with bleeding, GI, or cardiac disorders Use caution in older adults - Interactions: NSAIDs can reduce the effectiveness of antihypertensives, furosemide, thiazide diuretics, and oral antidiabetic medications. Aspirin, corticosteroids, alcohol, and tobacco can increase GI effects. NSAIDs can increase levels of oral anticoagulants and lithium. Increased risk of bleeding with the use of other NSAIDs, thrombolytics, antiplatelets, anticoagulants, and salicylates. - Nursing Administrations: Oral or IV - Nursing Evaluation of Medical Effectiveness: - Client education: *[Chapter 36 Miscellaneous Pain Medications]* - **Sumatriptan** (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) Be sure to address client education. - Purpose: migraine-specific medication (serotonin receptor agonists). It works by narrowing the blood vessels around the brain and reducing substances that trigger headaches, pain, nausea, and sensitivity to light and sounds. - Complications: Chest pressure (Heavy arms or chest tightness \[manifestations are self-limiting and not dangerous\]) Coronary artery vasospasms/angina (do not administer for clients at risk for coronary artery disease) Dizziness or vertigo (avoid driving or operating heavy machinery) - Contraindications/precautions: Pregnancy, lactation, reproductive precautions - Interactions: Concurrent use of MAOIs can lead to MAOI toxicity Concurrent use with ergotamine or another triptan can cause vasospastic reactions. Selective serotonin reuptake inhibitors (SSRIs) taken with triptans can cause serotonin syndrome (confusion, agitation, hyperthermia, diaphoresis, possible death). - Nursing Administrations: Oral, subcutaneous, inhalation, transdermal - Nursing Evaluation of Medical Effectiveness: Reduction in intensity of migraines Termination of migraine headaches - Client education: - **Lidocaine** (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) - Purpose: decrease pain by blocking the conduction of pain impulses in a circumscribed area. Loss of consciousness does not occur. Pain management for dental procedures, minor surgical procedures, labor and delivery, and diagnostic procedures. And regional anesthesia - Complications: CNS excitation and seizures followed by respiratory depression, leading to unconsciousness. Hypotension cardiosuppression, bradycardia, heart block, reduced contractile force, and cardiac arrest (common in spinal anesthesia due to sympathetic block) - Contraindications/precautions: Patients with a known hypersensitivity to local anesthetics. Use cautiously in patients with severe liver disease, heart block, or a history of malignant hyperthermia. - Interactions: It can interact with other medications that affect heart rhythm, such as beta-blockers and antiarrhythmics. - Nursing Administrations: Parenteral (injection), monitor for signs of adverse effects. - Nursing Evaluation of Medical Effectiveness: - Client education: Advise clients to avoid activities requiring alertness until the effects of lidocaine have worn off. Avoid hot food or drinks if applied in the mouth. - What information stands out about **EMLA**? Hint: This medication has unique administration principles. Topical cream for anesthesia before procedures. Apply to intact skin 1 hr before routine procedures or superficial puncture and 2 hr before more extensive procedures or deep puncture. Apply to the smallest surface area needed to minimize systemic absorption. Prior to the procedure, remove the dressing and clean the skin with aseptic solution. It can be applied at home before coming to the facility.