Pharmacology Basics Part 3: Anxiety, Pain, and Inflammatory Meds PDF

Pharmacology Basics Part 3:Anxiety,Pain Medications & Anti-inflammatories M. Lawrimore, MSN, RN Tucker: Chapters 16, 19,20,26 & 27 Nervous System  The nervous system is responsible for controlling the functions of the body. It is composed of the central nervo...

Pharmacology Basics Part 3:Anxiety,Pain Medications & Anti-inflammatories M. Lawrimore, MSN, RN Tucker: Chapters 16, 19,20,26 & 27 Nervous System  The nervous system is responsible for controlling the functions of the body. It is composed of the central nervous system (CNS) and the peripheral nervous system (PNS).PNS is composed of sensory receptors that bring information into the CNS and motor nerves that carry away information (p331)  It operates through the use of electrical impulses and chemical messengers to transmit information throughout the body in response to internal and external stimuli. (p332)  Much of drug therapy for the nervous system involves receptor sites and the release or uptake and breakdown of neurotransmitters (p340) Anxiety- The feeling of tension, nervousness, apprehension, or fear that involves unpleasant reactions to stimuli (p343)  Mechanism of action:  Benzodiazepines are a group of CNS depressants which reduce anxiety by inducing feelings of calm, drowsiness and sleep. They act by facilitating the binding of the inhibitory neurotransmitter GABA (gamma-aminobutyric acid) at various GABA receptors throughout the CNS.(p344) Anxiety Meds  Benzodiazepines – used to prevent anxiety without associated sedation.  Indications:  Indicated for treatment of:  Anxiety disorders  Alcohol withdrawal  Hyperexcitability / agitation  Seizure disorders  Insomnia  Preop for relief of anxiety Anxiety Meds  Drugs in the Benzodiazepine Class  Alprazolam – Xanax  Diazepam – Valium  Lorazepam – Ativan  Note these drugs end in “lam” or “pam” Considerations for antianxiety meds  Avoid abrupt discontinuation after prolonged use  Not give if renal or hepatic dysfunction, history of drug abuse or B/P  Xanax, Valium and Ativan are examples  Increase in 3D’s – drowsiness, dizziness, decreased BP  Enhances action of GABA (inhibitory transmitter)  Teach to rise slowly from supine  Yes alcohol should be avoided  Pharmacology Made Insanely Easy,Manning and Rayfield,Ican publishing, Duluth,GA, 2017,p439. Anxiety Med Antidote  Flumazenil is a nonspecific competitive antagonist at the benzodiazepine receptor that can reverse benzodiazepine-induced sedation Anesthetic – local pain relief  Lidocaine – a local anesthetic used to primarily prevent the patient from feeling pain for a specified time frame  Powerful nerve block  Work by causing a temporary interruption in the production and conduction of nerve impulses  Usually applied directly to the area causing the pain (p480-481) Pain Medication / Anesthetic/Antiarrhythmic  Lidocaine  Mechanism of action: As an anesthetic  Acts on the CNS to produce tranquilization and sleep before invasive procedures. When used as a local anesthetic, it inhibits nerve impulses from sensory nerves.  Indications: Pain management for dental procedures and minor surgeries  Consideration: Monitor vital signs, protect the numbed area from injury  Mechanism of action: As an Antidysrhythmic  Indications: Treatment of ventricular arrhythmias such as ventricular tachycardia & ventricular fibrillation  Considerations: Monitor EKG and vital signs. Does not mix with amphotericin B or cefazolin  Pharmacology Made Insanely Easy,Manning and Rayfield,Ican publishing, Duluth,GA, 2017,p.378 & p.36 Pain  Pain is a sensory and emotional experience associated with potential tissue damage  A hard sensation for the patient to cope with  Pain meds work in the central nervous system (brain and spinal cord) to alter the way pain impulses arriving from the peripheral nerves are processed  (p448) Pain Meds  Opioid Agonists Mechanism of Action:  Inhibit pain transmission by mimicking the body's natural pain control mechanisms, increases the pain threshold. There are mu and kappa opioid receptors.  Mu receptors are primarily pain blocking receptors. Besides analgesia, mu receptors account for respiratory depression, feeling of euphoria, decreased GI activity, pupil constriction and development of physical dependence.  Kappa receptors are associated with some analgesia, pupil constriction, sedation, and dysphoria. Pain Meds  Indications:  Moderate to severe pain  Preoperative medication Opioid Pain Medications  Codeine  Fentanyl - Sublimaze  Hydromorphone – Dilaudid  Morphine – MS Contin  Oxycodone – Oxycontin, Roxicondone  Methadone – Dolophine  No one specific ending Pain Med Considerations  The 6 D’s  Depressed respirations  Dizzy  Drowsy  Decreased GI peristalsis & urine output  Decreased BP  Drug dependence Pharmacology Made Insanely Easy,Manning and Rayfield,Ican publishing, Duluth,GA, 2017,p363. Pain Med Antidote  Naloxone is an opioid antagonist; a medication approved by the Food and Drug Administration (FDA) designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone Anti-inflammatory Meds  Mechanism of action:  Inhibits prostaglandin synthesis by inhibiting the enzyme cyclo- oxygenase; resulting in analgesic, anti-inflammatory, and antipyretic activities. Anti-inflammatory Meds  Indications:  To reduce fever and the inflammatory process  Musculoskeletal disorders (rheumatoid arthritis / osteoarthritis)  Analgesia for mild to moderate pain Nonsteroidal Anti-inflammatory Meds NSAIDS  Cox 1  Acetylsalicylic acid – Bayer Aspirin  Ibuprofen – Motrin, Advil  Diclofenac - Voltaren  Meloxicam - Mobic  Naproxen - Aleve  Cox 2  Celecoxib – Celebrex Mechanism of Action for Cox 1 and Cox 2  Cyclooxygenases (COX-1 and COX-2) are key enzymes in the conversion of arachidonic acid to prostaglandins and other lipid mediators. Because it can be induced by inflammatory stimuli, COX-2 has been classically considered as the most appropriate target for anti-inflammatory drugs Indications for Cox 1 and Cox 2  NSAIDs work by reducing the production of prostaglandins, chemicals that promote inflammation, pain, and fever Considerations for NSAIDS   BIRTH Undesirable effects No alcohol  See birth  Bone marrow depression  Aspirin sensitivity – do not give  Increased GI Distress  Inhibits prostaglandins  Renal toxicity  Do take with food  Tinnitus  Stop 5-7 days before surgery  Hepatotoxicity  Pharmacology Made Insanely Easy,Manning and Rayfield,Ican publishing, Duluth,GA, 2017,p257. Antidote for NSAIDS  No specific antidote for nsaids Nonopioid analgesic / Antipyretic  Acetaminophen – Tylenol: a selective cyclo- oxygenase-2 inhibitor  Mechanism of action: Acetaminophen is a pain reliever and fever reducer. It is thought to work to relieve minor aches and pains by elevating the body's overall pain threshold so you feel less pain, and lowers your fever by helping your body eliminate excess heat by acting directly on the thermoregulatory cells in the hypothalamus. It blocks pain receptors in the brain blocking pain and reducing inflammation Nonopioid analgesic / Antipyretic Indications  Indications:  Relieve mild to moderate pain from headaches  Muscle aches  Menstrual period cramps  Colds and sore throats  Toothaches  Backaches  Reactions to vaccinations (shots)  Reduce fever Nonopioid analgesic / Antipyretic Nursing Considerations  Acetaminophen  Look for diaphoresis, tachycardia, and malaise  Intake of one glass of water is recommended  Via nebulizer, administer Muco-myst- the antidote for overdose  Errors in dosing may result in liver damage  Renal disease, alcohol abuse and hepatic disease- use cautiously  Pharmacology Made Insanely Easy, Manning and Rayfield,Ican publishing, Duluth,GA, 2017,p261. Opioid Narcotic Analgesia  Tramadol – Ultram  Mechanism of Action - Tramadol is a centrally-acting synthetic analgesic with a dual mechanism of action - binding at µ-opioid receptors and inhibiting noradrenaline and serotonin re-uptake. It is structurally related to codeine and morphine Opioid Narcotic Analgesia Considerations  Tramadol  Treatment for moderate to severe pain  Reuptake of serotonin and norepinephrine are inhibited; renal and hepatic impairment may occur  Assess characteristics of pain; bowel function  Monitor serum creatinine, liver enzymes; hemoglobin  Norman Norepinephine and Sara Serotonin will not get taken up on TRAM (because reuptake is inhibited)  Pharmacology Made Insanely Easy,Manning and Rayfield,Ican publishing, Duluth,GA, 2017,p367. Opioid Narcotic Analgesia Antidote  Naloxone may reverse the opioid effects of tramadol but not the serotonin or norepinephrine effects. According to Clinical Toxicology, diazepam and naloxone can be efficient as an antidote for the effects of tramadol  (p453)