Color Code:
Complications
Diagnostic Testing
Important Information
Condition
Medications
Lab Values
Pharmacology
Pain Medications
● Nonopioid Analgesics
○ NSAIDs - COX-1, COX-2 inhibitors
■ Suppresses inflammation, reduces fever. treats mild to moderate pain, relieves dysmenorrhea
■ Adverse effects: gastric upset, heartburn, nausea, gastric ulceration
● Reye’s syndrome: vomiting, confusion, seizures, loss of consciousness
■ Aspirin - stops clot formation (anticoagulant)
● A/E: renal impairment - weight gain, reduced urine output, edema, bloating
■ Ibuprofen (Advil and Motrin)
● Reduces the cardioprotective effects of low-dose aspirin
■ Administration:
● Do NOT crush or chew enteric-coated or sustained-release forms
● Take with water or milk
● Test and treat H. pylori infection prior to beginning long-term therapy
● Discontinue aspirin 1 week before surgery
● Discontinue if pregnant
● Expected prophylactic dose for aspirin: 81 mg/day
● Report:
○ Signs of bleeding - bruising, petechiae, excessive bleeding, dark-colored stools
○ Chest pain, SOB, headache, numbness/weakness, visual disturbances, confusion
○ Tinnitus, decreased hearing - earliest sign of Salicylism (AKA aspirin toxicity)
○ Celecoxib - COX-2 inhibitor
■ Adverse effects: chest pain, SOB, numbness, headache, confusion
■ Contraindicated: Sulfonamide allergy
○ Acetaminophen (Tylenol)
■ Reduces fever, treats mild to moderate pain
■ Adverse effects: liver damage, hypertension (daily use), Acetaminophen toxicity - diaphoresis,
nausea, diarrhea
■ Concurrent use with Warfarin (Coumadin)
■ Administration:
● If overdose occurs, administer acetylcysteine
● Adults, children 12+ should NOT take more than 4 g/day
○ Tramadol (Ultram)
■ Treats moderate to moderately severe pain
■ Adverse effects: sedation, seizures, constipation, dry mouth, N/V
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Administration:
● Pts will not feel effects until one hour after administration
● Monitor respirations - administer Naloxone (Narcan) to restore respiratory rate
Opioid Analgesics
○ Opioid agonists
■ Treats moderate to severe pain, causes sedation, reduces anxiety
■ Adverse effects: constipation, sedation, respiratory depression, hypotension
■ Morphine
● Cholecystectomy contraindicated due to possible biliary colic
■ Fentanyl
■ Demerol
■ Methadone
■ Administration:
● Monitor vital signs, auscultate lungs for congestion
● Monitor bowel function and provide fiber supplements and stool softeners as needed
● Encourage pts to slowly rise from sitting position
○ Opioid agonist-antagonists
■ Treats moderate to severe pain, adjunct (supplements) to anesthesia
■ Adverse effects: respiratory depression, sedation, Abstinence syndrome - vomiting, abdominal
cramps, hypertension, tremor, fever
■ Butorphanol
● A/E: Headaches, nausea, dizziness
■ Pentazocine (Talwin)
Opioid Antagonists
○ Naloxone (Narcan)
■ Adverse effects: ventricular arrhythmias, hypertension, increased pain
■ Administration:
● Monitor vital signs every 5-15 minutes throughout administration
● Effects last 60-90 mins
● Prepare to administer medication every 2-3 minutes until reversal of undesirable effects
occur
Inflammation Medications
● Uricosuric
○ Treats Gout (high levels of uric acid in blood)
○ Adverse effects: Hypersensitivity syndrome - fever, rash, eosinophilia, liver/kidney dysfunction
○ Allopurinol
■ A/E: Sore throat, vertigo, bruising, vision changes; drowsiness
■ Can increase the effects of Warfarin
● Corticosteroids
○ Treats inflammatory and autoimmune conditions
○ Adverse effects: hyperglycemia, myopathy (weakness in muscles), hypokalemia, peptic ulcer disease
(gastric bleeding)
○ Prednisone (Deltasone)
■ May cause osteoporosis - encourage pts to increase weight-bearing exercises and report back
pain
■
Increase dosage during illness, infection, stressful events