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Inflammation is the body’s protective response to injury or infection.
Drugs that manage pain and inflammation act mainly by blocking prostaglandins, histamine, or immune mediators.
We divide them into:
- NSAIDs → mild/moderate pain, inflammation, fever
- Corticosteroids → severe inflammation
- Opioids / Non-opioids → pain control
- Antigout drugs → uric acid regulation (For “Big Toes”)
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- Purpose: Contain injury or destroy microorganisms.
- Causes: Physical, chemical, or infectious stimuli.
- Signs: Swelling, pain, warmth, redness.
- Types: Acute or chronic.
- Chemical Mediators: Histamine, leukotrienes, bradykinin, complement, prostaglandins.
- These are common drug targets.
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Receptor | Location | Effect When Stimulated | Example Drugs That Block It | Clinical Use |
H₁ | Body | Itching, pain, vasodilation, edema, bronchoconstriction | Diphenhydramine, Loratadine | Allergic reactions, rhinitis |
H₂ | Stomach | Stomach Acid | Famotidine, Ranitidine | GERD, ulcers, heartburn |
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- COX enzyme makes prostaglandins → promotes inflammation.
- Two types:
- COX-1: Protective (stomach lining, renal blood flow, platelet aggregation).
- Inhibition → bleeding, GI upset, ↓ renal function.
- COX-2: Inducible at injury sites; causes inflammation, pain, and fever.
- Inhibition → ↓ inflammation and pain.
Enzyme | Location | Function | When Inhibited | Example Drugs |
COX-1
(”The Good guy”) | All tissues | Protects stomach, kidneys, platelets | GI bleed, renal issues | Aspirin, Ibuprofen, Naproxen |
COX-2
(”The Bad Guy”) | Injury sites | Inflammation, pain, fever. | ↓ inflammation/pain | Celecoxib (Celebrex) |
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- NSAIDs → For mild–moderate pain, inflammation, fever.
- Inhibit prostaglandin synthesis.
- Analgesic, antipyretic, anti-inflammatory.
- Corticosteroids → For severe inflammation. (I mean, YOU don’t usually take steroids for normal pain right!)
- Suppress immune response.
Note: Acetaminophen has no anti-inflammatory action and is not an NSAID.
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Drug | Notes |
Ibuprofen (Advil, Motrin) | Pain, fever, inflammation (OTC/prescription). |
Indomethacin (Indocin) | Strong NSAID; for arthritis, bursitis, gout. |
Ketorolac (Toradol) | Potent short-term analgesic (post-surgery). Only we do IV |
Naproxen (Aleve) | Long-acting; arthritis/muscle pain. |
Diclofenac (Voltaren) | Oral or topical; joint/muscle pain. No antipyretic effect. |
Avoid NSAIDS in “Peptic Ulcer” pt.
NSAIDS 1st generation: All the ones you know.
NSAIDS 2nd generation: Celecoxib (Celebrex) ⇒ Same stuff as in 1st gen, but less gastrointestinal ulceration and bleeding. They are COX-2 selectives.
🧾 Aspirin (ASA)
- Class: Salicylate NSAID.
- Effects: Analgesic, antipyretic, anti-inflammatory, antiplatelet.
- ⚠️ High dose → Salicylism (tinnitus, dizziness, headache, sweating).
- ⚠️ Avoid in children <15 with flu → Reye’s Syndrome risk.
- ⚠️ Avoid in 3rd trimester pregnancy.
- ⚠️ Toxic level: >30 mg/dL (therapeutic 15–30 mg/dL).
Interactions: ⇒ Think on the Phrase (Bleeding glucose steroids)
- ↑ Bleeding with anticoagulants
- ↑ Hypoglycemia with oral antidiabetics
- ↑ Ulcer risk with steroids
- ↑ PT, INR, uric acid; ↓ K⁺, cholesterol, T₃/T₄
- Foods: prunes, raisins, licorice, curry, paprika
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- Class: Non-opioid analgesic, antipyretic (not NSAID).
- Action: Inhibits prostaglandins in CNS.
- Use: Pain, fever.
- Max dose: 4 g/day (3 g/day if liver risk).
- Toxicity: Hepatotoxicity, thrombocytopenia (is a condition characterized by a low platelet count in the blood, which can lead to excessive bleeding and bruising.).
- Antidote: Acetylcysteine (Mucomyst). ⇒ Think Acetami = Acetyl
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- Action: Inhibit COX-2 only → ↓ pain & inflammation, fewer GI effects.
- Examples: Celecoxib (Celebrex), Nabumetone (Relafen).
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- Mechanism: Suppress histamine & prostaglandins; inhibit immune response.
- Uses: Severe inflammation, autoimmune conditions.
- Risks:
- Adrenal suppression, hyperglycemia, mood swings
- Cataracts, peptic ulcers, osteoporosis, infections, Cushing’s syndrome
💎 Gout
- Definition: Inflammation of joints/tendons due to uric acid buildup.
- Cause: Defect in purine metabolism.
- Foods high in purine: Organ meats, sardines, salmon, liver, beer, gravy.
Drugs
Type | Drug | Action | Notes |
Anti-inflammatory | Colchicine | ↓ leukocyte migration | Take with food; avoid in renal/cardiac/GI issues |
Uric acid inhibitor | Allopurinol (Zyloprim) | ↓ uric acid production | Monitor CBC, liver/renal; yearly eye exam; avoid alcohol/caffeine; ↑ fluids |
Uricosuric | Probenecid (Benemid), Sulfinpyrazone (Anturane) | ↑ uric acid excretion | Take with food; caution with protein-bound drugs; ↑ fluids |
⚪ Non-Opioid Analgesics
- Drugs: Aspirin, Acetaminophen, Ibuprofen, Naproxen
- Use: Mild–moderate pain (headache, dysmenorrhea, arthritis).
⚫ Opioid Analgesics
- Use: Moderate–severe pain.
- Action: Act on CNS; suppress pain & cough centers.
- Side effects: N/V, constipation, ↓ BP, respiratory depression, urinary retention.
Drug | Notes |
Morphine | Prototype opioid |
Hydromorphone (Dilaudid) | Stronger than morphine |
Fentanyl (Duragesic, Sublimaze) | Very potent (patch/IV); chronic or surgical pain |
Oxycodone (OxyContin, Percocet) | Moderate–severe pain |
Codeine | Weak opioid; cough suppressant |
Meperidine (Demerol) | Rarely used; neurotoxic metabolite (normeperidine) |
💉 Patient-Controlled Analgesia (PCA)
- Common drugs: Morphine, Fentanyl, Hydromorphone
- Loading dose: Initial bolus
- Demand dose: Each button press
- Lockout time: Prevent overdose
- Basal rate: Continuous infusion (optional)
🩹 Transdermal Opioids
- Fentanyl patch (Duragesic) → continuous pain control for chronic pain.
- Avoid in patients <110 lb.
- More potent than morphine.
🚨 Opioid Antagonists
Drug | Use | Notes |
Naloxone (Narcan) | Reversal of opioid overdose | Short-acting; IV, IM, SubQ, nasal |
Naltrexone (ReVia) | Maintenance for opioid/alcohol dependence | Long-acting |
Nalmefene (Revex) | Reversal & respiratory depression | Longer duration than Narcan |
Side effects: Tremors, sweating, HTN, tachycardia, N/V, dysrhythmia, ↑ PTT/bleeding.
Nursing: Monitor vitals and bleeding continuously.
🧍♀️ Special Populations
- Children
- Older adults
- Cognitively impaired
- Cancer patients
- Substance abuse history
🧾 Pain Assessment Scales
Scale | Population | Description | Range | Notes |
Numeric Rating Scale (NRS) | ≥8 yrs, adults | 0–10 scale | 0–10 | Quick, common |
Visual Analog Scale (VAS) | Adults | Mark on 10 cm line | 0–10 | Research use |
Wong–Baker FACES | Children 3+, language barriers | Choose cartoon face | 0–10 | Great for kids |
FLACC | Infants 2 mo–7 yrs | Face, Legs, Activity, Cry, Consolability | 0–10 | Nonverbal measure |
CRIES | Neonates 0–6 mo | Crying, O₂ req, vitals, expression, sleep | 0–10 | Post-op infants |
PAINAD | Dementia | Observes breathing, facial cues | 0–10 | Long-term care use |
COMFORT | Infants, ICU | Observes movement, tone, tension | 8–40 | For sedation/pain |
FPS-R | Kids 4–12, elderly | Neutral faces (no tears) | 0–10 | Cross-cultural |
McGill Questionnaire | Adults | Word descriptors | 0–78 | Chronic pain detail |
Behavioral Pain Scale (BPS) | ICU, intubated | Facial, limb, compliance | 3–12 | ICU monitoring |
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