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Drug Class:
Non-narcotic analgesic, NSAIDs

MOA:
Inhibits the COX-2 enzymes in damaged tissue which inhibits prostaglandin release preventing pain and inflammation.

Pharmocodynamics:

Indications:
- Pain
- Tenderness
- Swelling
- Stiffness
- Relieve symptoms of arthritis (osteoarthritis, rheumatoid arthritis)

Patient Considerations:
-        Allergies

-        Side effects from Celecoxib (nausea, dyspepsia, GI ulceration or bleeding, raised liver enzymes)

-        Education

-        Patient history (previous conditions that may not tolerate the drug, such as being cautious if patient has previous cardiovascular diseases)
-  Making sure the patient hasn’t been given the same drug prior

Nursing Considerations:
-       Patient Allergies and if they have had them in the past

-       For more pain relief NSAID can be used with paracetamol and opioids for more severe pain

-       Patient pain scale and obs

-       Six rights of medication administration

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How / why does it occur?
- interaction with anticoagulants increases risk of bleeding because the blood clotting process is slowed
-other medications that contain paracetamol can alter the ingested paracetamol's absorption

What are they and what signs and symptoms would we see?
- irregular bowel movements
-bruising
-nausea and vomiting
-abdominal pain
-liver problems that can lead to liver toxicity

What do we as nurses do, prevent and/ or manage these?
-check medication chart
-check patient history
-monitor patient output/bowel movements
-monitor vital signs

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Drug Class: non-opioid analgesic

MOA/Pharmacodynamics : provides an analgesic effect by inhibiting prostaglandin synthesis in the CNS and activating descending pathways. also provides an antipyretic effect most likely due to the reduced production of prostaglandins in the hypothalamus.

Indications: used for mild to moderate pain, fever

Patient Considerations: hepatotoxicity (liver toxicity) due to paracetamol overdose

Nursing Considerations: adhering to the 6 rights of safe medication administration
patient's pain level
patient's allergies or previous adverse reactions
recent OBS

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1. How do you know that it is for your patient?
2. What makes the orders legal?
Were the orders legal?

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Drug Class: Opioid / narcotic

MOA: act on opiod recptors in CNS and GIT producing analgesia, respiratory depression, sedation and constipation

Pharmocodynamics:
lower resp rates - lower oxygen
sedation - modulating the decending inhibitory pathways from the brain
constipation - constipation - decreased bowel contractions and reduces rectal sensation

Indications: because constipation is side effect, perscribe with laxtives

Patient Considerations: dependace and other risk factors, allergies, pt history and other medications, avoid if pregnant or breastfeeding

Nursing Considerations: asses sedation, fluids and pain
respiratory depression has prolonged duration of 18-24 hours
naloxone is used to reverse opiod related sedation and respiratory depression
dont crush if in controlled release tablet form

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Drug Class: Opioid analgesic

MOA: acts on receptors in the CNS and GIT. reducing the transmission of pain impulse and by modulating the descending inhibitory pathways from the brain

Indications: severe pain, acute or chronic pain

Patient Considerations: patient history, current medications, risk factors

Nursing Considerations: renal impairment, respiratory depression

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1. yes, because he's still experiencing extreme pain so medications not having desired effect, try non pharmaceutical pain management. Escalate to doctor.
2. pain assessments, e.g coldspa, pain in relation to surgery or new pain? other pain or just in arm? undergoing drug and alcohol addiction assesement
3. means of distraction

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How / why does it occur?
- acts on the opioid receptors which decreases respiratory rate and causes respiratory depression

What are they and what signs and symptoms would we see?
- bradypnoea (low RR)
- altered state of consciousness

What do we as nurses do;
- monitor RR as well as all other vital signs
- complete regular GCS
- familiarise yourself with patients other medications and past history
- don't combine alcohol and other medications that can cause drowsiness eg. sleeping pills, anxiety medications, antidepressants

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1. Change of management (managing his pain in other ways other than medications eg. change of position in bed, fluid and food intake). Could also change the assessment as there might be further issues going on.

2. How much do you drink on a weekly basis? What type of pain is it? Is there any other pain anywhere else?

3. Speaking to his doctor to get another opinion, calling the pain team to see if there is any other options to manage his pain

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Drug Class: Benzodiazepine

MOA: sedative, muscle relaxant, anti convulasant and amnesic effect

Pharmocodynamics: CNS depressant, act by facilitating the binding of inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS

Indications: muscle spasms, anxiety symptoms, spacticity

Patient Considerations:

Nursing Considerations:

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Question 1:
Our assessment and management would change, we would use a multimodal approach and start using non-pharmaceutical techniques such as a heating compress, re positioning and meditation. if all else fails we would consult a doctor for a re assessment of our patients pain management.

Question 2:
Ask james about the characteristics of the pain, such as:
- Where does it hurt?
- What does it feel like?
- Does it get worse on exertion?
- Using the numeric pain rating scale

Question 3:
- Using a range of health professionals such as doctors, and physios to contribute to pain managment

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How / why does it occur?
- Toxic accumulation of active metabolites, causing dehydration and hypertension
- Opioids produce their respiratory depressant effects by activating opioid receptors

What are they and what signs and symptoms would we see?
- Low Resp rate
- Low Urine Output

What do we as nurses do; prevent and/ or manage these?
- Monitor renal output
- Monitor resp rate/exertion
- Checking Drug Chart

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How does it occur?
- increases risk for bleeding further

What are they and what signs and symptoms would we see?
- drugs that raise risks of side effects are: NSAIDS (Aspirin, paracetamol, ibuprofen), platelet inhibitors, herbal supplements (e.g fish oil, garlic, ginger)
- symptoms of bleeding include abdominal pain

What do we as nurses do;
- prevent and/ or manage these?

- monitor for rebound blood clots

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Drug Class:
Herapin

MOA:
Anticoagulant often used to prevent DVT

Pharmacodynamics:
Initiates clotting factors IIA and Xa

Indications:
Used to treat and prevent VTE in surgical patients and immobilised patients.

Patient Considerations:
Bruising and pain at the injection site, hyperkalaemia (high potassium), pregnancy safe

Nursing Considerations:
Can not be injected IM due to risk of haematoma.

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How / why does it occur?
What are they and what signs and symptoms would we see?
What do we as nurses do;
- prevent and/ or manage these?

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It would change assessment/management of his pain by creating further caution when administering medication which alter liver function (e.g paracetamol)

We could ask him which medication he self-administers at home, including how much alcohol he consumes to assist with his pain as he mentioned

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How / why does it occur?

Interacts with blood thinners and steroids

Blood thinners:
- As both blood thinners and celecoxib both reduce the ability of platelets to form clots, it increases the risk of bleeding

Steroids:
- As they are both anti-inflammatory's and raise the risk of developing GI side effects as both drugs

What are they and what signs and symptoms would we see?

Blood thinners:
- Serious bleeding (GI and brain bleedings)
- Nose bleeds
- Dizziness

Steroids:
- GI ulcers
- Stomach pain

What do we as nurses do;
- prevent and/ or manage these?
- Ensuring the drug chart is checked correctly

- Understanding of the patient’s medical history and how it could potentially impact the medication

- Checking what other medications the patient is prescribed or has recently taken to ensure there will be no significant interactions
- Not being afraid to ask or question what is being prescribed or why
- Monitor the patient for changes in vital signs