Pain, drug therapies

MANAGING ANXIETY. Fhtients may exhibit varying degrees of anxiety related to tiieir illness and infection and die necessary drug therapy. When these drug are given by die parenteral route, patients may experience anxiety because of the discomfort or pain that accompanies an IM injection or IV administration. The nurse reassures die patient that every effort will be made to reduce pain and discomfort altiiough complete pain relief may not always be possible. 

Chloroquine Take this drug witii food or milk. Avoid foods diat acidify die urine (cranberries, plums, prunes, meats, cheeses, eggs, fish, and grains). This drug may cause diarrhea, loss of appetite, nausea, stomach pain, or vomiting. Notify die primary healtii care provider if these symptoms become pronounced. Chloroquine may cause a yellow or brownish discoloration to the urine this is normal and will go away when the drug therapy is discontinued. Notify the primary health care provider if any of the following occur ... 

Before giving a nonnarcotic analgesic to a patient, the nurse assesses the type, onset, and location of the pain. It is important to determine if this problem is different in any way from previous episodes of pain or discomfort. If the patient is receiving a nonnarcotic analgesic for an arthritic or musculoskeletal disorder or soft tissue inflammation, the nurse should examine the joints or areas involved. The appearance of the skin over the joint or affected area or any limitation of motion is documented. The nurse evaluates the patient s ability to carry out activities of daily living. This important information is used to develop a care plan, as well as to evaluate the response to drug therapy. 

The expected outcomes for the patient depend on the reason for administration of the NSAID but may include an optimal response to drug therapy, which includes relief of pain and fever, management of adverse reactions, and an understanding of and compliance with the prescribed treatment regimen. 

Promoting an Optimal Response to Therapy The patient with a musculoskeletal disorder may be in acute pain or have longstanding mild to moderate pain, which can be just as difficult to tolerate as severe pain. Along with pain, there may be skeletal deformities, such as the joint deformities seen with advanced rheumatoid arthritis. For many musculoskeletal conditions, drug therapy is a major treatment modality. Therapy with these drugs may keep the disorder under control (eg, therapy for gout), improve the patient s ability to carry out the activities of daily living, or make the pain and discomfort tolerable. 

During the preadministration assessment, the nurse reviews the patient s chart for the medical diagnosis and reason for administration of the prescribed drug. The nurse questions the patient regarding the type and intensity of symptoms (such as pain, discomfort, diarrhea, or constipation) to provide a baseline for evaluation of the effectiveness of drug therapy. 

Lactic acidosis (buildup of lactic acid in the blood) may also occur with die administration of metformin. Although lactic acidosis is a rare adverse reaction, its occurrence is serious and can be fatal. Lactic acidosis occurs mainly in patients with kidney dysfunction. Symptoms of lactic acidosis include malaise (vague feeling of bodily discomfort), abdominal pain, rapid respirations, shortness of breath, and muscular pain. In some patients vitamin B12 levels are decreased. This can be reversed with vitamin B12 supplements or with discontinuation of the drug therapy. Because... 

The nurse takes vital signs every 4 to 8 hours, depending on the patient s condition. The nurse evaluates the patient s response to drug therapy based on original assessments. Responses that may be seen include a decrease in pain, an increase in appetite, and a feeling of well-being. 

Pain related to skin condition or inoreased sensitivity to drug therapy... 

The mechanisms of pain and the ability to control pain may vary in different pain states. This is of particular importance in consideration of a rational basis for the treatment of both inflammatory and neuropathic pain where the damage to tissue and nerve leads to alterations in both the peripheral and central mechanisms of pain signalling. In respect of existing drug therapies, this plasticity, the ability of the system to change in the face of a particular pain syndrome, explains the effectiveness of NSAIDs in inflammatory conditions and yet is also responsible for some of the limitations in the effectiveness of opioids in neuropathic pain. 

Monitor for adequate relief of symptoms. Patients whose pain does not respond to drug therapy may have a psychological comorbid condition and may require psychiatric intervention. 

In this example, we see that Active Therapy vs. Placebo, or drug therapy, has a significant odds ratio because the 95% confidence interval line does not cross 1. It appears that patients on active therapy are almost four times as likely to experience clinical success as those who are not on active therapy, while controlling for the variables White vs. Black, Male vs. Female, and Baseline Pain (continuous). ... 

Patients with acute gout should be monitored for symptomatic relief of joint pain as well as potential adverse effects and drug interactions related to drug therapy. The acute pain of an initial attack of gouty arthritis should begin to ease within about 8 hours of treatment initiation. Complete resolution of pain, erythema, and inflammation usually occurs within 48 to 72 hours. 

Drug therapy in OA is targeted at relief of pain. Because OA often occurs in older individuals who have other medical conditions, a conservative approach to drug treatment is warranted. 

An individualized approach to treatment is necessary (Fig. 2-1). For mild or moderate pain, topical analgesics or acetaminophen can be used. If these measures fail or if there is inflammation, nonsteroidal antiinflammatory drugs (NSAIDs) may be useful. Appropriate nondrug therapies should be continued when drug therapy is initiated. 

Acetaminophen is recommended by the ACR as first-line drug therapy for pain management of OA. The dose is 325 to 650 mg every 4 to 6 hours on a scheduled basis (maximum dose 4 g/day maximum 2 g/day if chronic alcohol intake or underlying liver disease). Comparable relief of mild to moderate OA pain has been demonstrated for acetaminophen (2.6 to 4 g/ day) compared with aspirin (650 mg four times daily), ibuprofen (1,200 or 2,400 mg daily), and naproxen (750 mg daily). However, some patients respond better to NSAIDs. 

Patients should be monitored for symptomatic relief of ulcer pain as well as potential adverse effects and drug interactions related to drug therapy. 

Monitor for signs and symptoms of peripheral neuropathy, such as numbness, pain, or tingling in the feet or hands. Be aware that these symptoms usually resolve promptly if stavudine therapy is discontinued, but they may worsen temporarily after the drug is withdrawn. If symptoms resolve completely, expect to resume drug therapy at a reduced dosage... 

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