Analgesics and Anti-inflammatory Agents

NURS 1950Pharmacology

Nancy Pares, RN, MSNMetro Community College

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Pain is:

Pain tolerance is:

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Obj. 1 Define pain and Pain tolerance

Objective 2: Identify the factors which affect the individual’s response to pain

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What are the assessments?

What is included in a pain history?

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Obj. 3. Describe factors included in assessment of pain

Objective 4: Describe scheduled drugs

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Schedule I: high potential for abuse◦No accepted medical use in US

Schedule II:◦ high potential for abuse◦Opiate analgesics

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Obj. 4 Describe scheduled drugs

Schedule III: lower potential for abuse than schedule II.◦Tylenol with codeine

Schedule IV: lower potential for abuse than schedule III.◦Librium, Valium

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Schedule V: lowest potential for abuse◦Usually antidiarrheal and antitussive

◦Lomotil◦Robitussin A-C

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What are analgesics?

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Obj. 5 Define analgesics

Bind to opiate receptors in the CNS◦This inhibits transmission of pain impulse and alters pain perception

◦Also produce euphoria

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Obj. 6. Describe actions of narcotic analgesics

Some are opioid agonists◦What is an agonist?

Some are agonist-antagonists

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Side effects of opioids◦N/V◦Constipation ◦Respiratory depression◦Dependence◦Tolerance

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When the opioids are discontinued:◦Sweating, restlessness, diarrhea

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Signs and symptoms of overdose◦Respirations under 12/minute◦Pin-point pupils◦Coma What drug can be used to reverse these effects?

Why does it work?

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Objective 7: Compare the many effects of morphine sulfate (MS) and meperidine (Demerol)

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MS◦Oral◦Subc◦IV◦IM◦Rectal ◦Sublingual ◦“mother” of all

narcotics

Demerol◦Oral◦Subc◦IV◦IM

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MS 5-20 mg dose q 4 hr

10-60 min onset

Longer duration of action than Demerol

Demerol◦50-100 mg q 3-4

hr◦10-45 min onset◦Shorter duration

of action than MS

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Assessment of painAssessment of respirationsMS can be used in cancer painMeperidine (Demerol) metabolite is normeperidine: causes hallucinations

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Nursing Implications

What narcotic agents have you given?

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Obj. 8 list other narcotic agents

Many narcotic agents available Given by every routeSome are only in oral form

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Some narcotic analgesics are◦Hydrocodone + acetaminophen (Vicodin)

◦Fentanyl (Duragesic)◦Oxycodone + ASA (Percodan)

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A client is receiving MSContin q 12 hr-30 mg

At the next dose time, there is break through pain.

Can the client also have the MSIR dose?

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Thinking Question

Narcotics work in the CNS and affect the nociceptors (nerve endings) and the neurotransmitter pathways of pain transmission

Acetaminophen, ASA, and the NSAIDs work in the periphery and interfere with prostaglandins

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Obj. 9 compare narcotics with acetaminophen, asa and nsaids

Nonopioid drugs are also readily available (OTC) and inexpensive

Are antipyretic and ASA and some NSAIDs have antiplatelet activity

No tolerance or dependence is caused as is the case with opiates

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Double lockSign outUse non-drug interventionsAssess painGive meds before pain severeDon’t under treat pain

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Obj. 10 describe nursing interventions associated with narcotic administration

Objective 11describe the use of salicylates

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Peripherally acting Interfere with synthesis of prostaglandins◦What are prostaglandins?

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Obj.11 describe nursing implications associated with salicylates

Acetylsalicylic acid (aspirin, ASA) used over 100 years

AnalgesicAntipyreticAnti-inflammatoryAntiplatelet

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What are the doses for ASA?◦As analgesic◦As anti-inflammatory◦As antipyretic◦As antiplatelet

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Contraindicated if: on anticoagulants

if gastric ulcerpregnancychildren with viral infectionsHypersensitive—teach client to read OTC labels

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Nursing Implications

Client must take adequate fluids If GI upset, take with food or antacid◦Options: buffered ◦ enteric coated

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What does it mean when the label says the ASA is buffered?

What does enteric coating mean?◦Can EC drugs be crushed or chewed?

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ASA can cause false + for glycosuria SE: tinnitus and vertigo with high doses Store ASA in closed, child proof container Overdose needs prompt treatment

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Objective 13: identify the signs of salicylate poisoning

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Acetaminophen (Tylenol)

◦Nonopioid analgesic◦Antipyretic ◦Available as a liquid

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Obj. 14 Identify the uses, advantages and major disadvantages of acetamenophen

Disadvantage of Tylenol:◦Hepatotoxicity (over 4 gm/day)◦Nephrotoxicity

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Objective 15: list some non-narcotic analgesics

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Buprenophine HCl (Buprenex) Butophanol tartrate (Stadol) Pentazocine HCl (Talwin) Ibuprofen (Motrin) Naproxin (Aleve)

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If your client is taking Percocet and also has Tylenol ordered, what precautions will you take?

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Question

Objective 16: identify some nonsteroidal anti-inflammatory agents

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Nonsteroidal anti-inflammatory agents modify inflammation response◦Inhibit prostaglandin synthesis◦Includes Aspirin as well as Motrin, Aleve, indomethacin (Indocin), oxaprozin ( Daypro), ketoralac (Toradol) Toradol only one given IM, IV

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New NSAIDs are the COX-2 inhibitors

Vioxx off the market 2004Celecoxib (Celebrex) and its cousin Bextra under review

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Advantage of COX-2 inhibitors:◦ Less GI bleeding than other NSAIDs◦ Once a day or BID dosing

Disadvantages:◦ Can’t use if allergic◦ expensive

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Gouty arthritis: ◦caused by uric acid crystals◦Deposit in joints and subq tissue◦Treat ASAP when acute attack occurs◦Treat acute attack with colchicine IV, oral

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Obj.17 Define gout and list drugs used in treatment

think it prevents migration of granulocytes to inflamed area so no lactic acid released

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Colchicine action

Adverse effects of colchicine◦N/V◦Diarrhea◦GI bleeding◦Neuritis◦Myopathy ◦Alopecia◦Bone marrow depression

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NSAIDs may be used for inflammation, pain and fever

Two other types of drugs used for gout◦Uricosurics increase excretion of uric acid

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Alternate treatments for gout

Adverse effects:◦kidney stones can develop

Examples: probenecid (Benemid) and sulfinpyrazone (Anturane)

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uricosurics

With Benemid keep urine alkaline No ASA Anturane works like Benemid but also affects clotting time◦Can cause GI bleeding, skin rash and blood dyscrasias

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Allopurinol (Zyloprim) prevents formation of uric acid◦Usually 300 mg dose 1x daily◦Can be given with colchicine or a NSAID

◦SE of allopurinol: skin rash, hepatotoxicity

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AssessmentNursing diagnoses

◦Pain◦Chronic pain◦Risk for injury◦Deficient knowledge

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Nursing Process

Goals ◦Pain to be controlled◦Chronic pain will be controlled◦Demonstrate a proactive approach to pain management

◦No injury from pain management◦Verbalize knowledge◦Implement plan

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Use pain-relieving measures Pain history Be proactive Don’t under treat Record pain relief Assess respirations Assess nausea, vomiting and decreasing BP

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Acetaminophen: no substitute for ASA

If allergic to ASA, avoid some NSAIDs

Indomethacin: ulcerogenic, aggravate epilepsy, psychiatric disorders

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Nursing for anti-gout medicationsAssess those on colchicineStart colchicine at first signAvoid those things that

aggravate gout:High-fat diet, purine-rich foods, thiazide diuretics, liver extracts, nicotinic acid, penicillin, cancer chemotherapeutic agents, levodopa, ethambutol, egotamine

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