1 Mosby items and derived items 2011 2007

ADJUVANT DRUGS 6/16/2021 Assist primary drugs in relieving pain Fall 2012 NSAIDs Antidepressants Anticonvulsants Corticosteroids Example: Adjuvant drugs for neuropathic pain Amitriptyline (antidepressant) Gabapentin or pregabalin (anticonvulsants) 2

WORLD HEALTH ORGANIZATION ANALGESIC LADDER 6/16/2021 Fall 2012 3

NONOPIOID ANALGESICS: ACETAMINOPHEN Analgesic and antipyretic effects Little to no antiinflammatory effects Available over the counter and in combination products with opioids Fall 2012 6/16/2021 4

MECHANISM OF ACTION Similar to salicylates Blocks pain impulses peripherally by inhibiting prostaglandin synthesis Fall 2012 6/16/2021 5

INDICATIONS 6/16/2021 Mild to moderate pain Fever Alternative for those who cannot take aspirin products Fall 2012 6

TOXICITY AND MANAGING OVERDOSE Even though available over the counter, lethal when overdosed Overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity Long-term ingestion of large doses also causes nephropathy Recommended antidote: acetylcysteine regimen Fall 2012 6/16/2021 7

DOSAGE Maximum daily dose for healthy adults is 3000 mg/day 2000 mg for elderly or those with liver disease Fall 2012 6/16/2021 Inadvertent excessive doses may occur when different combination drug products are taken together Be aware of the acetaminophen content of all medications taken by the patient (over-the-counter and prescription) 8

INTERACTIONS Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic Should not be taken in the presence of Fall 2012 6/16/2021 Drug allergy Liver dysfunction Possible liver failure G-6 -PD deficiency 9

HERBAL PRODUCTS: FEVERFEW 6/16/2021 Fall 2012 Related to the marigold family Antiinflammatory properties Used to treat migraine headaches, menstrual cramps, inflammation, and fever May cause GI distress, altered taste, muscle stiffness May interact with aspirin and other NSAIDs, and anticoagulants 10

ANALGESICS: NURSING IMPLICATIONS 6/16/2021 Fall 2012 Before beginning therapy, perform a thorough history regarding allergies and use of other medications, including alcohol, health history, and medical history Obtain baseline vital signs and I&O Assess for potential contraindications and drug interactions 11

ANALGESICS: NURSING IMPLICATIONS (CONT’D) Assessment Fall 2012 Perform a thorough pain assessment, including pain intensity and character, onset, location, description, precipitating and relieving factors, type, remedies, and other pain treatments 6/16/2021 of pain is now being considered a “fifth vital sign” Rate pain on a 0 to 10 or similar scale 12

ANALGESICS: NURSING IMPLICATIONS (CONT’D) 6/16/2021 Fall 2012 Be sure to medicate patients before the pain becomes severe so as to provide adequate analgesia and pain control Pain management includes pharmacologic and nonpharmacologic approaches; be sure to include other interventions as indicated 13

ANALGESICS: NURSING IMPLICATIONS (CONT’D) 6/16/2021 Fall 2012 Patients should not take other medications or over-the-counter preparations without checking with their physician Instruct patients to notify physician for signs of allergic reaction or adverse effects 14

MONITOR FOR THERAPEUTIC EFFECTS 6/16/2021 Fall 2012 Decreased complaints of pain Decreased severity of pain Increased periods of comfort Improved activities of daily living, appetite, and sense of well-being Decreased fever (acetaminophen) 15