Analgesics and Antiinflammatory Agents NURS 1950 Pharmacology Nancy

Analgesics and Anti-inflammatory Agents NURS 1950 Pharmacology Nancy Pares, RN, MSN Metro Community College 1

Obj. 1 Define pain and Pain tolerance �Pain is: �Pain tolerance is: 2

�Objective 2: Identify the factors which affect the individual’s response to pain 3

Obj. 3. Describe factors included in assessment of pain �What are the assessments? �What is included in a pain history? 4

�Objective drugs 4: Describe scheduled 5

Obj. 4 Describe scheduled drugs �Schedule abuse I: high potential for ◦ No accepted medical use in US �Schedule II: ◦ high potential for abuse ◦ Opiate analgesics 6

�Schedule III: lower potential for abuse than schedule II. ◦ Tylenol with codeine �Schedule IV: lower potential for abuse than schedule III. ◦ Librium, Valium 7

�Schedule abuse V: lowest potential for ◦ Usually antidiarrheal and antitussive ◦ Lomotil ◦ Robitussin A-C 8

Obj. 5 Define analgesics �What are analgesics? 9

Obj. 6. Describe actions of narcotic analgesics �Bind CNS to opiate receptors in the ◦ This inhibits transmission of pain impulse and alters pain perception ◦ Also produce euphoria 10

�Some are opioid agonists �Some are agonist-antagonists ◦ What is an agonist? 11

�Side effects of opioids ◦ N/V ◦ Constipation ◦ Respiratory depression ◦ Dependence ◦ Tolerance 12

�When the opioids are discontinued: ◦ Sweating, restlessness, diarrhea 13

�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? 14

�Objective 7: Compare the many effects of morphine sulfate (MS) and meperidine (Demerol) 15

�MS ◦ Oral ◦ Subc ◦ IV ◦ IM ◦ Rectal ◦ Sublingual ◦ “mother” of all narcotics �Demerol ◦ Oral ◦ Subc ◦ IV ◦ IM 16

�MS � 5 -20 mg dose q 4 hr � 10 -60 min onset �Longer duration of action than Demerol �Demerol ◦ 50 -100 mg q 34 hr ◦ 10 -45 min onset ◦ Shorter duration of action than MS 17

Nursing Implications �Assessment of pain �Assessment of respirations �MS can be used in cancer pain �Meperidine (Demerol) metabolite is normeperidine: causes hallucinations 18

Obj. 8 list other narcotic agents � What narcotic agents have you given? 19

�Many narcotic agents available �Given by every route �Some are only in oral form 20

�Some narcotic analgesics are ◦ Hydrocodone + acetaminophen (Vicodin) ◦ Fentanyl (Duragesic) ◦ Oxycodone + ASA (Percodan) 21

Thinking Question �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? 22

Obj. 9 compare narcotics with acetaminophen, asa and nsaids � 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 23

� 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 24

Obj. 10 describe nursing interventions associated with narcotic administration �Double lock �Sign out �Use non-drug interventions �Assess pain �Give meds before pain severe �Don’t under treat pain 25

�Objective 11 describe the use of salicylates 26

Obj. 11 describe nursing implications associated with salicylates �Peripherally acting �Interfere with synthesis of prostaglandins ◦ What are prostaglandins? 27

�Acetylsalicylic acid (aspirin, ASA) used over 100 years �Analgesic �Antipyretic �Anti-inflammatory �Antiplatelet 28

�What ◦ As are the doses for ASA? analgesic anti-inflammatory antipyretic antiplatelet 29

Nursing Implications �Contraindicated if: on anticoagulants �if gastric ulcer �pregnancy �children with viral infections �Hypersensitive—teach client to read OTC labels 30

�Client must take adequate fluids �If GI upset, take with food or antacid ◦ Options: buffered ◦ enteric coated 31

�What does it mean when the label says the ASA is buffered? �What does enteric coating mean? ◦ Can EC drugs be crushed or chewed? 32

� ASA can cause false + for glycosuria � SE: tinnitus and vertigo with high doses � Store ASA in closed, child proof container � Overdose needs prompt treatment 33

�Objective 13: identify the signs of salicylate poisoning 34

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Obj. 14 Identify the uses, advantages and major disadvantages of acetamenophen � Acetaminophen (Tylenol) ◦ Nonopioid analgesic ◦ Antipyretic ◦ Available as a liquid 36

�Disadvantage of Tylenol: ◦ Hepatotoxicity (over 4 gm/day) ◦ Nephrotoxicity 37

�Objective 15: list some nonnarcotic analgesics 38

. � Buprenophine HCl (Buprenex) � Butophanol tartrate (Stadol) � Pentazocine HCl (Talwin) � Ibuprofen (Motrin) � Naproxin (Aleve) 39

Question �If your client is taking Percocet and also has Tylenol ordered, what precautions will you take? 40

�Objective 16: identify some nonsteroidal anti-inflammatory agents 41

�Nonsteroidal antiinflammatory 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 42

�New NSAIDs are the COX-2 inhibitors �Vioxx off the market 2004 �Celecoxib (Celebrex) and its cousin Bextra under review 43

�Advantage of COX-2 inhibitors: ◦ Less GI bleeding than other NSAIDs ◦ Once a day or BID dosing � Disadvantages: ◦ Can’t use if allergic ◦ expensive 44

Obj. 17 Define gout and list drugs used in treatment �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 45

Colchicine action � think it prevents migration of granulocytes to inflamed area so no lactic acid released 46

�Adverse effects of colchicine ◦ N/V ◦ Diarrhea ◦ GI bleeding ◦ Neuritis ◦ Myopathy ◦ Alopecia ◦ Bone marrow depression 47

Alternate treatments for gout �NSAIDs may be used for inflammation, pain and fever �Two other types of drugs used for gout ◦ Uricosurics increase excretion of uric acid 48

uricosurics �Adverse effects: ◦ kidney stones can develop �Examples: probenecid (Benemid) and sulfinpyrazone (Anturane) 49

�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 50

�Allopurinol (Zyloprim) prevents formation of uric acid ◦ Usually 300 mg dose 1 x daily ◦ Can be given with colchicine or a NSAID ◦ SE of allopurinol: skin rash, hepatotoxicity 51

Nursing Process �Assessment �Nursing diagnoses ◦ Pain ◦ Chronic pain ◦ Risk for injury ◦ Deficient knowledge 52

�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 53

� Use pain-relieving measures � Pain history � Be proactive � Don’t under treat � Record pain relief � Assess respirations � Assess nausea, vomiting and decreasing BP 54

�Acetaminophen: no substitute for ASA �If allergic to ASA, avoid some NSAIDs �Indomethacin: ulcerogenic, aggravate epilepsy, psychiatric disorders 55

Nursing for anti-gout medications �Assess those on colchicine �Start colchicine at first sign �Avoid those things that aggravate gout: High-fat diet, purine-rich foods, thiazide diuretics, liver extracts, nicotinic acid, penicillin, cancer chemotherapeutic agents, levodopa, ethambutol, egotamine 56