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Analgesics and Anti-inflammatory Agents

Analgesics and Anti-inflammatory Agents. NURS 1950 Pharmacology Nancy Pares, RN, MSN Metro Community College. Obj. 1 Define pain and Pain tolerance. Pain is: Pain tolerance is:. Objective 2: Identify the factors which affect the individual’s response to pain.

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Analgesics and Anti-inflammatory Agents

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

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

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

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

  5. Objective 4: Describe scheduled drugs

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

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

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

  9. Obj. 5 Define analgesics • What are analgesics?

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

  11. Some are opioid agonists • What is an agonist? • Some are agonist-antagonists

  12. Side effects of opioids • N/V • Constipation • Respiratory depression • Dependence • Tolerance

  13. When the opioids are discontinued: • Sweating, restlessness, diarrhea

  14. 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?

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

  16. MS • Oral • Subc • IV • IM • Rectal • Sublingual • “mother” of all narcotics • Demerol • Oral • Subc • IV • IM

  17. 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

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

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

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

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

  22. 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?

  23. 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

  24. 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

  25. 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

  26. Objective 11describe the use of salicylates

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

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

  29. What are the doses for ASA? • As analgesic • As anti-inflammatory • As antipyretic • As antiplatelet

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

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

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

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

  34. Objective 13: identify the signs of salicylate poisoning

  35. 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 non-narcotic 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 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

  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

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