Analgesics and Anti-inflammatory Agents

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

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

6. Objective 4: Describe scheduled drugs

7. 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

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

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

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

11. 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

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

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

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

15. 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?

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

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

19. 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

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

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

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

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

24. 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?

25. 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

26. 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

27. 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

28. Objective 11describe the use of salicylates

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

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

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

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

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

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

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

36. Objective 13: identify the signs of salicylate poisoning

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

39. Disadvantage of Tylenol: • Hepatotoxicity (over 4 gm/day) • Nephrotoxicity

40. Objective 15: list some non-narcotic analgesics

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

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

43. Objective 16: identify some nonsteroidal anti-inflammatory agents

44. 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

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

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

48. 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

49. Colchicine action • think it prevents migration of granulocytes to inflamed area so no lactic acid released

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