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Chapter 10

Chapter 10. Analgesic and Antipyretic Agents. Analgesic drugs relieve pain . Analgesics. Pain is what the patient says it is! 0 -10 scale Wong-Baker FACES scale Infant behavioral scales. Pain Definition. Pain = brain’s perception/interpretation of nerve signals

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Chapter 10

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  1. Chapter 10 Analgesic and Antipyretic Agents

  2. Analgesic drugs relieve pain Analgesics

  3. Pain is what the patient says it is! • 0-10 scale • Wong-Baker FACES scale • Infant behavioral scales Pain Definition

  4. Pain = brain’s perception/interpretation of nerve signals • Treat all complaints of pain • Pain: the fifth vital sign Pain

  5. Most common and well-described theory of pain • Uses the analogy of a gate to describe how impulses from injured tissues are sensed in the brain Pain Transmission: Gate Theory

  6. Endogenous neurotransmitters • Endorphins • Enkephalins • Produced to fight pain • Marathon runners and cyclists • Bind to opioid receptors • Inhibit transmission of pain by closing the gate Neurotransmitters

  7. Treat the cause. • Select a safe analgesic. • Select the analgesic that provides effective relief. • Provide psychological support. Management of Pain

  8. Non-pharmacologic nursing actions: • position change, massage, heat, reassurance, guided imagery, laughter, distraction, music/art therapy etc. Management of Pain

  9. Opium has been used for thousands of years to alleviate pain. • Opium is derived from the poppy plant. • Opium produces pain relief by attaching to pain receptors Opioid Analgesics

  10. Narcotics are derivatives of opium • strong pain relievers • Induce alteration in mental status Narcotics (Opioid Analgesics)

  11. Respiratory depression • Euphoria • Nausea and vomiting • Urinary retention • Diaphoresis and flushing • Pupil constriction (miosis) • Constipation Effects of Opioid Analgesics

  12. Main: • to alleviate moderate to severe pain • Also: • Cough suppression • Diarrhea treatment Uses for Opioid Analgesics

  13. Respiratory: rate slows and depth becomes shallow • 12-20 breaths/minute normal • May slow to less than 8/minute • Constipation concerns Complications of Opioid Analgesics

  14. Thorough history • Baseline v/s, assessments • potential contraindications, drug interactions? • If respirations are below normal, hold med and consider Narcan • Assess pain after Narcan administration –alternate medication? Opioids: Nursing Assessments

  15. Oral forms–take with food • Ensure safety measures Opioid Analgesics: Nursing Implications

  16. A common response to chronic opioid treatment • Larger doses of opioids required Opiates: Opioid Tolerance

  17. Physiologic adaptation to the presence of an opioid • If in need of pain relief, give the medication Opiates: Physical Dependence

  18. A pattern of compulsive drug use when the medication is not needed for physical pain relief Opiates: Psychological Dependence (Addiction)

  19. Law: narcotics must be kept under a double lock Opioid Analgesics: Nursing Implications

  20. Monitor for therapeutic effects • Increased comfort • Activities of daily living improved Opioid Analgesics: Therapeutic Effects

  21. Naloxone (Narcan) and naltrexone (ReVia) • Opiate antagonists • Bind to opiate receptors, prevent response • reverses opioid-induced respiratory depression • Overdose treatment • Narcan • Charcoal Opiate Antagonists

  22. Rotate site for IM injections. • Follow guidelines for IV administration (dilution, rate of administration, etc) • Check dosages carefully Opioid Analgesics: Nursing Implications

  23. Prevent constipation. • Provide fluid and fiber. • Prevent respiratory depression. • Provide instruction for clients. • Drug administration • Position changes Opioid Analgesics: Nursing Implications

  24. Analgesic agents • Salicylates (ASA) • Acetaminophen (Tylenol) • Combination narcotic and non-narcotic analgesics • Anti-inflammatory analgesic agents • Nonsteroidal anti-inflammatory drugs (NSAIDs) Analgesic Agents

  25. Used for more than 100 years • Currently is primarily used for its effects on platelets • Treats mild to moderate pain • Antipyretic effect ASA (Acetylsalicylic Acid)

  26. Gastrointestinal irritation and bleeding • Increases bleeding time • Tinnitus • Children: Reye’s syndrome • Risk increases if recent viral infection • Causes encephalopathy and liver dysfunction • Symptoms include intractable vomiting, and altered mental status ASA: Side Effects

  27. Charcoal • Correction of acid-base balance • Dialysis ASA Overdose treatment

  28. mild to moderate pain • antipyretic • Weak anti-inflammatory • Minimal effect on CNS • FDA in 2011 lowered maximum daily dose recommendation to 3 grams for healthy adults Analgesic Agents: Acetaminophen

  29. Most common: tension and vascular headaches • ASA (aspirin), APAP (acetaminophen), Valium • Migraine most common form of vascular headache • beta-blockers, calcium channel blockers, ergot and ergot-like drugs: Ergostat, ergotamine tartrate, dihydroergotamine mesylate (D.H.E.) • Eletriptan hydrobromide (selective serotonin receptor agonist) headache pain

  30. Migraine: • Imitrex (sumatriptan): • use at headache onset – not preventive • PO and intranasal forms may be repeated Q 2 hours until max daily dose reached or headache minimized Headache pain

  31. Acute overdose causes hepatic necrosis. • Doses of 150 mg/kg • Long-term ingestion of large doses can result in nephropathy • Maximum healthy adult dosage is now 3 grams/day Acetaminophen: Side Effects

  32. Treatment: acetylcysteine (mucomyst) • Oral form • IV form now approved Acetaminophen: Acute Overdose

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