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Chapter 10Analgesic and
Antipyretic Agents
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Analgesics
Analgesic drugs relieve pain
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Pain Definition
Pain is what the patient says it is!
0-10 scaleWong-Baker FACES scaleInfant behavioral scales
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Pain
Pain = brain’s perception/interpretation of nerve signals ◦Treat all complaints of pain◦Pain: the fifth vital sign
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Pain Transmission: Gate Theory
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
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Neurotransmitters
Endogenous neurotransmitters◦Endorphins◦Enkephalins
Produced to fight pain◦Marathon runners and cyclists
Bind to opioid receptorsInhibit transmission of pain by
closing the gate
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Management of Pain
Treat the cause. Select a safe analgesic. Select the analgesic that
provides effective relief. Provide psychological support.
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Management of Pain
Non-pharmacologic nursing actions: ◦position change, massage, heat, reassurance, guided imagery, laughter, distraction, music/art therapy etc.
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Opioid Analgesics
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
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Narcotics (Opioid Analgesics)
Narcotics are derivatives of opium
strong pain relievers◦Induce alteration in mental status
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Effects of Opioid Analgesics
Respiratory depressionEuphoriaNausea and vomitingUrinary retentionDiaphoresis and flushingPupil constriction (miosis)Constipation
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Uses for Opioid Analgesics
Main: ◦to alleviate moderate to severe pain
Also:◦Cough suppression◦Diarrhea treatment
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Complications of Opioid Analgesics
Respiratory: rate slows and depth becomes shallow◦12-20 breaths/minute normal◦May slow to less than 8/minute
Constipation concerns
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Opioids: Nursing Assessments
Thorough historyBaseline v/s, assessmentspotential contraindications, drug
interactions?If respirations are below normal, hold med
and consider NarcanAssess pain after Narcan administration –
alternate medication?
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Opioid Analgesics: Nursing Implications
Oral forms–take with food Ensure safety measures
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Opiates: Opioid Tolerance
A common response to chronic opioid treatment
Larger doses of opioids required
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Opiates: Physical Dependence
Physiologic adaptation to the presence of an opioid
If in need of pain relief, give the medication
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Opiates: Psychological Dependence (Addiction)
A pattern of compulsive drug use when the medication is not needed for physical pain relief
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Opioid Analgesics: Nursing Implications
Law: narcotics must be kept under a double lock
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Opioid Analgesics: Therapeutic Effects
Monitor for therapeutic effects◦Increased comfort◦Activities of daily living improved
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Opiate AntagonistsNaloxone (Narcan) and naltrexone
(ReVia)◦Opiate antagonists◦Bind to opiate receptors, prevent response
◦reverses opioid-induced respiratory depression
Overdose treatment◦Narcan◦Charcoal
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Opioid Analgesics: Nursing Implications
Rotate site for IM injections.Follow guidelines for IV administration (dilution, rate of administration, etc)
Check dosages carefully
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Opioid Analgesics: Nursing Implications
Prevent constipation.◦Provide fluid and fiber.
Prevent respiratory depression.Provide instruction for clients.
◦Drug administration◦Position changes
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Analgesic Agents
Analgesic agents◦Salicylates (ASA)◦Acetaminophen (Tylenol)◦Combination narcotic and non-narcotic analgesics
Anti-inflammatory analgesic agents◦Nonsteroidal anti-inflammatory drugs (NSAIDs)
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ASA (Acetylsalicylic Acid)
Used for more than 100 yearsCurrently is primarily used for its effects on platelets
Treats mild to moderate painAntipyretic effect
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ASA: Side Effects
Gastrointestinal irritation and bleedingIncreases bleeding timeTinnitusChildren: Reye’s syndrome
◦Risk increases if recent viral infection◦Causes encephalopathy and liver dysfunction
◦Symptoms include intractable vomiting, and altered mental status
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ASA Overdose treatment
CharcoalCorrection of acid-base balanceDialysis
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Analgesic Agents: Acetaminophen
◦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
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headache pain
Most common: tension and vascular headachesASA (aspirin), APAP (acetaminophen),
ValiumMigraine 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)
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Headache pain
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
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Acetaminophen: Side Effects
Acute overdose causes hepatic necrosis.◦Doses of 150 mg/kgLong-term ingestion of large doses can result in nephropathy
Maximum healthy adult dosage is now 3 grams/day
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Acetaminophen: Acute Overdose
Treatment: acetylcysteine (mucomyst)◦Oral form◦IV form now approved
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