Transcript Roach: Nonopioid Analgesics: Salicylates and Nonsalicylates

Introduction to Clinical
Pharmacology
Chapter 13Nonopioid Analgesics:
Salicylates and Nonsalicylates
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Pain
• Acute
• Chronic
• Pain sensation
– May be modified
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Salicylates
• Drugs derived from salicyclic acid
– Useful in pain management due to
analgesic, antipyretic, and antiinflammatory effects
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Salicylates: Actions and Uses
• Lowers body temperature
• Inhibit production of prostaglandins
• Aspirin: Inhibits prostaglandin synthesis and has
greater anti-inflammatory effects; prolongs bleeding
time
– ASA prolongs the bleeding time by inhibiting
aggregation of platelets
• ***Used for: Mild to moderate pain; reduce
elevated body temperature; treating inflammatory
conditions; decreasing risk of myocardial infarction;
reduces risk of transient ischemic attacks
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Salicylates: Adverse Reactions
• Gastrointestinal (GI) reactions:
– Gastric upset; heartburn; nausea;
vomiting; anorexia; GI bleeding; allergy
– Significant blood loss
HERBAL alert:
Willow bark used as an analgesic
– has fewer adverse reaction than
salicylates
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Salicylates: Contraindications and
Precautions
• Contraindicated in clients with:
– Known hypersensitivity; bleeding
disorders; children with chickenpox,
influenza
CHRONIC CARE ALERT
– May exceed recommended dose of ASA
•Develop salicylism
•s/s dizziness, tinnitus, flushing
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Salicylates: Interactions
• Interact with foods containing:
– Curry powder
– Paprika
– Licorice
– Prunes
– Raisins
– tea
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Nonsalicylates: Actions and Uses
• Actions:
– Analgesic and antipyretic activity: Same
as salicylates
– No anti-inflammatory action
• Uses:
– Used to treat mild to moderate painanalgesic; reduce elevated body
temperature-antipyretic; manage pain
and discomfort - arthritic disorders-antiinflammatory
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Nonsalicylates: Action and Uses
• Useful for people:
– With aspirin allergy; bleeding disorders;
receiving anticoagulant therapy; who had
recent minor surgical procedures
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Nonsalicylates: Adverse Reactions
• Adverse reactions: Skin eruptions; urticaria;
hemolytic anemia; pancytopenia;
hypoglycemia; jaundice; hepatotoxicity;
hepatic failure
• Overdose: Causes acute acetaminophen
poisoning or toxicity
– **s/s: n/v, confusion, liver tenderness,
hypotension, cardiac arrhythmias,
jaundice and acute hepatic and renal
failure
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Nonsalicylates: Contraindications and
Precautions
• Contraindication in patients with
Hypersensitivity
• Used cautiously in patients:
– With severe or recurrent pain or high or
continued fever
– Acetaminophen used cautiously during
pregnancy and lactation
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Chronic Care Alert
• Polypharmacy interactions:
– Acetaminophen + diabetics
• May cause falsely lower blood glucose value
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Nursing Process: Assessment
• Preadministration assessment:
– Assess: Type, onset, intensity, location of
pain
– Evaluate: Ability to carry out activities of
daily living
– Evaluate the response to drug therapy
– **Those who consume ETOH are at a greater risk of
hepatotoxicity with acetaminophen use
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Nursing Process: Assessment (cont’d)
• Ongoing assessment:
– Monitor relief of pain; reassess pain
rating 30-60 minutes following
administration of the drug; monitor vital
signs at least every 4 hours
– Assess and document - Severity, location,
and intensity of pain
– Report any adverse reactions
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Nursing Process: Implementation
• Promoting an optimal response to therapy:
– **Avoid salicylates 1 week before or after
any surgery
– Observe for adverse drug reactions
– Observe for signs of salicylism
– Therapeutic blood levels are between
100-300 mcg/ml
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Nursing Process: Implementation
• Promoting an optimal response to therapy
(cont’d):
– *Administer acetaminophen with full
glass of water; with meals or empty
stomach
– Symptoms of overdosage: Nausea;
vomiting; hypotension; generalized
malaise
– Acute overdosage treated with
acetylcysteine to prevent liver damage
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Nursing Process: Implementation
• Monitoring and managing patient needs:
– Impaired comfort:
•Check temperature before and 45-60
minutes after administration
•Suppository form of drug used: Check
after 30 minutes for retention of
suppository
•Notify PHCP if temperature not
controlled
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Nursing Process: Implementation
• Monitoring and managing patient needs
(cont’d):
– Pain:
•Notify PHCP if no relief from pain or
discomfort
•Check cause of new pain experienced;
report to PHCP other therapy may be
needed
•Check the color of the stools
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Nursing Process: Implementation
• Educating the patient and family:
– Develop a teaching plan that includes:
•Take the drug exactly as prescribed by
the primary health care provider
•Do not consistently use an OTC
nonopioid analgesic to treat chronic
pain
•Use of salicylates have been associated
with Reye’s syndrome in children with
chickenpox or influenza
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Nursing Process: Implementation
• Educating the patient and family (cont’d):
– Do not use these drugs on regular basis
unless PHCP notified
– Teaching on salicylates include:
•Salicylates deteriorate rapidly when
exposed to air, moisture, and heat
•Consult pharmacist about the product’s
ingredients if in doubt
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Nursing Process: Implementation
• Educating the patient and family (cont’d):
•Discontinue use 1 week before surgery
or dental procedure
– Teaching on acetaminophen include:
•Acetaminophen lacks anti-inflammatory
properties of aspirin
•Notify primary health care provider if
any adverse reactions occur
•Avoid use of alcoholic beverages
•**Pain persisting more than 10 daysconsult PCP
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Nursing Process: Evaluation
• Relief from Pain; body temperature normal
• Adverse reactions are identified, reported,
and managed
• Patient verbalizes the importance of
complying with the prescribed treatment
regimen
• Patient demonstrates understanding of
prescribed treatment regimen and adverse
effects
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