Transcript Analgesics and Antipyretics

Chapter 10
Analgesics and Antipyretics
Analgesics: alleviate pain without causing loss
of consciousness
Antipyretics: reduce fever
Pain p259
• Pain is measured in two ways:
– 1. pain threshold
– 2. pain tolerance
• An individual’s response to pain is a combination of
threshold, tolerance, and learned responses from
childhood.
• When the client complains of pain, it is important for
the nurse to treat it.
• Pain: the fifth vital sign
Pain Transmission p259-260
• Gate theory
• Activity in the large fibers
inhibits transmission of pain
messages on the small
fibers.
• Massage and liniments
stimulate large fibers and
close the gate for
recognition of pain impulses
by the small fibers.
Endorphins p260
• Neurotransmitters
• Produced to fight pain
– Marathon runners and cyclists
• Bind to opioid receptors
• Inhibit transmission of pain by closing the
gate
Physical signs and symptoms of pain
p280
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Perspiration
Nausea
Anxiety
Restlessness
Tension
Changes in vital signs
Management of Pain p260
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Treat the cause
Select the analgesic that provides effective
relief
Nursing actions: position change, imagery,
and back rub
Opioid Analgesics p261
table p 263
• Commonly called narcotics
• Main use: to alleviate moderate to severe pain
– Morphine: prototype
• Oral forms: MS Contin, Roxanol
• Opioids are also used for:
– Cough suppression: codeine
– Diarrhea treatment: lomotil
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Opioid analgesics
table p263
Fentanyl
Heroin
Hydrocodone
Meperidine
Methadone
Oxycodone
Effects of Opioid Analgesics p262
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Euphoria
Nausea and vomiting
Respiratory depression
Urinary retention
Diaphoresis and flushing
Pupil constriction
Constipation
Opiates: Opioid Tolerance p262
• Larger dose of opioids is required to achieve
the same therapeutic response
• Potential for addiction
• Signs and symptoms of opioid withdrawal
– Sweating, restlessness, diarrhea
Opioid Analgesics:
Nursing Implications
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Law: narcotics must be kept under a double lock
Oral forms–take with food
Ensure pt safety
Prevent constipation
Prevent respiratory depression
Monitor and document therapeutic effects
– Increased comfort
– Activities of daily living improved
Opioid combination products
table 275
• Opioid analgesics combined with aspirin or
acetaminophen
• Lower amounts of opioids are needed in these
combination products
• Examples
– Fiorinal w/codeine
– Percodan
– Vicodin
Opioid Antagonists p270
table p271
• Naloxone (Narcan) and naltrexone (ReVia)
– Bind to opiate receptors
– Used for reversal of opioid-induced respiratory
depression
– Assess patient following naloxone administration
Nonopioid analgesics p270
table p272
• Exert some opioid antagonist activity
• Examples:
• butorphanol (Stadol)
• nalbuphine (Nubain)
• pentazocine (Talwin)
• tramadol with acetaminophen (Ultracet)
• tramadol (Ultram)
Analgesic antipyretic agents p271
– Salicylates (ASA)
– Acetaminophen (Tylenol)
– Nonsteroidal anti-inflammatory drugs
(NSAIDs)
Salicylates p271
• ASA (Acetylsalicylic Acid)
aspirin
– Used for more than 100
years
– Treats mild to moderate
pain
– Antipyretic effect
– Anti-inflammatory effect
– Anti-platelet aggregation
ASA: Side Effects p272
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Gastrointestinal irritation and bleeding
Increases bleeding time
Tinnitus
Children: Reye’s syndrome
– Potential in children less than 18 years that have
a viral febrile illness and are treated with ASA
Acetaminophen p273
• Mechanism of action
• Analgesic for mild
to moderate pain
• Antipyretic
• Acetaminophen
has no antiinflammatory
qualities
• Acute overdose causes
hepatic necrosis
NSAIDS p274
• Non-steroidal anti-inflammatory drugs
• Ibuprofen, naproxen
– OTC
– Analgesic for mild to moderate pain
– Antipyretic
– Anti-inflammatory
• Do not use with ASA due to potential GI
irritation
Vascular headaches p274
• Caused by vasodilation of branches of the
carotid artery
• Migraines
• Table 10-7 p 276
– ergotamine tartrate
– Sumatriptan (Imitrex)
– topiramate (Topomax) prophylaxis
Nursing considerations
• Pain is universal
• Pain is assessed and
documented on a scale
– Numerical scale
– Wong faces scale
• Do not undertreat pain for
fear of causing addiction
• Administer pain medication
when patient asks for it if you
have a doctor’s order to
administer in that time frame.
p279
Patient controlled analgesia p286
• PCA pump:
– IV administration of pain
medicine.
• Patient has a control button
to push for his next dose of
med.
• Pump is programmed
• Frequently used for
postoperative pain.
– Highly effective
Pain management nursing
interventions
• Medicate patients:
• Before a procedure or an activity
• Scheduled administration is most effective
• When complaining of pain
• Nursing interventions
• Back rub
• position change
• relaxation therapy
Chronic pain p290
• Chronic pain is difficult to treat. It is often
treated with a combination of different classes
of medications for the best long term pain
relief.