*Acute pain: is brief and lasts less than 3 to 6 months.
Causes: range from sunburn to postoperative, procedural or traumatic pain
-Usually subsides when the injury is healed
*Chronic pain: lasts more than 6 months and is often associated with specific disease, such as cancer, sickle cell anemia, and end-stage organ or system failure.
Causes: Various neuropathic and musculoskeletal disorders such as headache,
fibromyalgia, rheumatoid
arthritis and osteoarthritis, are also causes of chronic pain. Analgesics and Pain Relief
*Analgesics: drugs used to relieve pain
Salicylates: Aspirin, Bayer, Alka-Seltzer with Aspirin
Nonsalicylates: Acetaminophen (Tylenol)
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Advil, Aleve, Celebrex
Opioids: general term used for the opium-derived or synthetic analgesic used in pain
control
Narcotic: term referring to the properties of a drug to produce numbness or stupor-like
state
•
Opioid and narcotic were once interchangeable, law enforcement agencieshave generalized the
term narcotic to mean a drug that is addictive and abusive or used illegally
○
Health care providers use the term opioid to describe the drugsAspirin (ASA) Pg. 1087
(Aspirin, Bayer, Alka-Seltzer with Aspirin)
ACTION
•
Lowers body temperature, anti-inflammatory effects, prolongs bleeding time•
Salicylates USES•
Mild moderate pain • Antipyretic • Decreases risk of MI•
Reduces risk of TIA stroke by inhibiting clotting (particularly in men)ADVERSE REACTIONS
*N/V, epigastic distress, GI bleeding, tinnitus, allergic/anaphylactic reactions; salicylism with overuse
CONTRAINDICATIONS
*Patients with bleeding disorders or GI bleed: children with chickenpox or influenza Reye’s syndrome (a life- threatening condition characterized by vomiting & lethargy progressing to coma) *Pregnancy Category D (aspirin) and C and should be
used cautiously during pregnancy/lactation
INTERACTIONS Drug:
Anticoagulant increased risk of bleeding NSAIDs increased serum of levels of NSAIDs
Activated charcoal decreases absorption of salicylates
Antacids decreases effects of salicylates Carbonic anhydrase inhibitors increased risk for salicylism
Feverfew, garlic, ginger, ginkgomay increase bleeding risk
NURSING PRECAUTIONS
*Adult no more than 4,000 mg or 3 g/day
*Child no more than 3,600 mg or 3.6 g/day
*Lab tests: PT/INR, liver function tests, urine ketones, pregnancy tests, more frequent CBGs with diabetes
*Monitor children for salicylate toxicity dehydration, fever, hyperventilation, agitation
*Discontinue use if ringing or buzzing in ears, impaired hearing, dizziness, GI discomfort of bleeding
*Avoid other aspirin containing medications without consulting MD
*Do not breast feed while taking medication
Acetaminophen
(Tylenol)
Pg. 107
ACTION•
Analgesic, AntipyreticUSES
• Mild to moderate pain
• Reducing elevated body temperature (fever)
ADVERSE REACTIONS
*Skin eruptions, urticaria (hives), anemia *Pancytopenia (a reduction in all blood components)
*Hypoglycemia
*Jaundice, hepatoxicity & hepatic failure CONTRAINDICIATIONS
*Habitual alcohol user at risk for hepatotoxicity
*Safe for short-term use ONLY *Pregnancy Category B
INTERACTIONS Drug:
Barbituratesincreases possibility of toxicity
and decreases effect of Tylenol
hydantoins (anticonvulsants) increases
possibility of toxicity and decreases effect of Tylenol
and decreases effect of Tylenol
Loop Diuretics decreases effectiveness of
diuretics
NURSING PRECAUTIONS
*Asses alcohol use
*Long-term use can lead to serious GI toxicity can cause bleeding,
ulceration & perforation
*Do NOT take other cold
medications that contain
acetaminophen without MD advice
*Adult < 4,000 mg or 4 g/day *Child < 2,600 mg or 2.6 g/day *Overdose treat with activated
charcoal &
N-acetylcysteine (Mucomyst), follow-up treatment sulfa based to continue through GI system and
absorb residual Tylenol
*Avoid use of 1 week before/after surgery ➢ Observe signs of salicylism (overdose)
○
Levels greater than 400 mcg: result in respiratory alkalosis; hemorrhage*Tinnitus/impaired hearing hold next dose; first sign of internal bleeding
Ibuprofen
(Advil, Motrin) Pg. 654
ACTION
• Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
USES
•
Mild moderate pain • Rheumatoid disorders • FeverADVERSE REACTIONS
*Nausea, dizziness, dyspepsia, gastric or duodenal ulcer, GI bleeding, headache, light- headedness, vertigo, stroke (most common in elderly), decrease/increase in blood pressure, polyuria, dysuria, oliguria, hematuria, cystitis, reduction in blood cell components, prolonged bleeding, rash, erythema, irritation, skin eruptions, SJS CONTRAINIDICATIONS
trimesters of pregnancy & lactation, patients with hypertension (lowers effects of
antihypertensive), peptic ulceration/GI bleed INTERACTIONS
Drug:
Anticoagulants increased risk of bleeding
Lithium (mood stabilizer) increased
effectiveness &
possible toxicity of lithium
Cyclosporine (immunosuppressive)
increased
effectiveness of cyclosporine
Hydantoins (anticonvulsant) increased
effectiveness of anticonvulsant
Diuretics decreased effectiveness of
diuretic
Antihypertensives decreased effectiveness of antihypertensive
Acetaminophen (in long-term use)
increased risk of renal impairment
Herbal: Capsicum (hot pepper) used to
dilate blood vessels and increase supply of nutrients to injured joints; should be avoided with ulcers (no spicy foods).
NURSING PRECAUTIONS
*Take with food, enteric coding GI upset *Elderly are more vulnerable to GI bleed due to higher incidence of rheumatoid arthritis and osteoarthritis, NSAID use on long-term basis
*Report any changes in vision; blurred, diminished
vision or change in color vision **caution when driving
or task requiring alertness**
*Lab tests: Hemoglobin levels, renal/hepatic function
*Symptoms of acute toxicity in children: apnea,
cyanosis, response only to painful stimuli, dizziness
*Do not give to children younger than 3 months or for longer than 2 days without calling MD
*Do not take aspirin concurrently with ibuprofen
Naproxen Pg. 864
ACTION
• Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
USES
• Rheumatoid, juvenile and osteoarthritis
•
Mild moderate pain• Dysmenorrhea
• General aches and fever ADVERSE REACTIONS
*Dizziness, headache, nausea, vomiting, gastric or duodenal ulcer, GI bleeding CONTRAINDICATIONS
*Hypersensitivity to NSAIDs, during ALL trimesters of pregnancy & lactation, patients with hypertension (lowers effects of
antihypertensive), peptic ulceration/GI bleed INTERACTIONS
Drug:
Anticoagulants increased risk of bleeding
Lithium (mood stabilizer) increased
effectiveness &
possible toxicity of lithium
Cyclosporine (immunosuppressive)
increased
effectiveness of cyclosporine
Hydantoins (anticonvulsant) increased
effectiveness of anticonvulsant
Diuretics decreased effectiveness of
diuretic
Antihypertensives decreased effectiveness of antihypertensive
Acetaminophen (in long-term use)
increased risk of renal impairment
Herbal: Capsicum (hot pepper) used to
dilate blood vessels and increase supply of nutrients to injured joints; should be avoided with ulcers (no spicy foods).
NURSING PRECAUTIONS
*Take with food, enteric coding GI upset *Elderly are more vulnerable to GI bleed due to higher incidence of rheumatoid arthritis and osteoarthritis, NSAID use on long-term basis
*Report any changes in vision; blurred, diminished
vision or change in color vision **caution when driving
*Lab tests: Hemoglobin levels, renal/hepatic function
*Symptoms of acute toxicity in children: apnea,
cyanosis, response only to painful stimuli, dizziness
*Do not give to children younger than 3 months or for longer than 2 days without calling MD
*Do not take Aleve concurrently with ibuprofen