Analgesics: Opioids and Nonopioids

Analgesics

• Analgesics (pain medications) are divided into two types: nonopioids and opioids.
• Nonopioids are non-sedating, while opioids are sedating, causing a "low and slow" effect on the body.

Nonopioids

• Nonopioids include NSAIDs (Non-Steroidal Anti-inflammatory Drugs) and acetaminophen (Tylenol).
• NSAIDs and acetaminophen have antipyretic (fever-reducing) effects.
• Only NSAIDs have anti-inflammatory effects.
• Nonopioids do not affect the central nervous system (CNS) and do not cause "low and slow" vital signs.

Opioids

• Opioids are powerful pain medications that cause sedation and "low and slow" vital signs.
• Opioids do not have anti-inflammatory or antipyretic properties.

NSAIDs

• NSAIDs are used for mild to moderate pain.
• Helpful acronym to remember the different types of NSAIDs: NC
  • N: Naproxen (most commonly prescribed NSAID)
  • S: Salicylic acid (Aspirin)
  • A: Acetaminophen
    • Important Note: Acetaminophen is NOT an NSAID. Aspirin is an antiplatelet used to prevent blood clots.
  • I: Ibuprofen and Indomethacin (most people know ibuprofen)
• Key NSAID: Ketorolac (Toradol)
  • It is the only NSAID that can be administered intravenously.
  • Used as an antipyretic (fever reducer) and for anti-inflammation, especially for gout and rheumatoid arthritis (RA).
• Important note: NSAIDs relieve symptoms of gout and RA.

NSAID Mechanism of Action

• NSAIDs decrease prostaglandin production, reducing pain and inflammation.
  • Prostaglandins are thought to contribute to inflammation.
• NSAIDs also decrease platelet aggregation, especially Aspirin, which increases the risk of bleeding.

NSAID Risks

• Acronym to remember key risks associated with NSAIDs: NSAID
  • N: Not good for the entire body.
    • Can cause gastrointestinal (GI) bleeding, ulcers, bronchospasms (bad for asthma), hypertension (high blood pressure), worsening heart failure, and increased creatinine and BUN (blood urea nitrogen) levels, which are kidney function markers.
  • S: Sticky blood (increased risk of blood clots).
    • Bad for patients with a history of clots such as myocardial infarction (MI), stroke (cerebrovascular accident - CVA), deep vein thrombosis (DVT), and pulmonary embolism (PE).
    • Aspirin is an exception, as it is used to thin the blood for cardiac patients.
  • A: Asthma.
    • NSAIDs can cause bronchospasms in patients with asthma or nasal polyps.

NSAID Medication Administration

• Never take two NSAIDs simultaneously.
• Use the lowest effective dose for the shortest duration possible.

Acetaminophen (Tylenol)

• Acetaminophen (Tylenol) is not an NSAID.
• It is an antipyretic (fever reducer), but does not have anti-inflammatory effects.
• Acetaminophen is a safer alternative for patients with asthma or nasal polyps.

Conclusion

• Nurses should always clarify orders for patients with asthma or nasal polyps to ensure they don't receive NSAIDs.
• It is important to use the proper medication for specific conditions and to understand the potential risks associated with NSAIDs.

Analgesics are pain medications divided into nonopioids and opioids. Nonopioids, including NSAIDs and acetaminophen, have antipyretic effects, while only NSAIDs have anti-inflammatory effects. Opioids are powerful and cause sedation but lack anti-inflammatory or antipyretic properties. NSAIDs like naproxen and aspirin are used for mild to moderate pain.