IV therapy Drugs to manage pain

Study Notes

Analgesics are medications used to relieve pain.
Different types of pain require different types of analgesics.
Mild, acute pain is treated with aspirin (ASA) or acetaminophen.
Pain due to inflammation is treated with NSAIDs (nonsteroidal anti-inflammatory drugs).
Moderate to moderate-potency pain may be treated with opiates like Tylenol with codeine.
Severe acute pain is treated with opiate partial agonists or opiate agonists.
Analgesics come in several different classifications.

Schedule I drugs have a high potential for abuse and have no currently accepted medical use. Examples include Ecstasy, heroin, LSD, and marijuana.
Schedule II drugs have a high potential for abuse and may lead to severe psychological or physical dependence. Examples include hydromorphone, methadone, meperidine, oxycodone, fentanyl, morphine, opium, and some stimulants.
Schedule III drugs have less potential for abuse than Schedules I or II. They may lead to moderate or low physical dependence or high psychological dependence. Examples include hydrocodone/acetaminophen, buprenorphine, and others.
Schedule IV drugs have a low potential for abuse relative to Schedule III substances, primarily containing limited quantities of certain narcotics. Examples include alprazolam, carisoprodol, clonazepam, and others.
Schedule V drugs have a very low potential for abuse and consist primarily of preparations containing limited quantities of narcotics. Examples include Robitussin AC and similar preparations.

Salicylates are used for mild-to-moderate pain, antipyretic effects (fever reduction), inflammation, and as antiplatelet agents.
NSAIDs are used for pain relief, inflammation, and other conditions like mild-to-moderate pain, and primary dysmenorrhea (menstrual cramps).
Opiates are used for severe pain, anxiety reduction, and sometimes for opiate dependency or coughs.

Salicylates can cause GI upset, heartburn, nausea, vomiting, anorexia, bleeding, and hearing loss.
Non-salicylates can cause urticaria, hemolytic anemia, pancytopenia, hypoglycemia, jaundice, and hepatotoxicity.
NSAIDs can cause GI upset, pancytopenia, thrombocytopenia (low platelet count), and aplastic anemia.
Opiates can cause sedation, respiratory depression, and urinary retention.
Bleeding, ulceration, or perforation can happen with NSAIDs.
Constipation can occur with NSAIDs and opiates.

Salicylates should not be used for children under age 12 with viral illnesses due to Reye's syndrome risk. They're also contraindicated in patients with bleeding disorders or who have a history of viral illness.
NSAIDs use is contraindicated in the third trimester of pregnancy and in those allergic to sulfa drugs or with a history of cardiovascular disease or stroke.
Acetaminophen use is contraindicated with habitual alcohol use or concurrent use with salicylates or other NSAIDs.
Opiates use is contraindicated in patients with acute bronchial asthma, emphysema, upper airway obstruction, head injuries with increased intracranial pressure, or convulsive disorders with severe renal or hepatic dysfunction.

Salicylates can increase the risk of bleeding with anticoagulants and increase the risk of salicylism with carbonic anhydrase inhibitors.
NSAIDs can increase bleeding risks with anticoagulants and negatively impact diuretics and antihypertensives. Acetaminophen long-term use can increase risk of renal impairment.
Acetaminophen interacts with barbiturates, increasing their toxicity. It also interacts with isoniazid and rifampin, potentially increasing their toxicity.
Opiates can interact with alcohol, antihistamines, sedatives, and barbiturates, potentially increasing CNS depression and respiratory depression.

Give analgesics with food.
Monitor for bleeding tendencies, GI problems, and any surgical history or hepatic problems.
Aspirin should be avoided in children under 12 with viral infections to prevent Reye's syndrome.
Monitor for respiratory depression.
Monitor for therapeutic effectiveness
Prevent patient safety.
Do not use opiates with other central nervous system depressants.
Taper off opiate use when the medication is discontinued.