IV therapy Drugs to manage pain

Drug Classifications - Analgesics

• 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.

Schedules of Controlled Substances

• 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.

Types of Analgesics

• Salicylates (e.g., aspirin)
• NSAIDs (e.g., ibuprofen, naproxen)
• Opiates (e.g., morphine, codeine)
• Non-salicylates (e.g., acetaminophen)

How Analgesics Work

• Salicylates and NSAIDs are thought to work by inhibiting prostaglandins.
• The mechanism of action for acetaminophen is not fully known.
• Opiates bind to opiate receptor cells in the central nervous system (CNS).

Uses of Analgesics

• 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.

Adverse Reactions

• 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.

Contraindications

• 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.

Interactions

• 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.

Nursing Interventions

• 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.

Examples of Medications

• Specific examples of different types of analgesics are provided for each class.