IV Therapy Drugs to Manage Pain PDF

Drug Classifications-- Analgesics Pain Management Mild, acute pain—ASA, acetaminophen Pain due to inflammation—NSAIDS Moderate pain—moderate potency opiate; e.g. tylenol with codeine Severe acute pain—opiate partial agonists or opiate agonist Types of Analgesics Salicyla...

Drug Classifications-- Analgesics Pain Management Mild, acute pain—ASA, acetaminophen Pain due to inflammation—NSAIDS Moderate pain—moderate potency opiate; e.g. tylenol with codeine Severe acute pain—opiate partial agonists or opiate agonist Types of Analgesics Salicylates NSAIDS Opiates Non-salicylates - Acetaminophen How They Work Salicylates Thought to inhibit prostaglandins NSAIDS Thought to inhibit prostaglandin synthesis Acetaminophen Action unknown Opiates Bind with opiate receptor cells in CNS Uses Salicylates Mild-to-moderate pain Antipyretic (not for children under 12) Inflammatory conditions Antiplatelet agent (reduces risks for TIAs in men, and risk of MI) Non-Salicylates Mild to moderate pain Antipyretic Managing pain for arthritic disorders NSAIDS Mild to Moderate/Chronic pain Inflammatory conditions Antipyretic Primary dysmenorrhea Opiates Severe pain Reduce anxiety Opiate dependency Severe cough Adverse Reactions Salicylates-GI upset, Heartburn, N/V, Anorexia, GI bleeding, Hearing loss Nonsalicylates-Urticaria, Hemolytic anemia, Pancytopenia, Hypoglycemia, Jaundice, Hepatotoxicity NSAIDS-GI upset!!, pancytopenia, thrombocytopenia, aplastic anemia Opiates-sedation, respiratory depression, urinary retention Adverse Reactions Bleeding, ulceration, and perforation that may occur at any time during therapy with or without symptoms (NSAIDs, salicylates) Constipation (NSAIDs and opiates) Contraindications Salicylates Bleeding disorders of any kind and cause Children with viral illness NSAIDS 3rd trimester and lactation Celebrex—if allergic to sulfa drugs, history of cardiovascular disease or stroke Bleeding disorders, including GI bleeding disorders Allergic to ASA Acetaminophen Habitual alcohol users Concurrent use with salicylates or NSAIDs Contraindications Opiates Acute bronchial asthma, emphysema, upper airway obstruction Head injuries or increased intracranial pressure Convulsive disorders, severe renal or hepatic dysfunction Interactions Salicylates Anticoagulant—increased risk of bleeding Carbonic anhydrase inhibitors—increased risk for salicylism NSAIDs Anticoagulants—increased risk of bleeding Diuretics—decreased effect of diuretic Antihypertensives—decreased effectiveness of antihypertensive Acetaminophen (long term use)—increased risk of renal impairment Interactions Acetaminophen Barbiturates—increased risk of toxicity of barbiturates and decreased effect of acetaminophen Isoniazid and rifampin—increased risk of toxicity of INH and rifampin Loop diuretics—decreased effect of acetaminophen Opiates Alcohol, antihistamines, sedatives, barbiturates— increased risk of CNS depression, including respiratory depression Nursing Interventions  Give with food  History of GI problems, bleeding tendencies  Discontinue at least 1 week prior to any surgery  Not indicated in patients with hepatic disease  Aspirin NOT used in children < 12 with viral illnesses because of Reye’s syndrome (vomiting, lethargy, coma, permanent brain damage, death)  Monitor for respiratory depression  Monitor for therapeutic effectiveness  Protect patient safety  Don’t use opiates with other depressants  Taper off opiates  Examples Salicylates Aspirin Non-Salicylates Acetaminophen NSAIDS Lodine (etodolac)—30 minutes before meals or 2 hours after meals Motrin, Advil (ibuprofen) Indocin (indomethacin)—used for gouty arthritis—significant toxic effects Toradol (ketorolac) Aleve, Naprosyn, Anaprox (naproxen) Celebrex (celecoxib)—do not give to those allergic to sulfa (COX-2) Miscellaneous analgesics-tramadol (Ultram) Combination drugs: Percocet, Lorcet, Lortab Opiates Morphine Hydrocodone Dilaudid-hydromorphone Demerol-Meperidine Fentanyl Oxycodone Stadol Opiate Antagonists Actions Prevents or reverses the effects of opiates Not specific—will reverse all effects of opiates, not just the undesirable Uses Postoperative respiratory depression Suspected opiate overdose Opiate Antagonists Adverse Effects Sweating Nausea and vomiting Tachycardia Tremors Increased blood pressure  Opiate Antagonists Examples Revex—nalmefene Narcan—naloxone Nursing Interventions Assess for rebound effects Monitor pain levels