NON- OPIOID/ NON NARCOTIC

USES: mild to moderate pain of the skeletal muscle &

joint
: NOT addictive & are less potent than
narcotic analgesics
MOA: act on peripheral nervous system at the
pain receptor sites by inhibiting
prostaglandin synthesis
: effective for dull, throbbing pain of HA,
dysmenorrhea, pain from inflammation, minor
abrasions, muscular pain and mild- moderate
arthritis
: most analgesics have an antipyretic effect
EG: aspirin, acetaminophen, ibuprofen, naproxen
► ASPIRIN
: a salicylate, oldest non narcotic analgesic drug
: MOA: inhibit synthesis of prostaglandin
: Primary effect: analgesic (antipyretic, anti
inflammatory, anti platelet)
: CI: children < 12 y.o. (Reye’s syndrome)
: DI: + warfarin, heparin, thrombolytics =
increase bleeding
: ibuprofen + insulin / OHA = hypoglycemia
: SE: gastric irritation, excess bleeding might
occur during the first two days of
menstruation
Nursing Responsibilities:
• take with food
• with glass of water
• monitor platelet bleeding time PT
• d/c aspirin 7 days prior to surgery
►ACETAMINOPHEN (Tylenol, Tempra)
MOA: weakly inhibits prostaglandin synthesis which
decreases pain sensation & heat
- is safe, effective analgesic & antipyretic drug used
for muscular aches & fever caused by viral infections
- causes no / little gastric distress; does not interfere
with platelet aggregation, no anti inflammatory effect

CI: severe hepatic / renal disease, alcoholism,

hypersensitivity

DI: + caffeine = increase effect

+ oral contraceptives,
anticholinergics = decrease effects
: S/E/ AE: hepatotoxicity, early symptoms of
hepatic damage (N/V, diarrhea & abdominal
pain)
NURSING CONSIDERATIONS:
1. liver enzymes, self medication should not
be used for more than 10 days for adults
& 5 days for children
2. keep out of children’s reach
3. acetylcysteine ( antidote)
4. no alcohol
 NARCOTIC ANALGESICS / OPIOID
ANALGESICS
MOA: binds to opiate receptors in the CNS, reduces
stimuli from sensory nerve end, pain threshold is
increased
USES: moderate – severe pain
: suppresses pain muscles
: suppresses respiratory & coughing by acting on
the respiratory & cough centers in the medulla of
the brainstem
: most opioids with exception to meperidine
(Demerol) have an antitussive property
- have 2 isomers ( levo & dextro)
: levo- isomers: produce an analgesic effect
only, can cause physical dependence
: dextro – isomers: do not cause physical
dependence
: both levo & dextro: posses an antitussive
response
CI: with respiratory dysfunction, head injuries,
increase ICP, hepatic & renal disease, alcoholism
DI: + alcohol, sedatives- hypnotics & other CNS
depressants = increase CNS depression
: may increase ALT / AST
SE:
► N/V ( particularly in ambulating patients)
► constipation ( less in demerol)
► moderate decrease of blood pressure,
► orthostatic hypotension ( high dose)
► antitussive effect ( except demerol)
► CNS: drowsiness, dizziness, confusion, sedation,

PUPIL CONSTRICTION
►pinpoint pupil – sign of
toxicity
Examples:
 Codeine: not as potent as morphine
 Morphine sulfate: potent analgesics ( can
depress respiration), effective against MI,
dyspnea – pulmonary edema, pre op meds
 meperidine (Demerol): shorter duration of
action than morphine, potency varies
according to dosage
 : most commonly used narcotic
for alleviating post op pain, no
antitussive property
: preferred in pregnancy ( does
not diminish uterine contractions
& causes less neonatal
respiratory depression)
: not prescribed for long term
use

** withdrawal symptoms called

ABSTINENCE SYNDROME occurs
24 – 48 hours after last narcotic
dose ( irritability, diaphoresis,
restlessness, muscle twitching,
tachycardia, hypertension)
NURSING CONSIDERATIONS:
• VS do not give if RR is < 10/ min, BP < 90/70
mmHg
• Administer before pain reaches its peak to maximize
the effectiveness
• Should not taken with alcohol or sedative- hypnotics
• Check urine output & bowel elimination
• Assist patient in ambulation
• Have naloxone (Narcan) ready as antidote
• Do not abruptly withdraw medicine
• Assess for toxicity due to over dosage
• Instruct about deep breathing & coughing exercises
especially in patients with altered pulmonary
function
 NARCOTIC ANTAGONIST
► Antidotes for overdoses of narcotic analgesics
► Have higher affinity to the
opiate receptor site than
the narcotic being taken
► Blocks the receptor &
displaces any narcotic that
would be at the receptor, thus
inhibiting the narcotic action
► Reverses respiratory and CNS depression
► EG: naloxone (Narcan)- IM, IV
► NSG: VS q5, q15, q30 until stable
NARCOTIC ADDICTED
PERSON
► METHADONE : a narcotic but
causes less dependency that the
narcotics it is replacing
► Helps the narcotic addicted
person to withdraw from
narcotics without causing
withdrawal symptoms
► Given OD ( longer half life)
NARCOTIC AGONIST - ANTAGONIST

► a narcotic antagonist is added to a narcotic

agonist to decrease narcotic abuse
► EG: pentazocine (Talwin), Butorphanol
tartrate (Stadol), Nalbuphine HCL (Nubain),
Buprenorphine (Buprenex)