2 Be WOW DO THEY WORK? ACTION ‘They work by acting on Mu, delta and Kappa receptors located on neuronal cell membranes. The presynaptic action of opicids to inhibit neurotransmitter release is considered to be their major A, effect in the nervous system. ay WHY DO WE GIVE THEM ? INDICATIONS ADVERSE REACTIONS CNS: Euphoria, weakness, headache Lightheadedness, dizziness, sedation Miosis, insomnia, agitation, tremor Increased intracranial pressure, impairment of mental and physical tasks — Resp:Depression of rate and depth of breathing Gk Nausea, vomiting Dry mouth, biliary tract spasms Constipation, anorexia Cardio: Facial flushing Tachycardia, bradycardia, palpitations Peripheral circulatory collapse @ GU: Urinary retention or hesitancy Spasms of the ureters and bladder ‘sphincter MISC: Pruritus, rash, and urticaria ‘Sweating, pain at injection site, and local ¢ Moderatto vere aout pain tance tration & Comr oaennospesetings $ across arity & Secason achat INTERACTIONS i" ‘© Obstetric analgesia ~~ Alcohol: Increased CNS depression ° Tee ‘Antihistamines: Increased CNS Irveara tartan eran & Indice coracounsocaton’ @ —Atdepressants: ncreased CNS % Relieves persistent severe depression fy 4 Sedatives:nceased CNS depression «OSE ewaanes $ Phenothiazines: Increased ra of CNS ‘ dopresion 4 Barbituratos: Respiratory depression, NURSING MANAGEMENT & ATTEN EDUCATION 9 ONS status 4 Monitor vitals for significant increase of decrease in pulse rate or a significant decrease in blood pressure % When applying a transdermal patch ensure you remove the old fone and dispose of it in te sharps container % Have the patient avoid other CNS depressants such as alcohol Morphine sulphate ( agonist) Hydromorphone (agonist) fentanyl( agonist) Butorphanol (agonist-antagonist) hypotension, sedation ANTIDOTE & Naloxone : Narcan the antagonist “Reversal agent" for opioids and can be administered based on protocol if there is a suspected opioid overdose nar, ac \ PI 0) I ) 5 ae HERBAL CONSIDERATIONS Passionflower has been used in medicine to teat pain, anxiety, and insomnia. Some herbalists use it to treat symptoms of parkinsonism, & Often used in combination with other natural substances, such valerian, chamomile, and hops, for promoting relaxation, rest, and sleep. % large doses may cause CNS depression. The use of passionflower is contraindicated in pregnancy and in patiens taking the monoamine oxidase inhibitors (MAOIs). ® —_Passionflower contains coumarin; the risk of bleeding may be increased in patients taking warfarin (Coumadin) and passionfiower. ‘The following are recommended dosages for passionfiower: eT 1-4 cups per day (made with 1 tablespoon of the crude herb per cup) Tincture (2 5 mL): 2 teaspoons (10 mL) 3-4 times daily @ Dried herb: 2 9 3-4 times daily BaP CAUTION When patients experience a drop in respiratory rate, sometimes you can increase the rate of respirations by coaching the patient to breathe. Should an antidote be needed, naloxone (Narcar) should be administered with great caution and nly when necessary in patients receiving an opioid for severe pain. Naloxone removes all of the pain-relieving effects ofthe opioid and may lead to withdrawal symptoms or the retum of intense pain. Heat can increase the absorption ofthe drug in a transdermal system, causing overdose ofthe drug. Caution patients and familes never to place a heating bianket or pad over the patch. Also, teach Patients to be aware of other heat sources as well such as tanning lamps, hot tubs, saunas, or hot bathe. Epidural analgesia should be administered only by those specifically tained in the use of IV and epidural anesthetics. Oxygen, resuscitation, and intubation equipment should be readily avaiable Ha patient is transfering from levorethadyl to methadone, the nurse should wait 8 hours after the last dose of levomethad/ before administering the first dose of methadone or other opicid. ‘Astramorph, avinza ‘acute! chronie pain, preop sedation, 10-301mg athe ‘myocardial infarction Dilaudid Moderate to severe pain 24mg et-ohe Duragesic .sublimaze onsolis, Chron pain “Transdermal 25-175 mea based on nail 200-1600 meg dose based on pain teverty stadol ‘Acute pain, adjunct to anesthesia 1-4 mg IM. 0.08 mg 96 V oN. Sublingual 1218 may1) § NSAIDS = Pi gree WERBAL CONSTDERATIONS 4 Capsicum (ot peppe i the HOW DO THEY WORK? ADVERSE REACTIONS substance at wen Speed ACTION 4 @t:Nausea, voting dyspepsia, snoreia, dry mouth topealy produces warmth and diarthen, consipaton epigecbc pal, ndigeston burg sensations. Caspcan Naaids have an ntinlrmatory abbominaldshess,niocinl uceaton, somali ‘works by inning substance tect witout the dangerous sco jaundice DSP wen applied to the skin ettects of steroids. Tey have bah ¢ GN: Dizinoss,ansiely,ightneadecnoss, vertgo, panetates the [ons and stops tnalgesic and eniyretic properties. headache, crowalness, ormoleee, earn, {he destruction of catlage, NSAIDS ore thought to nn Consion, depression, stoke, peytie surance. raloves pai, andincresses prostaglndin syhess by blocking & CARDIO: Decrease oricreave blood pressure, heart fect, and may decrease the the enzyme eyloonygenaae, tenure, cardiac aniytmie, ocean, reco pep ulcer. Tes pen of Spoor genace + Rena pohura «yeu, olga, pomaha cys, went elevated BUN, Acute renal fare @Cox-t: An enzyme that ¢ Hematology: Bancytopena,trombocytopenia helps mainte stomach neuvopenta,cosinophita, leukopenia, agranulocytosis, tang, arias anemia Conch: An enzyme that 4 DERM: Rosh ecchymasis, purpura, dermatitis, triggers pain and steven-jonnson syndrome NURSING MANAGEMENT internation + ENDO: weight increase or decrease, fushing, sweating, menstrual disturbances, & PATIENT EDUCATION E nie pcapriae © Assess painiovel Sensory taste changes, hint, tinnitus, vival $ deeseenel WHY DO WE GIVE THEM? disturbances, thirst, fever, chills, vaginits Hanis cence pwscibed 3 Take wih food INDICATIONS & Inform practitioners that you are 4 Pain associated win - tang NSAIDS musculoskeletal disorders suct =~ Mi) > CONTRAINDICATIONS & Contact he HCP iffever lasts Bb ostoervils and theumoto 7 more than 24 hours arthritis. ° Known hypersensitivity + Do not use for chronic pain * Mild to moderate pain * Hypersensitivity to aspirin + Use caution when driving ~~ Dysmenorrhea * ee a cae EES NT OE Call the HCP ifrash, hives, * Fever nee Visual disturbances, weight 4+ Bonet give celecons to those who have aanaleroy to sulfonamides gain, edema black sto, * Carciacdsease INTERACTIONS Stroke @ Anticoagulants: crease te risk of bleedin & Hypertension & Litas Risk of tium toxic ° 3 Glboeding CAUTION @ Cyclosporine: Increased eles of cylospoine «= ~—~Peplculcars Celecoxt ascocate wth nd increased © Rydantoinss nceased elect of aniconvuleants fskofcarlovescular thrombosis, & _Antinypertensves: decrease elec of mmyoeardal infarction, nd stoke. anhyperensives ¢ Acetaminophen: mereased risk of ena impalnnent Ibuprofen Advil, motrin Mild to moderate pain, 400mg orally q 4-6 hr. Max dose ‘heumatoid artis, fever, 329 menstrual pain indomethacin Indocin | Rheumatoid disorders 20-50 mg orally, 3-4 times daily Ketorolac va Moderatto severe acute pain | Siglo done 60mg iM. 30maIV thst coo tg 48 Mex tose 2g ese ee p RRheumaioid disorders, juvenile | 250-500 mg q68 tr orally. Max osteoartis, ito moderate pan, dose 1.259 menstu pain, ever Celocoxlb(cox-2) inhibitor colatrex ‘Acute pain, ankylosing sponylis, | 100-200 mg orally BID reduces colorectal polyps, dysmenorrhea, osteoarthritisL Ml OW DO THEY WORK? “ACTION” Analgesic and antipyretics. ‘They lower body temperature by dilating peripheral blood vessels which causes heat to dissipate which in turn cools the body. They decrease pain by ink iting prostaglandins. Prostaglandins cause increased pain sensitivity. They also cause decreased platelet aggregation as a result of prostaglandin synthesis. WHY DO WE GIVE THEM! oe oe “INDICATIONS” Relieve mild to moderate pain Reducing fever Treat inflammatory disease such as rheumatoid arthritis, osteoarthritis, rheumatic fever Decrease the risk of myocardial infarction Decrease the risk of stroke Maintain pregnancy in high risk populations, especially in tho who have inadequate uterine or placental blood flow. ADVERSE REACTIONS * Gastric upset, heartburn, nausea, vorniting ® Anorexia *® — Glbleeding Salicylate poisoning booeseees SALICYLATES CONTRATNDICATIONS % Known hypersensitivity: Patients Who have asthma, allergies, and ‘nasal polyps or who are allergic to tartrazine are at an increased risk for developing hypersensitivity reactions, Bleeding disorders Gl bleeding of any cause Blood abnormalities Those on anticoagulants or antineoplastic therapy eoee INTERACTIONS Foods that contain salicylates * such as prunes, raisins, paprika, tea, and licorice potentiate the adverse effects of salicylates, * Anticoagulants: Increased risk for bleeding, . NSAIDS: Increased serum levels of NSAIDS * Activated charcoal: decreased absorption of salicylates ° Antacids: Decrease absorption of salicylates. Carbonic anhydrase inhibitors: Increased risk for * salicyism oo eo oe THERAPEUTIC LEVEL 400-300 meg/ mL. SALICYLATE POISONING Tinnitus, Dizziness, Mental confusion Nausea, vomiting, diarrhea. CNS depression, Headache Hyperventilation, Thirst Flushing, Respiratory alkalosis o> Hemorrhage, Asterixis 8 Pulmonary edema, Convulsions Fever,Goma, Shock Renal and respiratory failure HERBAL CONSTDERATIONS Willow bark has been used to reduce pain and lower fevers. The chemical structure was reproduced in a laboratory and mass produced as synthetic salicylic acid. Willow bark should be used with caution in patients with peptic ulcers or other conditions where aspirin is contraindicated. NURSING MANAGEMENT Pain: Assess pain and limitation of movement; note type, location, and intensity before and at the peak (see Time/Action Profile) after administration. Fever: Assess fever and note associated signs (diaphoresis, tachycardia, malaise, chil). Avoid salicylates for 1 week prior to surgery to decrease risk of bleeding. Do not take salicylates after surgery until healing has occurred. Use lowest effective dose for shortest period of time. ‘Administer after meals or with food or an antacid to minimize gastric invitation. Food ‘slows but does not alter the total amount absorbed. Do not crush or chew enteric-coated tablets. Do not take antacids within 1~ 2 hr of ‘enteric-coated tablets. Some ‘extended-release tablets may be broken or ‘crumbled but must not be ground up before swallowing. See manufacturer's prescribing information for individual products. Patient/Family Teaching Instruct patient to take salicylates with a full Glass of water and to remain in an upright Position for 15~ 30 min after administration. ‘Advise patient to report tinnitus; unusual bleeding of gums; bruising; black, tarry stools; or fever lasting longer than 3 day Analgesic, antipyretic, anti 25-650 mg orally inflammatory stroke Up to 8g / day 94 rectally prevention Baby aspirin 81mg Diflunisal NA ‘Same as aspirin 250-500 mg q 8-12 hr Magnesium salicylate Bufferin, ecotrin Same as aspirin 1650 mg orally q 3 hr. Max dose 1090 mg/dayHOW DO THEY WORK? . "ACTION : Acetaminophen is a non salicylate with an unknown mechanism of action. Itis not antiinflammatory. It does not . inhibit platelet aggregation and is the drug of choice when bleeding is an issue. Also given to those whom have an aspirin allergies WHY DO WE GIVE THEM? oe 66 CONTRATNDICATIONS __ NURSING MANAGEMENT Rows Hypersenalivity ‘Acetaminophen should be taken ‘coho! abuse Doruttake wth NSAIDS orsacytes «Wh aigasof ater. OTC pain relievers, Ifthe body temp remains elevated Contact the heath care provider. CAUTION Do not self treat chronic pain with OTC pain relovers, Be aware of polypharmacy © poaacon interactions when administering acetaminophen. Acetaminophen may alter blood glucose levels by showing a false low, as a result inaccurate ‘doses of antidiabetic medications may be given. “INDICATIONS” ey, » Oo} Indications ¥ (SYMPTOMS OF ACUTE Treats mild to moderate hoes pain ACETAMINOPHEN TOXICITY Rechces ter & Nausea, vomiting, contusion, Managing pain and INTERACTIONS liver tenderness, hypotension, Gisoriake " — Barbiturates: Increased risk of toxicity and cardiac arrhythmias, jaundice, decreased effect of acetaminophen acute hepatic and renal failure. * Hydantoins: increased risk of toxicity and decreased eects of acetaminophen ° Isoniazid and Rifampin: Increased risk of ADVERSE REACTIONS * (Serna ecaased otet of & Hives acetaminophen % Hemolytic anemia & Loop dluretics: Decreased effects of loop % —Pancytopenia ciuroti, Hypoglycemia % — Jaindee % Reye's syndrome % Acute acetaminophen toxicity can cause lver necrosis and eventually liver failure. ‘Acetaminophen Tylenol Fever & Pain 325-850 mg /day orally. Max dose 3g/day