Analgesics and Antipyretics Chapter 10 Analgesics and Antipyretics

Analgesics: alleviate pain without causing loss of consciousness Antipyretics: reduce fever

Pain p259 Pain is measured in two ways: 1. pain threshold 2. pain tolerance An individual’s response to pain is a combination of threshold, tolerance, and learned responses from childhood. When the client complains of pain, it is important for the nurse to treat it. Pain: the fifth vital sign

Pain Transmission p259-260 Gate theory Activity in the large fibers inhibits transmission of pain messages on the small fibers. Massage and liniments stimulate large fibers and close the gate for recognition of pain impulses by the small fibers.

Endorphins p260 Neurotransmitters Produced to fight pain Marathon runners and cyclists Bind to opioid receptors Inhibit transmission of pain by closing the gate

Physical signs and symptoms of pain p280 Perspiration Nausea Anxiety Restlessness Tension Changes in vital signs

Management of Pain p260 Treat the cause Select the analgesic that provides effective relief Nursing actions: position change, imagery, and back rub

Opioid Analgesics p261 table p 263 Commonly called narcotics Main use: to alleviate moderate to severe pain Morphine: prototype Oral forms: MS Contin, Roxanol Opioids are also used for: Cough suppression: codeine Diarrhea treatment: lomotil .

Opioid analgesics table p263 Fentanyl Heroin Hydrocodone Meperidine Methadone Oxycodone

Effects of Opioid Analgesics p262 Euphoria Nausea and vomiting Respiratory depression Urinary retention Diaphoresis and flushing Pupil constriction Constipation

Opiates: Opioid Tolerance p262 Larger dose of opioids is required to achieve the same therapeutic response Potential for addiction Signs and symptoms of opioid withdrawal Sweating, restlessness, diarrhea

Opioid Analgesics: Nursing Implications Law: narcotics must be kept under a double lock Oral forms–take with food Ensure pt safety Prevent constipation Prevent respiratory depression Monitor and document therapeutic effects Increased comfort Activities of daily living improved

Opioid combination products table 275 Opioid analgesics combined with aspirin or acetaminophen Lower amounts of opioids are needed in these combination products Examples Fiorinal w/codeine Percodan Vicodin

Opioid Antagonists p270 table p271 Naloxone (Narcan) and naltrexone (ReVia) Bind to opiate receptors Used for reversal of opioid-induced respiratory depression Assess patient following naloxone administration

Nonopioid analgesics p270 table p272 Exert some opioid antagonist activity Examples: butorphanol (Stadol) nalbuphine (Nubain) pentazocine (Talwin) tramadol with acetaminophen (Ultracet) tramadol (Ultram)

Analgesic antipyretic agents p271 Salicylates (ASA) Acetaminophen (Tylenol) Nonsteroidal anti-inflammatory drugs (NSAIDs)

Salicylates p271 ASA (Acetylsalicylic Acid) aspirin Used for more than 100 years Treats mild to moderate pain Antipyretic effect Anti-inflammatory effect Anti-platelet aggregation

ASA: Side Effects p272 Gastrointestinal irritation and bleeding Increases bleeding time Tinnitus Children: Reye’s syndrome Potential in children less than 18 years that have a viral febrile illness and are treated with ASA

Acetaminophen p273 Mechanism of action Analgesic for mild to moderate pain Antipyretic Acetaminophen has no anti-inflammatory qualities Acute overdose causes hepatic necrosis

NSAIDS p274 Non-steroidal anti-inflammatory drugs Ibuprofen, naproxen OTC Analgesic for mild to moderate pain Antipyretic Anti-inflammatory Do not use with ASA due to potential GI irritation

Vascular headaches p274 Caused by vasodilation of branches of the carotid artery Migraines Table 10-7 p 276 ergotamine tartrate Sumatriptan (Imitrex) topiramate (Topomax) prophylaxis

Nursing considerations p279 Pain is universal Pain is assessed and documented on a scale Numerical scale Wong faces scale Do not undertreat pain for fear of causing addiction Administer pain medication when patient asks for it if you have a doctor’s order to administer in that time frame.

Patient controlled analgesia p286 PCA pump: IV administration of pain medicine. Patient has a control button to push for his next dose of med. Pump is programmed Frequently used for postoperative pain. Highly effective

Pain management nursing interventions Medicate patients: Before a procedure or an activity Scheduled administration is most effective When complaining of pain Nursing interventions Back rub position change relaxation therapy

Chronic pain p290 Chronic pain is difficult to treat. It is often treated with a combination of different classes of medications for the best long term pain relief.