2. Analgesics and Antipyretics Chapter 16

3. Pain Common Signs and Symptoms Contorted facial expression Changes in posture Increased vital signs Restlessness, lethargy Self-focus Fatigue

4. Analgesics Common Side Effects Lightheadedness, dizziness Orthostatic hypotension Drowsiness Constipation Diarrhea Headaches Nausea and vomiting

5. Pain Pain perception—aware of painful stimulus Pain threshold—acknowledging a stimulus is painful Pain tolerance—ability to tolerate pain Naturally released endorphins block painful impulses to brain

6. Pain Medications Analgesics—relieve pain –more effective if used prior to onset of severe pain Antipyretic—reduce fever Anti-inflammatory—reduce inflammation Many medications accomplish all three (i.e., aspirin)

7. Types of Analgesics Opioid—narcotic containing opium (morphine, Demerol) Nonopioid—contains no opium Co-analgesia—two medications used together for synergistic effect Adjuvant—used to increase or hasten action of principal medication

8. Analgesic Ladder to Treat Pain Mild pain—acetaminophen, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) around the clock Moderate pain—mild opioids (i.e., codeine, hydrocodone) Severe pain—morphine or Demerol

9. Narcotic Analgesics Side Effects Work on CNS Sedation Addiction and psychological dependence Respiratory depression, constipation Itching, nausea Confusion, euphoria Vertigo or lightheadedness Avoid alcohol—enhances effect

10. Commonly Used Controlled Analgesics

12. Transdermal Fentanyl Duragesic ® Used for chronic persistent pain (i.e., cancer patients) 72-hour continuous opioid administration Clean skin with water before administration Avoid heat sources, soap, oil, lotion, alcohol— may alter absorption

13. Nonopioid Analgesics Control mild to moderate pain Greatest action on peripheral nervous system No physical dependency or tolerance No altered consciousness, mental function Ceiling effect may occur

14. Nonopioid Analgesics

15. Analgesics: Patient Education for Compliance If patient is allergic to one analgesic, take care when taking another Avoid with kidney/liver disease, pregnant, breast-feeding patients Contact physician if pain persists Take with meals if stomach distress occurs Avoid aspirin in children with viral infections

16. Analgesics: Patient Education for Compliance Stop aspirin at least 5 days before surgery (blood clotting properties) Do not place aspirin on gums or teeth (irritation or burns) Do not take aspirin with strong vinegar odor (deterioration) Acetaminophen may cause false-positive decrease in blood glucose levels on home testing strips

17. Combination Drugs for Analgesia Relieve moderate or severe pain Narcotic and non-narcotic combined Drug names ending in -cet contain acetaminophen Drug names ending in -dan contain aspirin

18. Analgesics Selected Combination Medications

20. Analgesics Selected Combination Medications (Non-Narcotic)

21. Selected Adjuvant Medications

22. Analgesics Children and Elderly Use with caution Poisoning may result from inappropriate use Do not use aspirin with viral infections in children (Reye’s syndrome) Do not call any medicine “candy” Elderly patients more prone to gastric irritation and constipation Opioids have higher peak values, longer duration of action