1. Analgesic and Antipyretic Agents
Chapter 10
Analgesic and Antipyretic Agents

2. Analgesic drugs relieve pain
Analgesics

3. Pain is what the patient says it is! 0-10 scale Wong-Baker FACES scale
Infant behavioral scales
Pain Definition

4. Pain Pain = brain’s perception/interpretation of nerve signals
Treat all complaints of pain
Pain: the fifth vital sign
Pain

5. Pain Transmission: Gate Theory
Most common and well- described theory of pain
Uses the analogy of a gate to describe how impulses from injured tissues are sensed in the brain
Pain Transmission: Gate Theory

6. Neurotransmitters Endogenous neurotransmitters Endorphins Enkephalins
Produced to fight pain
Marathon runners and cyclists
Bind to opioid receptors
Inhibit transmission of pain by closing the gate
Neurotransmitters

7. Select a safe analgesic.
Management of Pain
Treat the cause.
Select a safe analgesic.
Select the analgesic that provides effective relief.
Provide psychological support.

8. Non-pharmacologic nursing actions:
position change, massage, heat, reassurance, guided imagery, laughter, distraction, music/art therapy etc.
Management of Pain

9. Opium has been used for thousands of years to alleviate pain.
Opium is derived from the poppy plant.
Opium produces pain relief by attaching to pain receptors
Opioid Analgesics

10. Narcotics (Opioid Analgesics)
Narcotics are derivatives of opium
strong pain relievers
Induce alteration in mental status
Narcotics (Opioid Analgesics)

11. Effects of Opioid Analgesics
Respiratory depression
Euphoria
Nausea and vomiting
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
Constipation
Effects of Opioid Analgesics

12. Uses for Opioid Analgesics
Main:
to alleviate moderate to severe pain
Also:
Cough suppression
Diarrhea treatment

13. Complications of Opioid Analgesics
Respiratory: rate slows and depth becomes shallow
12-20 breaths/minute normal
May slow to less than 8/minute
Constipation concerns

14. Opioids: Nursing Assessments
Thorough history
Baseline v/s, assessments
potential contraindications, drug interactions?
If respirations are below normal, hold med and consider Narcan
Assess pain after Narcan administration – alternate medication?

15. Opioid Analgesics: Nursing Implications
Oral forms–take with food
Ensure safety measures

16. Opiates: Opioid Tolerance
A common response to chronic opioid treatment
Larger doses of opioids required

17. Opiates: Physical Dependence
Physiologic adaptation to the presence of an opioid
If in need of pain relief, give the medication

18. Opiates: Psychological Dependence (Addiction)
A pattern of compulsive drug use when the medication is not needed for physical pain relief

19. Opioid Analgesics: Nursing Implications
Law: narcotics must be kept under a double lock

20. Opioid Analgesics: Therapeutic Effects
Monitor for therapeutic effects
Increased comfort
Activities of daily living improved

21. Opiate Antagonists
Naloxone (Narcan) and naltrexone (ReVia)
Opiate antagonists
Bind to opiate receptors, prevent response
reverses opioid-induced respiratory depression
Overdose treatment
Narcan
Charcoal

22. Opioid Analgesics: Nursing Implications
Rotate site for IM injections.
Follow guidelines for IV administration (dilution, rate of administration, etc)
Check dosages carefully

23. Opioid Analgesics: Nursing Implications
Prevent constipation.
Provide fluid and fiber.
Prevent respiratory depression.
Provide instruction for clients.
Drug administration
Position changes

24. Analgesic Agents Analgesic agents Salicylates (ASA)
Acetaminophen (Tylenol)
Combination narcotic and non- narcotic analgesics
Anti-inflammatory analgesic agents
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Analgesic Agents

25. ASA (Acetylsalicylic Acid)
Used for more than 100 years
Currently is primarily used for its effects on platelets
Treats mild to moderate pain
Antipyretic effect

26. ASA: Side Effects Gastrointestinal irritation and bleeding
Increases bleeding time
Tinnitus
Children: Reye’s syndrome
Risk increases if recent viral infection
Causes encephalopathy and liver dysfunction
Symptoms include intractable vomiting, and altered mental status
ASA: Side Effects

27. ASA Overdose treatment
Charcoal
Correction of acid-base balance
Dialysis
ASA Overdose treatment

28. Analgesic Agents: Acetaminophen
mild to moderate pain
antipyretic
Weak anti-inflammatory
Minimal effect on CNS
FDA in 2011 lowered maximum daily dose recommendation to 3 grams for healthy adults

29. headache pain ASA (aspirin), APAP (acetaminophen), Valium
Most common: tension and vascular headaches
ASA (aspirin), APAP (acetaminophen), Valium
Migraine most common form of vascular headache
beta-blockers, calcium channel blockers, ergot and ergot-like drugs: Ergostat, ergotamine tartrate, dihydroergotamine mesylate (D.H.E.)
Eletriptan hydrobromide (selective serotonin receptor agonist)
headache pain

30. Headache pain Migraine: Imitrex (sumatriptan):
use at headache onset – not preventive
PO and intranasal forms may be repeated Q 2 hours until max daily dose reached or headache minimized
Headache pain

31. Acetaminophen: Side Effects
Acute overdose causes hepatic necrosis.
Doses of 150 mg/kg
Long-term ingestion of large doses can result in nephropathy
Maximum healthy adult dosage is now 3 grams/day

32. Acetaminophen: Acute Overdose
Treatment: acetylcysteine (mucomyst)
Oral form
IV form now approved