1. Analgesics and Antipyretics
Chapter 10
Analgesics and Antipyretics

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

3. 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

4. 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.

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

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

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

8. 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 .

9. Opioid analgesics table p263
Fentanyl
Heroin
Hydrocodone
Meperidine
Methadone
Oxycodone

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

11. 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

12. 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

13. 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

14. 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

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

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

17. 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

18. 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

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

20. 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

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

22. 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.

23. 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

24. 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

25. 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.