Drugs for Pain Control (Analgesics)

what to do before prescribing pain medications for patients with pain

• therapeutic massage

• guided imagery

• acupuncture

• meditation

• prayer

how to assess for pain

rate on a scale from 0-10 and localizing pain

2 main classes of pain medications

1. non-opioids

2. opioids

2 examples of non-opioid analgesics

1. acetaminophen

2. non-steroidal anti-inflammatory drugs (NSAIDs)

acetaminophen & pain management

• doesnt work with inflammation

• works only for pain and fever

EX. tylenol, ofirmev

non-steroidal anti-inflammatory drugs (NSAIDs) and pain management

• works with inflammation, fever, and pain

EX. advil, aleve, ibuprofen

max dose of acetaminophen

4 g/day

max dose of aspirin (ASA)

4g/day

max dose of ibuprofen (IBU)

1.2 g/day

(provider can manage pt on up to 3.2 g/day)

nursing consideration with acetaminophen (non-opioid)

• must watch liver function (ALT, AST)

  • jaundice, fatigue, bruising, edema

• careful use of combo medications

• no anti-inflammatory properties

avoid acetaminophen in …

HIV and alcoholics

examples of OTC NSAID’s

1. naproxen/aleve

2. IBU (<800mg)

   1. advil, motrin

3. aspirin

examples of prescription NSAID’s

1. ketorolac/Toradol

2. indomethacin/Indocin

3. meloxicam/Mobic

4. celecobix/Celebrex

NSAIDs and cardiac concerns

• can increase the risk for thrombotic (blood clot) events (MI, CVA)

• increased blood pressure

• worsening heart failure

which NSAID is an exception for cardiac concerns

aspirin

NSAIDs and GI concerns

• GI bleed

• coffee ground emesis

• black tarry stools

• decreased hematocrit and hemoglobin

• BP lower with tachycardia

normal hemoglobin in women

12-15 g/dL

normal hemoglobin in men

14-18 g/dL

normal hematocrit in women

>35%

normal hematocrit in men

>40%

NSAIDs and renal concerns

• need renal and liver function tests

• renal labs (BUN and creatinine)

• assess for S/S (decreased UOP)

• GFR not below 60mL/min

normal BUN range

10-20

normal creatinine range

0.5-2 mg/dL

main nursing considerations when using NSAIDs

• education for cardiac patients who might not understand the cardiac effects

• take with food to decrease GI upset and reduce risk of GI bleed

• increase fluids

• tinnitus may be indication of overdose with increases concerns about GI bleed and thrombotic events

significant antiplatelet effects of aspirin

• D/C 1 week before surgery

• used for prevention of stroke and MI

• used for acute MI

• caution if pt. taking anticoagulants

all NSAIDs have an antiplatelet affect, not as strong as …

aspirin

aspirin is not for children less than ___ years of age

19

use aspirin with caution in patients with …

asthma

opioid analgesics MOA

stimulate the mu and kappa receptors in the CNS

opioids are … drugs with high ____ potential

scheduled; abuse

multiple routes with opioid pain management

IV, IM, PO, transdermal

opioid pain med prototype

morphine

7 examples of opioids for pain management

• hydromorphine

• oxycodone

• hydrocodone

• fentanyl

• butorphanol

• codeine

3 examples of mixed analgesics

1. hydrocodone/acteaminophen

2. hydrocodone/ibuprogen

3. oxycodone/acteaminophen

what does norco 5/325 mean

5 mg of hydrocodone + 325 mg of acteminophin in one tablet

nursing considerations with opioids

• excellent pain relief

• sometimes decreases anxiety and can be sedating

• scheduled controlled substances (remember wasing)

major adverse effects with opioids

• severe respiratory depression

• bradycardia

• somnolence

• dizziness and drowsiness

• N/V

• constipation

• urinary retention

if HR is too low, do not …

administer med (<55bpm)

#1 opioid antagonist

naloxone/narcan

naloxone/narcan

used in overdose situations and if severe respiratory depression in the hospital setting

opioid overdose S/S for when to use naloxone

• unable to wake pt

• respiratory rate <8

• poor pulse ox

• cyanosis

how does naloxone/narcan work

• rips opioid off of mu and kappa receptors

• does suddenly and abruptly, pain relief immediately gone

• severely painful in overdose clients

• can give multiple doses bc half life is shorter than opioid

serious side effects of narcan

• dangerous spike in BP

• seizures

• dysrhythmias

• hyperventilation

• return of pain

other side effects with narcan

• cramping

• vomiting

• anxiety

how to know when to give pain meds to a patient

• assess pain evaluation

• pain severity (0-10)

• monitor to prevent and/or intervene

• major side effects