Pain meds and antagonists

1st gen NSAIDS Asprin & ibuprofen

• Cox 1 &2 inhibitor, pain and fever reliever, inhibit platelet aggulation

• ADRs: gi ulcers, bleeding, renal dysfunction, Reye’s syndrome, sallicylism.

• Contradictions: pregnancy, peptic ulcer disease, bleeding disorders, caution, with smoking, alcohol, H pylori.

• Nursing implications: Monitor signs of bleeding and salicylism

2nd gen NSAIDS CELECOXIB

• Inhibits Cox 2, Relieve pain and suppresses inflammation

• ADRs: G.I. ulcers, bleeding, renal dysfunction, vasoconstriction

• Contradictions: Pregnancy, severe hepatic/renal impairment, bleeding disorders, caution with HF, CVA, DM.

• Nursing implications: take low-dose ASA with long-term therapy & with food, report, gastric, irritation, signs of bleeding and Thromboembolic events

Non-opioid analgesic/acetaminophen

• Inhibit Cox but limited to CNS, Relieve pain and fever.

• ADR’s: Liver damage In toxic doses, hypertension with daily use.

• Contraindications: Alcohol, alcoholism, caution with anemia, immune, suppression, hepatic, or renal disease.

• Nurse implications: no more than 4 g per day report, abdominal discomfort, sweating, and diarrhea. Acetylcysteine for OD.

Dual mechanism analgesic agent/tramadol

• Binds to opioid receptors Blocks reuptake Of norepinephrine and serotonin and CNS.

• ADR’s: Nausea, constipation, sedation, dizziness, headache, seizure, urinary retention.

• Contraindication: alcohol or drug intoxication, seizure, disorders, respiratory depression, caution with liver, renal disease.

• Nurse implementation: Avoid driving, lightheadedness, increased fluid, and fiber intake.

Opioid analgesic/morphine

• Binds to MU opioid, receptors, causes analgesia sedation and euphoria.

• ADR’s: Respiratory depression, sedation, dizziness, decreased intestinal motility, orthostatic hypotension, urinary retention, cough suppression.

• Contraindication: Pregnancy, renal failure, respiratory depression, caution with head injury, hypotension.

• Nurse Implications: Short term, only when needed, do not drive, tolerance with long-term use, must be tapered off.

Opioid antagonist/Naloxone

• Blocks opioid, receptors, reverses effects of opioids.

• ADR’s: Ventricular, dysrhythmias, tachycardia, hypertension, vomiting, tremors.

• Contraindication: respiratory depression, not caused by opioids, caution with cardiac irritability or head injury.

• Nurse implications: Worn of pain/euphoria monitor heart rhythm only last 60 to 90 minutes monitor for OD reoccurrence.