Non-opiates (mild to moderate pain)

acetaminophen

• analgesic AND antipyretic effects

• little to no anti-inflamm effects

• available OTC and in combination products with opioids

• used for mild to moderate pain and fever

• alternative for those who cannot take aspirin products

• Maximum daily dose is being lowered to 3000 from 4000

• 2000 mg for older adults and those with liver disease

• be aware of the acetaminophen content of all med taken by the pt

• should not be take in the presence:

  • drug allergy

  • liver dysfction

  • possible liver failure

  • G6PD deficiency

  • alcohol or others tht are hepatoxic

• Toxicity and managing overdose:

  • even though OTC can still be lethal when overdosed

  • overdose: causes hepatic necrosis: hepatotoxicity

  • long term ingestion of large doses also cause nephropathy

  • antidote: acetylcysteine regimen

• cannot take vicenin along with this

• onset 10-30

• half life: 1-4

• duration of action: 3-4

Transdermal lidocaine

• places directly on areas of discomfort

• indicated for tx of post herpetic pain

• indicated for tx of post herpetic pain

• worn for 12 hours on and 12 hours off

• can use up to 3 patches at one time

• minimal systemic adverse effects

• excellent for local relief, local anesthetic, directly where it hurts

Mechanism of action

• closing the gate stops the impulses

• if no impulses are transmitted to higher centers in the brain, there is no pain perception

• world hlth org 3 step ladder

  • step 1 : non-opioids

  • step 2: opioids

adverse effects

• acetaminophen: generally well tolerated (skin disorders, N/V)

• transdermal: site of tx redness or edema, unusual skin sensations

contraindication

• dermal patch: blisters

nursing interventions

• be carful with morphine and naloxone since morphine has a longer half life of 2-4 hrs you have to give multiple doses of naloxone tht has a half life of 30-80 min until morphine has gotten out of the body

indications

• common in football player injuries

Adjuvant drugs (acetaminophen, ibuprofen, gabapentin)

• assist primary drugs in relieving pains

  • NSAIDs (ibuprofen)

  • Antidepressants (SSNRIs)

  • anticonvulsants (gabapentin)

  • Corticosteroids (dexamethasone)

  • example: for neuropathic pain

    • Amitriptyline (antidepressant)

    • gabapentin or pregabalin (anticonvulsants)

Ketorolac and ibuprofen

• anti-inflamm properties with powerful analgesic effects

• indicated for Moderate to severe

• adverse effects

  • renal impariment

  • edema

  • GI pain

  • dyspepsia

  • Nausea

  • 5 TIMES MAX

• ibuprofen: musculoskeletal pain: OA, RA, and dental pain

  • also for anti-pyretic effects

  • primary adverse effects: GI pain, ulceration, blding

  • cautiously in older adults, alcholics, PUD