NON-OPIOID Acetaminophen(Tylenol) Therapeutic class: Analgesic, antipyretic Aspirin (ASA, Acetylsalicylic Acid) Analgesic, NSAID, antipyretic Non-Opioid Analgesics COMMON USES WHAT I NEED TO KNOW AS A BRAND NEW NURSE *Antifever DOC for children and adolescents due to the risk of Reye s Syndrome with aspirin products. * Indicated for the treatment of mild to moderate pain, or fever. Minimal to no antiinflammatory effects. *Primary alternative to NSAIDs * Hepatotoxic in large doses, contraindicated with known liver disease or in clients who consume alcohol on a regular basis. *Acetaminophen inhibits warfarin metabolism, which can cause warfarin to accumulate to toxic levels. *With long-term use monitor hepatic function tests, ALT, AST, and bilirubin *Treat overdose with IV or oral N-acetylcysteine (Acetadote), or inhaled or oral acetylcysteine (Mucomyst) Indicated for the treatment of mild to moderate pain, especially pain associated with inflammation. *Antipyretic *Anticoagulant, indicated to reduce the risk of MI, strokes and colorectal cancer *Most serious adverse effect is GI complaints including GI bleeding. *Available in enteric-coated and buffered preparations for clients who experience GI effects. *Discontinue 1 week prior to surgery due to its anticoagulant effects *Excreted in urine, may affect urine testing for glucose and vanillylmandelic acid (VMA) * Aspirin contraindicated in children and adolescents due to the risk of Reye s Syndrome. * Contraindicated with vitamin K deficiency and peptic ulcer disease.
NSAIDS Common NSAIDS: Ibuprofen (Advil, Motrin), Naproxen sodium (Anaprox, Aleve), Meloxicam (Mobic), ketorolac tromethamine (Toradol) Analgesic, NSAID, antipyretic NSAIDS: COX 2-Inhibitors Celecoxib (Celebrex) NSAID, Analgesic *DOC for the treatment of mild to moderate pain, especially pain associated with inflammation. *Antipyretic *Certain types of arthritis *Acute pain, especially associated with multiple types of arthritis * Most serious adverse effect is GI complaints including GI bleeding. * Take with food or milk to decrease GI upset. * Contraindicated with peptic ulcer disease. *Monitor renal function and urine output with long-term use. *Use with caution in clients with history of heart failure, hypertension, or MI. Toradol is contraindicated in clients that are allergic to aspirin. * Most serious adverse effect is GI complaints and headache *May increase the risk of serious thrombotic events, MI, or stroke *May cause fluid retention *Associated with hepatotoxicity with long-term use
OPIOID Tramadol (Ultram) Opioid analgesic. Does not have abuse potential and is not a scheduled drug Hydromorphone hydrochloride (Dilaudid) Morphine Sulfate (Duramorph, MS Contin, DepoDur) Duramorph and DepoDur are administered via epidural route Opioid Analgesics COMMON USES WHAT I NEED TO KNOW AS A BRAND NEW NURSE *Indicated for the treatment of moderate to severe pain and chronic pain. * Adverse effects include drowsiness, dizziness, HA, nausea and vomiting, constipation. * Seizures have been reported in clients taking Tramadol. *Moderate to severe pain *Moderate to severe pain requiring continuous analgesia for an extended period of time (new indication) *Tablet form available in extended-release. Do not crush or break *Most serious adverse effects: respiratory depression and bradycardia *May cause constipation *Commonly abused opioid *Indicated for symptomatic relief of moderate to severe pain *DOC for MI pain because it decreases the workload of the heart. *Pre-anesthetic *Epidural single-dose for extended pain relief *Most serious adverse effect: respiratory depression, overdose can cause respiratory arrest. *Causes peripheral vasodilation which may result in orthostatic hypotension *May cause constipation, commonly severe with maintenance dose *Contraindicated in clients with GI obstruction; may mask gallbladder pain *Commonly abused opioid
Meperidine (Demerol) *Indicated for moderate to severe pain * Pre-op sedation, adjunct to anesthesia. *Preferred obstetric analgesic because it does not delay uterine contractions and causes less neonatal respiratory depression than other opioid narcotics. *Moderate to severe pain associated with pancreatitis Fentanyl (Duragesic, Sublimaze) *Option for clients allergic to Morphine *Short-acting analgesic indicated for moderate to severe pain and sedation. *Often used during operative and perioperative periods. *Adjunct to regional and general anesthesia *Management of moderate to severe chronic pain in clients who require around-the-clock opioid analgesics *Management of breakthrough pain associated with cancer Codeine *Indicated for mild to moderate pain *Frequently used antitussive and cough suppressant. Other Opioid Analgesics: Common examples: Vicodin, Lortab, Percodan, Percocet, Oxycontin * Adverse effects include drowsiness, dizziness, respiratory depression, constipation, nausea and vomiting. *Use with caution in elderly clients and clients with debilitating diseases. *Avoid in clients with hepatic or renal disease.. * Available in patch form for chronic severe pain. * Adverse effects include: constipation, dizziness, euphoria, hypotension, bradycardia, respiratory depression, circulatory depression and cardiac arrest. * Less analgesic and respiratory effects than other opioid narcotics. *Dose needed to suppress cough is low with minimal potential for abuse * Adverse effects include: dizziness, euphoria, drowsiness, constipation, hypotension, bradycardia and pruritis Indicated for mild to moderate pain. * Combination drugs combined with aspirin, Acetaminophen or an NSAID. * Adverse effects similar to those seen with codeine and nonopioid analgesics. *Constipation *Monitor for hepatotoxicity in long-term use of acetaminophen combination forms