ANALGESICS

Samples

NON-OPIOD ANLAGESICS

It prevents prostaglandin formation in inflamed tissues

Inhibits stimulation of pain receptors Inhibit prostaglandin synthesis in the CNS to stimulate peripheral

vasodilation

to reduce fever

TYPES
Salicilates Acetomenophen Non-steroidal anti-inflammatory drugs (NSAIDs) Cyclooxygenase-2 (COX-2) drugs

SALICYLATES
Absorbed in small intestine and stomach Found all over the body Metabolized by live and excreted via urine Examples: aspirin (ASA), salsalate (Disalcid)

ACETAMINOPHEN
Absorbed in GI tract and rectal mucosa Distributed in all body fluids and can pass placenta Metabolized by liver and excreted via the urine and breast milk Example: acetaminophen (Tylenol, Tempra)

NSAIDS
Absorbed in GI tract Distributed widely Metabolized by liver and excreted via the urine Examples: diclofenac (Cataflam), ibuprofen (Advil) ketorolac tromethamine (Toradol), mefenamic acid (Ponstel), naproxen sodium (Anaprox)

COX-2
Absorbed in the GI tract Distributed widely Metabolized by the liver and excreted by the urine and feces Example: celecoxib (Celebrex)

WHEN TO USE
Pain (mild to moderate) Arthritis and osteoarthritis (except MFA) Fever (acetomenophen, ASA and ibuprofen) Inflammation (ASA, naproxen) TIA and MI (ASA) Dysmenorrhoea (MFA, ibuprfen, naproxen, ketorolac)

WHEN NOT TO USE

Aspirin hypersensitivity Bleeding disorders Pregnancy Heart disease

ADVERSE REACTIONS
N and V Diarrhea Heartburn Dizziness Headache Tinnitus Rash Ulcer

GI pain and upset

NURSING ACTIONS
Give drugs before meals and with meal for GI upset Salcicylates are NO-NO to influenza, varicella or viral illness Reyes Syndrome Monitor patients taking COX-2 for thromboembolic events

OPIOD ANALGESICS

Opium Poppy

OPIOD ANALGESICS
Binds with opioid receptors in the CNS to alter perception and emotional response to pain Examples: codeine, meperidine (Demerol), morphine sulfate, oxycodone (OxyContin)

MIXED OPIOID AGONISTANTAGONIST

Weakly antagonize the effects of opiates at the receptors Examples: butorphanol (stadol), nalbuphine (Nubain)

WHEN TO USE
Adjuncts to anesthesia Cough relief (codeine) Pain due to MI or pulmonary edema (morphine) Pain unresponsive to non-opioid analgesics

WHEN NOT TO USE

Opioid abuse

ADVERSE REACTIONS
Orthostatic hypotension RESPIRATORY DEPRESSION Psychological dependence Pupil constriction Neurotoxicity Seizures (meperidine)

NURSING ACTIONS
Asses patients vital signs specially RR Prolonged use can cause dependency and tolerance NALOXONE (Narcan) is the anti-dote for opioid overdose

ANAESTHESIA

Injection Sites

Rapid Acting Hypnotics

Stabilizes neuronal membranes to produce progressive, reversible CNS depression Anaesthesia extension, induction and maintenance Example: propofol (Diprivan), thiopental sodium (Penthotal)

TYPES OF ANESTHESIA

GENERAL Total loss of consciousness and sensation (can also cause AMNESIA)
Intravenous Inhalation rectal

HE ABOUT GENERAL ANESTHESIA

Type of anaesthesia NPO 8 hours prior surgery Avoid CNS depressants ALCOHOL 24 hours prior Adverse reactions and S and S

REGIONAL All painful sensations in one region without inducing unconsciousness

Topical Local - Involves injection of a local anesthetic (numbing agent) directly into the surgical area to block pain sensations Field block Nerve blocks - A local anesthetic is injected near a specific nerve or group of nerves to block pain from the area of the body supplied by the nerve. Spinal and Epidural - A local anesthetic is injected near the spinal cord and nerves that connect to the spinal cord to block pain from an entire region of the body, such as the belly, hips, or legs. IV regional

INHALATION ANAESTHETICS
Depresses CNS to produce LOC, loss of responsiveness to sensory stimulation and muscle relaxation Example: enflurane (ethrane), halothane (Flouthane), isoflurane (Forane), nitrous oxide

NURSING ACTIONS
Keep ATROPINE available to reverse bradycardia Monitor temperature frequently hypothermia usually occurs with inhalation anaesthesia Shivering is common during recovery

Use extra blankets/heat, administer O2

INJECTABLE ANAESTHESIA
Depresses CNS Usually used for PAIN Example: sufentanil (Sufenta)

LOCAL ANAESTHESIA
Provide analgesic relief by blocking the conduction of nerve impulses at the point of contact PAIN Examples: lidocaine HCL, bupivacaine HCL (Marcaine)

TOPICAL ANAESTHESIA
Blocks nerve impulse transmission Stimulate nerve endings and interfere with pain perception Causes surface numbing Examples: bezocaine, butamben, dyclonine, procaine, lidociane and tetracaine