The nonnarcotic analgesics are a group of drugs used to relieve pain

The NONNARCOTIC ANALGESICS are: Salicylates nonsalicylates (acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs)

SALICYLATES
include aspirin (acetylsalicylic acid) analgesic (relieves pain), antipyretic (reduces elevated body temperature) anti-inflammatory effects.

SALICYLATES
MECHANISM OF ACTION analgesic action of the salicylates is due to the inhibition of prostaglandins PROSTAGLANDINS are fatty acid derivatives found in almost every tissue of the body and body fluid. increase the sensitivity of peripheral pain receptors.

SALICYLATES
USES The salicylate nonnarcotic analgesics are used for the following reasons: Relief of mild to moderate pain; Reduction of elevated body Treatment of inflammatory conditions, such as rheumatoid arthritis, osteoarthritis, and rheumatic fever

SALICYLATES
USES Reduction of the risk of myocardial infarction in those with unstable angina or previous myocardial infarction (aspirin only); Reduction of the risk of transient ischemic attacks or strokes in men who have had transient ischemia of the brain due to fibrin platelet emboli (aspirin only)

SALICYLATES
ADVERSE REACTIONS Gastric upset, heartburn, nausea, vomiting, anorexia, and gastrointestinal bleeding allergic reactions : hives, rash, angioedema, bronchospasm with asthma-like symptoms, and anaphylactoid reactions

SALICYLATES
SALICYLATE TOXICITY Salicylate toxicity produces a condition called SALICYLISM SALICYLISM Dizziness Tinnitus (a ringing sound in the ear) Impaired hearing Nausea

SALICYLATES
SALICYLISM Vomiting Flushing Sweating Rapid deep breathing Tachycardia Diarrhea

SALICYLATES
SALICYLISM Mental confusion Lassitude Drowsiness Respiratory depression and coma (large doses)

SALICYLATES
CONTRAINDICATIONS
hypersensitivity

to the salicylates or

the NSAIDs Pregnancy: produce adverse maternal effects Anemia postpartum hemorrhage Prolonged gestation or labor

SALICYLATES
CONTRAINDICATIONS adverse fetal effects low birth weight intracranial hemorrhage in premature infants Stillbirths neonatal death

SALICYLATES
CONTRAINDICATIONS Children or teenagers with influenza or chickenpox (aspirin) Reyes syndrome a life threatening condition characterized by vomiting and lethargy, progressing to coma).

SALICYLATES
INTERACTIONS
Food

containing salicylate (curry powder, paprika, licorice, prunes, raisins, and tea) may increase the risk of adverse reactions. Coadministration of the salicylates with activated charcoal decreases the absorption of the salicylates. Antacids may decrease the effects of the salicylates

SALICYLATES
INTERACTIONS Coadministration with the carbonic anhydrase inhibitors increases the risk of salicylism. Aspirin may increase the risk of bleeding during heparin administration. Coadministration with the NSAIDs may increase NSAID blood levels

NONSALICYLATES
Acetaminophen

(Tylenol, Datril,

Panadol) Substitute for patients who are allergic to aspirin or who experience extreme gastric upset when taking aspirin. drug of choice for treating children with fever and flu-like symptoms.

NONSALICYLATES
MECHANISM OF ACTION Acetaminophen is a nonsalicylate nonnarcotic analgesic whose mechanism of action is unknown. analgesic and antipyretic activity No antiinflammatory action

NONSALICYLATES
USES mild to moderate pain reduce elevated body temperature (fever). aspirin allergy bleeding disorders, such as bleeding ulcer or hemophilia receiving anticoagulant therapy, minor surgical procedures

NONSALICYLATES
ADVERSE REACTIONS usually occur with chronic use or when the recommended dosage is exceeded. Adverse reactions include skin eruptions urticaria (hives) hemolytic anemia pancytopenia (a reduction in all cellular components of the blood)

NONSALICYLATES
ADVERSE REACTIONS Hypoglycemia jaundice (yellow discoloration of the skin) hepatotoxicity (damage to the liver) hepatic failure (seen in chronic alcoholics

NONSALICYLATES
ACUTE ACETAMINOPHEN POISONING Acute acetaminophen poisoning or toxicity single 10- to 15-g dose Dosages of 20 to 25 g may be fatal the liver cells necrose or die The risk of liver failure increases patients who are chronic alcoholics. Acute hepatic and renal failure

NONSALICYLATES
SIGNS OF ACUTE ACETAMINOPHEN POISONING Nausea Vomiting Confusion Liver tenderness Hypotension Arrhythmias Jaundice Acute hepatic and renal failure

NONSALICYLATES
CONTRAINDICATIONS, PRECAUTIONS, AND INTERACTIONS Hypersensitivity chronic alcoholics used cautiously during pregnancy and lactation. Use with the barbiturates, hydantoins, isoniazid, and rifampin may increase the toxic effects and possibly decrease the therapeutic effects of

NONNARCOTIC ANALGESICS: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

have

analgesic and antipyretic properties. exact mechanisms of actions are not known, inhibiting prostaglandin (synthesis by inhibiting the action of the enzyme cyclooxygenase, the enzyme responsible for prostaglandin synthesis.

 Prostaglandins

sensitize pain receptors and increase the pain associated with other chemical mediators such as bradykinin and histamine act as pyrogens (fever-producing agents).

 The

NSAIDs act to inhibit the activity of two related enzymes: 1. cycloo1xygenase-1 (COX-1) helps to maintain the stomach lining; and 2. cyclooxygenase-2 (COX-2) that triggers pain and inflammation.

 newer

NSAIDs (celecoxib and rofecoxib) appear to work by specifically inhibiting the COX-2 enzyme, without inhibiting the COX-1 enzyme.

NONNARCOTIC ANALGESICS: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

USES Osteoarthritis , rheumatoid arthritis, and other musculoskeletal disorders Mild to moderate pain relief dysmenorrhea Fever reduction

NONNARCOTIC ANALGESICS: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

ADVERSE REACTIONS Gastrointestinal tract nausea, vomiting, diarrhea, constipation, epigastric pain, indigestion,abdominal distress or discomfort, intestinal ulceration,stomatitis, jaundice, bloating, anorexia, and dry mouth

NONNARCOTIC ANALGESICS: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

ADVERSE REACTIONS Central Nervous System dizziness, anxiety, lightheadedness,vertigo, headache, drowsiness, insomnia, confusion, depression, and psychic disturbances

NONNARCOTIC ANALGESICS: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

ADVERSE REACTIONS
Cardiovascular

congestive heart failure, decrease or increase in blood pressure, and cardiac arrhythmias Renal hematuria, cystitis, elevated blood urea nitrogen, polyuria, dysuria, oliguria, and acute renal failure in those with impaired renal function

NONNARCOTIC ANALGESICS: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

ADVERSE REACTIONS
Special sensesvisual disturbances, blurred or diminished vision, diplopia, swollen or irritated eyes, photophobia, reversible loss of color vision, tinnitus, taste change, and rhinitis

NONNARCOTIC ANALGESICS: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

CONTRAINDICATIONS, PRECAUTIONS, AND INTERACTIONS hypersensitivity used cautiously in patients withbleeding disorders, renal disease, cardiovascular disease,or hepatic impairment and in the elderly. used with extreme caution during

COMMON ADVERSE REACTIONS OF SELECTED NSAIDs Celecoxib most common adverse reactions dyspepsia, abdominal pain, diarrhea, nausea, and headache. may compromise renal function.

COMMON ADVERSE REACTIONS OF SELECTED NSAIDs

Ibuprofen used in children with juvenile arthritis and for fever reduction in children 6 months to 12 years. Common adverse reactions seen with ibuprofen include headache, dizziness, somnolence, nausea, dyspepsia, gastrointestinal pain, and rash.

COMMON ADVERSE REACTIONS OF SELECTED NSAIDs Naproxen Common adverse reactions seen with naproxen include headache, vertigo (dizziness), somnolence, insomnia, nausea, dyspepsia, gastrointestinal pain, and rash.

NSAIDs: NURSING IMPLICATIONS

Before

beginning therapy, assess for conditions that may be contraindications to therapy, especially: GI lesions or peptic ulcer disease Bleeding disorders Assess also for conditions that require cautious use. Perform lab studies as indicated (cardiac, renal, liver studies, CDC, platelet count).

NSAIDs: NURSING IMPLICATIONS

Perform Several

a medication history to assess for potential drug interactions. serious drug interactions exist: alcohol heparin phenytoin oral anticoagulants steroids sulfonamides

NSAIDs: NURSING IMPLICATIONS Salicylates are NOT to be given to children under age 12 because of the risk of Reyes syndrome. Because these agents generally cause GI distress, they are often better tolerated if taken with food, milk or an antacid to avoid GI irritation. Explain to patients that therapeutic effects may not be seen for 3 to 4 weeks.

NSAIDs: NURSING IMPLICATIONS educate patients about the various side effects of NSAIDs, and to notify their physician if these effects become severe or if bleeding or GI pain occur. Patients should watch closely for the occurrence of any unusual bleeding, such as in the stool. Enteric-coated tablets should not be crushed or chewed.

NSAIDs: NURSING IMPLICATIONS Monitor for therapeutic effects, which vary according to the condition being treated:

decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area

No Alcohol SE BIRTH bone marrow depression,

increased GI distress, Renal Toxicity, Tinnitus and Hepatotoxicity

Aspirin sensitivity do not give Inhibits prostaglandins Do take with food Stop 5-7 days before surgery