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Non-Opioid Analgesics
NSAIDs
Second Generation NSAIDs
Acetaminophen
Opioid Analgesics and Antagonists
Classification
Opioids
Mu Receptor Activation and Physical Dependence
Treat mild to moderate joint pain, stiffness, and inflammation in clients with osteoarthritis. Have anti-inflammatory, antipyretic, and analgesic actions. Include nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. NSAIDs can be categorized into first and second-generation drugs. Examples of 1st generation NSAIDs: Aspirin, ibuprofen, naproxen, diclofenac. Ketorolac is used parenterally initially, then switched to oral route for short-term treatment of moderate to severe pain.
Example: Celecoxib. Suppress inflammation, relieve pain, decrease fever, and may protect from colorectal cancer. Purposes include inflammation suppression, analgesia, fever reduction, dysmenorrhea relief, and inhibition of platelet aggregation. Complications of NSAIDs include dyspepsia, gastrointestinal issues, GI bleeding, nephrotoxicity, and CNS effects. Nursing interventions involve monitoring hemoglobin/hematocrit, kidney function, and assessing for allergies and GI history. Education for patients includes taking NSAIDs with food, water, or milk, avoiding alcohol, and not chewing or crushing certain tablets.
Slows the production of prostaglandins in the central nervous system. Acts as an analgesic and antipyretic, preferred over NSAIDs for children. Complications of acetaminophen include acute toxicity, with specific dosage limits based on client characteristics. Interactions with alcohol and warfarin can lead to liver damage and increased bleeding risk. Education includes contacting the provider if pain or fever persists, and recognizing signs of toxicity.
Opioid agonists are Schedule II drugs that act on mu receptors. Activation of mu receptors leads to analgesia, respiratory depression, euphoria, and sedation.
Mu receptor activation is associated with physical dependence.
Kappa Receptor Activation
Agonist-Antagonist Opioids
Nursing Actions and Considerations
Interactions and Contraindications
Opioid Antagonists
Naloxone and Naltrexone
Nursing Considerations
This activation can lead to analgesia, euphoria, sedation, and respiratory depression. Example: Morphine attaches to mu receptors and produces analgesia, euphoria, sedation, and respiratory depression. Contraindicated after biliary tract surgery due to potential complications.
Activation of kappa receptors results in analgesia, sedation, and decreased gastrointestinal motility. Uses include moderate to severe pain management (post-operative, myocardial infarction, childbirth, cancer), sedation, and cough suppression. Example drugs: Fentanyl (IV, IM, transmucosal, transdermal), Meperidine (Oral, SQ, IM, IV), Methadone (Oral, SQ, IM), etc.
Cause analgesic response when administered with a pure agonist. Example drug: Butorphanol (IV, IM, intranasal) with purposes like low abuse potential, less respiratory depression, and relief of mild to moderate pain. Complications may include abstinence syndrome, sedation, respiratory depression, dizziness, and headache.
Assess pain level before administration. Hold medication and notify provider if respiration is less than 12/min. Administer IV opioids slowly over 4-5 minutes. Have naloxone and resuscitation equipment available. Monitor PCA dosing and transitions from PCA to oral opioids. Avoid abrupt discontinuation of opioids; taper doses over 3 days.
Interactions with CNS depressants like barbiturates, benzodiazepines, and alcohol. Caution in clients with asthma, emphysema, head injuries, infants, older adults, inflammatory bowel disease, enlarged prostate, hepatic or renal disease. Contraindications include pregnancy, lactation, respiratory depression, kidney failure, and biliary tract surgery.
Naloxone (IV, IM, SQ) and Naltrexone interfere with the action of opioids by competing for opioid receptors. Uses include treatment of opioid abuse, reversal of effects like respiratory depression and severe constipation. Complications may include tachycardia, tachypnea, and abstinence syndrome.
