Chapter 10 Analgesics and Antipyretics. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 10 - 2 Pain When.

Chapter 10

Analgesics and Antipyretics

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

10 - 2

Pain

When nerve signals are sent to the brain (CNS) after feeling a hurtful sensation inside or outside the body, the brain perceives these signals as pain.

When the client complains of pain, it is important for the nurse to treat it.

Pain: the fifth vital sign


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Pain Transmission

Tissue injury causes the release of: Bradykinin Histamine Prostaglandins Serotonin

These substances stimulate nerve endings, starting the pain process.


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Pain Transmission Gate Theory

Most common and well-described theory of pain

Uses the analogy of a gate to describe how impulses from injured tissues are sensed in the brain


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Pain Transmission in the Spinal Cord

A fibers Myelin sheath Large fiber size Conduct quickly Sharp and well-

localized

C fibers No myelin sheath Small fiber size Conduct slowly Dull and

nonlocalized


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Neurotransmitters

Body has endogenous neurotransmitters

Endorphins Enkephalins

Produced by body to fight pain Marathon runners and cyclists

Bind to opioid receptors Inhibit transmission of pain by closing

the gate


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Management of Pain

Treat the cause. Select a safe analgesic. Select the analgesic that provides

effective relief. Provide psychological support. Nursing actions: position change

and back rub


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Analgesics

Analgesic drugs relieve pain without causing loss of consciousness.


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Opioid Analgesics

Opium has been used for thousands of years to alleviate pain.

Opium is derived from the poppy plant. Opium produces pain relief by attaching

to pain receptors. Narcotics are derivatives of opium. Narcotics are strong pain relievers.


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Classifications of Opioid Analgesics

Classifications based on their actions: Agonist Agonist-antagonist Partial agonist


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Uses for Opioid Analgesics

Main use: to alleviate moderate to severe pain

Opioids are also used for: Cough suppression Diarrhea treatment


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Effects of Opioid Analgesics

Euphoria Nausea and vomiting Respiratory depression Urinary retention Diaphoresis and flushing Pupil constriction (miosis) Constipation


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Complications of Opioid Analgesics

Respiratory implications Constipation concerns


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Opioid Analgesics: Nursing Assessments

Perform a thorough history. Obtain baseline vital signs and

assessments. Assess for potential contraindications

and drug interactions.


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Opioid Analgesics: Nursing Implications

Oral forms–take with food Ensure safety measures


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Opiates: Opioid Tolerance

A common response to chronic opioid treatment

Larger dose of opioids is required


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Opiates: Physical Dependence

Physiologic adaptation to the presence of an opioid

If in need of pain relief, give the medication


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Opiates: Psychological Dependence (Addiction)

A pattern of compulsive drug use when the medication is not needed for physical pain relief


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Law: narcotics must be kept under a double lock

(continues)


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Pain management approaches Medical/nursing

Medicate clients before a procedure or an activity and/or

When they are complaining of pain Nursing

Back rub, musical therapy, and relaxation therapy

(continued)


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Opioid Analgesics: Therapeutic Effects

Monitor for therapeutic effects Increased comfort Activities of daily living improved


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Opiate Antagonists

Naloxone (Narcan) and naltrexone (ReVia)

Opiate antagonists Bind to opiate receptors and prevent a

response Used for reversal of opioid-induced

respiratory depression


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Rotate site for IM injections. Follow proper guidelines for IV

administration, such as dilution and rate of administration.

Check dosages carefully.

(continues)


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Prevent constipation. Provide fluid and fiber.

Prevent respiratory depression. Provide instruction for clients.

Drug administration Position changes

(continued)


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Analgesic Agents

Analgesic agents Salicylates (ASA) Acetaminophen (Tylenol) Combination narcotic and non-narcotic

analgesics Anti-inflammatory analgesic agents

Nonsteroidal anti-inflammatory drugs (NSAIDs)


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ASA (Acetylsalicylic Acid)

Used for more than 100 years Action: peripherally interferes with

synthesis of prostaglandins and chemical substances released from injured tissue

Treats mild to moderate pain Antipyretic effect


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ASA: Side Effects

Gastrointestinal irritation and bleeding Increases bleeding time Tinnitus Children: Reye’s syndrome


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Analgesic Agents: Acetaminophen

Mechanism of action Blocks pain impulses peripherally

Relieves pain Reduces a fever–antipyretic Weak anti-inflammatory Minimal effect on the central nervous system


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Acetaminophen: Side Effects

Acute overdose causes hepatic necrosis.

Doses of 150 mg/kg Long-term ingestion of large doses can result in

nephropathy


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Acetaminophen: Acute Overdose

Treatment: acetylcysteine Oral form IV form now approved Prevents the formation of hepatotoxic

metabolites

Chapter 10 Analgesics and Antipyretics. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 10 - 2 Pain When.

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