1. Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 17 Nonopioid Analgesics: Salicylates and Nonsalicylates

2. Copyright © 2008 Lippincott Williams & Wilkins. Pain Assessment Nursing role in providing Pain Management –Need to take patient’s report of pain seriously –Understand patient’s pain level –Teach patient to rate pain 0-10 –Fifth vital sign: Accurate assessment necessary for effective pain management

3. Copyright © 2008 Lippincott Williams & Wilkins. Drug Classification: Analgesics Definition: Drugs used to relieve pain Subcategories of Analgesics –Salicylates (Aspirin) –Non Opiods (Tylenol) –Opiod Analgesics/Narcotics (Morphine) –NSAIDs (Motrin)

4. Copyright © 2008 Lippincott Williams & Wilkins. Salicylates Drugs derived from salicyclic acid –Useful in pain management due to analgesic, antipyretic, and anti-inflammatory effects Medications to Recognize: –aspirin “acetylsalicyclic acid” or “ASA” – salsalate (Disalcid)

5. Copyright © 2008 Lippincott Williams & Wilkins. Salicylates: Actions and Uses Lower body temperature Inhibit production of prostaglandins (chemical that causes inflammation) Aspirin: prolongs bleeding time Used for: Mild to moderate pain; reducing elevated body temperature; treating inflammatory conditions; decreasing risk of myocardial infarction; reducing risk of transient ischemic attacks

6. Copyright © 2008 Lippincott Williams & Wilkins. Salicylates: Adverse Reactions Gastrointestinal (GI) reactions –Gastric upset; heartburn; nausea; vomiting; anorexia; GI bleeding; –Allergy to salicylates manifested by: Hives, rash, angioedema, bronchospasm, anaphylactoid reactions

7. Copyright © 2008 Lippincott Williams & Wilkins. Salicylates: Contraindications and Precautions Contraindicated in clients with: –Known hypersensitivity; bleeding disorders; children with chickenpox or influenza (risk for Reyes Syndrome)

8. Copyright © 2008 Lippincott Williams & Wilkins. Nonsalicylates: Actions and Uses Actions –Analgesic and antipyretic activity: Same as salicylates –No anti-inflammatory action Uses –Used to treat mild to moderate pain; reduce elevated body temperature; manage pain and discomfort – arthritic disorders Medications to Recognize – acetaminophen “APAP” (Tylenol)

9. Copyright © 2008 Lippincott Williams & Wilkins. Nonsalicylates: Action and Uses Useful for people with aspirin allergy; bleeding disorders; receiving anticoagulant therapy; who had recent minor surgical procedures

10. Copyright © 2008 Lippincott Williams & Wilkins. Nonsalicylates: Adverse Reactions Adverse reactions: hepatotoxicity; hepatic failure Overdose: Causes acute acetaminophen poisoning or toxicity

11. Copyright © 2008 Lippincott Williams & Wilkins. Nonsalicylates: Contraindications and Precautions Contraindication in patients with hypersensitivity Used cautiously in patients: –With severe or recurrent pain or high or continued fever –Who are pregnant or lactating (acetaminophen)

12. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Assessment Preadministration assessment –Assess: Type, onset, intensity, location of pain –Evaluate ability to carry out activities of daily living –Evaluate the response to previous drug therapy

13. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Implementation Check temperature before and 45-60 minutes after administration Suppository form of drug used: Check after 30 minutes for retention of suppository Notify PHCP if temperature not controlled

14. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Implementation Educating the patient and family –Discontinue use 1 week before surgery or dental procedure –Teaching on acetaminophen includes: Acetaminophen lacks anti-inflammatory properties of aspirin Notify primary health care provider if any adverse reactions occur Avoid use of alcoholic beverages

15. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Evaluation Relief from pain; body temperature normal Adverse reactions are identified, reported, and managed Patient verbalizes the importance of complying with the prescribed treatment regimen Patient demonstrates understanding of prescribed treatment regimen and adverse effects

16. Copyright © 2008 Lippincott Williams & Wilkins. End of Presentation