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Introductory Clinical Pharmacology Chapter 17 Nonopioid Analgesics: Salicylates and Nonsalicylates 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 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) 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) 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 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 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) 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) 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 Copyright © 2008 Lippincott Williams & Wilkins. Nonsalicylates: Adverse Reactions • Adverse reactions: hepatotoxicity; hepatic failure • Overdose: Causes acute acetaminophen poisoning or toxicity 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) 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 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 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 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 Copyright © 2008 Lippincott Williams & Wilkins. End of Presentation Copyright © 2008 Lippincott Williams & Wilkins.