Pain 

•  Tissue damage activates free nerve endings (nociceptors) of peripheral nerves 
• Nociceptors - abundant in arteriole walls, joint, muscle, skin, soft tissue 
• Acute vs. Chronic pain (require different treatments) (chronic pain - 3 months or longer) 
• Opioids vs. Nonopiod meds 

Analgeis-Antipyretic-Anti-inflammatory drugs 

Aspirin (Acetylsalisylic Acid)

NSAID 

Prototype: Aspirin (for the NSAIDS) 

Action: 

• Non-selectively inhibits COX (1 & 2) / inhibits formation of prostaglandins 
• analgesic, anti-pyretic, anti-inflammatory & antiplatelet 

Therapeutic Use: 

• mild to moderate pain / fever / inflammation / decreases risk of thrombus (PFIT)
• low dose given for: MI / angina / stroke / primary prevention of MI / thromboembolism prevention in surgery patients (MASPT) 

Adverse Effects: stomach irritation / bleeding 

Nursing Education: 

• Toxicity - salicysm, tinnitus (ringing in ears)
• Avoid other otc meds that contain ASA
• Stop use 2 weeks before/after invasive procedures
• TAKE WITH FOOD, & ADEQUATE FLUIDS
• highly bound drug to blood albumin
• DO NOT GIVE TO CHILREN R/T REYE'S SYNDROME
• Watch for signs of bleeding
• Not for use in pregnancy 
• Increased effects with ETOH, anticoagulants, opioids, steroids

Acetaminophen (Tylenol) 

IV: Ofirmev

Action: 

• antipyretic and analgesic effects only (doesn't cause GI effects of aspirin) 

Therapeutic Use: 

• reduces pain & fever (can use with GI problems) 

Adverse Effects: hepatic failure with high doses / nephrotoxicity with overdose  

Contraindications: 

Nursing Education: 

• Read labels
• NO MORE THAN 4 GRAMS/DAY
• Drug of choice for: febrile children, elderly & impaired renal function, pregnancy
• alternate acetaminophen and ibuprophen for children's fever
• watch for duration of use
• avoid ETOH 

Misc: 

• May use with GI problems 
• additive effect w/ other opioids 
• Overdose treatment: Mucomyst (orally) 

NSAIDS 

Ibuprofen (Motrin, Advil) 

Action: 

• antipyretic, analegesic, anti-inflammatory

Therapeutic Use: 

• fever / pain / inflammation / arthritis / menstrual cramps 

Misc: 

• less GI upset than ASA

Indomethacin (Indocin)

Action: 

• analgesic, antipyretic, STRONG anti-inflammatory

Therapeutic Use: 

• fever / pain / inflammation / arthritis / menstrual cramps 

Misc: 

• Higher risk of side effects than Motrin 

Selective COX-2 Inhibitor 

celecoxib (Celebrex)

Drug: celecoxib (Celebrex) 

Action: 

• selective COX-2 Inhibitor 
• block prostaglandin associated with pain and inflammation without GI upset / No GI bleeding

Therapeutic Use: 

• arthritis 

Adverse effect: increased risk of adverse cardiovascular event / risk of GI bleeding with long term use 

Nursing Implications: 

• Advise patient of risk 

Anti-Gout Agents 

Prototype: Colchicine

Other Drugs: 

• allopurinol (Zyloprim)

Action: 

• prevents uric acid formation 

Therapeutic Use: 

• treatment & prevention of gout

Nursing implications: 

• Give w/ food
• Increase fluid to 3000 mL/day
• Rest and immobolize affected area
• Avoid ETOH
• Low purine diet (anchovies, sardines, game meats, organ meats, yeast)
• May cause drowsiness

Misc: 

Gout is the body's inability to metabolize uric acid

symptoms: hyperuricemia (>6 mg/dL), sever pain, inflammation and edema in musculoskeletal system 

Other: pregabalin (Lyrica)

Action: 

• decreases number of pain signals sent out by damaged nerves

Therapeutic Use: 

• neuropathic pain / fibromyalgia/ partial seizures

Adverse effects:  tiredness / dizziness / N/V

Opioid Analgesics

Action: Stimulate opiate receptors and bind to the receptors in CNS

causing inhibition of ascending nerve pathways 

Receptors: mu, kappa, delta

• Most schedule II drugs, well absorbed orally
• Oral - significant first pass risk

Use: for severe to moderate acute pain / terminal malignancy /MI / burns / trauma / post-op pain 

Adverse effects:  sedation (greatest effect) / respiratory depression / postural hypotension / flushing / N/V / constipation / urinary retention / pupil constriction 

Contraindications: allergy / Increased intracranial pressure / respiratory problems / dependence, tolerance, or addiction 

Nursing implications: 

• MONITOR FOR SEDATIOn
• Alternate with non-narcotics
• No ETOH w/ opioids (metabolized in liver, both create sedative effects) 
• Do not drive, operate machinery, or smoke
• constipation is a common side effect
• IR vs. SR 
• May be used in PCA pumps (allows for patient to administer their own meds in controlled dosages; used post-operatively) 

*Use with caution in chronic pain b/c of dependence 

Morphine 

• Prototype for opioids 

Additional Opioids 

oxycodone (OxyContin)

• popular drug of abuse
• can be combined with ASA - Percodan or acetaminophen - Percocett

Opioid Antagonist 

Drug: naloxone (Narcan) 

Action: compete with opioids for receptor sites in brain 

use: reverse or block anesthesia, CNS, and resp. depression from narcotics

adverse effects: increased heart rate / increasted BP / increased respiratory / return of pain / produces withdrawal symptoms 

nursing implications: 

• administer slowly 
• injections may need to be repeated (due to short half-life) 

Opioid Agonist / Antagonist 

Drug: 

• butorphanol (Stadol)
• nalbuphine (Nubain)

Action: agonist at some receptors, antagonist at others 

nursing implications: 

• never give to someone who has received opioid analgesics (due to antagonist activity) 
• complicated med b/c it'll reverse effects of opioid analgesics

Methadone (Dolophine) 

Action:  blocks receptors in brain affected by opioids 

longer acting than morphine, abuse, wean 

use: opioid addiction / cancer pain

nursing implications: 

• patient must continue with treatment if ever admitted to hospital 

misc:

• slow withdrawal process
• reduces drug cravings
• doesn't create sense of euphoria
• effects last between 24-36 hours (daily dose)