Roach: Nonopioid Analgesics: Salicylates and Nonsalicylates

Introduction to Clinical Pharmacology Chapter 13 Nonopioid Analgesics: Salicylates and Nonsalicylates Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Pain is the unpleasant sensory and emotional perception associated with actual or potential tissue damage

The sensation of pain is sent from the peripheral tissue to the brain where it is interpreted. Pain medications change the sensation in the tissues or modulate the signal in the brain Acute pain has a short duration of less than 3 to 6 months, whereas chronic pain lasts more than 6 months Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates Drugs derived from salicylic acid

Useful in pain management due to analgesic, antipyretic, and antiinflammatory effects Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates: Actions and Uses Lower body temperature Inhibit production of prostaglandins Aspirin: Inhibits prostaglandin synthesis and has greater anti-inflammatory effects; 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 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates: Adverse Reactions Gastrointestinal (GI) reactions: Gastric upset; heartburn; nausea; vomiting; anorexia; GI bleeding; allergy Significant blood loss Allergy to salicylates manifested by:

Hives, rash, angioedema, bronchospasm, anaphylactoid reactions Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates: Contraindications and Precautions Contraindicated in clients with: Known hypersensitivity; bleeding disorders; children with chickenpox, influenza Used cautiously in clients: With hepatic and/or renal disease; during

pregnancy and lactation; with pre-existing hypoprothrombinemia; with vitamin K deficiency; with GI irritation or peptic ulcer; with mild diabetes or gout Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates: Interactions Interactant drug Effect of interaction Anticoagulant

Increased risk for bleeding NSAIDs Increased serum levels of the NSAID Activated charcoal Decreased absorption of the salicylates

Antacids Decreased effects of the salicylates Carbonic anhydrase inhibitors Increased risk for salicylism

Copyright 2014 Wolters Kluwer Health | 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 discomfortarthritic disorders

Copyright 2014 Wolters Kluwer Health | 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 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonsalicylates: Adverse Reactions Adverse reactions: Skin eruptions; urticaria;

hemolytic anemia; pancytopenia; hypoglycemia; jaundice; hepatotoxicity; hepatic failure Overdose causes acute acetaminophen poisoning or toxicity Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonsalicylates: Contraindications and Precautions Contraindicated in patients with hypersensitivity

Used cautiously in patients: With severe or recurrent pain or high or continued fever Acetaminophen used cautiously during pregnancy and lactation Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonsalicylates: Interactions Interactant drug Effect of interaction

Barbiturates Increased possibility of toxicity and decreased effect of acetaminophen Hydantoins Increased possibility of toxicity and decreased effect of acetaminophen Increased possibility of toxicity and decreased effect of acetaminophen

Isoniazid and rifampin Loop diuretics Decreased effectiveness of the diuretic Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment Preadministration assessment: Assess type, onset, intensity, and location

of pain Evaluate ability to carry out activities of daily living Develop a care plan Evaluate the response to drug therapy Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment (cont.) Ongoing assessment: Monitor relief of pain; reassess pain rating 30 to 60 minutes following administration of the drug; monitor vital signs at least

every 4 hours Assess and document severity, location, and intensity of pain Report any adverse reactions Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Nursing Diagnosis and Planning Impaired Comfort related to fever of the disease process (e.g., infection or surgery) Chronic or Acute Pain related to peripheral nerve damage and/or tissue inflammation due

to the disease process Impaired Physical Mobility related to muscle and joint stiffness Risk for Poisoning related to increased salicylate or acetaminophen use Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation Promoting an optimal response to therapy: Avoid salicylates 1 week before or after any surgery Observe for adverse drug reactions

Observe for signs of salicylism Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont.) Promoting an optimal response to therapy (cont.): Symptoms associated with salicylates: Levels greater than 150 mcg: Result in mild salicylism Levels greater than 250 mcg: Result in symptoms of mild salicylism

Levels greater then 400 mcg: Result in respiratory alkalosis; hemorrhage Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont.) Promoting an optimal response to therapy (cont.): Administer acetaminophen with full glass of water, with meals or on empty stomach Symptoms of overdosage: Nausea; vomiting; diaphoresis; generalized malaise

Acute overdosage treated with acetylcysteine to prevent liver damage Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont.) Monitoring and managing patient needs: Impaired comfort: Check temperature before and 45 to 60 minutes after administration Suppository form of drug used: Check after 30 minutes for retention of suppository

Notify PHCP if temperature not controlled Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont.) Monitoring and managing patient needs (cont.): Pain: Notify PHCP if no relief from pain or discomfort Check cause of new pain experienced; report to PHCP as other therapy may be

needed Check the color of the stools Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont.) Monitoring and managing patient needs (cont.): Impaired physical mobility Acute pain or long-standing mild to moderate pain Determine degree of immobility Assist with ambulation

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont.) Monitoring and managing patient needs (cont.): Risk for poisoning Withhold drug and report any sensory alterations immediately if suspected Explain that hearing loss disappears when the drug therapy is discontinued

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont.) Educating the patient and family: Develop a teaching plan that includes: Take the drug exactly as prescribed by the primary health care provider Take the drug with food or a full glass of water Do not consistently use an OTC nonopioid analgesic to treat chronic pain

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont.) Educating the patient and family (cont.): Do not use these drugs on regular basis unless PHCP notified Teaching on salicylates includes: Salicylates deteriorate rapidly when exposed to air, moisture, and heat Consult pharmacist about the products ingredients if in doubt Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process: Implementation (cont.) Educating the patient and family (cont.): 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 2014 Wolters Kluwer Health | 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 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Pain is the unpleasant sensory and emotional perception associated with actual or potential tissue damage. Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Pain is the unpleasant sensory and emotional perception associated with actual or potential tissue damage.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Chronic pain has a short duration of less than 3 to 6 months, whereas acute pain lasts more than 6 months. Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False

Acute pain has a short duration of less than 3 to 6 months, whereas chronic pain lasts more than 6 months. Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Respiratory distress is the primary adverse reaction of salicylates. Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False Gastric distress is the primary adverse reaction of salicylates. Long-term users should be monitored for potential bleeding from the GI tract. Ringing in the ears (tinnitus) can be an early sign of salicylism (toxic reaction). Children should refrain from aspirin use due to Reyes syndrome. Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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