1. Medications for Pain &
Inflammation
ATI 4.2
Senior Class

2. Learning Objectives
• Assess/monitor a need for pain med
• Plan and provide care to meet the client’s need for pain interventions
• Assess/monitor effectiveness of pain intervention
• Advocate for the client’s needs
• Provide appropriate client education
• Reinforce client teachings regarding the purposes & possible effects of
pain meds
• Assess/monitor client for expected effects of meds
• Assess/monitor client for side/adverse effects of meds
• Assess/monitor client for actual/potential specific food & med interactions
• Identify contraindications, actual/potential incompatibilities & interactions
between meds---intervene appropriately
• Identify symptoms/evidence of an allergic reaction---respond
appropriately
• Evaluate/monitor and document the therapeutic and adverse/side effects
of meds
• Assess/collect data regarding client’s med use over time

3. Key Points
 Analgesics are meds that relieve pain
Narcotics
NSAIDs
Anti-migraine agents
 Anti-inflammatory agents are meds that reduce
inflammation
Salicylates
Glucocorticoids
Anti-gout meds
Disease-modifying anti-rheumatic drugs (DMARDs)

4. Key Points
• Certain anti-inflammatory meds have properties that reduce fever
(antipyretic) such as salicylates and ibuprofen
• Salicylates and NSAID’s reduce platelet aggregation and can be used to
reduce a client’s risk of thrombosis. This anti-platelet effect can also pose
a greater risk for bleeding and requires careful monitoring of clients
• Salicylates, NSAIDs, glucocorticoids pose the risk for gastric ulceration
• Acetaminophen (Tylenol) has analgesic and antipyretic effects, does not
have anti-inflammatory effects, and does not reduce platelet aggregation
• Tylenol overdose poses a risk for severe injury to the liver
• Prolonged use of narcotic analgesic, such as morphine and/or meperidine
(Demerol) may result in:
– Tolerance
– Physical dependence
– Addiction

5. NSAIDs
Expected Action:
Inhibition of cyclooxygenase: COX-2 inhibition
results in
 inflammation, pain & fever
Inhibition of COX-1 results in the
 of platelet aggregation

6. NSAIDs
Therapeutic Uses:
Inflammation suppression
Analgesia for mild to moderate pain
Fever reduction
Dysmenorrhea
Low level suppression of platelet aggregation

7. NSAID’s
 Selective Protoype:
1st generation NSAIDs (COX-1 & COX-2 Inhibitors):
aspirin ASA
2nd generation NSAIDs (selective COX-2 Inhibitors):
celecoxib (Celebrex)
 Other Meds
– 1st generation:
ibuprofen (Motrin, Advil),
naproxen (Naprosyn),
ketorolac (Toradol)
– 2nd generation:
Valdecoxib (Bextra)

8. NSAIDs
 Side/Adverse Effects:
GI (dyspepsia, abd pain, heartburn, N)
Aspirin-induced gastric ulcer, perforation & bleeding
Weight gain, urine output, BUN & creatinine levels
Salicylism (tinnitus, sweating, headache & dizziness, resp.
alkalosis
Reye syndrome (occurs w/children in whom aspirin are
used to reduce fever who have viral illness like chicken pox
or influenza
 Interactions: Meds & Food
Warfarin
Glucocorticoids
Alcohol
Ibuprofen decrease anti-platelet effect of low-dose aspirin
used to prevent MI

9. NSAIDs
• Interventions & Education
– Stop aspirin 1 week before an elective surgery or expected date of
childbirth
– Take aspirin w/food, mild or a full glass of H2O to reduce gastric
discomfort
– Don’t chew or crush enteric-coated or sustained-release aspirin
tablets
– Notify primary care provider if signs & symptoms of gastric discomfort
or ulceration occur
– Client unable to tolerate due to GI ulceration, risk of bleeding, or renal
impairment:
• Give Celebrex
– Toradol is used for short-term treatment of moderate to severe pain
like w/postoperative recovery
• Provides analegisa w/o anti-inflammatory effect
• Used concurrently w/opioids increased effects of opioids w/o occurrence of
adverse effects
• Used w/other NSAIDs serious adverse effects can occur use no more than 5
days usually start as parenteral administration & then progress to oral doses

10. NSAIDs
Evaluation of Effectiveness
Reduction in inflammation
Reduction of fever
Relief from mild to moderate pain or
dysmenorrhea
Platelet aggregation suppression

11. Acetaminophen
Selective Prototype: Tylenol
Expected Action:
Slows the production of prostaglandins in the CNS
Therapeutic Uses:
Analgesic effect
Anti-pyretic effect

12. Acetaminophen
 Side/Adverse Effects:
Acute toxicity—liver damage w/NVD, sweating, abd
discomfort progressing to liver failure, coma & death
 Contraindicated:
Use cautiously w/those who consume 3 or more
alcoholic drinks/day & taking Warfarin
 Interactions: Meds & Food
Alcohol
Warfarin

13. Acetaminophen
 Intervention & Education
 Keep a running total of daily intake
 Follow recommended dosage as prescribed to prevent
toxicity
 Don’t exceed 4 g/day
 If overdose, liver damage can be reduced by administering
weight-based dosage of antidote:
 Acetylcysteine (Mucomyst) diluted via oroduodenal tube
 Evaluation & Effectiveness:
 Relief of pain
 Reduction of fever

14. Opioid Agonist
Selective Prototype:
Morphine Sulfate
Other Meds:
fentanyl (Sublimaze, Duragesic)
meperidine (Demerol)
methadone (Dolophine)
codeine
oxycodone (OxyContin)

15. Opioid Agonist
• Expected Action:
• Act on mu receptors & to a lesser degree on
kappa receptors
• Activation of mu produces analgesia resp.
depression, euphoria & sedation
• Activation of kappa produces
analgesia, sedation & GI motility

16. Opioid Agonist
Therapeutic Uses
Relief of moderate to severe pain
(postop, MI, cancer)
Sedation
Reduction of bowel motility
Codeine: cough suppression

17. Opioid Agonist
 Side/Adverse Effects:
Respiratory depression
Constipation
Orthostatic hypotension
Urinary retention
Cough suppression
Sedation
Emesis, Biliary colic
Opioid overdose triad: coma, resp. depression, &
pinpoint pupils

18. Opioid Agonist
• Contraindications:
 Biliary tract surgery
 Premature Infants
 Asthma, Emphysema and/or head injuries
 Infants and older adults (risk of resp. depression)
 Pregnant client risk of physical dependence of the fetus
 In labor risk of resp. depression (newborn) & inhibition of labor
by decreasing uterine contraction
 Extremely Obese greater risk for prolonged side effects due to
accumulation of med metabolized @ slower rate
 IBD due to risk of megacolon or paralytic ileus
 Enlarged prostate due to risk of Acute Urinary Retention
 REPEATED USE OF DEMEROL results sin accumulation of
normeperidine which can result in seizures and neurotoxicity
 Don’t administer more than 600 mg/24 hr of Demerol & limit
its use to less than 48 hr.

19. Opioid Agonists
 Interactions: Meds & Food
Barbiturates
Phenobarbital
Benzpdiazepine
Alcohol
Benadryl
TCA—Elavil amitriptyline
Additive anticholinergic agents
MAOI
Anti-hypertensives

20. Opioid Agonists
• Interventions & Education:
 Assess pain regularly & document response
 Baseline vitals if RR < 12/min notify PCP & withhold
 Follow controlled substances procedures
 Double check opioid doses w/another nurse 1st
 Administer opioids IV slowly over a period of 4 to 5 mins have naloxone
(Narcan) & resuscitation equip. available
 Warn client not to dose w/o consulting PCP
 Administer opioids on fixed regular schedule around the clock to cancer
clients & supplemental doses PRN
 Advise client w/physical dependence not to discontinue abruptly taper &
withdraw slowly over 3 days
 Closely monitor PCA settings & reassure client of its safety but mainly to use
prior to activities
 Switching to Oral Dose ensure client receive PCA up to the onset of oral med
 Parenteral Duragesic is used primarily in surgery to induce anesthesia 100 x >
potent than morphine
 With 1st fentanyl will take many hours to achieve desired effect give short
acting opioids prior to onset of therapeutic effect & for breakthrough pain

21. Opioid Agonists
• Evaluation & Effectiveness
Relief of moderate to severe pain
Cough suppression
Resolution of diarrhea