NSAIDS ( NONSTEROIDAL

ANTIINFLAMMATORY
DRUGS)

ZCMIRAFLORES,RN,MN

Drugs used for pain

1.Nonopioid

analgesics- used for

relief of mild-moderate pain
inflammation and fever and as
prophylaxis for thromboembolic
disorders
2. Agonists and mixed opioid agonist
antagonist- treat pain thats
unresponsive to nonopiod analgesics
3. Opioid antagonist -used to
reversed effect of the opioid
analgesic when respiratory or CNS
depression has occurred

Nursing responsibilities
Monitoring

VS and

the pts.
satisfaction
Preventing
constipation
Evaluating pain
relief

4. General ,local and topical anesthetics

Causes: analgesia, muscle

relaxation and decreased LOC

LOCAL ANESTHETICS blocks

sensation on the skin, in body
tissues when infiltrated ,in
epidural or spinal blocks
TOPICAL ANESTHETICS are
used to relieve or prevent and
anesthetize injection
or
catheter insertion sites

Nursing interventions
Maintaining

airway

patency
Having resuscitation
equipment on hand
Observing the patient for
arrhythmias

Anatomy and Physiology

NOCICEPTORS
-free nerve endings
located primarily on the
skin, periosteum, join
surfaces and arterial
walls
-part of the efferent
neurons
-origin of pain
sensation

 Dorsal

horn of the spinal cord

-receives pain impulse after of

nociceptors which are afferent neurons
neurotransmitters
ex.
.somatostatin- endocrine system
hormone)
.epinephrine (adrenaline)
.norepinephrine- stress hormone/fight
flight response
.Serotonin (emotions)
-is where nociceptor ends

Chemical mediators
Stimulants

nociceptors
Are released and synthesized in
response to tissue damage
Include :
.prostaglandins(pain/dilation of
smooth muscles
thermoregulatory center-fever)
.histamine (allergic reactions)
.bradykinin (inflammation) and
.serotonin(emotions)

Function of pain
1. Act as a protective
mechanism
indicating
an underlying
physiological and
psychological problem
2. subjective varies widely
from
person to person,
based
upon a persons
perception, emotional
state, ethic ,cultural or
religious influences

Pain theory

GATE CONTROL THEORY

States that the dorsal

horn is the regulator
between peripheral
fibers and the CNS
;acts as a gatekeeper
of pain and non pain
signals before sending
an impulse to the CNS

NONOPIOI
D
ANALGESI
CS

Mechanism of action
Act peripherally to prevent
prostaglandin formation in
inflamed tissues with two
actions
a. inhibit stimulations of
pain receptors
b. Inhibit prostaglandin
synthesis in the CNS
and
stimulate peripheral
vasodilation to reduce fever
(antipyretic action)

Drug examples

Salisylate

analgesics :
aspirin
(ASA)
Choline and magnesium
salicylates : (Trilisate)
Choline salisylate
(Arthropan)
diflunisal (Dolobid)
Salsalate (Disalcid)

 Para-aminophenol

derivative
nonopiod
analgesics:
Acetaminophen
(Tempra ,Tylenol)

NSAIDS
Diclofenac (Ctaflam, Voltaren)
Fenoprofen calcium (Naflon)
Flurbiprofen (Ansaid)
Ibufrofen
(Advil,Motrin,Nuprin,Ketoprofen,Ketorolac
thromethamine (Toradol),Mefenamic acid
(Ponstan),Naproxen
(Naprosyn),Naprosen
Na
(Anaprox)Piroxicam (Feldene),Sulindac
(Clinoril),Tolmetin (Tolectin)
COX-2 drugs : Celecoxib (Celebrex)

Indications
Mild- moderate pain
Arthritis and
osteoarthritis
Fever reduction
Inflammation reduction
Prevention of transient
ischemic attack and MI
(smoothens the platelets)
Dysmenorrhea

contraindications
Aspirin hypersentivity
(asthma, nasal polyps)
Bleeding disorders
Pregnancy except
acetaminophen
Children ( increased risk to
develop Reyes
syndrome)
History of heart diseases
and sulfa allergy
(celecoxib)

Adverse reactions:
GI

pain and upset

nausea/vomiting
Diarhea
Heartburn
Dizziness
headache tinnitus
rash
sever thrombotic events
ulcers

Interactions
Aspirin

with
anticoagulants
increases
risk of bleeding

Nursing responsibilities

Administer the drugs before meals

for a rapid effect and with meals
for GI irritation reduction

Advice pts. that CDC warns

children against giving salicylates
to children or adolescents with
influenza, varicella, or viral illness

Closely monitor pts. taking COX-2

drugs for thromboembolic events

Opiod agonists
and mixed opioid
agonist-antagonist

Mechanism of action
Bind

to opiate
receptors in the
CNS to alter the
perception of and
emotional
response to pain

Drug examples:
Opioids analgesics
Codeine
Fentanyl (sublimaze,duragesic)
Hydromorphone (Dilaudid)
Levorphanol (Levo-dromoran)
Meperidine (Demerol)
Methadone (Dolophine)
Morphine sulfate (Duramorph,MS cotin MSIR)
Oxycodone ( Oxycontin,Roxicodone)
Propoxyphene (Darvon,DarvonN)
Sfentanil (Sufenta)

Indications
Adjuncts to anesthesia
Cough relief (codeine and
hydromorphone)
Pain due to MI or acute pulmonary
edema (Morphine)
Pain unresponsive to nonopioids
analgesics
Local naesthesia via epidural route
(fentanyl and morphine)
Local anesthesia via transdermal patch
( fentanyl)
Temporary maintenance of opioid
addiction (methadone)

Mixed opioid agonists-antagonist

Buprenorphine (Buprenex)
Butophanol (Stadol)
Nalbuphine (Nubain)
Pentazocine (Talwin)

Contraindications/precauti
ons of opioid abuse (may
History
induce withdrawal
symptoms)

Caution: head injury,heapatic

or renal disease,CNS
depression,pregnant
and
breastfeeding pts. (NEONATAL
WITHDRAWAL) (may need to
reduce dose for these pts)

Adverse reactions
Orthostatic hypotension (slowly change
position)
Sedation
Constipation (Inc. OFI, consumption of bulk
foods)
Respiratory depression
Psychological dependence (long term used)
pupil constriction
Nephrotoxicity
Seizures (Meperidine)

Interactions
Avoid

use with
alcohol, sedating
antihistamines,hypno
tics, MAO inhibitors,
tricylic
antidepressants
causes additive CNS
depression

Nursing responsibilities

Asses pts bp,pulse,and

respiratory
status before
administering the drug and all
throughout
analgesic therapy
Asses pts. pain before drug
administration
To prevent withdrawal
symptoms stop drug gradually
(s/sx includes N/v, tremors
and agitation)
Bear in mind : NALOXONE
(antidote for opiate overdose)

Topics for pt. discussions

Medication

prescribed
Administration
instructions
s/sx including
adverse reactions

OPIOID antagonists

Mechanism of Action
Competitively

blocks
the effects of opioids
without producing
analgesic effects

Displaced

the opioid
attached to the
opiate receptor

Indication
Reverse

CNS and
respiratory depression
in opioid overdose
Adjunctive therapy to
keep detoxified
patients drug free
Treat opioid overdose

Drug examples:
Nalmefene

(Revex)
Naloxone
(Narcan)
Naltrexone
(ReVia,Trexan)

Indication
Reverse

the CNS
and respiratory
depression in
OPIOD overdose

Adjunct

therapy
in treating drug
abuse detoxify
pts drug free

Contraindications:
Use

cautiously in pts
physically dependent on
opioids inc. risk of
severe withdrawal
symptoms

Adverse reactions:
Nausea
Vomiting
Hypotension
Hypertension
Arrhythmias
Hyperventilation
tremors

Nursing responsibilities

Assess resp status, Bp.LOC

until opioid wears off

Opioid antagonist dosage

should be adjusted according
to the pts. pain
level

Give only the amount required

to reverse respiratory
depression or increased
mental alertness