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The nonnarcoticanalgesics are a group
of drugs used to relievepain
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The NONNARCOTICANALGESICS are:Salicylates
nonsalicylates(acetaminophen),
nonsteroidal anti-inflammatorydrugs (NSAIDs)
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include aspirin (acetylsalicylicacid)
analgesic (relieves pain),
antipyretic (reduces elevatedbody temperature)
anti-inflammatory effects.
SALICYLATES
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MECHANISM OF ACTIONanalgesic action of the salicylates isdue to the inhibition of prostaglandins
PROSTAGLANDINS are fatty acidderivatives found in almost everytissue of the body and body fluid.
increase the sensitivity of peripheralpain receptors.
SALICYLATES
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USESThe salicylate nonnarcotic analgesicsare used for the following reasons:
Relief of mild to moderate pain; Reduction of elevated body
Treatment of inflammatory
conditions, such as rheumatoidarthritis, osteoarthritis, andrheumatic fever
SALICYLATES
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USES Reduction of the risk of myocardialinfarction in those with unstableangina or previous myocardialinfarction (aspirin only);
Reduction of the risk of transientischemic attacks or strokes in men
who have had transient ischemia ofthe brain due to fibrin platelet emboli(aspirin only)
SALICYLATES
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ADVERSE REACTIONS Gastric upset, heartburn, nausea,vomiting, anorexia, and
gastrointestinal bleedingallergic reactions : hives, rash,angioedema,
bronchospasm with asthma-likesymptoms, and anaphylactoidreactions
SALICYLATES
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SALICYLATE TOXICITY Salicylate toxicity produces acondition called SALICYLISM
SALICYLISM Dizziness
Tinnitus (a ringing sound in the ear) Impaired hearing Nausea
SALICYLATES
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SALICYLISM Vomiting Flushing
Sweating Rapid deep breathing Tachycardia Diarrhea
SALICYLATES
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SALICYLISM
Mental confusion Lassitude Drowsiness
Respiratory depression andcoma (large doses)
SALICYLATES
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CONTRAINDICATIONS hypersensitivity to the salicylates orthe NSAIDs
Pregnancy: produce adversematernal effects
Anemia
postpartum hemorrhage Prolonged gestation or labor
SALICYLATES
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CONTRAINDICATIONS
adverse fetal effectslow birth weight intracranial hemorrhage inpremature infantsStillbirthsneonatal death
SALICYLATES
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CONTRAINDICATIONSChildren or teenagers withinfluenza or chickenpox (aspirin)
Reyes syndromea life threatening conditioncharacterized by vomiting andlethargy, progressing tocoma).
SALICYLATES
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INTERACTIONS
Food containing salicylate (currypowder, paprika, licorice, prunes,raisins, and tea) may increase the riskof adverse reactions.
Coadministration of the salicylateswith activated charcoal decreases the
absorption of the salicylates. Antacids may decrease the effects ofthe salicylates
SALICYLATES
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INTERACTIONS
Coadministration with the carbonicanhydrase inhibitors increases the
risk of salicylism.Aspirin may increase the risk ofbleeding during heparin
administration.Coadministration with the NSAIDsmay increase NSAID blood levels
SALICYLATES
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Acetaminophen (Tylenol, Datril,Panadol)
Substitute for patients who are
allergic to aspirin or who experienceextreme gastric upset when takingaspirin.
drug of choice for treating childrenwith fever and flu-like symptoms.
NONSALICYLATES
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MECHANISM OF ACTIONAcetaminophen is a nonsalicylatenonnarcotic analgesic whose
mechanism of action is unknown.analgesic and antipyretic activityNo antiinflammatory action
NONSALICYLATES
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USESmild to moderate painreduce elevated body
temperature (fever). aspirin allergy bleeding disorders, such as
bleeding ulcer or hemophilia receiving anticoagulant therapy, minor surgical procedures
NONSALICYLATES
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ADVERSE REACTIONSusually occur with chronic use orwhen the recommended dosage is
exceeded.Adverse reactions include skin eruptions
urticaria (hives) hemolytic anemia pancytopenia (a reduction in all
cellular components of the blood)
NONSALICYLATES
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ADVERSE REACTIONS Hypoglycemia
jaundice (yellow discoloration
of the skin) hepatotoxicity (damage to theliver)
hepatic failure (seen in chronicalcoholics
NONSALICYLATES
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ACUTE ACETAMINOPHENPOISONINGAcute acetaminophen poisoning or
toxicity single 10- to 15-g dose
Dosages of 20 to 25 g may be fatal
the liver cells necrose or die The risk of liver failure increases
patients who are chronic alcoholics.Acute hepatic and renal failure
NONSALICYLATES
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SIGNS OF ACUTE ACETAMINOPHENPOISONINGNausea
VomitingConfusionLiver tenderness
HypotensionArrhythmiasJaundice
Acute hepatic and renal failure
NONSALICYLATES
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CONTRAINDICATIONS,PRECAUTIONS, ANDINTERACTIONS
Hypersensitivitychronic alcoholicsused cautiously during pregnancy andlactation.
Use with the barbiturates, hydantoins,isoniazid, and rifampin may increasethe toxic effects and possibly decrease
the therapeutic effects of
NONSALICYLATES
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NONNARCOTIC ANALGESICS
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have analgesic and antipyreticproperties.
exact mechanisms of actions are notknown, inhibiting prostaglandin (synthesis
by inhibiting the action of the enzymecyclooxygenase, the enzymeresponsible for prostaglandinsynthesis.
NONNARCOTIC ANALGESICS:
NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDS)
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Prostaglandins
sensitize pain receptors andincrease the pain associated withother chemical mediators such asbradykinin and histamine
act as pyrogens (fever-producingagents).
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The NSAIDs act to inhibit theactivity of two related enzymes:1. cycloo1xygenase-1 (COX-1)
helps to maintain the stomachlining; and2. cyclooxygenase-2 (COX-2)
that triggers pain andinflammation.
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newer NSAIDs (celecoxib androfecoxib) appear to work byspecifically inhibiting the COX-2enzyme, without inhibiting theCOX-1 enzyme.
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NONNARCOTIC ANALGESICS:
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USESOsteoarthritis , rheumatoid arthritis,and other musculoskeletal disorders
Mild to moderate pain reliefdysmenorrhea Fever reduction
NONNARCOTIC ANALGESICS:
NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDS)
NONNARCOTIC ANALGESICS:
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ADVERSE REACTIONSGastrointestinal tract
nausea, vomiting, diarrhea,constipation, epigastric pain,indigestion,abdominal distress ordiscomfort, intestinalulceration,stomatitis, jaundice,bloating, anorexia, and dry mouth
NONNARCOTIC ANALGESICS:
NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDS)
NONNARCOTIC ANALGESICS:
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ADVERSE REACTIONSCentral Nervous System
dizziness, anxiety,lightheadedness,vertigo,headache, drowsiness, insomnia,confusion, depression, andpsychic disturbances
NONNARCOTIC ANALGESICS:
NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDS)
NONNARCOTIC ANALGESICS:
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ADVERSE REACTIONS Cardiovascular
congestive heart failure, decrease orincrease in blood pressure, andcardiac arrhythmias
Renalhematuria, cystitis, elevated bloodurea nitrogen, polyuria, dysuria,oliguria, and acute renal failure in
those with impaired renal function
NONNARCOTIC ANALGESICS:
NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDS)
NONNARCOTIC ANALGESICS:
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ADVERSE REACTIONSSpecial sensesvisual disturbances,
blurred or diminished vision, diplopia,swollen or irritated eyes, photophobia,reversible loss of color vision, tinnitus,
taste change, and rhinitis
NONNARCOTIC ANALGESICS:
NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDS)
NONNARCOTIC ANALGESICS:
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CONTRAINDICATIONS,PRECAUTIONS, AND
INTERACTIONShypersensitivityused cautiously in patientswithbleeding disorders, renal disease,cardiovascular disease,or hepaticimpairment and in the elderly.
used with extreme caution durin
NONNARCOTIC ANALGESICS:
NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDS)
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COMMON ADVERSE REACTIONSOF SELECTED NSAIDs
Celecoxib
most common adverse reactions
dyspepsia, abdominal pain,
diarrhea, nausea, and headache.may compromise renal function.
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COMMON ADVERSE REACTIONS OF
SELECTED NSAIDsIbuprofen used in children with juvenile
arthritis and for fever reduction inchildren 6 months to 12 years.
Common adverse reactions seen
with ibuprofen include headache,dizziness, somnolence, nausea,dyspepsia, gastrointestinal pain, andrash.
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COMMON ADVERSE REACTIONS OFSELECTED NSAIDs
Naproxen
Common adverse reactions seenwith naproxen include headache,vertigo (dizziness), somnolence,
insomnia, nausea, dyspepsia,gastrointestinal pain, and rash.
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NSAIDs: NURSING IMPLICATIONSBefore beginning therapy, assess forconditions that may becontraindications to therapy,especially:
GI lesions or peptic ulcer disease
Bleeding disordersAssess also for conditions that requirecautious use.
Perform lab studies as indicated(cardiac, renal, liver studies, CDC,
latelet count).
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NSAIDs: NURSING IMPLICATIONS
Perform a medication history to assess
for potential drug interactions. Several serious drug interactions exist:
alcohol
heparin
phenytoin
oral anticoagulants
steroids
sulfonamides
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NSAIDs: NURSING IMPLICATIONSSalicylates are NOT to be given tochildren under age 12 because of therisk of Reyes syndrome.
Because these agents generallycause GI distress, they are oftenbetter tolerated if taken with food,milk or an antacid to avoid GIirritation.
Explain to patients that therapeuticeffects may not be seen for 3 to 4weeks.
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NSAIDs: NURSING IMPLICATIONS
educate patients about the variousside effects of NSAIDs, and to notifytheir physician if these effectsbecome severeor if bleeding or GI pain occur.
Patients should watch closely for theoccurrence of any unusual bleeding,such as in the stool.
Enteric-coated tablets should not becrushed or chewed.
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NSAIDs: NURSING IMPLICATIONSMonitor for therapeutic effects,which vary according to the
condition being treated:
decrease in swelling, pain,
stiffness, and tenderness of a jointor muscle area
N
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No Alcohol
SE BIRTH bone marrow depression,increased GI distress, Renal Toxicity, Tinnitusand Hepatotoxicity
Aspirin sensitivity do not give
Inhibits prostaglandins
Do take with food
Stop 5-7 days before surgery