NURS 1950
Pharmacology
Nancy Pares, RN, MSN
Metro Community College
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 Pain
is:
 Pain
tolerance is:
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 Objective
2: Identify the factors
which affect the individual’s
response to pain
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4
 What
are the assessments?
 What
is included in a pain history?
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 Objective
drugs
4: Describe scheduled
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 Schedule
abuse
I: high potential for
◦ No accepted medical use in US
 Schedule
II:
◦ high potential for abuse
◦ Opiate analgesics
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 Schedule
III: lower potential for
abuse than schedule II.
◦ Tylenol with codeine
 Schedule
IV: lower potential for
abuse than schedule III.
◦ Librium, Valium
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 Schedule
abuse
V: lowest potential for
◦ Usually antidiarrheal and antitussive
◦ Lomotil
◦ Robitussin A-C
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 What
are analgesics?
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 Bind
CNS
to opiate receptors in the
◦ This inhibits transmission of pain
impulse and alters pain perception
◦ Also produce euphoria
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 Some
are opioid agonists
◦ What is an agonist?
 Some
are agonist-antagonists
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 Side
effects of opioids
◦ N/V
◦ Constipation
◦ Respiratory depression
◦ Dependence
◦ Tolerance
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 When
the opioids are
discontinued:
◦ Sweating, restlessness, diarrhea
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 Signs
and symptoms of overdose
◦ Respirations under 12/minute
◦ Pin-point pupils
◦ Coma
 What drug can be used to reverse
these effects?
 Why does it work?
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 Objective
7: Compare the many
effects of morphine sulfate (MS)
and meperidine (Demerol)
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
MS
◦ Oral
◦ Subc
◦ IV
◦ IM
◦ Rectal
◦ Sublingual
◦ “mother” of all
narcotics

Demerol
◦ Oral
◦ Subc
◦ IV
◦ IM
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MS
 5-20 mg dose q
4 hr
 10-60 min
onset
 Longer duration
of action than
Demerol


Demerol
◦ 50-100 mg q 34 hr
◦ 10-45 min onset
◦ Shorter duration
of action than
MS
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 Assessment
of pain
 Assessment of respirations
 MS can be used in cancer pain
 Meperidine (Demerol) metabolite
is normeperidine: causes
hallucinations
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
What narcotic agents have you given?
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 Many
narcotic agents available
 Given by every route
 Some are only in oral form
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 Some
narcotic analgesics are
◦ Hydrocodone + acetaminophen
(Vicodin)
◦ Fentanyl (Duragesic)
◦ Oxycodone + ASA (Percodan)
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A
client is receiving MSContin q
12 hr-30 mg
 At the next dose time, there is
break through pain.
 Can the client also have the MSIR
dose?
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

Narcotics work in the CNS and affect the
nociceptors (nerve endings) and the
neurotransmitter pathways of pain
transmission
Acetaminophen, ASA, and the NSAIDs work in
the periphery and interfere with
prostaglandins
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


Nonopioid drugs are also readily available
(OTC) and inexpensive
Are antipyretic and ASA and some NSAIDs
have antiplatelet activity
No tolerance or dependence is caused as is
the case with opiates
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 Double
lock
 Sign out
 Use non-drug interventions
 Assess pain
 Give meds before pain severe
 Don’t under treat pain
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 Objective
11describe the use of
salicylates
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 Peripherally
acting
 Interfere with synthesis of
prostaglandins
◦ What are prostaglandins?
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 Acetylsalicylic
acid (aspirin, ASA)
used over 100 years
 Analgesic
 Antipyretic
 Anti-inflammatory
 Antiplatelet
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 What
◦ As
◦ As
◦ As
◦ As
are the doses for ASA?
analgesic
anti-inflammatory
antipyretic
antiplatelet
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 Contraindicated
if: on
anticoagulants
 if gastric ulcer
 pregnancy
 children with viral infections
 Hypersensitive—teach client to
read OTC labels
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 Client
must take adequate fluids
 If GI upset, take with food or
antacid
◦ Options: buffered
◦
enteric coated
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 What
does it mean when the label
says the ASA is buffered?
 What does enteric coating mean?
◦ Can EC drugs be crushed or chewed?
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



ASA can cause false + for glycosuria
SE: tinnitus and vertigo with high doses
Store ASA in closed, child proof container
Overdose needs prompt treatment
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 Objective
13: identify the signs of
salicylate poisoning
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
Acetaminophen (Tylenol)
◦ Nonopioid analgesic
◦ Antipyretic
◦ Available as a liquid
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 Disadvantage
of Tylenol:
◦ Hepatotoxicity (over 4 gm/day)
◦ Nephrotoxicity
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 Objective
15: list some nonnarcotic analgesics
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




Buprenophine HCl (Buprenex)
Butophanol tartrate (Stadol)
Pentazocine HCl (Talwin)
Ibuprofen (Motrin)
Naproxin (Aleve)
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 If
your client is taking Percocet
and also has Tylenol ordered,
what precautions will you take?
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 Objective
16: identify some
nonsteroidal anti-inflammatory
agents
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 Nonsteroidal
antiinflammatory agents modify
inflammation response
◦ Inhibit prostaglandin synthesis
◦ Includes Aspirin as well as
Motrin, Aleve, indomethacin
(Indocin), oxaprozin ( Daypro),
ketoralac (Toradol)
 Toradol only one given IM, IV
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 New
NSAIDs are the COX-2
inhibitors
 Vioxx off the market 2004
 Celecoxib (Celebrex) and its
cousin Bextra under review
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 Advantage
of COX-2 inhibitors:
◦ Less GI bleeding than other NSAIDs
◦ Once a day or BID dosing

Disadvantages:
◦ Can’t use if allergic
◦ expensive
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
Gouty arthritis:
◦ caused by uric acid crystals
◦ Deposit in joints and subq tissue
◦ Treat ASAP when acute attack occurs
◦ Treat acute attack with colchicine
 IV, oral
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
think it prevents migration of granulocytes to
inflamed area so no lactic acid released
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 Adverse
effects of colchicine
◦ N/V
◦ Diarrhea
◦ GI bleeding
◦ Neuritis
◦ Myopathy
◦ Alopecia
◦ Bone marrow depression
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 NSAIDs
may be used for
inflammation, pain and fever
 Two other types of drugs used for
gout
◦ Uricosurics increase excretion of uric
acid
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 Adverse
effects:
◦ kidney stones can develop
 Examples:
probenecid (Benemid)
and sulfinpyrazone (Anturane)
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With Benemid keep urine alkaline
 No ASA
 Anturane works like Benemid but also
affects clotting time
◦ Can cause GI bleeding, skin rash and
blood dyscrasias

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
Allopurinol (Zyloprim) prevents
formation of uric acid
◦ Usually 300 mg dose 1x daily
◦ Can be given with colchicine or a
NSAID
◦ SE of allopurinol: skin rash,
hepatotoxicity
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 Assessment
 Nursing
diagnoses
◦ Pain
◦ Chronic pain
◦ Risk for injury
◦ Deficient knowledge
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 Goals
◦ Pain to be controlled
◦ Chronic pain will be controlled
◦ Demonstrate a proactive approach
to pain management
◦ No injury from pain management
◦ Verbalize knowledge
◦ Implement plan
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






Use pain-relieving measures
Pain history
Be proactive
Don’t under treat
Record pain relief
Assess respirations
Assess nausea, vomiting and decreasing BP
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 Acetaminophen:
no substitute for
ASA
 If allergic to ASA, avoid some
NSAIDs
 Indomethacin: ulcerogenic,
aggravate epilepsy, psychiatric
disorders
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Nursing
for anti-gout
medications
 Assess those on colchicine
 Start colchicine at first sign
 Avoid those things that aggravate
gout:
High-fat diet, purine-rich foods,
thiazide diuretics, liver extracts,
nicotinic acid, penicillin, cancer
chemotherapeutic agents, levodopa,
ethambutol, egotamine
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