Generic Name: naloxone
Brand name: NarCan
Classification: opioid antagonist; RR <8 or sedation level -4 or -5
Dosage/Route:
Dosage/Route prescribed to client:
Rate of administration with IV meds:
.4 mg; may repeat q 2-3 min. some
.1 mg IVstat; may repeat q 3-5 min x Follow Order Set; generally:
patients may require up to 2 mg.
3 doses to a total of .4 mg
Administer 2.5 mL (.1 mg) longer than 1
Dilute 1 vial of naloxone (.4 mg/mL
min,
in 9 mL of NS)
If needed administer another 2.5 mL
.4 mg/10 ML of fluid, want to give
over 1 min,
2.5 mL of fluid per dose
Repeat.
Is dose within recommended
DO NOT BOLUS; should be given over
ranges?
course of time and attempt to arouse pt
YES
Major Side effects: Ventricular arrhythmias, hypertension/hypotension, pain, n/v
Data used to indicate medication is effective: improved respiratory function
Medication administration concerns:
Monitor resp rate, rhythm, depth, pulse, ECG, BP and LOC frequently for 3-4 hr after expected peak; assess for pain
after administration; assess for s/sx of opioid withdrawl
Patient/client teaching points: Explain purpose ; explain shorter halflife than opioid so probably will require multiple
dosing; explain will completely prevent pain relief and will induce previous pain
Generic Name: morphine
Brand name:
Classification: opioid agonist; Schedule II, binds to opiate receptors in CNS, depresses CNS and alters
perception of pain stimuli
Major Side effects:
-CNS: confusion, sedation, dizziness, dysphoria, eupohoria, floating, hallucinations, HA, unusual dreams
-EENT: blurred vision, diplopia, miosis -RESP: respiratory depression
-CV: hypotension, bradycardia -GI: constipation, N/V -GU: urinary retention -DERM: flushing, itching
-physio/psychological dependence, tolerance
Data used to indicate medication is effective: pain evaluation (pain maintained at 6/10 or decreased)
Medication administration concerns: Breakthrough pain, changes in LOC, BP, pulse, and respirations,
change in bowel function
Patient/client teaching points:
Caution patient that medication may affect LOC or result in dizziness/drowsiness, and tell them to call for
help when ambulating to bathroom
Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to
getting out of bed
Tell patient to rotate in bed Q2 hrs (or call for assistance to rotate) to prevent atelectasis
Equianalgesic Comparison of Pure Narcotics
Drug Name
Description
 100 x stronger than
fentanyl
morphine
(Sublimaze, Actiq)

INCREASING ANALGESIC STRENGTH 
diacetylmorphine
(heroine)
oxycodone
(Percodan/
Percocet)
morphine
hydrocodone
(Vicodin)
methadone
meperidine
(Demerol)





Schedule II
10x more potent than
codeine
Oxycodone: ER
Used in combo w/ ASA
or Tylenol
Prototype









codeine
Can be used PCA or
Actiq lollipop
More lipid soluble; illegal
in US (Schedule I)



Schedule II
Used as
analgesic/antitutssive
Common outpt
LONGEST DURATION
Used for detox or
maintanence (more mild
withdrawl)
o Tolerance, less of
a buzz
Same potency with less
duration
No antitussive properties
Given to stop shivers Post
Op
Given pain control for
allergy to Morphine
Schedule II/III
1/10th potency of morphine
(5x than ASA /tylnol)
Some ppl have genetic
block inhibiting them to
metabolize to MS
Generic Name: hydrocodone/acetominophen
Brand name: Vicodin
Classification: combination: opioid agonist/nonopioid analgesic combinations; schedule II (III in
combination)
Why is patient/client receiving this? Management of moderate to severe pain, antitussive; binds to
receptors in CNS, alters perception of and response to painful stimuli
Dosage/Route: PO: 2.5-10 mg q 3-6 hrs, in combination products acetaminophen should not exceed 4
g/day and should not exceed 5 tablets/day of ibuprofen Availability: 5mg hydrocodone/500 mg
acetaminophen
Major Side effects:
CNS: elevated ICP, seizures, periph neuropathy -CV: torsade de pointes, qt interval prolongation
-GI:, hepatotoxicity, pseudomembranous colitis, n/v -Endo: hyperglycemia/hypoglycemia
hypersensitivity incl
Medication administration concerns: -use with extreme caution in patients taking MAOI’s (produce severe,
unpredictable rxns) - assess bp, pulse and respirations, if respiratory is below 10, assess level of sedation
-assess bowel function -assess pain: prolonged use may lead to physical and psychological dependence and
tolerance
Patient/client teaching points: explain therapeutic value to enhance analgesic effect, -instruct pt how and
when to ask for and take pain meds -notify if pain control is not sufficien t
tramadol (Ultram)
Centrally acting analgesic; opioid-like analgesic; schedule IV
Why is pt receiving this? Moderate to moderately severe pain, synthetic analgesic that acts at
mu receptor
Dose IR: PO given either rapid (50-100 mg q 4-6 hrs) or gradual titration (25 mg/day initially
increase by 25 mg q 3 days to reach 25 mg qid, eventually 50 mg qid)
ER: 100 mg q daily, may titrate up to 300 mg/day if not receiving IR
SE dizziness, sedation, HA, constipation, seizures (rare), LESS RESP DEPRESSION, serotonin
syndrome, physical/psychological dependence
Med admin assess pain before and 2-3 hr following admin, assess bp and rr, not meant for pts
w/ opioid dependence, assess previous analgesic hx (i.e. allergies), administered w/out regard to
meals ; incr risk of seizures w/ abx and MAOIs, addative CNS depression
Pt education Explain purpose of med, how to ask for pain meds, dizziness/drowsiness (driving,
fall risk), turn/cough/deep breath q 2 hrs to prevent atelectasis, notify for adverse s/sx
NSAIDS
(antiinflamatory/analgesic)
1st generation inhibit Cox1
and Cox2


Acetamiinophen
(antipyretic/analgesic)
2nd generation inhibit Cox 2
(thought to be safer)
COX 1 “GOOD”: found in all tissues, mediates “housekeeping”
o Synthesizes prostaglandins to protect gastric mucosa, promote renal blood flow
o Promotes platelet aggregation
o Synthesizes prostacyclin-> vasodilation
o Inhibition results in: bleeding, renal impairment, gastric ulceration BUT prevents clots
COX 2 “BAD”: synthesized at site of tissue injury, also found in brain, blood vessels, kidney, and colon
o Mediates inflammation, sensitizes receptors to painful stimuli, vasodilation, contribute to
colon CA
o Inhibition results in: suppression of inflammation/pain/fever, protection against colonCA BUT
impairs renal function and promotes MI/stroke
ASPIRIN
Classification: salicylates
Major Side effects:
-EENT: tinnitus -GI: bleeding, dyspepsia, epigastric distress, nausea, abd pain, anorexia,
hepatotoxicity-Hemat: anemia, hemolysis-Derm: rash, urticarial
-Allergic rxns incl. anaphylaxis and laryngeal edema
Data used to indicate medication is effective: resolution of pain/fever
Medication administration concerns:
-may increase risk of bleeding with warfarin, heparin and thrombolytic
-Ibuprofen may negate cardioprotective antiplatelet effects of aspirin
-may increase activity of sulfonamides
-increased risk of GI irritation with NSAIDS
Patient/client teaching points: Pt to alert nurse for adverse rxns
NSAIDS and types of pain
 NSAIDS and muscle pain (strain or contusion):
o No benefit greater than placebo
o MAY actually delay healing; many sports medicine professionals use only for
short duration (24-48 hrs)
 NSAIDS and ligament injury
o Limited and mixed results
o May be beneficial if promotes mobility
o Unsure if healing benefit from anti-inflammatory or analgesic properties
 NSAIDS and Bone
o Marked association between NSAIDS and non-union/delayed healing



Acetaminophen: Liver
ASA: GI bleed and kidneys
Ibuprofen: renal and liver
ketorolac (Toradol)
NSAID, nonopioid analgesic
st
Why is pt receiving this? 1 parenteral NSAID : strong analgesia w/ minimal anti-inflammatory ,
short term mgmt. of pain (not to exceed 5 days total). Inhibits prostaglandin synthesis producing
peripherally mediated analgesia.
Dose PO (only intended to supplement parenteral therapy): 20 mg initially followed by 10 mg q
4-6 hrs (renal impairment adjustment needed)
IM: single dose: 60 mg, multiple dosing 30 mg q 6 hrs ; availability 15 mg/mL
IV: single dose: 30 mg, multiple dosing 30 mg q 6 hr (not to exceed 120 mg/day)
Administer undiluted: [15-30 mg/mL], administer over at least 15 sec
SE Stroke, drowsiness, abnormal thinking, dizziness, asthma, dyspnea, MI, edema, GI bleeding,
oliguria, renal toxicity, SJS, TENS, prolonged bleeding time, injection site pain, paresthesia,
anaphylaxis
Med admin Minimal anti-inflammatory. Administering greater dose increases SE w/ no
increased benefit, duration of therapy of all routes should not exceed 5 days, should always
initially be given IM/IV. Probenecide increases levels. Lithium toxicity. May decrease
effectiveness if used w/ other NSAIDS.
Pt education Dizziness (fall risk precautions), take as directed, avoid use w/ ETOH, ASA,
acetaminophen, adverse s/sx
celecoxib (Celebrex)
NSAID, 2nd generation COX Inhibitor (COX2 inhibitor)
Why is pt receiving this? relief of osteoarthritis, RA, mgmt. of acute pain incl. dysmenorrhea.
Inhibits COX 2 (“the bad cox”) which results in less ulcerogenic SE but does not provide
beneficial platelet aggregation.
Dose PO: chronic conditions typically 200 mg/day; acute pain: 400 mg initially then 200 mg
additionally PRN first day, then 200 mg twice daily
SE dizziness, HA, insomnia, MI, STROKE, THROMBOSIS, edema, GI Bleeding, exfoliative
dermatitis, SJS, TENS
Med admin May decrease effectiveness of ACE inhibitors, thiazide diuretics, and furosemide,
lithium toxicity. Use w/ 1st generation nullifies benefits of 2nd generation selectivity. Assess pts
for allergy to SULFONAMIDEs, ASA, or NSAIDS, assess for skin rash. Administered w/out regard
to meals, capsules may be opened.
Pt education Take as directed, notify if signs of GI toxicity or other s/sx occur
dronabinol (Marinol)
Schedule I
 Level of evidence weak: may not work for RA, hyperalgesia
o May have some neuroprotective quality: slow progression of Alzheimer’s
 LUNG INJURY is irreversible even after abstainence, so SMOKING NEVER RECCOMENDED
 Adverse effects in youth
 Nursing responsibilities
o Decrease opioid use
o Assess for CV Risks (may cause MI even w/ no risk factors;)
o Professionalism/communication
o ONLY USE FDA Approved formulations
Generic Name: acetaminophen
Brand name: Tylenol
Classification: analgesic, antipyretic
Dosage/Route: 325-650 mg PO q6hrs OR 1 g PO tid or qid OR 1300 mg q8hrs (So as not to exceed
3g/24 hrs)
1000 mg IV q6hrs OR 650 mg IV q4hrs (not to exceed 1000 mg/dose, 4g/day, and less than 4hr
dosing interval)
Rate of administration with IV meds: Intermittent infusion: infuse over 15 min IV diluents
compatible with IV medication: N/A
Major Side effects: -CNS (IV): agitation, anxiety -CV (IV)): hypotension or hypertension
-GI: hepatotoxicity -GU: renal failure with chronic use -DERM: rash -HEMAT: neutropenia,
pancytopenia -MS (IV): muscle spasms
Data used to indicate medication is effective: pain evaluation (pain maintained at 6/10 or
decreased), temperature via temporal artery (fever reduced to < or equal to 38.5 C)
Medication administration concerns: Hepatotoxicity with chronic acetaminophen or alcohol use
Patient/client teaching points: During medication reconciliation, confirm no use of OTC
medications as can increase hepatotoxic effects
acetylcysteine (Mucomyst)
Therapeutic antidote
Why is pt receiving this? PO: antidote for mgmt. of potentially hepatotoxic overdose of
acetaminophen
Dose PO: 140 mg/kg initially followed by 70 mg/kg q 4 hr for 17 additional doses; can also be
given IV: loading odse 150 mg/kg over 60 min followed by maintanence dose 50 mg/kg over 4
hrs then second maintanence dose 100 mg/kg over 16 hr
Dilute in D5W to concentrations varying based on dose and on pt wt
SE drowsiness, vasodilation, tachycardia, rhinorrhea, bronchospasm, chest tigntess, n/v,
stomatitis, rash, allergic rxns
Med admin activated charcoal may absorb Mucomyst and decrease effectiveness. IV most
effective if administered within 8 hrs of OD; assess severity of ingestion, plasma levels, Assess
for anaphyalaxis w/ IV, monitor cardiac/renal function, serum glucose and electrolytes. AVOID
contact w/ metals/rubbers. Dilute 20% PO w/ cola, water or juice.
Pt education Explain medication purpose
Nitrous oxide
 Used often in dental procedures
 100% excretion through lungs
 High analgesia at low []’s
Inhalation anesthetic
Halothane (-ane)
Volatile liquids (mixed w/ O2)
propofol (Diprivan)
General anesthetic HIGH ALERT
Why is pt receiving this? Induction of general anesthesia, maintanence of balanced anesthesia
when used with other agents. Initiation/maintanence of monitored anesthesia care (MAC)
sedation of intubated patients in ICU. Short acting hypnotic w/ unkown MOA
Given IV
SE propofonol infusion syndrome, discoloration of urine (green), bradycardia, hypotension,
dizziness, apnea, burning/tingling at IV site
Med admin Works less than 60 sec, lasts about 5 min. Addative CNS depression. Assess RR pulse
and BO continouolsy Frequently casues apnea lasting >60 s. Monitor for infusion syndrome
(metabolic acidosis, hyperkalemia, lipemia, rhabdo, hepatomegaly, cardiac/renal failure). Assess
allergy to egss/soybeans