NR 293 Exam 2 Drugs. Chamberlain College of Nursing.Drug Class:
NON-OPIOID ANALGESICS
generic name / (Trade name)
acetaminophen (Tylenol)
MOA:
•
... [Show More] Blocks peripheral pain impulses by inhibition of
prostaglandin synthesis.
• Lowers febrile temperatures by acting on
hypothalamus (heat is dissipated through
vasodilation and increased blood flow)
Indications:
• Mild to moderate pain and fever
• Appropriate alternative to aspirin
o Drug of choice for children with flu
syndromes because use of aspirin in
children results in Reye syndrome
• Shares analgesic / antipyretic effects of salicylates
and other NSAIDs, but does not have many of the
adverse effects of these drugs:
o CV effects (e.g., edema)
o Platelet effects (e.g., bleeding)
o GI irritation/ulceration/bleeding
o Aspirin-related acid-base changes
Adverse Effects:
• Hepatotoxicity (associated with excessive doses)
o Hepatic necrosis (acute overdose, or chronic
unintentional misuse)
• Rare, but severe:
o Nephrotoxicity
o Blood dyscrasias/disorders
Contraindications:
• Liver disease
• Chronic alcohol consumption
• G6PD deficiency
Drug Interactions:
• Alcohol and other hepatotoxic drugs:
o Phenytoin
o Barbiturates
o Warfarin
o Isoniazid & rifampin
o Beta blockers
o Anticholinergics
Nursing Implications:
• Monitor liver function (AST/ALT)
• Assess serum acetaminophen concentration level
(no sooner than 4 hours after ingestion)
Patient Teaching:
• Warn patients with regular intake of alcohol not to exceed recommended dosages because of increased risk for liver
dysfunction / liver failure
o Ideally, alcohol consumption > 3 drinks daily
Drug Profile:
• Acetylcysteine is the antidote for acetaminophen toxicity
o Effective when given within 10 hours of suspected overdose
o PO acetylcysteine is bad tasting with an odor of rotten eggs, and vomiting of PO dose is common (repeat
dose if vomiting occurs within 1 hour of dosing)
o IV form (Acetadote) is available and better tolerated
• Maximum daily dose 3000 mg daily, but maximum daily dose for chronic heavy alcohol abusers is 2000 mg
Drug Class:
NON-OPIOID ANALGESICS
generic name / (Trade name)
tramadol hydrochloride (Ultram)
MOA:
• Non-opioid analgesic with opioid-like activity
• Inhibits reuptake if both norepinephrine and
serotonin
• Rapidly absorbed and unaffected by food
• Metabolized in liver and eliminated renally
Indications:
• Treatment of moderate to moderately severe pain
Adverse Effects:
• Drowsiness, dizziness, h/a, nausea, constipation,
and respiratory depression
• Seizures
Contraindications:
• Drug allergy (may include allergy to opioids due to
cross-reactivity)
• Precaution in hepatically/renally impaired
• Respiratory disorders (e.g., asthma)
Drug Interactions:
• Increases risk for seizure
o Tricyclic antidepressants
o Selected serotonin reuptake inhibitors
(SSRIs)
o Monoamine oxidase inhibitors (MAOIs)
o Neuroleptics
o Other drugs that reduce seizure threshold
o St. John’s wort, chamomile, kava, and
valerian
Nursing Implications:
• Assess patient’s use of other medications, especially
CNS depressants and allergies
• Assess level of pain
• Monitor vital signs, especially respirations
• Assess liver and kidney functions
• Fall precautions
Patient Teaching:
• Avoid taking with St. John’s wort, chamomile, kava, and valerian – increases CNS depression
• Notify prescriber of use of other CNS depressant drugs or antiseizure drugs
• Change positions / rise slowly
• Call, don’t fall
• Increase fluids and fiber [Show Less]