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    Ppt chapter014 Ppt chapter014 Presentation Transcript

    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical Pharmacology Chapter 14- Nonopioid Analgesics: Salicylates and Nonsalicylates
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment • Nursing role in providing contraceptive care: – Need to take patient’s report of pain seriously – Understand patient’s pain level – Teach patient to rate pain 0-10 – Fifth vital sign: Accurate assessment necessary for effective pain management
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates • Drugs derived from salicyclic acid – Useful in pain management due to analgesic, antipyretic, and anti- inflammatory effects
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates: Actions and Uses • Lowers body temperature • Inhibit production of prostaglandins • Aspirin: Inhibits prostaglandin synthesis and has greater anti-inflammatory effects; prolongs bleeding time • Used for: Mild to moderate pain; reduce elevated body temperature; treating inflammatory conditions; decreasing risk of myocardial infarction; reduces risk of transient ischemic attacks
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates: Adverse Reactions • Gastrointestinal (GI) reactions: – Gastric upset; heartburn; nausea; vomiting; anorexia; GI bleeding; allergy – Significant blood loss – Allergy to salicylates manifested by: •Hives, rash, angioedema, bronchospasm, anaphylactoid reactions
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates: Contraindications and Precautions • Contraindicated in clients with: – Known hypersensitivity; bleeding disorders; children with chickenpox, influenza • Used cautiously in clients: – With hepatic and/or renal disease; during pregnancy and lactation; pre-existing hypoprothrombinemia; vitamin K deficiency; GI irritation peptic ulcer; mild diabetes or gout
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Salicylates: Interactions Interactant drug Effect of interaction Anticoagulant Increased risk for bleeding NSAIDs Increased serum levels of the NSAID Activated charcoal Decreased absorption of the salicylates Antacids Decreased effects of the salicylates Carbonic anhydrase inhibitors Increased risk for salicylism
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonsalicylates: Actions and Uses • Actions: – Analgesic and antipyretic activity: Same as salicylates – No anti-inflammatory action • Uses: – Used to treat mild to moderate pain; reduce elevated body temperature; manage pain and discomfort - arthritic disorders
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonsalicylates: Action and Uses • Useful for people: – With aspirin allergy; bleeding disorders; receiving anticoagulant therapy; who had recent minor surgical procedures
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonsalicylates: Adverse Reactions • Adverse reactions: Skin eruptions; urticaria; hemolytic anemia; pancytopenia; hypoglycemia; jaundice; hepatotoxicity; hepatic failure • Overdose: Causes acute acetaminophen poisoning or toxicity
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonsalicylates: Contraindications and Precautions • Contraindication in patients with Hypersensitivity • Used cautiously in patients: – With severe or recurrent pain or high or continued fever – Acetaminophen used cautiously during pregnancy and lactation
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonsalicylates: Interactions Interactant drug Effect of interaction Barbiturates Increased possibility of toxicity and decreased effect of acetaminophen Hydantoins Increased possibility of toxicity and decreased effect of acetaminophen Isoniazid and rifampin Increased possibility of toxicity and decreased effect of acetaminophen Loop diuretics Decreased effectiveness of the diuretic
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment • Preadministration assessment: – Assess: Type, onset, intensity, location of pain – Evaluate: Ability to carry out activities of daily living – Develop a care plan – Evaluate the response to drug therapy
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment (cont’d) • Ongoing assessment: – Monitor relief of pain; reassess pain rating 30-60 minutes following administration of the drug; monitor vital signs at least every 4 hours – Assess and document - Severity, location, and intensity of pain – Report any adverse reactions
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Nursing Diagnosis and Planning • Impaired comfort; chronic or acute pain; impaired physical mobility; disturbed sensory perception • Expected outcome: – Optimal response to therapy; relief from pain and fever; management of adverse drug reactions; understanding and compliance with the prescribed treatment regimen
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy: – Avoid salicylates 1 week before or after any surgery – Observe for adverse drug reactions – Observe for signs of salicylism
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): – Symptoms associated with salicylates: •Levels greater than 150mcg: Result in mild salicylism •Levels greater than 250mcg: Result in symptoms of mild salicylism •Levels greater then 400mcg: Result in respiratory alkalosis; hemorrhage
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): – Administer acetaminophen with full glass of water; with meals or empty stomach – Symptoms of overdosage: Nausea; vomiting; diaphoresis; generalized malaise – Acute overdosage treated with acetylcysteine to prevent liver damage
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs: – Impaired comfort: •Check temperature before and 45-60 minutes after administration •Suppository form of drug used: Check after 30 minutes for retention of suppository •Notify PHCP if temperature not controlled
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): – Pain: •Notify PHCP if no relief from pain or discomfort •Check cause of new pain experienced; report to PHCP other therapy may be needed •Check the color of the stools
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): – Impaired physical mobility •Acute pain or long standing mild to moderate pain •Determine degree of immobility •Assist with ambulation
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): – Disturbed sensory perception: Auditory •Assess patient: For tinnitus or impaired hearing •Withhold drug and report any sensory alterations immediately if suspected •Explain: Hearing loss disappears when the drug therapy is discontinued
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family: – Develop a teaching plan that includes: •Take the drug exactly as prescribed by the primary health care provider •Take the drug with food or a full glass of water •Do not consistently use an OTC nonopioid analgesic to treat chronic pain
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family (cont’d): – Do not use these drugs on regular basis unless PHCP notified – Teaching on salicylates include: •Salicylates deteriorate rapidly when exposed to air, moisture, and heat •Consult pharmacist about the product’s ingredients if in doubt
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family (cont’d): •Discontinue use 1 week before surgery or dental procedure – Teaching on acetaminophen include: •Acetaminophen lacks anti-inflammatory properties of aspirin •Notify primary health care provider if any adverse reactions occur •Avoid use of alcoholic beverages
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Evaluation • Relief from Pain; body temperature normal • Adverse reactions are identified, reported, and managed • Patient verbalizes the importance of complying with the prescribed treatment regimen • Patient demonstrates understanding of prescribed treatment regimen and adverse effects
    • Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation