Class: Analgesics/Non-Opioid; Antipyretic

Agent(s) Common Uses Contraindications Route Onset of Action Interactions

Acetaminophen Anti-fever drug of choice Liver disease or PO PO: ½ to 1 hr Increased hepatoxicity with
(Tylenol) (DOC) for children and alcohol consumption alcohol
adolescents. Mild to Hypothrombinemia if taken
Warfarin Rectal Rectal: ½ to 1 hr with warfarin
moderate pain, or fever.
Primary alternative to Caution in pregnancy and
NSAIDs breastfeeding
Decreases the effects of
barbiturates

Mechanism of Action
May block pain impulses peripherally and increasing the pain threshold. This causes the body to require a higher degree of pain before the
client feels it. Antipyretic action results from inhibition of prostaglandins in the CNS (Hypothalamic heat regulating center).

Advantages/Disadvantages
Side Effects Adverse Effects

Easy to administer and obtain under many Drowsiness or stimulation, rash Hepatotoxicity (nausea, upper stomach pain,
brand names. Few side effects. or urticaria itching, loss of appetite, dark urine, clay
colored stools or jaundice), GI bleeding,
leukopenia, neutropenia, thrombocytopenia

Nursing Interventions Client Education

Hepatotoxic in large doses. Do not exceed recommended dosage to prevent toxicity.

Monitor renal function: BUN, urine creatinine, occult blood Do not use with alcohol or herbal medication without
Acetaminophen inhibits warfarin metabolism, which can cause warfarin to physician approval.
accumulate to toxic levels. Notify physician if pain and fever last more than 3 days.
Monitor hepatic function tests, ALT, AST, and bilirubin Teach signs and symptoms of Hepatotoxicity (nausea,
Treat overdose with IV or oral N-acetylcysteine (Acetadote), or inhaled or upper stomach pain, itching, loss of appetite, dark urine,
oral acetylcysteine (Mucomyst) clay colored stools or jaundice)

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: NSAID
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Ketorolac (Toradol) MIld to Pregnancy Intranasal Increase toxicity with
Ibuprofen (Advil, moderate pain Hypersensitivity PO 30-60 minutes methotrexate, lithium.
Motrin), Naproxen Asthma IM 30 minutes Increase bleeding risk with
anticoagulants, salicylates,
sodium (Anaprox, Hepatic disease IV 10 minutes
thrombolytics, SSRIs.
Aleve), Meloxicam Peptic ulcer disease Increase renal impairment with
(Mobic) ACE inhibitors.

Mechanism of Action

Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis. Anti-inflammatory, antipyretic effects.

Advantages/Disadvantages
Side Effects Adverse Effects

Dizziness Drowsiness Seizures

Tremors Headache MI
Tinnitus Blurred vision Stroke
Nausea/vomiting Anorexia GI bleeding
Diarrhea Constipation Hepatic failure
Flatulence Cramps Nephrotoxicity
Dry mouth Hematuria
Angioedema

Nursing Interventions Client Education

IM injection deeply and slowly in large muscle mass. Report blurred vision, tinnitus as toxicity may occurring
Monitor for signs of bleeding. Avoid driving, other hazardous activities if dizziness/drowsiness occurs
Monitor for hepatic dysfunction Avoid alcohol, salicylates, other NSAIDS
Discard nasal bottle within 24 hours of opening.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Opioids
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Hydromorphone Moderate to severe GI obstruction PO Varies Increases effect with
(Dilaudid), Morphine pain. May mask IM 15-30 min alcohol, tranquilizers,
Cancer pain antidepressants, kava
sulfate, Oxycodone, Gallbladder pain. IV Rapid
Morphine: DOC - MI
Hydrocodone, Fentanyl kava, St. John’s wort.
(Duragesic), Tramadol
(Ultram)

Mechanism of Action

Binds with the opiate receptor in the central nervous system. Suppresses pain impulses as well as respiration and coughing by
acting on the respiratory and cough centers of the medulla of the brainstem.
Advantages/Disadvantages
Side Effects Adverse Effects

Gold standard for cancer pain. Constipation Respiratory depression

There is no ceiling on the dose of an opioid Sleepiness Orthostatic hypotension
for a cancer client. It is client dependent. Nausea/Vomiting Increased intracranial pressure
May need larger doses to relieve increasing Itching
pain to overcome drug tolerance. But the Confusion
medication is not withheld with cancer pain. Anorexia

Nursing Interventions Client Education

Administer before pain reaches its peak to maximize effectiveness. Do not crush extended release tablets.
Monitor vital signs for signs of hypotension and respiratory depression. Drink 8-10 (8 ounce) glasses of fluid each day.
I&O Eat foods high in fiber or roughage.
Check bowel sounds for decreased peristalsis.
Have naloxone (Narcan) available for overdose.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Salicylate - Mild Analgesic
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Acetylsalicylic Acid Platelet aggregation Sensitivity PO 30 minutes Do not take with
(Aspirin) to reduce risk of MI, GI Bleeding other NSAIDS as it will
strokes. decrease blood level and
Vitamin K deficiency Rectal Rectal - erratic
Mild to moderate effectiveness of NSAID.
pain relief, especially Cerebral hemorrhage
Coumadin taken with ASA
associated with will increase anticoagulant
inflammation. levels.

Mechanism of Action

Keeps the blood flowing because the platelets don’t stick together, so more blood flow and oxygen get to the heart muscle. This
leads to less pain. Inhibits prostaglandins to decrease inflammation and pain.
Advantages/Disadvantages
Side Effects Adverse Effects

Inexpensive, readily available. GI distress GI bleeding

Indicated in initial treatment for clients Ulcer
suffering from acute ischemic stroke who
are not candidates for fibrinolytic therapy

Nursing Interventions Client Education

Administer chewable tablet 160-325 mg orally at onset of chest pain Take with food, milk or water to decrease GI upset.
for quick absorption. Enteric coated can decrease gastric distress.
Observe for signs of bleeding Do not crush enteric coated tablets.
Do not give to children with the flu or virus.
Do not take with alcohol.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis