U

C
C Anti-inflammatories
analgesics
 Analgesics
It is a drug which relieves pain without loss of consciousness
Pain has become known as the “fifth vital sign”
Types of Pain
Acute Sudden; short duration; from trauma injury, inflammation, surgeyr
Chronic Pain persist in 3 months or more
Cancer Pain occurs from pressure on nerves and organs, blockages to blood supply
or metastasis to bone
Somatic Pain in skeletal; muscles, joints and ligaments
Superfic Pain form surface areas such as skin and mucus membrane
ial
Vascular Pain occurs from vascular or peripheral tissues contributing to headaches,
migraine
Visceral Pain from smooth muscle and organs
 Anti-inflammatories(nonopioid analgesics)
Inhibit biosynthesis of prostaglandin and are
called prostaglandin inhibitor. They inhibit
inflammatory process and therefore called anti-
inflammatory
Relieve pain ( analgesic), reduce elevated body
temp.(antipyretic), inhibit platelet aggregation
(anti coagulant)
Aspirin: the oldest and the first analgesic used.
Classification #1: non steroidal anti-inflammatory drugs
These drugs have potent anti inflammatory effects
that mimic the effects of corticosteroids(cortisone),
they are not chemically related to corticosteroids and
therefore called NSAIDs
Indications: conditions where pain and inflammation
are present, fever, thrombosis
Contraindication: Peptic ulcer or stomach bleeding,
uncontrolled hypertension, kidney disease,
Inflammatory bowel disease
 7 groups of NSAIDS’s
1. Salicylates
2. Para-chlorobenzoic acid derivatives or indoles
3. Phenylacetic acids- diclofenac sodium
4. Propionic acid derivatives
5. Fenamates
6. Oxicams
7. Selective COX-2 inhibitors
 Nonsteroidal

Diflunisal (salicylates) For mild to moderate pain, osteoarthritis, and rheumatoid arthritis. May cause rash,
headache, nausea, diarrhea, dyspepsia, Gi bleeding, perforation and elevated
hepatic enzyme
Olsalazine sodium For ulcerative colitis, may cause headache. Arthralgia, nausea, diarrhea, dyspepsia
(salicylate derivatives)
Indomethacin For mild to severe pain, acute gout, tendinitis, ankylosing spondylitis and arthritis.
(para-chlorobenzoic May cause constipation, headache, nausea, dyspepsia, hyperkalemia and
acid) hyponatremia
Diclofenac sodium For mild to severe pain, rheumatoid arthritis, osteoarthritis, and spondylitis. May
(Phenylacetic acid) cause anemia, lacrimation, ocular hypertension, xeropthalmia, blurred vision,
keratitis, dermatitis, dyspepsia, flatulence and GI bleeding/perforation
Naproxen (Propionic For mild to moderate, osteoarthritis and rheumatoid arthritis, gout, bursitis, and
Acid) dysmenorrhea. May cause drowsiness, dizziness, flatulence, constipation,
flatulence, tinnitus, infection, edema
Ketorolac (propionic For short term pain management(5days of less)may cause dyspepsia, abdominal
acid) pain, constipation, flatulence, diaphoresis, injection site reaction. Ocular edema
Nefenamic acid For mild to moderate pain, osteoarthritis, and rheumatoid arthritis. May cause
(anthranilic acids) dizziness, headache, rash flatulence and pyrosis.
Celecoxib ( Second gen. For rheumatoid arthritis, osteoarthritis, relieve dysmenorrhea, ankylosing
NSAIDs COX-2- spondylitis. May cause sinusitis, pharyngitis, anorexia, dyspepsia, flatulence,
inhibitors) flatulence, constipation, infection, arthralgia
 ASPIRIN
C Anti-inflammatory, antipyretic, analgesic, anti-
platelet aggregate
Type: salicylates
H Treatment of fever, inflammation, pain
E Best taken in full stomach
C Tinnitus indicates toxicity
Avoid over the counter drug remedies
May cause bronchospasm
K Asses the patient for bleeding tendencies
Induce vomiting if overdose occurs
 IBUPROFEN
C Non-opioid analgesic, treatment of rheumatoid arthritis,
osteoarthritis
H Relief from pain
E Best taken with meals
C Adverse effect: GI bleeding, blood dyscrasia
Report: ringing/roaring in the ears which indicate toxicity;
manifestation of kidney damage like changes in urinary
pattern, increase wt., edema, increased in joint pains, fever,
blood in the urine(bleeding)
Use sunscreen to prevent photosensitivity
K Avoid concurrent use with aspirin, piroxicam(feldene),
NSAIDs and alcohol which may precipitate bleeding
 Piroxicam (Feldene)
C NSAID’s, anti rheumatic
H Decreased pain, stiffness and joint inflammation
E Best taken with food to decrease GI upset. To increase
absorption, take it at the same time each day
C Side effects: drowsiness, headache
Signs of toxicity: blurred vision, ringing in the ears,
nephrotoxicity
K Full therapeutic effects may take up to 1 month
Avoid drugs that may increase bleeding like aspirin and
coumadine
Do not break crush or chew capsules
Drink 6-8 glasses of water per day
 Classification #2: paracetamol
Indications: mild to moderate pain (if combined
with opioid) and fever
Contraindication: Severe hepatic impairment
Acetaminophen (Tylenol)
C Analgesic, antipyretic
H Relief from pain
E Take with food if GI upset is noted
C Can cause hepatotoxicity
K Keep antidote acetylcysteine at the bedside
Assess for allergy
 Tylenol with codeine
C Analgesic; used to treat headache in a patient
taking heparin
H Relief from pain
E Administer as directed
C Hard stools are common side effect
K Assess the patient’s elimination pattern
 Classification #3: OPIOIDS
Indications: severe pain, cough, diarrhea and constipation
Contraindications: severe respiratory instability, acute psychiatric
instability or uncontrolled suicide risk
Codeine phosphate
C Anti-tussive, narcotic-antagonist, analgesic
H Relief from pain
E Administer as directed; given to lactating women 4-6 hours before feeding to
minimize drug levels in the breastmilk
C It can cause constipation
Avoid driving
K Use laxative to counteract constipation
Raise side rails, it may cause drowsiness
Has minimal effect on respiratory function, so it is the best analgesic for
patient with head injuries
Contraindicated to patients with pancreatitis
 Meperidine HCL (Demerol)
C Narcotic analgesic; used to relieve pain form
nephrolithiasis
H Relief from pain
E Administer as directed
C Avoid activities that require alertness
Avoid alcohol, it may cause facial flushing
K Keep antidote, naloxone HCL at the bedside
 Phenazopyridine HCL (pyridium)
C Urinary analgesic
H Relief from pain

E upset
Best taken with meals to decrease GI

C urine orange or red

Inform patient that the durg makes he

K Assess for jaundice

 Morphine sulfate
C Narcotic agonist, analgesic, it is given to decrease anxiety in a
patient with pulmonary edema; it promotes venous pooling of
blood in the pheripheral blood vessels, so it decreases venous
return to the heart
H Relief from pain
E Best taken with food
C Avoid driving
Report severe nausea and vomiting
K Keep antidote naloxone hydrochloride at the bedside
Instruct the patient to lay down during Iv administration
Morphine was thought to cause more pain in pancreatitis because
it was believed to increase spasm of the sphincter of Oddi,
however recent evidence suggest otherwise
 Opioids: opium and synthetics
Generic Uses and consideration
Oxycodone For moderate to sever pain. Avoid taking in a long period of time. May cause
HCl drowsiness, blurred vision, dry mouth, weakness, euphoria, edema and urinary
retention
Fentanyl For moderate to sever pain and anesthesia induction and maintenance. May cause
drowsiness, euphoria, headache, confusion, weakness, hypokalemia, rash and
tolerance
Meperidine For moderate to severe pain and sedation induction and maintenance. May cause
euphoria weakness, visual disturbance, dry mouth, orthostatic hypotension, urinary
retention and respiratory depression
Methadone For moderate to severe pain, opiate agonist dependence and withdrawal. May cause
blurred vision, euphoria, orthostatic hypotension, edema, constipation, urinary
retention and respiratory depression
Hydromorphon For moderate to severe pain. May cause headache, dyspepsia, nausea, vomiting,
e bitartrate constipation, dyspnea, dehydration, edema, flushing, infection. Taper off
discontinuation
 opioid agonist antagonist
Medications in which an opioid antagonist is added to an opioid
agonist, maybe used to decrease substance use disorder.
Nalbuphine For moderate to severe pain, and for anesthesia
HCL induction and maintenance. May cause diaphoresis,
erectile dysfunction, bradycardia, dyspnea,
hypo/hypertension
Sufentanil For acute pain when alternative treatment options are
inadequate. May cause nausea, vomiting, chest wall
rigidity, dizziness, HPN
Butophanol For moderate to sever pain and anesthesia induction and
tartrate maintenance. May cause insomnia, nasal congestion,
nausea, vomiting, tolerance
 Opioids antagonist
This are antidotes for drug toxicity of natural and synthetic
analgesics.
It blocks the receptor and displaces any opioids that would
normally be at the receptor which inhibits the opioid action
Naloxone HCL For opioid overdose and opioid induced respiratory
depression. May cause flushing, agitation, confusion dizziness,
tachycardia, headache, hyperhidrosis, bleeding, dyspnea
Naltrexone HCl For opioid agonist and alcohol dependence. May cause headache
insomnia, anxiety, anorexia, diarrhea, abdominal pain, bleeding,
constipation, weakness
Lofexidine For opioid withdrawal, May cause bradycardia, dizziness,
drowsiness, orthostatic hypotension, dry mouth, nausea, vomiting
tinnitus, bleeding sweating and withdrawal
 Drugs to treat severe migraine headaches
Dihydroergotamin For migraine and cluster headache. May cause
e mesylate ( ergot drowsiness, dizziness, rhinitis, pharyngitis,
alkaloids) paresthesia,
Sumatriptan For migraines and cluster headaches. May cause
( Selective headache, blurred vision, paresthesia, flushing,
Serotonin Receptor myalgia, hyperhidrosis, pruritus, skin discoloration
Agonist)
Zolmitriptan For migraines, May cause dizziness, paresthesia,
headache, dry mouth, hyperesthesia and weakness.
Erenumab ( Gene- For migraine prophylaxis. May cause antibody
Related Peptide) formation, injection site reaction, erythema, rash,
urticaria and pruritus
Fremanezumab For migraine prophylaxis. May cause antibody
formation, injection sire reaction, erythema, rash,
urticaria and pruritus