Analgesics: Non-Narcotic

Question 1

Ibuprofen (Motrin, Advil)

Onset: 30-60 minutes
Peak effects: 1-2 hours
Duration: 6-8 hours
Half-life: 2-4 hours

MOA: An NSAID that has analgesic, anti-inflammatory, and antipyretic properties. Is considered a peripherally acting analgesic

Answer 1

Class: NSAID

Action: anti-inflammatory, analgesic, anti-pyretic

Indications: mild to moderate pain, fever

Contraindications: known hypersensitivity

Precautions: GI irritation and hemorrhage can result from NSAID therapy. Long-term usage increases the incidence of serious GI side effects. Ibuprofen is cleared through the kidneys, and long-term use can result in renal impairment

Side effects: edema, HTN, rash, itching, nausea, heartburn, constipation, diarrhea, drowsiness, dizziness, wheezing

Route: PO

Adult dose: 200-800 mg/dose

Peds dose: 5-10 mg/kg/dose every 6 hours

Question 2

Ketorolac (Toradol)

Onset: 30 minutes
Peak effects: 45-60 min
Duration: varies
Half-life: 4-6 hours

MOA: An NSAID that has analgesic, anti-inflammatory, and antipyretic effects. Considered a peripherally acting analgesic

Answer 2

Class: NSAID

Action: anti-inflammatory, analgesic, antipyretic

Indications: mild to moderate pain

Contraindications: known hypersensitivity

Precautions: GI irritation and hemorrhage can result from therapy with NSAIDs. Long-term usage increases the incidence of serious GI side effects. Ketorolac is cleared through the kidneys. Long-term usage can result in renal impairment. Use caution in pt’s with renal insufficiency

Side effects: edema, HTN, rash, itching, nausea, heartburn, constipation, diarrhea, GI hemorrhage, drowsiness, dizziness, wheezing

Interactions: IM ketorolac has been found to reduce the diuretic response to furosemide

Route: IM, IV

Adult dose: IM- 30-60 mg
IV- 15-30 mg

Peds: 0.5 mg/kg/dose max dose of 30 mg

Question 3

Acetaminophen, Paracetamol (Tylenol)

Onset: 15-30 minutes
Peak effects: 30-120 minutes
Duration: 3-4 hours
Half-life: 1-3 hours

MOA: inhibits the enzyme cyclooxygenase. Has analgesic and antipyretic properties

Answer 3

Class: aniline analgesic and antipyretic

Action: analgesic and antipyretic

Indications: mild to moderate pain, fever

Contraindications: known hypersensitivity, pts with liver disease

Precautions: is metabolized by the liver, and overdoses can be toxic to the liver. Is the most common cause of acute liver failure

Side effects: minimal within recommended dose

Interactions: chronic alcohol can increase the hepatotoxicity of acetaminophen

Route: PO, IV

Adult dose: PO- 325-650 mg every 4-6 hours
IV- 650-1,000 mg

Peds dose: PO- 10-15 mg/kg every 4-6 hours
IV- 12.5 mg/kg for children ages 2-12

Question 4

Nitrous Oxide (Nitronox)

Onset: 2-5 minutes
Peak effects: 2-5 minutes
Duration :2-5 minutes
Half-life: unknown

MOA: A CNS depressant with analgesic properties. In prehospital setting, it is delivered in a fixed mixture of 50% nitrous oxide and 50% oxygen. It MUST be self-administered.

Answer 4

Class: Analgesic and anesthetic gas

Action: CNS depressant with analgesic properties

Indications: pain of musculoskeletal origin, particularly fractures; burns; suspected ischemic chest pain; states of severe anxiety, including hyperventilation

Contraindications: AMS, head injury, COPD, thoracic injury suspected of pneumothorax, severe abdominal pain and distension suggestive of bowel obstruction

Side effects: dizziness, light-headedness, AMS, hallucinations, N/V

Interactions: can potentiate the effects of other CNS depressants such as narcotics, sedatives, hypnotics, and alcohol

Dose: self-administered