Pain Meds

Question 1

Acetaminophen (Tylenol)

Answer 1

Route: Oral

Indications: mild pain, fever

Contradictions: previous hypersensitivity, severe hepatic impairment/acute liver disease

Side effects: nausea, vomiting, diarrhea, constipation, anxiety

Adverse reactions: hepatoxicity, renal failure, cardiac damage, toxic epidermal necrosis, rash

RN considerations: OTC and prescriptions contains acetaminophen–be aware when calculating daily dose.
Reduce total daily dose & increase dosing intervals for patients with hepatic/renal impairment

Teachings: take drug EXACTLY as directed. Do not exceed recommended amount.
consult doctor if fever lasts over 3 days
stop use and tell healthcare provider if rash occurs

Question 2

Acetylsalicyclic acid

Answer 2

Route: Oral

Indications: Mild pain, fever, inflammatory disorders, prophylaxis for M.I

Contradictions: Hypersensitivity to aspirin, cross-sensitivity with NSAIDs, bleeding disorders

Side effects: nausea, vomiting, dyspepsia (indigestion), epigastric distress, abdominal pain

Adverse reactions: GI bleeding, hypersensitivity reactions (anaphylaxis), tinnitus

RN considerations:
For inflammatory conditions–give scheduled doses,
Monitor patient for hypersensitivity reactions,
Monitor salicylate levels–severe toxic levels >400mcg/mL

Teachings: Take with food or water to reduce GI reactions, and sit upright for 15-30 minutues.
Avoid the use of alcohol
Consult healthcare provider if tinnitus occurs
Consult doctor if fever lasts >3 days

Question 3

Ibuprofen (Advil)

Answer 3

Route: Oral

Indications: pain, inflammation, reduces fever

Contradictions: hypersensitivity, active GI bleeding/ulcer disease, severe heart falure

Side effects: nausea, vomiting, constipation, abdominal discomfort

Adverse reactions: heart failure, M.I, stroke, GI bleeding

RN considerations:
assess pain before and 1-2 hrs after admin
assess for S/S GI bleeding & skin rashes

Teachings: Take drug exactly as directed & do not exceed recommended amount
May cause drowsiness–avoid driving
Avoid drinking alcohol

Question 4

Oxycodone

Answer 4

Route: Oral

Indications: moderate to severe pain

Contradictions: hypersensitivity, respiratory depression, acute/several bronchial asthma

Side effects: nausea, vomiting, constipation, confusion, sedation

Adverse reactions: respiratory depression, orthostatic hypertension, blurred vision

RN considerations:
Assess BP, pulse, & RR before and periodically during administration
Assess risk for opioid addiction, abuse, or misuse before administration

Teachings: Instruct patient on how and when to ask for/take pain meds
Advise patient that this drug is known to be abused–protect from theft
May cause drowsiness–avoid driving

Question 5

Fentanyl patch

Answer 5

Route: Topical

Indications: moderate to severe chronic pain

Contradictions: hypersensitivity, acute/mild/intermittent/post op pain, resp. depression, acute/severe bronchial asthma

Side effects: nausea, vomiting, constipation, confusion, drowsiness

Adverse reactions: apnea, respiratory depression, bradycardia, hypotension, adrenal insufficiency

RN considerations:
Monitor ECG continuously & BP&RR frequently during administration
Assess risk for opioid addictions use, or misuse prior to administration
Assess bowel function routinely

Teachings:
Instruct how and when to ask for and take pain medication
Instruct correct method for application and disposal of patch
Avoid grapefruit juice

Question 6

Lidocaine patch

Answer 6

Route: Topical

Indications: pain due to post-op neuralgia

Contradictions: hypersensitivity, 3rd degree heart block, wolf-Parkinson-white syndrome

Side effects: nausea, vomiting, confusion, drowsiness

Adverse reactions: seizure, cardiac arrest

RN considerations: Monitor ECG continuously & BP&RR frequently during administration
Monitor for pain intensity periodically during therapy

Teachings:
May cause drowsiness–avoid driving
Explain purpose of lidocaine to patient
Avoid contact with water bc patch may not stick