Pharmacologic Profile

General Use

Used to control mild to moderate pain and/or fever. Phenazopyridine is used only to treat urinary tract pain, and capsaicin is used topically for a variety of painful syndromes.

General Action and Information

Most nonopioid analgesics inhibit prostaglandin synthesis peripherally for analgesic effect and centrally for antipyretic effect.

Contraindications

Hypersensitivity and cross-sensitivity among NSAIDs may occur.

Precautions

Use cautiously in patients with severe hepatic or renal disease, chronic alcohol use/abuse, or malnutrition.

Interactions

Long-term use of acetaminophen with NSAIDs may ↑ the risk of adverse renal effects. Prolonged high-dose acetaminophen may ↑ the risk of bleeding with warfarin. Hepatotoxicity may be additive with other hepatotoxic agents, including alcohol. NSAIDs ↑ the risk of bleeding with warfarin, thrombolytic agents, antiplatelet agents, some cephalosporins, and valproate (effect is greatest with aspirin). NSAIDs may also ↓ the effectiveness of diuretics and antihypertensives.

Nursing Implications

Assessment

• Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at an ↑ risk for developing hypersensitivity reactions.
• Assess pain and limitation of movement; note type, location, and intensity prior to and at the peak (see Time/Action Profile) following administration.
• Assess fever and note associated signs (diaphoresis, tachycardia, malaise, chills).
• Hepatic, hematologic, and renal function should be evaluated periodically throughout prolonged high-dose therapy. Aspirin and most NSAIDs prolong bleeding time due to suppressed platelet aggregation and, in large doses, may cause prolonged prothrombin time. Monitor hematocrit periodically in prolonged high-dose therapy to assess for GI blood loss.

Potential Nursing Diagnoses

• Acute pain (Indications)
• Risk for imbalanced body temperature (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Administer salicylates and NSAIDs after meals or with food to minimize gastric irritation.

Patient/Family Teaching

• Instruct patient to take salicylates and NSAIDs with a full glass of water and to remain in an upright position for 15–30 min after administration.
• Adults should not take acetaminophen longer than 10 days and children not longer than 5 days unless directed by health care professional. Short-term doses of acetaminophen with salicylates or NSAIDs should not exceed the recommended daily dose of either drug alone.
• Caution patient to avoid concurrent use of alcohol with this medication to minimize possible gastric irritation; 3 or more glasses of alcohol per day may ↑ the risk of GI bleeding with salicylates or NSAIDs. Caution patient to avoid taking acetaminophen, salicylates, or NSAIDs concurrently for more than a few days, unless directed by health care professional to prevent analgesic nephropathy.
• Advise patients on long-term therapy to inform health care professional of medication regimen prior to surgery. Aspirin, salicylates, and NSAIDs may need to be withheld prior to surgery.

Evaluation/Desired Outcomes

• Relief of mild to moderate discomfort.
• Reduction of fever.