(see Table 8.14. Equianalgesic Dosing for Opioid Analgesics - Table 8-14 for Equianalgesic Dosing)
| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Acetaminophen (Tylenol, Datril, Panadol)—PO 325–650 mg q4h | Simple fever or pain | Analgesic and antipyretic actions; no anti-inflammatory or anticoagulant effects | No remarkable side effects when taken for a short period |
| NURSING IMPLICATIONS: Consult with physician if no relief after 4 days of therapy | |||
| Aspirin (acetylsalicylic acid)—PO or rectal 0.3–0.6 gm Ecotrin (enteric-coated aspirin)—PO 81–325 mg | Minor aches and pains; fever from colds and influenza; rheumatoid arthritis; anticoagulant therapy | Selectively depresses subcortical levels of CNS | Erosive gastritis with bleeding; coryza, urticaria; nausea, vomiting; tinnitus, impaired hearing, and respiratory alkalosis |
 NURSING IMPLICATIONS: Administer with food or after meals ; observe for nasal, oral, or subcutaneous bleeding; push fluids; check hematocrit (Hct), hemoglobin (Hgb), prothrombin times frequently; avoid use in children with flu; do not take ecotrin with milk or dairy | |||
| Butorphanol (Stadol)—IM 1–2 mg; IV 0.5–2 mg | Obstetric use: Control pain, especially during labor. Avoid in clients who are opioid addicted. | 30–40 times more potent than meperidine; onset: 2–15 min; duration; 0.5–2 hr | No excessive sedation. Neonatal respiratory depression less than with meperidine. Pseudo-sinusoidal FHR pattern after administration. |
| NURSING IMPLICATIONS: Care must be taken that drug is not given with meperidine, as it may potentiate effects of meperidine; avoid in clients who are opioid addicted | |||
| Celecoxib (Celebrex)—PO 100–200 mg twice daily or 200 mg daily | Arthritis; acute pain; dysmenorrhea | NSAID, anti-inflammatory, analgesic, antipyretic; inhibits prostaglandin synthesis | Back pain; peripheral edema; diarrhea; dizziness; rash, rhinitis |
| NURSING IMPLICATIONS: Monitor for signs of fluid retention and edema; report promptly unexplained weight gain, rash | |||
| Codeine—PO, IM, Subcu 15–60 mg (gr ¼ to 1) | Control pain; may be used during the puerperium | Nonsynthetic narcotic analgesic | Of little use during labor; allergic response; constipation; GI upset |
| NURSING IMPLICATIONS: Note response to the medication; less respiratory depression; preferred for client with head injury | |||
| Etodolac (Lodine)—PO 400–1,200 mg/day, 300–400 q6–8h | Management of osteoarthritis; mild to moderate pain | Inhibits prostaglandin synthesis; suppression of inflammation and pain (NSAID) | Dyspepsia; asthma; drowsiness, dizziness; rash, tinnitus, anaphylaxis |
| NURSING IMPLICATIONS: Give 30 min before or 2 hr after meals for rapid effect; may be taken with food to decrease GI irritation | |||
| Fentanyl transdermal (Duragesic)—25–100 mcg/hr | Chronic pain; not recommended for postoperative pain Obstetric use: Short-acting pain control during labor | Binds to opiate receptors in the CNS to alter response to and perception of pain | Drowsiness, confusion, weakness; constipation, dry mouth, nausea, vomiting, anorexia; sweating |
| NURSING IMPLICATIONS: Apply to upper torso, flat, nonirritated surface; when applying, hold firmly with palm of hand 10–20 sec | |||
| Hydrocodone/Acetaminophen (Vicodin)—PO 5–10 mg q4–6h | Moderate to severe pain Obstetric use: in postpartum to control pain | Bind to opiate receptors in CNS; alter perception of and response to painful stimuli | Confusion, sedation, hypotension, constipation |
| NURSING IMPLICATIONS: Assess: type, location, and intensity of pain before and 1 hr (peak) after giving; prolonged use may lead to physical and psychological dependence; give with food or milk to reduce GI irritation | |||
| Hydromorphone (Dilaudid)—PO 2–4 mg q3–6h; IM 1–2 mg q3–6h up to 2–4 mg q4–6h; IV 0.5–1.0 mg q3h | Moderate to severe pain; antitussive | Binds to opiate receptors in the CNS; alters perception and response to pain | Sedation, confusion, hypotension, constipation |
| NURSING IMPLICATIONS: Give PO with food or milk; give IV 2 mg over 3–5 min; fluids, bulk , and laxatives to minimize constipation | |||
| Ibuprofen (Motrin)—PO 300–800 mg 3–4 times/day (not to exceed 3,200 mg/day) | Nonsteroid anti-inflammatory, antirheumatic used in chronic arthritis pain Obstetric use: uterine cramping postpartum (not used during pregnancy) | Inhibition of prostaglandin synthesis or release | GI upset, leukopenia; sodium/water retention |
| NURSING IMPLICATIONS: Give on empty stomach for best result; may mix with food if GI upset severe; teach caution when using other medications | |||
| Indomethacin (Indocin)—PO 25 mg 3–4 times/day; increase to max. 200 mg daily in divided doses | Rheumatoid arthritis; bursitis; gouty arthritis Closure of patent ductus arteriosus (PDA) in premature infants and some newborn | Antipyretic/anti-inflammatory action; inhibits prostaglandin biosynthesis | GI distress, bleeding; rash; headache; blood dyscrasias; corneal changes |
| NURSING IMPLICATIONS: Monitor GI side effects; administer after meals for best effect or with food, milk, or antacids if GI symptoms severe | |||
| Ketorolac (Toradol)—PO, IV 10 mg q4–6h; IM 30–60 mg initially, then 15–30 mg q6h; ophthalmic 1 gtt 4 times daily for 1 wk | Short-term management of pain; ocular itching due to allergies (NSAID) | Inhibits prostaglandin synthesis, producing peripherally mediated analgesia; antipyretic/anti-inflammatory | Drowsiness, dizziness, dyspnea; prolonged bleeding time; dyspepsia |
| NURSING IMPLICATIONS: May be given routinely or prn; advise dentist or physician before any procedure | |||
| Meperidine HCl (Demerol)—PO, IM 50–100 mg q3–4h | Pain due to trauma or surgery; allay apprehension before surgery | Acts on CNS to produce analgesia, sedation, euphoria, and respiratory depression | Palpitations, bradycardia, hypotension; nausea, vomiting; syncope, sweating, tremors, convulsions |
| NURSING IMPLICATIONS: Check respiratory rate and depth before giving drug; give IM, because subcutaneous administration is painful and can cause local irritation | |||
| Obstetric use: maternal relaxation may either slow labor or speed up labor | Acts as a uterine irritant; depresses CNS, maternal and fetal; allays apprehension; PO peak action 1–2 hr; IM peak action first hour | Maternal side effects same as above; also can depress fetus | |
| NURSING IMPLICATIONS: Monitor maternal vital signs, contractions, progress of labor, and response to drug; fetal heart rate; if delivery occurs during peak action, prepare to give narcotic antagonist to mother or neonate or both | |||
| Morphine SO4—PO 10–30 mg (Roxanol, MS Contin); Subcu 8–15 mg; IV 4–10 mg; rectal 10–20 mg | Control pain and relieve fear, apprehension, restlessness, as in pulmonary edema | Depresses CNS reception of pain and ability to interpret stimuli; depresses respiratory center in medulla | Nausea, vomiting; flushing; confusion; urticaria; depressed rate and depth of respirations, decreased blood pressure |
| NURSING IMPLICATIONS: Check rate and depth of respirations before administering drug; observe for gas pains and abdominal distention; smaller doses for aged; monitor vital signs; observe for postural hypotension | |||
| Obstetric use: preeclampsia, eclampsia; uterine dysfunction; pain relief | Increases cerebral blood flow; provides antihypertensive action; CNS depressant | Respiratory and circulatory depression in mother and neonate; may depress contractions | |
| NURSING IMPLICATIONS: Observe for level of sedation, respirations, arousability, and deep tendon reflex; give narcotic antagonist as necessary; check I&O (urinary retention possible) | |||
| Nalbuphine (Nubain)—IV 1 mg at 6- to 10-min intervals | Obstetric use: pain relief during labor. Avoid in clients who are opioid addicted. | Onset: 2–15 min; duration 1–4 hr | Increased sedation and limited ceiling effect; ceiling effect for neonatal respiratory depression |
| NURSING IMPLICATIONS: Less nausea and vomiting and sedation if given with patient-controlled analgesia (PCA). Prophylactic nalbuphine seems unable to prevent pruritus | |||
| Naproxen (Naprosyn)—PO 250–500 mg twice daily | Mild to moderate pain; dysmenorrhea; rheumatoid arthritis; osteoarthritis (NSAID) | Inhibits prostaglandin synthesis; suppression of inflammation | Headache, drowsiness, dizziness, nausea, dyspepsia, constipation, bleeding |
| NURSING IMPLICATIONS: Take with a full glass of water; avoid exposure to sun | |||
| Oxycodone HCl (OxyContin)—PO 3–20 mg; Subcu 5 mg | Postpartum use: control pain; may be used during puerperium; 5–6 times more potent than codeine | Less potent and addicting than morphine; for moderate pain—episiotomy and “afterpains”; peak action 1 hr | See Morphine SO4 |
| NURSING IMPLICATIONS: Administer per order and observe for effect | |||
| Pentazocine (Talwin)—PO 50–100 mg; IM 30–60 mg q3–4h | Relief of moderate to severe pain | Narcotic antagonist, opioid antagonist properties, equivalent to codeine | Respiratory depression, nausea, vomiting, dizziness, light-headedness, seizures |
| NURSING IMPLICATIONS: Monitor respirations, BP; caution with client with myocardial infarction (MI), head injuries, chronic obstructive pulmonary disease (COPD) | |||