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Drug Information Table: NSAIDs, Acetaminophen, Opioids, and Glucocorticoids, Study notes of Nursing

Manchester University (MU)Nursing

notes on various nursing topics

Typology: Study notes

2022/2023

Uploaded on 04/24/2023

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jayme-eaton 🇺🇸

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Drug Information Table
NSAIDs (COX-1 and COX-2 Inhibitors) – aspirin (ASA); ibuprofen (Advil, Motrin)
THERAPEUTIC USE • Inflammation suppression
• Analgesia for mild to moderate pain
• Fever reduction
• Dysmenorrhea
• Inhibition of platelet aggregation (aspirin)
ADVERSE DRUG
REACTIONS
• Gastric upset, heartburn, nausea, gastric ulceration
• Bleeding (less with non-aspirin NSAIDs)
• Kidney dysfunction
• Salicylism (aspirin)
• Reye’s syndrome (aspirin)
• Thromboembolic events (non-aspirin NSAIDs)
INTERVENTIONS • Monitor for signs of gastrointestinal bleeding (black or dark-colored stools, ab-
dominal pain, nausea, hematemesis).
• Test for and treat Helicobacter pylori infection prior to long-term therapy.
• For clients at high risk for gastric bleeding, recommend a proton pump inhibitor.
• Monitor for signs of bleeding (easy bruising, petechiae, excessive bleeding from
minor injuries).
• Monitor intake and output; watch for low urine output and fluid retention.
• Monitor for rapid rises in BUN and creatinine.
• Monitor for tinnitus, diaphoresis, headache, dizziness, and respiratory alkalosis.
Stop aspirin therapy for clients reporting these symptoms.
• Recommend acetaminophen (Tylenol) and not aspirin or NSAIDs for children and
adolescents under age 18 who have viral infections, particularly chickenpox and
influenza.
• Recommend non-aspirin NSAIDs for short periods and in low doses only.
• Recommend low-dose aspirin to prevent these events if prescribed by provider.
• Monitor for signs of myocardial infarction and cerebrovascular accident.
ADMINISTRATION • Make sure clients swallow enteric-coated or sustained-release forms whole and
do not crush or chew them.
• Discontinue 1 week before scheduled surgery.
• Monitor for initial and continued therapeutic effects.
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Drug Information Table

NSAIDs (COX-1 and COX-2 Inhibitors) – aspirin (ASA); ibuprofen (Advil, Motrin)

THERAPEUTIC USE •^ Inflammation suppression

  • Analgesia for mild to moderate pain
  • Fever reduction
  • Dysmenorrhea
  • Inhibition of platelet aggregation (aspirin) ADVERSE DRUG REACTIONS
  • Gastric upset, heartburn, nausea, gastric ulceration
  • Bleeding (less with non-aspirin NSAIDs)
  • Kidney dysfunction
  • Salicylism (aspirin)
  • Reye’s syndrome (aspirin)
  • Thromboembolic events (non-aspirin NSAIDs) INTERVENTIONS •^ Monitor for signs of gastrointestinal bleeding (black or dark-colored stools, ab- dominal pain, nausea, hematemesis).
  • Test for and treat Helicobacter pylori infection prior to long-term therapy.
  • For clients at high risk for gastric bleeding, recommend a proton pump inhibitor.
  • Monitor for signs of bleeding (easy bruising, petechiae, excessive bleeding from minor injuries).
  • Monitor intake and output; watch for low urine output and fluid retention.
  • Monitor for rapid rises in BUN and creatinine.
  • Monitor for tinnitus, diaphoresis, headache, dizziness, and respiratory alkalosis. Stop aspirin therapy for clients reporting these symptoms.
  • Recommend acetaminophen (Tylenol) and not aspirin or NSAIDs for children and adolescents under age 18 who have viral infections, particularly chickenpox and influenza.
  • Recommend non-aspirin NSAIDs for short periods and in low doses only.
  • Recommend low-dose aspirin to prevent these events if prescribed by provider.
  • Monitor for signs of myocardial infarction and cerebrovascular accident. ADMINISTRATION •^ Make sure clients swallow enteric-coated or sustained-release forms whole and do not crush or chew them.
  • Discontinue 1 week before scheduled surgery.
  • Monitor for initial and continued therapeutic effects.

CLIENT INSTRUCTIONS •^ Take with food, milk, or 8 oz of water to minimize gastrointestinal effects.

  • Avoid alcohol.
  • Report persistent gastric irritation and signs of bleeding.
  • Report any unusual or prolonged bleeding.
  • Report changes in urine output, weight gain, or signs of fluid retention such as edema or bloating.
  • Report ringing or buzzing in the ears, sweating, headache, and dizziness.
  • Stop taking aspirin if these symptoms develop.
  • Do not give aspirin or NSAIDs to children under age 19 who have viral infections, particularly chickenpox and influenza; use acetaminophen instead.
  • Report chest pain or heaviness, shortness of breath, sudden and severe headache, numbness, weakness, visual disturbances, or confusion.
  • Take low-dose aspirin once daily to reduce the risk of heart attack and stroke if prescribed.

CONTRAINDICATIONS •^ Teratogenic

  • Hypersensitivity to aspirin and other NSAIDS
  • Peptic ulcer disease
  • Bleeding disorders (hemophilia, vitamin K deficiency)
  • Children or adolescents with chickenpox or influenza (especially aspirin)
  • Perioperative use prior to coronary artery bypass grafting (non-aspirin NSAIDs)
  • Within 1 week of any elective surgery (aspirin)

PRECAUTIONS •^ Older adults

  • Cigarette smoking
  • Alcohol use disorder
  • Helicobacter pylori infection
  • Heart failure
  • Hypertension
  • Hypovolemia
  • Asthma
  • Chronic urticaria
  • Advanced kidney dysfunction

INTERACTIONS •^ Anticoagulants, glucocorticoids, and alcohol increase the risk of bleeding.

  • Ibuprofen decreases the antiplatelet effects of low-dose aspirin.
  • ACE inhibitors and angiotensin receptor blockers increase the risk of kidney failure.
  • Antihypertensive effects of ACE inhibitors decrease the risk of lithium carbonate (Lithobid) and methotrexate toxicity increases.

PRECAUTIONS •^ Alcohol use disorder

  • Heart failure
  • Diabetes mellitus
  • Hypertension
  • Asthma
  • History of gastrointestinal bleeding or peptic ulcer disease
  • Cardiovascular disease
  • Mild or moderate liver impairment
  • Renal insufficiency
  • Cerebrovascular accident

INTERACTIONS •^ Diuretic effects of furosemide (Lasix) decrease.

  • Fluconazole (Diflucan) increases celecoxib levels.
  • Anticoagulant effects of warfarin (Coumadin) increase.
  • Glucocorticoids and alcohol increase the risk of bleeding.
  • Antihypertensive effects of ACE inhibitors decrease.
  • Risk of lithium carbonate (Lithobid) toxicity increases.

Drug Information Table

Acetaminophen – acetaminophen (Tylenol)

THERAPEUTIC USE •^ Analgesia for mild to moderate pain

  • Fever reduction ADVERSE DRUG REACTIONS
  • Liver damage (overdose)
  • Hypertension (with daily use, particularly women) INTERVENTIONS •^ Monitor for early symptoms of overdose/poisoning (abdominal discomfort, nau- sea, vomiting, sweating, diarrhea); liver damage results in 48 to 72 hr following overdose.
  • Prepare to administer acetylcysteine (Mucomyst, Acetadote) orally or IV to coun- teract overdose and reduce liver injury.
  • Monitor blood pressure. ADMINISTRATION •^ Administer orally or rectally.
  • Caution clients that the drug is available in many combination products as well as many formulations; clients must read labels carefully to avoid overdose.
  • Do not administer more than 4 g/day (adults).
  • Infants and children should be given the manufacturer’s recommended dose based on their age. CLIENT INSTRUCTIONS •^ Do not exceed 4 g/day (adults).
  • Report any abdominal discomfort, nausea, vomiting, sweating, or diarrhea imme- diately.
  • Have blood pressure checked regularly. CONTRAINDICATIONS •^ Alcohol use disorder PRECAUTIONS •^ Anemia
  • Immunosuppression
  • Hepatic or kidney disease INTERACTIONS •^ Alcohol increases the risk of liver injury (with high doses of acetaminophen).
  • Warfarin (Coumadin) increases the risk of bleeding.
  • Cholestyramine (Questran) reduces absorption.

INTERACTIONS •^ Monoamine oxidase inhibitors (MAOIs) pose a risk for hypertensive crisis.

  • Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, MAOIs, and triptans pose a risk for serotonin syndrome.
  • Responses to CNS depressants increase.
  • Carbamazepine (Tegretol) decreases levels.
  • St. John’s wort increases sedative effects.

Drug Information Table

Opioid agonists – morphine

THERAPEUTIC USE •^ Analgesia for moderate to severe pain

  • Preoperative sedation and anxiety reduction
  • NOTE: For detailed information about fentanyl (Sublimaze), see the Neurological System 1 module. ADVERSE DRUG REACTIONS
  • Respiratory depression
  • Sedation, dizziness, lightheadedness, drowsiness
  • Constipation
  • Nausea, vomiting
  • Orthostatic hypotension
  • Urinary retention
  • Cough suppression
  • Potential for abuse along with tolerance and cross-tolerance with other opioids (larger doses required for usual effect) INTERVENTIONS •^ Monitor vital signs, pulse oximetry, lung sounds.
  • For respiratory rates below 12/min, withhold the drug and stimulate breathing.
  • Administer an opioid antagonist such as naloxone to restore respiratory rate.
  • Monitor clients when ambulating.
  • Monitor bowel function.
  • Administer fiber supplement and/or stool softeners.
  • Administer an antiemetic.
  • For vomiting, ensure adequate hydration.
  • Monitor blood pressure.
  • Monitor intake and output, watching for signs of urinary retention, such as blad- der distention.
  • Encourage clients to urinate every 4 hr.
  • Prepare to insert a urinary catheter to drain the bladder.
  • Auscultate lung sounds regularly.
  • Encourage clients (especially postoperatively) to cough frequently to prevent a buildup of respiratory secretions.
  • Have suction equipment available.
  • Recommend the lowest possible effective dose and short-term only.
  • Advise clients with physical dependence not to discontinue opioids abruptly; taper the dose over 3 days. ADMINISTRATION •^ Measure baseline vital signs before administration and monitor throughout therapy.
  • Administer orally, IM, IV, SC, rectally, or epidurally.
  • Make sure clients swallow sustained-release forms whole and do not crush or chew them.
  • Administer IV opioids slowly and with recommended dilution over 4 to 5 min; have naloxone and resuscitation equipment available.
  • Monitor PCA use and pump settings carefully.
  • Administer to clients with cancer on a fixed, around-the-clock dosing schedule, not PRN.

Drug Information Table

Opioid agonist-antagonists – butorphanol, pentazocine (Talwin, Talwin NX)

THERAPEUTIC USE •^ Analgesia for moderate to severe pain

  • Anesthesia adjunct ADVERSE DRUG REACTIONS
  • Respiratory depression (limited)
  • Sedation, dizziness, lightheadedness, drowsiness, headache
  • Nausea
  • Increased cardiac workload
  • Abstinence syndrome (hypertension, vomiting, cramping in opioid-dependent clients) INTERVENTIONS •^ Measure baseline vital signs.
  • Monitor respirations.
  • For respiratory rates below 12/min, withhold the drug and stimulate breathing.
  • Monitor clients when ambulating.
  • Consider alternative drug if nausea does not resolve.
  • Do not administer to clients with myocardial infarction or cardiac insufficiency.
  • Ask clients about opioid use before administration. ADMINISTRATION •^ Administer butorphanol IM, IV, or intranasally and pentazocine orally (in combina- tion with acetaminophen or naloxone), subcutaneously, IM, or IV.
  • Measure baseline vital signs before administration and monitor throughout ther- apy. Do not give the drug if the respirations are slower than 12/min.
  • Have naloxone and resuscitation equipment available.
  • For intranasal administration, give one spray and repeat every 60 to 90 min as needed.
  • For preoperative IM administration, give 60 to 90 min before surgery.
  • Monitor therapeutic effects.
  • Do not discontinue the drug abruptly. CLIENT INSTRUCTIONS •^ Use the drug only when needed and short-term.
  • Do not take prior to driving or activities requiring mental alertness.
  • Sit or lie down if feeling lightheaded.
  • Change positions gradually.
  • Lie down when feeling nauseated.
  • Do not use for anginal pain.
  • Do not take opioids while taking butorphanol. CONTRAINDICATIONS •^ Acute myocardial infarction
  • Opioid dependence PRECAUTIONS •^ Schedule IV controlled substance
  • History of substance abuse
  • Cardiac insufficiency
  • Reduced respiratory reserve
  • Head injury, increased intracranial pressure
  • Hypertension
  • Hepatic or kidney disease

INTERACTIONS •^ CNS depressants (barbiturates, phenobarbital, benzodiazepines, and alcohol) increase CNS depression and increase the risk of respiratory depression.

  • Opioid effects decrease.

Drug Information Table

Uricosurics/Antihyperuricemic – allopurinol (Zyloprim)

THERAPEUTIC USE •^ Hyperuricemia due to chronic tophaceous gout, cancer chemotherapy, and some blood dyscrasias ADVERSE DRUG REACTIONS

  • Hypersensitivity syndrome (fever, rash, eosinophilia, liver and kidney dysfunction)
  • Gastrointestinal disturbances (nausea, vomiting, diarrhea)
  • Drowsiness, headache, vertigo
  • Agranulocytosis, aplastic anemia, bone marrow depression
  • Metallic taste in the mouth
  • Cataracts (with drug therapy longer than 3 yr) INTERVENTIONS •^ Monitor for symptoms of hypersensitivity syndrome.
  • Stop drug therapy immediately for signs of hypersensitivity syndrome.
  • For vomiting, ensure adequate hydration.
  • Give after meals.
  • Monitor clients when ambulating.
  • Give mild analgesic for headache.
  • Monitor CBC.
  • Monitor for unusual taste sensations.
  • Recommend regular ophthalmologic examinations. ADMINISTRATION •^ Give orally or IV.
  • Monitor uric acid levels (initially, every 1 to 2 weeks to establish the appropriate dosage).
  • Obtain baseline CBC and test liver and kidney function before therapy and moni- tor periodically thereafter.
  • Allow crushing tablets and mixing them with food or fluid.
  • Administer IV using recommended dilution and infuse over 30 to 60 minutes
  • Make sure clients drink at least 3 L of fluid per day. CLIENT INSTRUCTIONS •^ Report fever, rash, abdominal pain, swelling, or low urine output immediately and stop taking the drug.
  • Take the drug with food.
  • Avoid driving or activities requiring mental alertness if drowsy.
  • Try over-the-counter analgesics as needed to relieve headache.
  • Report bleeding, easy bruising, or sore throat.
  • Suck on hard candy or chew gum to minimize unusual taste sensations.
  • Report blurred vision and/or loss of color acuity.
  • Minimize exposure of eyes to sunlight.
  • Obtain periodic eye examinations. CONTRAINDICATIONS •^ Hypersensitivity to allopurinol PRECAUTIONS •^ Bone marrow depression
  • Liver or kidney dysfunction
  • Peptic ulcer disease
  • Lower gastrointestinal tract disease

INTERACTIONS •^ Warfarin (Coumadin) requires lower dosages.

  • The risk of mercaptopurine (Purinethol), theophylline (Theolair), and azathioprine (Imuran) toxicity increases.
  • Ampicillin (Principen) increases the risk for rash.

CLIENT INSTRUCTIONS •^ Report increased stress, as higher dosages are required at such times.

  • Taper the dose before discontinuing it.
  • Report polyphagia, polydipsia, and polyuria.
  • Report muscle pain or weakness.
  • Avoid taking NSAIDs.
  • Take the drug with food or meals.
  • Report indigestion or bloody vomitus as well as black, tarry stools.
  • Report signs of infection, such as a sore throat.
  • Report weight gain or edema (hypernatremia).
  • Report weakness (hypokalemia).
  • Understand that long-term therapy may cause some changes in fat distribution throughout the body.
  • Take the drug on alternate days for long-term therapy.
  • Perform weight-bearing exercise daily.
  • Consume adequate calcium and vitamin D.
  • Report blurred vision and loss of color acuity.
  • Minimize exposure of eyes to sunlight.
  • Obtain periodic eye examinations.

CONTRAINDICATIONS •^ Recent live virus immunization

  • Systemic fungal infection
  • Cataracts

PRECAUTIONS •^ Heart failure

  • Peptic ulcer disease
  • Diabetes mellitus
  • Hypertension
  • Kidney dysfunction
  • Myasthenia gravis
  • Osteoporosis

INTERACTIONS •^ Potassium-depleting diuretics, such as furosemide (Lasix), increase risk of hypoka- lemia.

  • The risk of digoxin-induced dysrhythmias increases with digoxin.
  • NSAIDs increase risk of gastrointestinal bleeding and ulceration.
  • Effects of insulin and oral hypoglycemics decrease in clients who have diabetes.
  • Prednisone prevents the body from responding to vaccines
  • Live vaccine administration increases risk for decreased antibody response and increased risk of adverse effects