DRUGS USED IN PAIN MANAGEMENT

General Anesthetics
Prototype :
a. Inhalation anesthetics
- enflurane (Ethrane), halothane
- isoflurane (Forane), nitrous oxide
b. Injection anesthetics
- fentanyl (Sublimaze), ketamine (Ketalar),
thiopental Na (Penthotal), etomidate (Amidate)
Mechanism of actions :
- cause CNS depression, by producing loss of consciousness, unresponsiveness to pain
stimuli, and muscle relaxation.
Nursing considerations :
1. Instruct client NPO for 8 hours before administration.
2. Monitor cardio pulmonary depression and hypotension.
3. Monitor urinary retention.
4. Monitor body temperature
- malignant hyperthermic crisis :
dantrolene (antidote)
5. Avoid alcohol or CNS depressants for 24 hours after anesthesia.
6. In patient who received halothane, monitor signs of hepatic fatal side effects :
- rash, fever, nausea, vomiting
- jaundice and altered liver function.



Local and Topical Anesthetic
Prototype :
local : bupivacaine, lidocaine, tetracaine, procaine, mepivacaine, prilocaine
topical : benzocaine, butacaine, dibucaine,lignocaine
Mechanism of action :
- block transmission of impulses across nerve cell membrane.
Adverse effects :
- cardiac dysrhythmias
Nursing considerations :
- lignocaine + prilocaine (EMLA cream) should be applied topically 60 minutes before
procedure.
- administer cautiously to the areas of large broken skin.
- observe for fetal bradycardia in pregnant clients.






Analgesics
Prototype :
a. Narcotic analgesics
- codeine, meperidine (Demerol) morphine, butorphanol (Stadol)
nalbuphine (Nubain)
b. Non – narcotic analgesic
NSAIDs – aspirin (aminosalicylic acid), mefenamic acid (Ponstan),
ibuprofen (Motrin), naproxen, ketoprofen (Orudis), ketorolac.
paracetamol and acetaminophen (Tylenol)
Mechanism of actions :
a. Narcotic analgesics
- alter pain perception by binding to opiod receptors in CNS.
b. Non- narcotic analgesic
- relieves pain and fever by inhibiting the prostaglandin pathway.
Nursing considerations :
1. Monitor respiratory depression & hypotension in clients taking narcotic analgesic.
2. Injury and accident precautions in clients taking narcotic analgesic.
3. Warn clients about possibility of dependency,and do not discontinue narcotics
abruptly in the narcotic-dependent clients.
4. Naloxone is antidote for narcotic overdose.
5. Advice clients to take NSAIDs with food and monitor bleeding complications.
6. Aspirin is contraindicated in clients below 18 years old with flu-like symptoms.
7. Monitor hearing loss in clients taking aspirin.
8. Monitor liver function in clients taking acetaminophen.
9. N-acetylcysteine is antidote for paracetamol overdose.