Analgesics

Opioids
o Examples
morphine, hydrocodone/acetaminophen (Vicodin), hydromorphone
(Dilaudid), fentanyl (Duragesic Patch), tramadol (Ultram)
o Action
bind to opioid receptors in brain, spinal cord, and other areas of the body;
reduce the sending of pain messages to brain
o Uses
moderate-severe pain that may not respond will to other meds
o Common Side Effects
N&V, constipation, drowsiness, sedation, lightheadedness, stomach upset,
flushing
o Serious Adverse Reactions
respiratory depression, allergic reactions including itchiness and
bronchospasm
o Contraindications
pregnancy, breastfeeding, significant respiratory disease, comatose
patients, phaeochromocytoma
take caution when giving to children
o Interactions
drugs that affect liver function can increase or decrease elimination of
opioids
o Teaching
dont stop without talking to the prescriber
dont stop suddenly because withdrawal may occur
tolerance builds when taken over a long period of time, so dosage may
need to be adjusted
avoid alcohol
take with food or milk to prevent upset stomach
NSAIDS
o Examples
aspirin, celecoxib (Celebrex), ibuprofen (Motrin), naproxen (Aleve),
ketorolac (Toradol)
o Action
block COX enzymes and reduce prostaglandins throughout the body;
reduces inflammation, pain, and fever
o Uses
treat inflammation, mild-moderate pain, and fever
headache, arthritis, sports injuries, menstrual cramps
aspirin used to inhibit clotting to prevent CVA and MI
celebrex can be used to prevent formation and growth of colon polyps
o Side Effects
most common: nausea, vomiting, diarrhea, constipation, decreased
appetite, rash, dizziness, headache, and drowsiness
more serious: stomach pain, swelling of feet/ankles, tinnitus (aspirin
especially)
most serious: kidney failure, liver failure, ulcers, and prolonged bleeding
after sx

Serious Adverse Reactions

allergic reaction: SOB
Reyes Syndrome with aspirin use in children/teenagers with
chickenpox/influenza
increase risk of potentially fatal stomach/intestinal adverse reactions:
bleeding, ulcers, and perforation
o Contraindications
kidney/liver/stomach problems, heart disease, HTN, diabetes, bld
problems, asthma, eye problems, nasal polyps, severe/long-lasting HA,
and allergies, pregnancy, breastfeeding
do not use for tx of pain resulting from CABG
o Interactions
reduce action of diuretics
decrease elimination of lithium and methotrexate
increased bleeding when used with other meds that increase bleeding
may raise BP, so may cancel out action of drugs used to treat HTN
increase negative effects of cyclosporine on kidney function
o Teaching
take with full glass of water, food, milk, or an antacid
stay in upright position for at least 30 min after consumption
seek immediate medical attention if taking for migraine and the pain isnt
relieved or worsens
limit alcohol and use caution when engaging in activities requiring
alertness
avoid prolonged sun exposure, use sunscreen, wear protective clothing
Benzodiazepines
Examples
o alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam
(Ativan), midazolam (Versed)
Action
o exact mechanism of action is unknown; reduce activity of the brain and spinal
cord by increasing effects of the neurotransmitter, GABA
Uses
o anxiety, seizures, insomnia
o sometimes for general anesthesia, sedation for sx, muscle relaxation, alcohol
withdrawal, N&V, depression, and panic attacks
Common Side Effects
o most common: sedation, dizziness, weakness, and unsteadiness
o less common: feeling of depression. loss of orientation, HA, sleep disturbance
Serious Adverse Reactions
o physical dependence; suddenly stopping after a few months of daily tx may cause
withdrawal, and may even produce seizures, tremors, muscle cramping, vomiting,
and sweating
Contraindications
o liver/kidney disease, pregnancy, breastfeeding, alcohol use
o take caution with elderly patients
Interactions
o cause excessive sedation when taken with other CNS depressants (alcohol,
barbiturates, narcotics, and tranquilizers)

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elimination of benzodiazepines is slowed by drugs that slow liver elimination

antacids may reduce absorption rate from intestine
pt shouldnt drink grapefruit juice
smoking decreases effectiveness
Teaching
o do not stop suddenly; does must be tapered slowly
Anticholinergics
Examples
o atropine, oxybutynin (Ditropan)
Action
o oppose action of acetylcholine; inhibit transmission of parasympathetic nerve
impulses, thereby reducing spasms of smooth muscles; balance production of
dopamine and acetylcholine in the body
Uses
o GI disorders like diarrhea, overactive bladder, and incontinence; asthma, COPD,
dizziness, motion sickness, HTN, Parkinsons; sometimes depression, sleep
disorders, certain types of toxic poisoning, and as an aid to anesthesia
Common Side Effects
o dry mouth, blurred vision, constipation, drowsiness, sedation, hallucinations,
memory impairment, difficulty urinating, confusion, delirium, decreased sweating
Signs of Overdose
o dizziness, severe drowsiness, fever, severe hallucinations, confusion, trouble
breathing, clumsiness, slurred speech, fast HR, flushing/warmth of skin
Contraindications
o myasthenia gravis, hyperthyroidism, glaucoma, enlarged prostate, postural
hypotension, severe colitis, blockage of urinary tract, tachycardia, HF, severe dry
mouth, hiatal hernia, severe constipation, liver disease, Downs syndrome,
pregnancy
Interactions
o other anticholinergics or drugs with anticholinergic side effects
o ACE Inhibitors antagonize action of anticholinergics
o drugs like Spiriva, Atrovent, and KCl tablets can enhance action of
anticholinergics
Teaching
o these raise body temp, so avoid hot baths/showers, use extra caution to not
become overheated during exercise
o avoid alcohol
Bisphosphonates
Examples
o alendronate (Fosamax), ibandronate (Boniva)
Action
o slow bone loss by increasing bone formation and decreasing bone turnover
Uses
o osteoporosis, Pagets disease, cancer metastatic to bone, postmenopausal women
with vertebral compression fractures or total hip bone density T-score below -2.5,
elderly men with non-traumatic fractures
Common Side Effects
o fever and flu-like symptoms when receiving through IV
o hypocalcemia, constipation or diarrhea, fatigue, feeling sick, gas, bloating

Serious Adverse Reactions

o gastroesophageal irritation, ostenecrosis of the jaw, kidney damage
Contraindications
o pregnancy, chronic kidney disease, hypocalcemia, osteomalacia, Vit D deficiency
o Oral bisphosphonates shouldnt be used in pts with serious esophageal disease or
those who cant stay upright for an hour
o use caution in pts with high PTH, gastric/intestinal bypass sx, and children
Interactions
o food, caffeine, milk, orange juice, and antacids reduce absorption
o use caution with other drugs that cause stomach/esophagus irritation, like aspirin
Teaching
o do not take oral doses with food, tea, coffee, or chocolate milk
o stay upright for 30-60 minutes after taking medication
o do not take other medications at the same time
o follow with a small sip of water to decrease risk of esophageal erosion