Analgesics: NSAIDs and Opioids Overview

Overview

Lecture covers analgesics: nonopioids (NSAIDs, acetaminophen) and opioids.
Focus on indications, mechanisms, adverse effects, and key nursing considerations.
Emphasis on exam tips and common NCLEX-style question points.

Nonopioids: NSAIDs and acetaminophen (Tylenol).
Opioids: CNS depressants causing sedation and decreased vital signs.
Main difference: nonopioids are non-sedating; opioids cause "low and slow" heart, lungs, brain.

Used for mild to moderate pain, fever reduction (antipyretic), and inflammation.
Common indications: gout, rheumatoid arthritis (RA), general anti-inflammatory needs.
Key examples summarized in an acronym (NSC/NSAIDs).

Name / Letter	Drug Example
N	Naproxen (neproxen)
S	Salicylic acid / Aspirin
A	Acetylsalicylic acid (aspirin)
I	Ibuprofen (and indomethacin)
K	Ketorolac (Toradol; IV formulation)

Decrease prostaglandin response to reduce pain and inflammation.
Prostaglandin inhibition also decreases platelet aggregation (notably aspirin), increasing bleeding risk.

GI: Increased risk of ulcers and GI bleeding.
Respiratory: Can precipitate bronchospasm; not safe for many asthmatic patients.
Cardiovascular: Can worsen hypertension and heart failure.
Renal: Causes increased BUN and creatinine; can impair kidney function.
Hematologic: Decreased platelet aggregation increases bleeding risk; paradoxically noted thrombosis risk contexts.
Nursing rule: Do not combine two NSAIDs; use lowest effective dose for shortest duration.

Adverse Area	Effect / Nursing Implication
GI	Ulcers, GI bleeding — monitor for signs of bleeding
Lungs	Bronchospasm — caution in asthma, nasal polyps
Heart	Hypertension, worsened heart failure — avoid in cardiac disease
Kidneys	Increased BUN/creatinine — monitor renal labs
Blood	Altered platelet function — bleeding risk; aspirin used for antiplatelet therapy

NSAIDs can trigger bronchospasm and exacerbate asthma.
Nasal polyps often associated with aspirin sensitivity — clarify orders.
If asthma or nasal polyps present, acetaminophen is usually the safer analgesic choice.

Cause CNS depression and sedation.
Produce "low and slow" vital signs: decreased respiratory rate, heart rate, and mental status.
Do not have anti-inflammatory or antipyretic properties.

Antipyretic: Fever reducer.
Prostaglandins: Mediators that promote inflammation and pain; NSAIDs inhibit their synthesis.
Antiplatelet: Reduces platelet aggregation (example: aspirin).
Bronchospasm: Airway constriction; relevant in asthma and NSAID sensitivity.

Verify patient history of asthma, nasal polyps, heart disease, kidney disease, and bleeding disorders before NSAID administration.
Prefer acetaminophen for patients with asthma or nasal polyps.
Avoid giving two NSAIDs together.
Use the lowest effective NSAID dose for the shortest period.
Monitor vital signs, renal labs (BUN, creatinine), and signs of bleeding when using NSAIDs.
Remember ketorolac (Toradol) can be given IV when parenteral NSAID is needed.

Use mnemonic for NSAIDs (N-S-A-I-K) to recall common agents.
Expect NCLEX-style questions distinguishing NSAID vs acetaminophen choice for asthma patients.
Remember: NSAIDs = anti-inflammatory + antipyretic; acetaminophen = antipyretic only, no anti-inflammatory effect.