10.6 Nonopioid Analgesics
Nonopioid analgesics include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS).
Acetaminophen
Mechanism of Action: Acetaminophen inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever primarily in the CNS.[1]
Indications: Acetaminophen is used to treat mild pain and fever; however, it does not have anti-inflammatory properties.
Nursing Considerations: Acetaminophen is safe for all ages and can be administered using various routes.
Geriatric populations should not exceed 3,000 mg in 24 hours, and chronic alcoholics should not exceed 2,000 mg in 24 hours due to the risk for hepatoxicity.
Side Effects/Adverse Effects: Adverse effects include skin reddening, blisters, rash, and hepatotoxicity.
Severe liver damage may occur if a client does the following:
- Takes more than 4,000 mg of acetaminophen in 24 hours (3,200 mg for geriatric adults, 2,000 mg for chronic alcoholics)
- Takes with other drugs containing acetaminophen
- Consumes three or more alcoholic drinks every day while using this product[2]
Some medications are combined with acetaminophen and are prescribed “as needed,” so the nurse must calculate the cumulative dose of acetaminophen over the previous 24-hour period. For example, Percocet 5/325 contains a combination of oxycodone 5 mg and acetaminophen 325 mg and could be ordered 1-2 tablets every 4-6 hours as needed for pain. If two tablets are truly administered every 4 hours over a 24-hour period, this would add up to 3,900 mg of acetaminophen, which would exceed the recommended guidelines for a geriatric client and could cause liver damage.
If overdose occurs, the antidote is acetylcysteine.
Health Teaching & Health Promotion: Medications should be taken as directed and the dosing schedule should be adhered to appropriately. Clients should not take the medication for greater than ten days. Additionally, clients should avoid taking alcohol while using these medications. If a rash occurs, this should be reported to the health care provider, and the medication should be promptly stopped. Use of medications may interfere with blood glucose monitoring. If a fever lasts longer than three days or exceeds 39.5º C, this should be reported to the health care provider.[3]
Now let’s take a closer look at the medication grid on acetaminophen in Table 10.6a.[4]
Medication grids are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medications. Basic information related to each class of medication is outlined below. Detailed information on a specific medication can be found for free at DailyMed. On the home page, enter the drug name in the search bar to read more about the medication. Prototype/generic medications listed in the grids below are also linked to a DailyMed page.
Table 10.