Nonopiod Analgesics: Salicylates and Nonsalicylates

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Pain Assessment: Assessment Guidelines:

1) Patient’s subjective description of the pain (What
does the patient feel like?)
2) Location(s) of the pain
3) Intensity , severity, and duration of pain
4) Any factors that influence pain
5) Quality of pain
6) Patterns of coping
7) Effects of previous therapy (if applicable)
8) Nurse’s observation of patient’s behavior

Assessment Questions:
 Does the pain keep you awake at night? Prevent you
from falling asleep or staying asleep?
 What makes your pain worse? What makes it better?
 Can you describe what your pain feels like? Sharp,
stabbing, burning or throbbing?
 Does the pain affect your mood? Are you depressed?
Irritable? Anxious?
 What over-the-counter or herbal remedies have you
used for pain?
 Does the pain affect your activity level? Are you
able to walk? Perform self-care activities?

Salicylates: Salicylates are derived from salicylic acid.

 Useful in pain management
 Analgesic (pain-relieving)
 Antipyretic (fever-reducing)
 Anti-inflammatory

Adriana A. Dayfallah
Examples:  Aspirin (acetyl-salicylic acid)
Trade name: Bayer, Ecotrin, Ecotrin (enteric coated),
Empirin
Buffered: Ascriptin, Aspirmox, Bufferin, Alka-Seltzer
w/Asprin
Uses: Analgesic, antipyretic
Adverse Reactions: Nausea, vomiting, epigastric disease,
GI bleed, tinnitus, alleric & anaphylactic reactions:
salicylism with overuse
Dosage Ranges: 325-650 mg orally or rectally q4hr up to
8 g/day
 Diflunisal
Trade name: Dolobid
Uses: Same as aspirin
Adverse Reactions: Same as aspirin
Dosage Ranges: 25-500 mg q8-12 hr (maximum dose, 1.5
g/day)
 Magnesium salicylate
Trade Name: Bufferin, Ecotrin
Uses: Same as aspirin
Adverse Reactions: Same as aspirin
Dosage Ranges: 650 mg orally q4hr or 1090 mg TID
 Salsalate
Trade Name: amigesicn disalcid
Uses: anti-inflammatory
Adverse Reactions: same as aspirin
Dosage Ranges: 3000 mg/day orally in divided doses

Nonsalicylate:  Acetaminophen
Trade Name: Tempra, Tylenol
Uses: Analgesic, antipyretic
Adverse Reactions: Rare when used as directed; skin
eruptions, urticaria, hemolytic anemia, pancytopenia,
jaundice, hepatoxicity
Dosage Ranges: 325-650 mg/day orally q4-6 hr;
maximum dose, 4 g/day

Adriana A. Dayfallah
Actions: Salicylates lower body temperature, heats up the body,
which in turn cools the body.
The analgesic action is due to the inhibition of
prostaglandins. They are fatty acid derivatives found in
almost every cell of the tissue of the body and body fluids.
When released, the sensitivity of pain receptors in the
tissue increases, making it more likely for the pt. to feel
pain. Salicylates prohibit the productions of
prostaglandins, making pain receptors less likely to send
pain messages to the brain. The reduction is also thought
to account for the anti-inflammatory activity.

Uses:Salicylate  Relieving mild to moderate pain

nonopioid analgesics
 Reducing elevated body temperature (exception:
diflusinal which is not used as an antipyretic)
 Treating inflammatory conditions such as
rheumatoid arthritis, osteoarthritis, and rheumatic
fever
 Decreasing the risk of myocardial infarction in those
with unstable angina or previous myocardial
infarction (aspirin only)
 Reducing the risk of transient ischemic attacks or
strokes in men who have had transient ischemia of
the brain due to fibrin platelet emboli (aspirin only).
This use has been found to be effective only in men
(not women).
 Helping maintain pregnancy in special at-risk
populations (low-dose aspirin therapy). It may be
used to prevent or treat inadequate uterine-placental
blood flow.

Adverse Reactions: GI  Gastric upset

systems
 anorexia
 GI bleeding
Allergies to salicylates may be manifested by hoves, rash,
angioedema, bronchospasm with asthma-like symptoms,
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 and anaphylactoid reactions.

Contraindications:  To pts. w/ knowm hypersensitivity to salicylates or

NSAIDs. Because they prolong bleeding time, they
are contraindicated in those w/bleeding disorders
these include:
 GI bleeding
 Blood dyscrasias (abnormalities)
 Those receiving anticoagulant or antineoplastic
drugs
 Pregnancy Category: D (aspirin) and C: should be
used with caution when breastfeeding or lactation
 Children or teens w/chickenpox – it is associated
with Reye’s syndrome (life threatening condition
characterized by vomiting and lethargy progressing
to coma)

Precautions: Used with caution in pts with:

 Hepatic or Renal disease
 Preexisiting hypprothrombinemia, and Vitamin K
deficiency
 Peptic ulcers
 Diabetes (mild)
 Gout

Interactions: Food containing salicylates (curry powder, paprika,

licorice, prunes, raisins, and tea) may increase the risk of
adverse reactions. The following interactions may occur
when a salicylate is mixed with another agent.
Interacting Drug:
 Anticoagulant – Common Use: blood thinner –
Effect of Interaction: increased risk for bleeding
 NSAIDs – Common Use: pain relief – Effect of
Interaction: increased serum levels of the NSAID
 Activated charcoal – Common Use: Antidote
(usually to poisons) – Effect of Interaction:
decreased absorption of the salicylates

Adriana A. Dayfallah
  Antacids – Common Use: relief of gastric upset,
heartburn – Effect of Interaction: decreased effects
of the salicylates
 Carbonic anhydrase inhibitors – Common Use:
reduction of intraocular pressure; also used as
diuretic – Effect of Interaction: increased risk for
salicylism

Nonsalicylates Acetaminophen
 Aspirin substitute for pts who are allergic to aspirin
or experience extreme gastric upset while taking
aspirin.
 Drug of choice for children with fever and flu-like
symptoms.

Actions: Mechanism of action is unknown. The analgesic and

antipyretic activity is the same as salicylates.
 Acetaminophen does not possess anti-inflammatory
action and is of no value in the Tx of inflammation
or inflammatory disorders.
 Does not inhibit platelet aggregation; analgesic
choice when bleeding tendencies are an issue.

Summary, Reflection, Analysis

Adriana A. Dayfallah
Questions/Main Ideas: Notes:

Summary, Reflection, Analysis

Adriana A. Dayfallah