Analgesics: Nursing pharmacology

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aspirin (Bayer, Ecotrin);
ibuprofen (Advil), naproxen (Aleve), ketorolac (Toradol);
celecoxib (Celebrex)

acetaminophen (Tylenol)

morphine, methadone (Methadose), meperidine (Demerol), codeine, oxycodone (OxyCONTIN), and fentanyl (Actiq, Duragesic, Fentora, Sublimaze); tramadol (Ultram); buprenorphine (Buprenex)
* High Alert Medications*

Non-opioid analgesics (NSAIDs)
Non-opioid analgesics
Opioid analgesics
COX inhibition (central and peripheral) → ↓ production of prostaglandins
COX inhibition (central) →
↓ production of prostaglandins
Activation of opioid receptors in the brain (mu, kappa, delta)
Headache; muscle and neuropathic pain; pain related to trauma / fractures
  • PO
  • IV
  • IM
  • TOP
  • PR
  • PO
  • IV
  • PR
  • PO
  • IV
  • IM
  • SC
  • TD
  • EPI
  • intrathecal
  • Headache, drowsiness, dizziness
  • Kidney damage
  • Hypersensitivity reactions
  • Reye syndrome (aspirin in children)
  • Hepatotoxicity
  • Sedation, nausea, vomiting, constipation, urinary retention, decreased blood pressure, orthostatic hypotension
  • Boxed warning: respiratory depression, coma, death, neonatal opioid withdrawal syndrome, dependence and addiction
  • Pregnancy, breastfeeding
  • Hypersensitivity to NSAIDs
  • Boxed warning: gastritis, gastric ulcers, bleeding
  • Boxed warning: pre- and post-CABG
  • Aspirin: not for children
  • Ketorolac: not for children, short term use for adults, dosage adjustment for elderly; renal disease, cerebrovascular bleeding, history of peptic ulcers, labor
  • Hepatic disease
  • Boxed warning: daily dose should not exceed 4 grams / 24 hours
  • Respiratory depression, head trauma, increased intracranial pressure, and coma
  • Concomitant use with other CNS depressants (alcohol, barbiturates, benzodiazepines)
aspirin (Bayer, Ecotrin);
ibuprofen (Advil), naproxen (Aleve), ketorolac (Toradol);
celecoxib (Celebrex)

acetaminophen (Tylenol)
morphine, methadone (Methadose), meperidine (Demerol), codeine, oxycodone (OxyCONTIN), and fentanyl (Actiq, Duragesic, Fentora, Sublimaze); tramadol (Ultram); buprenorphine (Buprenex)
* High Alert Medications*

All analgesics
  • Vital signs
  • Pain assessment
  • Pain management goal
  • Medical and medication history
  • Monitor for side effects
  • Reassessment for therapeutic effect
  • Baseline labs: CBC, BUN, creatinine
  • Monitor renal function
  • Monitor for side effects; e.g., headache, dizziness, or epigastric pain
  • Baseline labs: liver function
  • Level of consciousness
  • Hold medication if respiratory rate is less than 12 breaths per minute or for hypotension
  • Monitor for side effects; e.g., sedation, respiratory depression, urinary retention
  • Institute fall precautions
  • Have naloxone readily available
All analgesics

  • Non-pharmacological pain management methods
  • Management of side effects
  • Take with meals or milk
  • Avoid alcohol
  • Report symptoms of gastric distress
  • Take with or without food
  • Avoid alcohol
  • Do not exceed 4 grams / 24 hours
  • Report nausea, vomiting, abdominal pain
  • Take exactly as prescribed
  • Sedation: caution with activities that require alertness; avoid alcohol
  • Hypotension: sit or lie down if dizzy; make position changes slowly
  • Constipation: increase fluid and fiber intake
  • Urinary retention: empty bladder every four hours
  • Turn, cough, deep breathe regularly


Analgesics, also commonly known as painkillers, are medications primarily used to relieve pain, such as a headache, muscle and neuropathic pain, as well as pain related to trauma and fractures.

Analgesics can be subdivided into two main groups: non-opioid analgesics, and opioid analgesics. Keep in mind though that there are a number of other medications that primarily serve other purposes, but can be used as analgesics.

These medications include antidepressants like amitriptyline, anticonvulsants like gabapentin, and corticosteroids like dexamethasone, as well as local anesthetics like lidocaine.

Now, let’s start with non-opioid analgesics, which include non-steroidal anti-inflammatory drugs or NSAIDs, and acetaminophen. NSAIDs inhibit the enzyme cyclooxygenase or COX, both in the central nervous system and peripheral tissues.

Now, there are two types of COX enzymes. The first one is called COX-1, which is indirectly involved in platelet aggregation, production of protective mucus in the stomach and vasodilation of the renal vasculature.

On the flip side, COX-2 is only active in inflammatory cells and vascular endothelium during inflammation, and is involved in the production of small pro-inflammatory compounds like prostaglandins.

Now, a very commonly used NSAID is acetylsalicylic acid, often referred to as aspirin, which is taken orally. On the other hand, non-aspirin NSAIDs can be further classified as non-selective COX inhibitors that act on both COX-1 and COX-2, like ibuprofen, naproxen and ketorolac; and selective COX-2 inhibitors, like celecoxib.


Analgesics are drugs that reduce pain. They work by either blocking the transmission of pain signals or by reducing inflammation. There are many different types of analgesics available, and they can be divided into two main groups: Non-opioid analgesic agents which include non-steroidal anti-inflammatory drugs (NSAIDs); and opioid analgesics.

NSAIDs include ibuprofen, aspirin, and naproxen. These drugs work by blocking the action of cyclooxygenase (COX), an enzyme that is involved in the production of inflammatory mediators. Opioid analgesics include morphine, codeine, and fentanyl. These drugs work by binding to opioid receptors in the brain, which reduces the perception of pain.


  1. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  2. "Pharmacology 8th Edition: A Patient-Centered Nursing Process Approach" Elsevier Health Sciences (2014)
  3. "Focus on Nursing Pharmacology" LWW (2019)
  4. "WHO Analgesic Ladder" StatPearls (2019)
  5. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2019)

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