| Journals Watch
2002 This section features a regularly updated list of recently published articles relevant to nurse prescribing. Abstracts of the papers are included and users are encouraged to submit their views about published papers through the feedback section. Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribers’ Formulary for District Nurses and Health Visitors (NPF) and the Nurse Prescribers’ Extended Formulary (NPEF) and Drug tariff if they are in any doubt. Alternatively contact your Regional Nurse Prescribing Lead for clarification. Click here to visit the 2001 archive Analgesia
Analgesia
Courtenay M. Nurse prescribing and pain management. Nursing Times 2002; 98(32): 50-51 After reviewing the physiology of pain, the author examines the use of pain management preparations on the NPEF. In damaged tissues, arachidonic acid is released and converted into prostaglandins, which stimulate pain receptors in the surrounding areas. Aspirin is used to treat mild and moderate pain and is an NSAID. Its anti-inflammatory properties make it helpful in rheumatic and osteoarthritis conditions and it can also help reduce raised body temperature. Like other NSAIDS, its analgesic action is largely local to the damaged tissue rather than the brain: it blocks the conversion of arachidonic acid into prostaglandin. Its anti-pyretic action is on the hypothalamus. Side effects and contra-indications include: gastric irritation and bleeding (aspirin can irritate the gastric mucosal lining); anticoagulation (arachidonic acid is important in platelet aggregation and aspirin therefore inhibits this process); hypersensitivity; renal and hepatic disease; pregnancy; and Reye’s syndrome (it should not be given to children under 12 or breastfeeding mothers). Aspirin interacts with several other drugs and nurse prescribers need to be aware of these. It should not be used with other NSAIDS because of the increased possibility of side effects. Paracetamol is an analgesic and anti-pyretic used for mild to moderate pain. Children, the elderly and pregnant and lactating women can use it although its use is cautioned in people with hepatic and renal impairment or alcohol dependence. Hepatotoxicity results from doses not much greater than the therapeutic level and overdose symptoms may not appear for two days or more. Patients should be warned not to exceed the dose and told that many OTC drugs contain paracetamol. Although its mode of action is not fully understood, it is thought to inhibit cyclo-oxygenase (which converts arachidonic acid to prostaglandins) in the CNS and to act on peripheral pain chemoreceptors. Ibuprofen has analgesic, anti-inflammatory and anti-pyretic properties and is indicated in rheumatic disease, other musculoskeletal disorders and soft tissue injuries as an analgesic and an anti-inflammatory, and as an analgesic for mild to moderate pain in a range of other conditions. It works in a similar way to aspirin. Contra-indications include: history of hypersensitivity, hypersensitivity to aspirin or other NSAIDS, asthma, pregnancy, breastfeeding, coagulation defects, and active peptic ulcer disease. Caution should be exercised in the elderly, people with allergies and with renal, cardiac or hepatic impairment. There are a range of side effects including gastrointestinal effects, hypersensitivity reactions, headache, dizziness and fluid retention and renal failure in people with pre-existing renal problems. Patients should be informed about potential side effects and should avoid alcohol, aspirin and other NSAIDS. Website:
www.nursingtimes.net |
