Acetylsalicylic Acid (ASA)—Aspirin

Classification

Analgesic, antipyretic, antiplatelet; nonsteroidal antiinflammatory drug (first-generation NSAID)

Action

Is a nonselective cyclooxygenase inhibitor that decreases the formation of prostaglandins involved

in the production of inflammation, pain, and fever. Inhibits platelet aggregation.

Uses

• Relieves low-to-moderate pain

• Decreases inflammation in systemic lupus erythematosus, rheumatoid arthritis,

osteoarthritis, bursitis, and tendonitis

• Is a prophylactic medication to reduce the risk of transient ischemic attack, ischemic stroke,

and myocardial infarction

Contraindications and Precautions

• Hypersensitivity to salicylates

• Do not use during pregnancy

• History of gastrointestinal (GI) ulceration, peptic ulcer disease (PUD), or any bleeding

disorder

• Use in children with a recent history of viral infection (e.g., influenza, chickenpox) has been

associated with Reye syndrome

Side Effects

• Decreases platelet aggregation; increases bleeding potential

• Epigastric distress, heartburn, and nausea

• Aspirin overdose or toxicity—respiratory alkalosis that progresses to respiratory

depression and acidosis; hyperthermia, sweating, and dehydration with electrolyte

imbalance; tinnitus, headache

Nursing Implications

1. Give with milk or full glass of water to decrease gastric irritation.

2. Teach safety measures to parents regarding medications at home.

3. The potential for toxicity is high in older adults and children.

4. Teach patient to avoid concurrent use of alcohol to decrease GI irritation.

5. Patient should not take aspirin for at least 1 week before surgery.

6. Evaluate patient to determine purpose of medication—pain, inflammation, or antiplatelet

action.

Narcotic Antagonists: Naloxone (Narcan)

Actions

Opioid antagonists block (or antagonize) opiate-receptor sites. Principal use is the treatment of

opioid overdose.

Uses

• Reverse the opiate effects of narcotic overdose and respiratory depression

Contraindications and Precautions

• Patients who are using nonopioid drugs

• Neonates and children

• Patients with a history of dependency; may precipitate acute withdrawal

Side Effects

• Too rapid reversal of narcotic depression—nausea, vomiting, tremors, hypertension

• Minimal pharmacologic effects in absence of narcotics

• Reversal of analgesia

Nursing Implications

1. Preferred route of administration is intravenously; response is within 1 to 2 minutes, and

peak action is within 20 to 60 minutes.

2. Patient should be frequently assessed; if the narcotic analgesic lasts longer in the system

than the action of the Narcan antagonist, then respiratory depression may recur.

3. If patient has a history of opioid dependency, administration of Narcan may produce

symptoms of acute withdrawal.

4. If accidental poisoning or possible narcotic overdose is a concern, Narcan is usually

administered.

5. Not effective against barbiturates or other central nervous system depressant medications

Transdermal Medication Administration

General

• Transdermal medications are administered topically and absorbed through the skin into

the blood; they can exert a systemic effect.

• Avoids first-pass metabolism and decreases bioavailability of medication.

• Provides a controlled, constant release of medication.

• Patients who are obese or diaphoretic may have difficulty absorbing the medication.

• If a patient is going to have a magnetic resonance imaging (MRI) procedure, make sure the

patch of transdermal medication does not contain a metallic component. The U.S. Food and

Drug Administration (FDA) recommends that health care professionals note the presence

of a patch when they refer patients for an MRI. The patch may be removed before the MRI

and replaced after the exam is completed.

• Heat increases the absorption of transdermal medications. Check with the health care

provider (HCP) before administering a medication patch to a patient who has a

temperature higher than 102°F.

• Do not apply any heat over patch; doing so will increase absorption of medication.

• Do not allow medication to come in direct contact with fingers.

Administration Guidelines

1. Follow principles of medication administration.

2. Apply patch to dry, hairless area of subcutaneous tissue—preferably the chest, abdomen, upper back.

3. Remove old patch and cleanse area; apply new patch in a different area.

4. Do not apply a patch over an area of emaciated skin or on an area with irritated or broken

skin.

5. Do not apply an adhesive dressing over the patch.

6. Dispose old patches according to facility guidelines. Of specific concern is proper disposal

of fentanyl patches.

Ear Drop Administration

Procedure

• Position patient supine on his or her side with affected ear up.

• Medication should be at least room temperature, not cold.

• Open ear canal of an adult by drawing back on the pinna and slightly upward.

• Open ear canal of a child less than 3 years of age by drawing back on the pinna and slightly

downward.

• Allow the prescribed number of drops to fall along the inside of the ear and flow into the

ear by gravity. Do not attempt to put the drops directly on the eardrum.

• Have patient remain supine for a few minutes to keep the medication from leaking out.