Pain Ladder Decision: Opioid vs NSAID vs Acetaminophen — When to Use Which
Choosing the wrong analgesic class wastes time and risks organ damage — acetaminophen won't touch severe post-op pain, and defaulting to morphine for a mild headache exposes the client to respiratory depression. NCLEX questions test whether you match pain severity to the right drug class and monitor the right organ.
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- µ-opioid receptor agonist (CNS)
- COX inhibition then ↓ prostaglandins
- Central analgesic/antipyretic
- No anti-inflammatory effect
- Moderate–severe, acute, cancer pain
- Inflammatory pain (arthritis, sprain)
- Fever reduction
- Fever reduction
- Non-inflammatory pain
- PO (and other routes)
- PO (and other routes)
- PO (and other routes)
- Pain: location, intensity, quality
- Respiratory rate & sedation level
- Pain: location, intensity, quality
- GI distress, edema, renal function
- Pain: location, intensity, quality
- Total daily dose from all sources
- Bowel function (constipation)
- BUN/creatinine, CBC for GI bleed
- LFTs with chronic use or overdose
- ★Resp depression, sedation, constipation
- ★GI bleed/ulcers
- Renal injury
- Few at therapeutic dose
- ★Antidote = naloxone (Narcan)
- Black box: ↑ MI/stroke, GI bleed
- ★Max 4 g/day
- Overdose: liver injury, give NAC
- + benzos then fatal resp depression
- Avoid in CKD or active ulcer
- + anticoagulants then bleeding
- Caution with alcohol or liver disease
- Prevent constipation
- Safe storage, never share
- Do not combine with alcohol/sedatives
- Take with food or milk
- Report black/tarry stools
- Check combo products for acetaminophen
- Do not exceed 4 g/day
Opioids
- µ-opioid receptor agonist (CNS)
NSAIDs
- COX inhibition then ↓ prostaglandins
Opioids
- Moderate–severe, acute, cancer pain
NSAIDs
- Inflammatory pain (arthritis, sprain)
- Fever reduction
Opioids
- PO (and other routes)
NSAIDs
- PO (and other routes)
Opioids
- Pain: location, intensity, quality
- Respiratory rate & sedation level
NSAIDs
- Pain: location, intensity, quality
- GI distress, edema, renal function
Opioids
- Bowel function (constipation)
NSAIDs
- BUN/creatinine, CBC for GI bleed
Opioids
- ★Resp depression, sedation, constipation
NSAIDs
- ★GI bleed/ulcers
- Renal injury
Opioids
- ★Antidote = naloxone (Narcan)
NSAIDs
- Black box: ↑ MI/stroke, GI bleed
Opioids
- + benzos then fatal resp depression
NSAIDs
- Avoid in CKD or active ulcer
- + anticoagulants then bleeding
Opioids
- Prevent constipation
- Safe storage, never share
- Do not combine with alcohol/sedatives
NSAIDs
- Take with food or milk
- Report black/tarry stools
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Liver cap = acetaminophen, GI bleed + kidneys = NSAIDs, count respirations = opioids — the toxicity tells you which drug.
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