Nonnarcotics

Destmction of the aluminum complex with ammonia then permits hydrocarbon extraction of the alkaloid. The alkaloid is subsequently both isolated and used as its tartrate salt. This nonnarcotic dmg, for which tolerance may develop, is frequently used orally with caffeine (16) for treatment of migraine it acts to constrict cerebral blood vessels, thus reducing blood flow to the brain. 

Nonnarcotic Antitussives. The most centrally active, noimarcotic antitussive is dextromethorphan [125-71-3] (39). It is similar to codeine in terms of potency and mechanism of action, ie, it is a direct depressant of the cough center. It is unique in that even though it is stmcturaHy related to codeine, it is not addictive. 

Fominoben [18053-31 -1] (66) is another nonnarcotic drug which has shown antitussive activity comparable to codeiae when adrninistered both orally or parenteraHy ia a variety of animal species (95). 

Opioid drugs are often more effective than other nonnarcotic treatments, but they are also associated with more side effects making them less suitable for many patients. Higher doses which are more effective are also associated with undesirable effects such as sedation. 

Examples some sedatives and anxiety agents, nonnarcotic analgesics... 

The next three chapters deal with dragp used in the management of pain the nonnarcotic analgesics (salicylates, nonsalicylates [acetaminophen], and the nonsteroidal anti-inflammatory dragp) and the narcotic analgesics. 

The salicylates include aspirin (acetylsalicylic acid) and related drugp, such as magnesium salicylate and sodium salicylate. The salicylates have analgesic (relieves pain), antipyretic (reduces elevated body temperature), and anti-inflammatory effects. All the salicylates are similar in pharmacologic activity however, aspirin has a greater anti-inflammatory effect than the other salicylates. Specific salicylates are listed in the Summary Drug Table Nonnarcotic Analgesics Salicylates and Nonsalicylates. 

The salicylate nonnarcotic analgesics are used for the following reasons ... 

Acetaminophen is a nonsalicylate nonnarcotic analgesic whose mechanism of action is unknown. Lake the salicylates, acetaminophen has analgesic and antipyretic activity. However, acetaminophen does not possess antiinflammatory action and is of no value in the treatment of inflammation or inflammatory disorders. 

Before giving a nonnarcotic analgesic to a patient, the nurse assesses the type, onset, and location of the pain. It is important to determine if this problem is different in any way from previous episodes of pain or discomfort. If the patient is receiving a nonnarcotic analgesic for an arthritic or musculoskeletal disorder or soft tissue inflammation, the nurse should examine the joints or areas involved. The appearance of the skin over the joint or affected area or any limitation of motion is documented. The nurse evaluates the patient s ability to carry out activities of daily living. This important information is used to develop a care plan, as well as to evaluate the response to drug therapy. 

The expected outcomes of the patient depend on the reason for administration of a nonnarcotic analgesic but may include an optimal response to drug therapy, which... 

Do not consistendy use an OTC nonnarcotic analgesic to treat chronic pain without first consulting the primary healtii care provider. 

Nonnarcotic Analgesics Nonsteroidal Anti-inflammatory Drugs (NSAIDs)... 

Jaffe JH Drug dependence opioids, nonnarcotics, nicotine (tobacco), and caffeine, in Comprehensive Textbook of Psychiatry, 5th Edition, Vol 1. Edited by Kaplan HI, Sadock BJ. Baltimore, Williams c Wilkins, 1989, pp 642-686 Jaffe J, Knapp CM, Ciraulo DA Opiates clinical aspects, in Substance Abuse A Comprehensive Textbook. Edited by Lowinson JH, Ruiz P, Millman RB, et al. New York, Lippincott Williams and Wilkins, 2004, pp 158—165 Jarvis MA, Schnoll SH Methadone use dming pregnancy. NIDA Res Monogr 149 58— 77, 1995... 

Nurco DN, Kinlock TW, Hanlon TE, et al Nonnarcotic drug use over an addiction career a study of heroin addicts in Baltimore and New Ytrk City. Compr Psychiatry 29 450-459, 1988... 

Chasnoff, I.J. Schnol1, S.H. Burns, W.J. and Burns, K. Maternal nonnarcotic substance abuse during pregnancy Effects on infant development. Neurobehav Toxi col Teratol 6 277-280, 1984. Cooper, J.E. Cummings, A.J. and Jones, The placental transfer of phencyclidine in the pig Plasma levels in the sow and its piglets. J Phvsiol (Lond) 267 178-188, 1977. 

Narcotic analgesics decrease pain, improve sleep patterns, and increase functioning in patients with OA who are unresponsive to nonpharmacologic therapy and nonnarcotic analgesics. Conservative initial doses are warranted, with the dose titrated to adequate response. 

Coughing is a useful physiologic device utilized to clear the respiratory tract of foreign substances and excessive secretions. Coughing, however, does not always serve a useful purpose but can rob the patient of sleep. A number of agents are available to suppress this. Many of these are narcotic and have an undesirable abuse potential. One of the agents available which is claimed to be nonnarcotic is amicibone (45). The synthesis involves base-catalyzed alkylation of benzyl cyclohexan-ecarboxylate (44) with p-hexamethyleneiminoethyl chloride a reaction which may go through an aziridinium intermediate. 

List and discuss effects of nonnarcotic analgesic medications... 

Nonnarcotic analgesics. The nonnarcotic analgesics include aspirin, NSAIDs, and acetaminophen. Aspirin acts centrally and peripherally to block the transmission of pain impulses. Furthermore, it reduces fever and inflammation and inhibits synthesis of the prostaglandins that increase the sensitivity of nociceptors. 

Pain management should begin with nonnarcotic analgesics such as acetaminophen or a nonsteroidal antiinflammatory drug administered on a scheduled basis before meals to prevent postprandial exacerbation of... 

Pain Does not interfere with activity Repeated use of nonnarcotic pain reliever >24 h or interferes with activity Any use of narcotic pain reliever or prevents daily activity Emergency room (ER) visit or hospitalization... 

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