Clinical Medications WorksheetsGeneric Namepropoxyphene napsylate/acetaminophen

Trade NameDarvocet-N

Classificationopioid analgesics

Dose100-200 mg

RoutePO

Time/frequencyq 4 hours PRN

Peak2-3 hr

Onset15-60 min 

Duration4-6 hr 

For IV meds, compatibility with IV drips and /or solutionsN/A

Mechanism of action and indications(Why med ordered)Mild to moderate painBinds to opiate receptors in the CNSAlters the perception of and response to painful stimuli, while producing generalized CNS depression

Nursing Implications (what to focus on) Contraindications/warnings/interactionsAppears on Beers list. Elderly or debilitated patients require reduced dosagesUndiagnosed abdominal pain, Hypothyroidism,Common side effectsdizziness, weakness, nausea

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)Lisinopril: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.Lexapro, Restoril, Percocet, morphine, Reglan, Phenergan: Sedatives, tranquilizers, muscle relaxants, antidepressants, and other central nervous system (CNS) depressants may have additive CNS- and/or respiratory-depressant effects with propoxyphene. Misuse of propoxyphene, either alone or in combination with other CNS depressants, has been a major cause of drug-related deaths, particularly in patients with a history of emotional disturbances, suicidal ideation, or alcohol and drug abuse.

Lab value alterations caused by medicineMay cause ↑ serum amylase and lipase levels, May cause ↑ AST, ALT, serum alkaline phosphatase, LDH, and bilirubin

Be sure to teach the patient the following about this medicationInstruct patient on how and when to ask for pain medicationEncourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasisAdvise patient to change positions slowly to minimize orthostatic hypotensionAdvise patient that good oral hygiene, frequent mouth rinses, and sugarless gum or candy may decrease dry mouth

Nursing Process- Assessment(Pre-administration assessment)Assess type, location, and intensity of pain prior to and 2 hr (peak) following administration.Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk, and laxatives to minimize constipating effects. Stimulant laxatives should be administered routinely if opioid use exceeds 2-3 days, unless contraindicatedGeriatric patients may be more sensitive to CNS effects; monitor closely and assess falls risk

AssessmentWhy would you hold or not give this med?Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use

EvaluationCheck after givingDecrease in severity of pain without a significant alteration in level of consciousness