Analgesics Cheat Sheet
Pain medications — nonopioid, opioid & adjuvant drugs. Everything high-yield for the NCLEX-RN in one organized, expert-reviewed sheet.
What's in this cheat sheet
This cheat sheet is organized into 6 main sections:
Drug Classes
Three categories of pain medications — nonopioid (mild-moderate pain, mostly OTC), opioid (moderate-severe pain, dependence risk), and adjuvant drugs (e.g. antidepressants, muscle relaxants used off-label for pain).
Nursing Considerations
Core principles like rotating analgesic classes, premedicating before painful procedures, scheduling chronic pain meds around the clock, reassessing pain within 60 min (PO) or 30 min (IV), combining with non-pharmacologic methods, and never using placebos for pain.
Nonopioid Analgesics
How they work — inhibiting prostaglandin synthesis in the CNS or PNS — and the two main types: acetaminophen and NSAIDs/aspirin.
Acetaminophen
Treats pain and fever but has no anti-inflammatory effect. Key concerns: hepatotoxicity risk (avoid in liver disease/alcoholism), max dose under 3–4 g/day, hidden OTC sources, and acetylcysteine as the overdose antidote.
NSAIDs & Aspirin
Treat pain, fever, and inflammation. The three major adverse effects are GI distress, bleeding, and cardiovascular events. Special rules around food intake, anticoagulants, pregnancy (third trimester), and cardiovascular disease. Aspirin is the exception — it actually lowers MI/stroke risk via antiplatelet action but is contraindicated in children due to Reye syndrome.
Opioid Analgesics
Covers agonists (morphine, fentanyl, oxycodone, tramadol) and the antagonist naloxone. Most dangerous adverse effect: respiratory depression. Most common: constipation. Safety rules include never crushing extended-release tablets, never applying heat to fentanyl patches, only the client pressing the PCA button, and always having naloxone available. Client teaching centers on the "3 Fs" for constipation and slow position changes for orthostatic hypotension.
Quick Reference Table
A summary grid of all drugs with key cautions, contraindications, and what to monitor.
NCLEX Star Points
Six high-yield facts flagged as the most likely to appear on the NCLEX exam.
1. Drug Classes at a Glance
Three categories of pain medications.
Class 1 · Nonopioid
- · Mild → moderate pain
- · Most available OTC
- · Acetaminophen, NSAIDs
Class 2 · Opioid
- · Moderate → severe pain
- · Risk for tolerance & dependence
- · Morphine, fentanyl, oxycodone
Class 3 · Adjuvant
- · Medications from other classes
- · Also have analgesic properties
- · E.g. antidepressants, muscle relaxants
2. Core Nursing Principles
Nursing considerations for analgesia.
- Rotate analgesic classes for better control with fewer adverse effects
- Premedicate before painful procedures (wound care, PT)
- Schedule analgesics around the clock for chronic pain — not PRN only
- Reassess pain within 60 min of PO and 30 min of IV dosing
- Combine pharmacologic + non-pharmacologic methods (ice, heat)
- Never give a placebo (e.g. saline) for pain management
3 & 4. Nonopioid Analgesics — Acetaminophen
Inhibit prostaglandin synthesis in the CNS or PNS. Two main types: acetaminophen and NSAIDs/aspirin.
Acetaminophen
- · Treats pain and fever — no anti-inflammatory effect
- · Use NSAIDs instead for arthritis or gout
- · Preferred over NSAIDs when GI or bleeding risk present
- · Heavily metabolized in the liver
Max dose
<3–4 g/day (all sources combined)
Avoid / monitor
Liver disease or alcoholism. Monitor AST, ALT, ALP.
Overdose antidote
Acetylcysteine
Always ask about OTC medications — hidden sources of acetaminophen.
5. NSAIDs & Aspirin
Nonopioid · PNS — treat pain, fever, and inflammation.
- · Treat pain, fever, and inflammation
- · Inhibit prostaglandin synthesis in the PNS
- · Celecoxib (selective) = fewer GI effects but ↑ CV risk
Three major adverse effects
- · Take with food or milk — not on empty stomach
- · Monitor: dark stools, bleeding gums, petechiae
- · Avoid with anticoagulants; avoid in third trimester
- · May trigger asthma exacerbations
- · Monitor BUN + creatinine (↑ AKI risk)
Aspirin exception: ↓ MI/stroke risk via antiplatelet effect. Contraindicated in children (Reye syndrome).
6. Opioid Analgesics
Agonists bind opioid receptors in the CNS → block pain signals. Start low and go slow.
Routes & examples
- PO: oxycodone, tramadol
- IV: morphine, hydromorphone
- Patch: fentanyl (chronic only)
Adverse effects ranked
Most dangerous: Respiratory depression → give naloxone if RR <8–10/min
Most common: Constipation — does not improve with tolerance
Also: orthostatic hypotension, sedation, nausea/vomiting
Opioid safety rules
- · Never crush/chew extended-release opioids
- · Never apply heat over a fentanyl patch
- · Remove old patch before applying new one
- · Only the client presses the PCA button
- · Avoid concurrent benzodiazepines ↑ overdose risk
- · Highest risk: age >65, concurrent sedating meds
If client falls asleep mid-conversation: stop opioid, stimulate vigorously, notify HCP.
Client teaching
- Constipation: The 3 Fs — fluids, fiber, fitness. Add senna + docusate
- Orthostatic hypotension: Change positions slowly — fall risk
- Sedation: Limit benzodiazepines; caffeine for daytime drowsiness
- Nausea: Treat with ondansetron or metoclopramide
Overdose reversal: naloxone (Narcan) IV, IM, or intranasal.
Quick Reference Summary
All drugs with key cautions, contraindications, and what to monitor.
| Drug | Key caution | Do not use when… | Monitor for |
|---|---|---|---|
| Acetaminophen | Hepatotoxicity · max 3–4 g/day | Liver disease, alcoholism | AST, ALT · OTC hidden sources |
| NSAIDs (ibuprofen, naproxen, ketorolac) | GI upset · bleeding · CV events | Anticoagulants, CABG, CV disease, 3rd trimester | Dark stools, petechiae · BUN, creatinine |
| Aspirin (ASA) | Antiplatelet — ↓ MI/stroke risk | Children/adolescents (Reye syndrome) | Bleeding signs |
| Opioids (morphine, fentanyl, oxycodone) | Resp. depression · constipation · falls | RR <8–10/min without naloxone available | Respirations · LOC · sedation scale |
| Naloxone (Narcan) | Opioid antagonist — reversal agent | — | Repeat doses may be needed (shorter half-life than opioids) |
NCLEX Star Points
High-yield facts most likely to appear on the exam.
Avoid acetaminophen in liver disease or alcoholism — risk of hepatotoxicity.
Three major NSAID adverse effects: GI distress, bleeding, cardiovascular events.
Never apply heat to a fentanyl patch or allow anyone but the client to press the PCA button.
Give naloxone if client is unresponsive or RR <8–10/min.
For orthostatic hypotension: change positions slowly. For constipation: the 3 Fs — fluids, fiber, fitness.
Aspirin is the only NSAID that reduces (not increases) MI and stroke risk.
Analgesics Self-Test
6 quick questions — answers reveal after you submit.
Q1. A client with chronic alcoholism asks about taking a medication for a headache. Which analgesic is most concerning due to hepatotoxicity risk?
Q2. What are the THREE major adverse effects of NSAIDs the nurse should monitor for?
Q3. A client is found unresponsive with a respiratory rate of 6/min after receiving morphine. What is the priority medication?
Q4. Which teaching about a fentanyl patch is correct?
Q5. Why is aspirin considered the exception among NSAIDs?
Q6. A client on long-term opioids reports constipation. What is the best client teaching?
Answered 0 / 6 — unanswered count as incorrect.