Pain Medications

Types of analgesics: A. Nonnarcotic Analgesics: 1. Non- steroidal antiinflamatorydrugs (NSAIDs)
• naproxen (Aleve) • ibuprofen ( Advil, Midol) • aspirin

• diclofenac (Cataflam)
• ketorolac ( Toradol) • ketoprofen (Orudis) • piroxicam ( feldene)  Indomethacin

• mefenamic acid (Dolfenal, Ponstan) MOA:

 Aspirin –> irreversibly inhibits cyclooxygenase (both COX I & COX II)
--> blocks prostaglandin (PG) synthesis

 other NSAIDs --> reversibly inhibit COX I & COX II --> block PG synthesis
Indication: analgesic ( mild pains, somatic pains antipyretic, anti-inflammatory SE/ adverse effect: 1. 2. 3. 4. 5. 6. 7. gastric irritation GI bleeding nephrotoxic aplastic anemia hypersensitivity to ASA ( tinnitus, vertigo, bronchospasm, urticaria) Reye’s syndrome hyperventilation

New NSAID:  COX – 2 inhibitors • celecoxib (Celebrex) • valdecoxib (Bextra)
• rofecoxib (Vioxx) MOA: selectively inhibits COX-2 Indication: rheumatoid & osteoarthritis SE: same as other NSAIDs but less GI toxicity

2. Acetaminophen (Tempra , Tylenol) Acetaminophen combinations: • Acetaminophen with codeine (Tylenol with Codeine) • Acetaminophen with hydrocodone • Acetaminophen with oxycodne
MOA: reversibly inhibits COX mostly in CNS Indications: antipyretic, analgesic (moderate pain) Adverse Effects: hepatotoxic Antidote: acetylcysteine (Mucomyst)

Miscellaneous drug: • Tramadol o Moderate to severe pain o SE:  N & V,  dizziness & HA  constipation  seizures o CI: severe alcoholism, or with use of narcotics

B. Narcotics • morphine (MS Contin)
• • • • • fentanyl hydromorphone (Dilaudid) codeine meperidine (Demerol) heroin • methadone • dextromethorphan

others: loperamide & diphenoxylate

MOA: acts as agonist to opoid receptors to modulate synaptic transmissions Indications: • analgesic (chronic pain , severe acute pain, cancer pain, visceral pain,) • cough suppression (dextromethorphan, codeine) • acute pulmonary edema • maintenance programs for addicts (methadone) • diarrhea (loperamide, diphenoxylate) SE: 1. 2. 3. 4. 5. 6. addiction pinpoint pupils respiratory depression CNS depression constipation sleepiness

Antidote: naloxone or naltrexone (Opoid receptor antagonist)

Types of Pain: 1. Acute Pain (sudden pain from trauma, tissue injury, inflammation, surgery)
a. mild pain • nonnarcotics (acetaminophen, NSAIDS) b. moderate pain • combination of narcotic & nonnarcotic ( codeine & acetaminophen)

c. severe pain • narcotics (morphine & meperidine)

2. cancer pain (pressure on nerves & organs, metastasis to bones, blockage to blood supply) • narcotics (morphine& meperidine) 3. chronic pain (> 6 months, hard to treat)
• nonnarcotic drugs • narcotics used only: 1. be by oral route 2. have a long half-life 3. include adjunct therapy 4. not cause respiratory depression • nonnarcotics (NSAIDs)

4. somatic pain (skeletal muscles, ligaments & joints) 5. superficial (skin & mucous membrane)

• mild pain: nonnarcotic • moderate pain: combination narcotic & nonnarcotic • nonarcotics • narcotics

6. vascular pain ( headache/ migraines, PVD) 7. visceral pain (smooth muscles & organs)

WORK with reasons, not with excuses.
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