Pain Medications
Types of analgesics: A. Nonnarcotic Analgesics: 1. Non- steroidal antiinflamatorydrugs (NSAIDs)
naproxen (Aleve) ibuprofen ( Advil, Midol) aspirin mefenamic acid (Dolfenal, Ponstan) MOA: diclofenac (Cataflam) ketorolac ( Toradol) ketoprofen (Orudis) piroxicam ( feldene) Indomethacin
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 4. somatic pain (skeletal muscles, ligaments & joints) nonnarcotics (NSAIDs) 5. superficial (skin & mucous membrane) mild pain: nonnarcotic moderate pain: combination narcotic & nonnarcotic 6. vascular pain ( headache/ migraines, PVD) nonarcotics 7. visceral pain (smooth muscles & organs) narcotics
WORK with reasons, not with excuses.
anonymous