ANALGESIA Flashcards
Endophorin
mu
Dynophorin
Kappa
Enkephalin
Delta
Nociceptin
Orphan FQ receptor
If morphin is given orally
Absorption is slow as morphine undergoes extensive first pass metabolism
Morphine adverse effects:
- Nausea
- Vomiting
- Dizziness
- Mental Clouding
- Respiratory depression
- Urinary retention
- Hypotension
Withdrawal symptoms of sudden cessation of opioids:
- Drug seeking behavior
- Yawning
- Lacrimation
- Sweating
- Restlessness
- Mydriasis
- Tremors
- Nausea
- Tachycardia
1 mg of methadone is substituded to
4 mg of morphine
Methadone is gradually reduced and stopped within
10 days
1/10th as potent as morphine.
Pethidine
Less spasmodic action in smooth muscles
Pethidine
Pethidine has rapid and short duration of action
2-3 hours
Hass vagolytic effect and less histamine release safer for asthmatics
Pethidine
100x more potent than morphine
Fentanyl
Higly lipid soluble and fast acting
Fentanyl
Increases intracranial pressure
Fentanyl
Fentanyl is combine with what to produce neuroleptanalgesia
Droperidol
Synthetic centrally acting analgesia indicated to moderate and moderately severe pain
Tramadol
Used in the treatment of labor and cancer pain
Tramadol
Inhibits reuptake of serotonin and noreinephrine
Tramadol
Competitive against of all tyes of opioid receptors
Naloxone
Blocks u-receptors at much lower dosr
Naloxone
Naloxone is always injected at IV of
0.4 to 0.8 mg
Analgesics adverse effects:
- Epigastric distress
- Photosensitivity
- Haemolysis
- Nephrotoxicity
- Reye’s syndrome
6 . Salicylism - Acute salicylate intoxication
Salicylates are metabolised in the liver by
Glycine and glucoronide conjugation
What should the analgesic dose be
600 mg 3x a day
Analgesia contraindications:
- Petic ulcer patients
- bleeding disorder
- Chronic liver disease
- Pregnancy
It raises pain threshold
Paracetamol
Has Weak peripheral anti-inflammatory component
Paracetamol
Has poor ability to inhibit COX in the presence of peroxide
Paracetamol
One of the best drug to be used as antipyretic
Paracetamol
Paracetamol dose
500-1000 mg TDS
Better tolerated alternative to pain
Ibuprofen
Ibuprofen is contraindicated to
Petic ulcer and pregnancy
Selectively COX-2 inhibitor
Nemuslides
Primarily for short lasting painful inflammatory like sports injuries and sinusitis
Nemuslides
Dose of nemuslides
100 mg daily
NSAIDS for mile to moderate pain with little inflammation
Paracetamol or low dose ibuprofen
NSAIDS for acute muscoskeletal/injury associated inflammation
Diclofenac and ibuprofen
Exacerbation of acute pain-high dose
Aspirin and indomethacin
NSAIDS for severe pain
Asiprin or combination with narcotic drug