Analgesic agents Flashcards
baclofen
Brand - Lioresal
Class - Skeletal Muscle Relaxant (centrally acting)
Indication - Spasticity (stiff muscle)
Pregnancy - Risk
Black Box - Avoid abrupt discontinuation (oral/intrathecal)
Counseling - CNS effects may add to alcohol/other depressants; caution driving if sedating
MoA - Inhibits reflexes at the spinal level, possibly by hyperpolarization of terminals
acetaminophen
Brand - Tylenol
Class - COX Inhibitor
Indication - Analgesic/Antipyretic
Contraindications - Hepatic dysfunction
Black Box - Hepatotoxicity
Counseling - Avoid alcohol w chronic use
carisoprodol
Brand - Soma, Vanadom
Class - C-IV, Skeletal Muscle Relaxant (centrally acting)
Indication - Disorder of musculoskeletal system
Contraindications - Sensitivity to meprobamate, acute intermittent porphyria
Counseling - May cause dizziness/sedation, avoid alcohol, realize mental alertness. Withdrawing from prolonged therapy must be monitored for symptoms or seizures
MoA - Blocks interneuronal activity in descending reticular formation and spinal cord (> muscle relaxation)
hydrocodone (bitartrate) / acetaminophen
Brand - Norco
Class - C-II, Opioid
Indication - mod-severe pain
Pregnancy - Risk
Contraindications - Asthma, respiratory depression, GI obstruction
Black Box - Addiction, CNS depression
Counseling - use stimulant laxative, drowsiness, avoid alcohol
MoA - mu agonist
oxycodone / acetaminophen
Brand - Percocet
Class - C-II, Opioid
Indication - mod-severe pain
Pregnancy - Risk
Contraindications - Asthma, respiratory depression, GI obstruction
Black Box - hepatotoxicity
Counseling - CNS depressant
MoA - mu agonist
aspirin
Brand Name: Bayer
Drug Class: Analgesic, Antipyretic
Indication: Carotid endarterectomy, Cerebrovascular accident, Coronary bypass graft, Disorder of joint of spine, Fever, Generalized aches and pains, Headache/Migrane, Myocardial infraction, Pain, Perclutaneous coronary intervention, Rheumatoid/osteoarthritis, Angina, Systemic lupus erythematosus
MoA: Aspirin is a more potent inhibitor of both prostaglandin synthesis and platelet aggregation than its other salicylic derivatives due to the acetyl group on the aspirin molecule, which irreversibly inactivates cyclooxygenase via acetylation. This prevents the conversion of arachidonic acid to thromboxane A. Platelet aggregation is inhibited for their lifespan of 7-10 days.
Syndrome of asthma, rhitis, and nasal polyps; severe urticaria, angioedema, or bronchospasm may occur
Counseling: Instruct patients to report unusual or excessive bleeding. Side effects may include dyspepsia, agitation, confusion, dizziness, headache, lethargy, Reye syndrome, and seizures. Advise patient to take at the same time every day with a full glass of water, avoid alcohol and other NSAIDs.
fentanyl (transdermal)
Brand - Duragesic, Ionsys
Class - C-II, Opioid analgesic
Indication - Chronic Pain (mod-severe)
Contraindications - Acute/postoperative pain, bronchial asthma, mild pain management, opioid nontolerance, paralytic ileus
Pregnancy - Risk
Black Box - CYP3A4/5 inhibitors, respiratory depression, not for postoperative use, fatalities in children, non-interchangeable formulation, fever, careful disposal, REMS program, concurrent use w/ benzo’s or CNS depressants
Counseling - Apply to clean, dry, intact skin; remove old patch when new applied and monitor carefully esp in febrile patients. Use a laxative for constipation, may cause drowsiness.
MoA - Phenylpiperidine opioid agonist w/ predominant effects on the mu opioid receptor (x50-100 more potent than morphine as an analgesic)
celecoxib
Brand - Celebrex
Class - Cyclooxygenase-2 Inhibitor, NSAID
Indication - Rheumatoid/Osteoarthritis, Ankylosing spondylitis, acute pain (primary dysmenorrhea)
Contraindications - Asthma, urticaria, CABG surgery, treatment of perioperative pain, sensitivity of sulfonamides
Pregnancy - Risk
Black Box - GI/cardio toxic, CABG
Counseling - Tk w/ food to decrease GI upset. May pour onto applesauce if needed.
MoA - Inhibition of COX-2 enzyme isoform for inflammatory effects of NSAIDs
cyclobenzaprine
Brand - Flexeril
Class - Skeletal Muscle Relaxant (centrally acting)
Indication - Skeletal muscle spasm
Contraindication - Concomitant MAOI use, heart failure, acute coronary phase of AMI, heart block, hyperthyroidism
Counseling - Realize mental alertness, may cause dizziness/sedative. Tk ER c same time each day.
MoA - Relieves spasms w/o interfering w/ function. Does not resolve spasms from CNS disease. Reduces tonic motor activity (both gamma&alpha systems)
diclofenac
Brand - Cambia, Voltaren
Class - NSAID
Indication - Pain, dysmenorrhea, migraine, rheumatoid/osteoarthritis, ankylosing spondylitis
Contraindications - Concurrent ketorolac, asthma, CABG
Pregnancy - Risk
Black Box - CV, GI risk, CABG
Counseling - Tk w/ food for GI upset
MoA - Nonselective inhibitor of COX-1 and COX-2
gabapentin
Brand - Neurontin
Class - Anticonvulsant, Gamma aminobutyric acid analog
Indication - Partial seizure, Postherpetic neuralgia
Pregnancy - Suggest Risk
Counseling - Tk at bedtime (ER w/ dinner), wait 2 h after antacid, may cause dizziness/somnolence, report worsening depression and avoid sudden discontinuation
MoA - Structurally related to GABA but does not interact w/ GABA receptors or reuptake
lidocaine (topical patch)
Brand - Lidoderm
Class - Local anesthetic
Indication - Postherpetic neuralgia and localized pain
Counseling - App admin, leave patches for no >12 h within 24h. Only apply to intact skin w/o occlusive clothing.
MoA - Produces analgesic effect without a complete sensory block by stabilizing neuronal membranes through inhibition of ionic fluxes required for impulse conduction. Amide-type anesthetic.
ibuprofen
Brand - Motrin, Advil
Class - NSAID
Indication - Fever, Pain/headache, Juvenile/Rheumatoid/Osteoarthritis
Contraindications - Concurrent ketorolac/pentoxifylline, asthma, urticaria, CABG surgery, treatment of perioperative pain
Pregnancy - Risk
Black Box - CV events, GI toxic, CABG
Counseling - Tk w/ food for GI upset. Heart failure patients post discharge on NSAID avoidance due to fluid retention, edema leading to exacerbations.
MoA - Nonselective inhibitor of COX-1 and COX-2, reversibly alters platelet function (prolongs bleeding time)
meloxicam
Brand - Mobic
Class - NSAID
Indication - Juvenile/Rheumatoid/Osteoarthritis
Contraindications - Concurrent ketorolac/pentoxifylline, asthma, CABG
Pregnancy - Risk
Black Box - CV events, serious GI bleeding, CABG
Counseling - Tk w/ food for GI upset, consult OB/GYN if pregnant
MoA - Nonselective inhibitor of COX-1 and COX-2 which decreases prostaglandin precursors, has antipyretic, analgesic, and anti-inflammatory properties, reversibly alters platelet function and prolongs bleeding time.
methadone
Brand - Dolophine
Class - C-II, Opioid analgesic
Indication - Chronic pain, opioid abuse detoxification
Contraindications - Bronchial asthma, paralytic ileus, respiratory hypercarbia
Pregnancy - Risk
Black Box - Accidental ingestion, addiction/abuse, QTc prolongation, respiratory depression, concurrent use w/ benzo’s, REMS, neonatal opioid withdrawal, CYP interactions, conditions for use in addicition
Counseling - Use stimulant laxative to prevent constipation, avoid alcohol and CNS depressants, avoid driving, seek medical attention if short of breath or extremely drowsy. Breast-feeding users should monitor child.
MoA - Binds to opiate receptors in CNS to inhibit ascending pain pathways and produce generalized CNS depression. Similar to morphine but structurally unrelated, R is x10 higher affinity to S.
