Musculoskeletal and Pain Drugs Flashcards
give some examples of opiates?
codeine
morphine
oxycodone
what is the MoA for codeine and morphine and oxycodone?
Opioid receptor agonist; acts on mu, kappa and delta on presynaptic neurones. This gives numerous effects that increase nociceptive thresholds throughout the CNS and PNS.
what are the indications for codeine?
Mild to moderate pain
Persistent dry cough
Diarrhoea
list some side effects of codeine:
Nausea Vomiting Constipation Biliary spasm Headache on withdrawal
what is important clinically regarding pharmacokinetics/dynamics for codeine?
Metabolised to morphine which is responsible for analgesic effects.
Predominantly metabolised by the liver.
Active metabolites are excreted in the urine so can accumulate in renal failure.
10% of population resistant to codeine’s analgesic properties as they lack the demethylating enzyme that converts it to morphine
what info should be given to patient before starting on codeine?
Can be taken with paracetamol for a better analgesic effect.
Constipation is a likely side effect.
what are the indications for morphine?
Acute severe pain (including in setting of myocardial infarction)
Acute pulmonary oedema
Chronic pain
what are some side effects of morphine?
Nausea Vomiting Abdominal pain Constipation Respiratory depression Sedation
what is important clinically regarding pharmacokinetics/dynamics for morphine?
Predominantly metabolised by the liver.
Metabolites are active and can accumulate in renal failure.
Accumulation can result in respiratory and CNS depression.
what info should be given to patient before starting on morphine?
Often given with an anti-emetic to reduce nausea / vomiting.
what are the indications for oxycodone
Moderate to severe pain relief in cancer patients
Postoperative pain
Severe pain
list some side effects of oxycodone:
Nausea
Vomiting
Abdominal pain
Constipation
what is important clinically regarding pharmacokinetics/dynamics for oxycodone?
Available as long and short acting preparations
Predominantly metabolised by the liver.
Often administered via slow intravenous/subcutaneous infusion.
what info should be given to patient before starting on oxycodone?
Nausea and constipation are common side-effects.
give examples of non selective NSAIDs?
ibuprofen
diclofenac