Non-Narcotic Analgesics

Question 1

Antipyretic vs analgesic vs anti-inflammatory properties of NSAIDs

Answer 1

All are antipyretic and analgesic

Acetaminophen isn’t anti-inflammatory

Question 2

NSAID mechanism of action

Answer 2

• Inhibit the conversion of arachidonic acid to prostaglandins, thromboxane, and prostacyclin
• Inhibit cyclooxygenase (COX) and synthesis of prostaglandins and TXA2 (mediators of peripheral sensation and hyperalgesia)

Question 3

COX 1 vs COX 2

Answer 3

COX 1
-platelet aggregation
-hemostasis
-gastric mucosal protection
COX 2
-pain
-inflammation
-fever

Question 4

Negative side effects of NSAIDs

Answer 4

• Decreased hemostasis
• Renal dysfunction
• GI hemorrhage
• Deleterious effects on bone healing and osteogenesis
• Not used in ortho surgeries because of this

Question 5

Aspirin induced asthma

Answer 5

Applies to all NSAIDs, should be avoided if patients have this

Question 6

Ofirmev (IV acetaminophen)

Answer 6

Serum concentration after administration is 70% higher than the same oral dose

• Analgesia occurs in 10 minutes, peaks in 1 hour, lasts 4-6 hours (elimination half-life=2.4-3 hours)
• Clinical studies have found significant decrease in pain scores and reduced use of morphine)
• Adverse effects similar to placebo

Question 7

Selective COX 2 NSAID

Answer 7

Celebrex

Question 8

MIs and NSAIDs

Answer 8

All NSAIDs were found to be associated with an increased risk of acute MI

Question 9

Acetaminophen overdose

Answer 9

> 4 grams in 24 hours, not enough glutathione to detoxify N-acetyl-benzoquin oneimine (NAPQI), the highly reactive metabolite of acetaminophen
-Acetylcysteine can be given-replenishes glutathione

Question 10

TCAs for pain

Answer 10

Tricyclic antidepressants (amitriptyline, nortriptyline, and imipramine) can relieve many types of neuropathic pain