Pain and Inflammation Drugs Flashcards
OPQRRRST
Onset Provocation Quality Region Radiation Relief Severity Time (of pain)
Pain Rating /10 and Reasonable Treatment
<4/10:
non-opioids, NSAIDS, tylonel
4-6/10:
Opioids, PO (codeine/morphine)
<6/10:
Higher potency opioids, IV
What kind of meds stop pain at the peripheral level? CNS level?
Peripheral:
- non-opioids
- NSAIDS
CNS:
- non-opioid centrally acting (acetaminophen)
- Opioids
Acetaminophen
Centrally acting analgesic Not a NSAID Not antinflammatory Anti-pyretic, q4h PO Toxic Metabolite (N-acetyl benzo) then glutathione (phase 2) Cmax: 30-60m low PPB (20%)
What is an Agonist?
Initiates a physiologic response when combined with a receptor
Mu1 Receptor
Effect: Analgesic (supraspinal,spinal), low abuse potential. Bradycardia, Hypothermia, Urinary Retention
Agonists: Endorphins, morphine, synthetic opioids
Mu2 Receptor
Analgesic (spinal) Depression of ventilation Physical dependence CONSTIPATION Agonists: Endorphins, morphine, synthetic opioids
Kappa Receptor
Analgesic (supraspinal,spinal)
Dysphoria,sedation
Low abuse potentional
Diuresis
Agonists: Dynorphins
Delta
Analgesic: Supraspinal,spinal
Depression of ventilation
physical dependence
CONSTIPATION
Urinary retention
Agonists: enkephalins
High Efficacy Opioids:
Fentanyl Hydromorphone (dilaudid) Oxymorphone (numorphan) Meperidine (Demerol) Morphine Methadone (metadol) Tramadol (Ultram)
Moderate Efficacy Opioids:
Hydrocodone Oxycodone (OxyNeo and oxycotin) Percocet Percodan Vicodin Tramacet Buprenorphine
Low Efficacy Opioids
Codeine
Tylonel #1-4
Combination Drugs
Percocet (oxycodone and acetaminophen) Percodan (oxycodone and ASA) Vicodin (hydrocodone and acetaminophen) Tramacet (tramadol and acetaminophen) Tylonel #1-4 (acetaminophen and caffiene and codeine)
Med for GI Pain
Dicyclomine (Bentyl)
Muscarinic Antagonist, GI smooth muscle relaxant
Myocardial Pain Med
Morphine
Opioid, decreased vasoconstriction (decreased BP and CO)
Adverse Effects of Opioids:
CNS depression (sedation) N and V Itching Constipation Urinary Retention Euphoria
ANTAGONIST is Naloxone
NSAIDs
Useful if pain is associated with inflammation caused by cellular injury not allergy
-Prostaglandin target
Prostaglandins
Lipids, COX1 and 2
COX1
-Present in all tissues
-Protects gastric mucosa, supports kidney fx, promotes platelet aggregation
When inhibited: gastric bleeding and kidney failure
COX2
Present at site of tissue injury
-Mediates inflammation, sensitizes pain receptors, mediates fever in the brain
When inhibited: suppression of inflammation (this is the ideal treatment)
Selective Cox2 inhibitor?
Celecoxib (Celebrex)
-black box warning, can cause death.
Non Selective Cox inhibition?
NSAIDS -ASA, Ibuprofen (and others like it) \: Diclofenac (Voltaren0 Naproxen (Aleve, Naprosyn) Ketorolac (Toradol) Indomethacin (20x ASA POTENCY)
Chose ASA When…
Low dose antithrombotic
Low-moderate joint pain
Chose Ibuprofen When…
headache/1st migraine
soft tissue swelling (treatment of sprains)
