Pain and Musculoskeletal Flashcards
Naproxen
NSAID. Reduces pain, stiffness and inflammation
Mechanism of Naproxen
Non-selective COX inhibitors, inhibiting Cox-1 and Cox-2 preventing prostaglandin synthesis
Indications for Naproxen
- Chronic inflammation: Rheumatoid arthritis, Ankylosing spondylits osteoarthritis, gout
- Dysmenorrhoea: pain from menstrual cramps
Contraindications for Naproxen
Active peptic ulceration Bleeding disorder Renal insufficiency Asthma Cardiac problem and HTN Pregnancy
Side effects of Naproxen
Heartburn/ Indigestion, nausea and vomiting, headache, rash, breathlessness, blood stained stools, prolonged bleeding in peptic ulcers
Interactions of Naproxen
Antihypertensive drugs and diuretics
Ciclosporin: Naproxen increases the risk of kidney impairmen
Codeine
Mild Opioid
Mechanism of Codeine
Analgesia
Respiratory depression and suppression of cough
Relaxation of smooth muscles
Indications of Codeine
Milf-moderate pain but only short-term treatment, Cough suppressant
and Antidiarrhoeal drug
Contraindications of Codeine
Acute infective diarrhoea Active Ulcerative Colitis Lung disorder as can cause sputum retention Hepatic or renal insufficiency Pregnancy
Side effects of Codeine
Constipation
Bowel Obstruction
Habit-forming drug is used for a long time
Interactions of Codeine
Sedative drugs including alcohol will increase sedative effect on CNS e.g. sleeping drugs, antidepressants antihistamine, antipsychotics.
Morphine (DIamorphine, Oramorph)
Non-opioid
Indications for Morphine
Relieve pain caused by heart attack, injury, surgery or chronic disease e.g cancer.
Contraindications of Morphine
Severe respiratory disease e.g. COPD Hepatic or renal insufficiency Ulcerative colitis Phaechromocytoma Pregnancy
Side effects of Morphine
Nausea and vomiting Constipation Bowel Obstruction Drowsiness Respiratory depression Itch Dependency
Interactions of Morphine
Sedative drugs including alcohol will increase sedative effect on CNS.
Esmolol effects may be increased with Morphine
MAOIs may increase blood pressure
An opioid antagonist drug (reverses effects of Morphine)
Naloxone
Paracetamol (Alvedon, Calpol)
Non-opioid Analgesic
Mechanism of Paracetamol
Cox inhibitor selective for Cox-2
Antipyretic and analgesic effect
Indications of Paracetamol
Mild-moderate pain
Pyrexia
Peptic ulcers due to no bleeding effect
(Less irritant to stomach so prefered to aspirin)
Contraindications of Paracetamol
Hepatic impairment
Side effects of Paracetamol
Rash/ blood disorders
Analgesic nephropathy
Induced headache
Overdose: nausea and vomiting, sweating, pain
Interactions of Paracetamol
Warfarin: can increase INR
Carbamazepine: increase paracetamol metabolism
Coumarins: increase anticoagulant effect
Colestyramine: reduces absorption of paracetamol
Metocloparamide and Domperidone: increase rate of absorption of paracetamol
Imatinib
