Pain medications Flashcards
What meds can act on peripheral nociceptors
TRANSDUCTION SITES: Locas anesth. NSAIDs, COX-1 and COX-2 inhibitors Acetaminophen Capsaicin
What meds can act on peripheral nerve
local anesth.
opioids
What meds can act on Dorsal horn
Local anesth.
Opioids
NSAIDs
What meds can act on descending modulation
OPIOIDS:
Serotonin drugs
Neuropeptides
What meds can act on the brain
Opioids
Glutamine/GABA (Ultram)
Antidepresants (5HT/NE)
What are possible side effects of COX-2 inhibitors
Interfers with renal function
Reduces prostaglandin mediated vasodilation–> heart attacks and strokes.
COX-1 and 2 inhibitors are
Analgesic
anti-inflammatory
anti-pyretic
Acetaminophen (Tylenol) properties
Non NSAID
Non COX-1 or 2 inhibitor
Might block COX-3 and/or block 5HT
Analgesic: dental, headache, muscle, bone pain
anti-pyretic (children); interaction with seratonin–>sedative
Stable in solution
What are examples of NSAIDs
non-selective COX-1 and 2 inhibitors
Salicylates
Ibuprofen-like
Selective COX-2 inhibitors (Celebrex)
What are the properties of Salicylates (Aspirin)
COX-1 and 2 inhibitor Antipyretic; 300-600 mg Analgesia; 600mg (plateau) Anti-inflammatory; 1 gm Duration; 4 hrs Mild to mod somatic pain Often combined w; acetaminophen, caffeine, opioids
What are side effects of salicylates
DO NOT USE ON CHILDREN up to 19yo; Reyes syndrome
GI irritation and erosion
Anti-clotting; damages platelets; two weeks to recover
Tinnitis at high doses
Acid; present in wart remover.
What are the properties of Ibuprofen-type NSAIDs
COX-2 and 1 inhibitor Antipyretic; 400 mg Analgesia; 400 mg Anti-inflammatory; 800 mg Duration; 4 hrs Mild to mod pain relief ≥ aspirin
What are the side effects of Ibuprofen-like NSAIDs
GI ulcers
What are some Ibuprofen-type NSAIDs
Motrin
Advil
Naproxen (Alleve); longer-lasting but slower acting
Ketoprofen; Rx 50mg, more potent
Celebrex Rx; cox-2; no GI/anti-clotting action. poss CV effects.
What are other Rx NSAIDs
Indomethacin; non-selective, serious side effects.
Meloxican; Preferential cox-2 inh = less GI problems
Diflunisal (Dolobid); related to salycilates, bone pain
What are side effects of Acetaminophen
Liver toxin in high doses= 1 gm
Do not use on compromised liver patients
What are some NSAID anticoagulant contraindications
Cuomadin ( warfarin/pradaxa) Joint replacement Heart attack/stroke Major surgery Atrial fibrillation Hemophiliac
What are some Ulcer NSAID contraindications
Ulcers; Frequent upset stomach Bleeding in stools takes antacids Takes H2 blockers (Tagamet) Already taking high doses; Arthritis History of allergies
What are therapeutic uses of Opioids
Analgesia; somatic/visceral–> mild to severe
Antitussive; interferes with cough reflex
antidiarrheal
Causes drug dependance/withdrawals after 1 month
Equipotent dosis
Fentanyl 0.1mg Oxymorphone 1 mg Hydromorphone 1.5 mg Morphine 10 mg Oxycodone (Oxycontin/Percodan) 20 mg (Percoset) Oxycodone + acetaminophen Hydrocodone + acetaminophen (lortab/vicodin) 30 mg (dentist most com) Codeine 200 mg
What are other narcotic analgesics
Meperidine
Pentazocine; mod pain, mix ago/anta–> discourages abuse
Methadone/Buprenorphine; mod to strong, used to treat opioid addiction and as analgesic
What are opioid agonist side effects
Mostly mu receptors
Respiratory depression/dec pulmonary reflex
Constipation/ slow bowel movement
Sedation/additive or synergistic with CNS depressants
Euphoria/dependency/addiction
What is the tx for opioid OD
Naloxone (Narcan)
may precipitate withdrawals ( blocks endorphins)
What are opioids contraindications
history of substance abuse severe constipation Respiratory problems Use of CNS depresants History of allergies
