Pain Medications

Pain Medications Types of analgesics: A. Nonnarcotic Analgesics: 1. Non- steroidal antiinflamatorydrugs (NSAIDs) • naproxen (Aleve) • ibuprofen ( Advil, Midol) • aspirin

• diclofenac (Cataflam)

• mefenamic acid (Dolfenal, Ponstan)

• ketorolac ( Toradol) • ketoprofen (Orudis) • piroxicam ( feldene) 

Indomethacin

MOA:

 Aspirin –> irreversibly inhibits cyclooxygenase (both COX I & COX II) --> blocks prostaglandin (PG) synthesis

 other NSAIDs --> reversibly inhibit COX I & COX II --> block PG synthesis Indication: analgesic ( mild pains, somatic pains antipyretic, anti-inflammatory SE/ adverse effect: 1. 2. 3. 4. 5. 6. 7.

gastric irritation GI bleeding nephrotoxic aplastic anemia hypersensitivity to ASA ( tinnitus, vertigo, bronchospasm, urticaria) Reye’s syndrome hyperventilation

New NSAID:  COX – 2 inhibitors • celecoxib (Celebrex) • valdecoxib (Bextra) • rofecoxib (Vioxx)

MOA: selectively inhibits COX-2 Indication: rheumatoid & osteoarthritis SE: same as other NSAIDs but less GI toxicity

2. Acetaminophen (Tempra , Tylenol) Acetaminophen combinations: • Acetaminophen with codeine (Tylenol with Codeine) • Acetaminophen with hydrocodone • Acetaminophen with oxycodne MOA: reversibly inhibits COX mostly in CNS Indications: antipyretic, analgesic (moderate pain) Adverse Effects: hepatotoxic Antidote: acetylcysteine (Mucomyst)

Miscellaneous drug: • Tramadol o Moderate to severe pain o SE:  N & V,  dizziness & HA  constipation  seizures o

CI: severe alcoholism, or with use of narcotics

B. Narcotics • morphine (MS Contin)

others: loperamide & diphenoxylate

• • • • •

fentanyl hydromorphone (Dilaudid) codeine meperidine (Demerol) heroin • methadone • dextromethorphan MOA: acts as agonist to opoid receptors to modulate synaptic transmissions Indications: • analgesic (chronic pain , severe acute pain, cancer pain, visceral pain,) • cough suppression (dextromethorphan, codeine) • acute pulmonary edema • maintenance programs for addicts (methadone) • diarrhea (loperamide, diphenoxylate) SE: 1. 2. 3. 4. 5. 6.

addiction pinpoint pupils respiratory depression CNS depression constipation sleepiness

Antidote: naloxone or naltrexone (Opoid receptor antagonist)

Types of Pain: 1. Acute Pain (sudden pain from trauma, tissue injury, inflammation, surgery) a. mild pain • nonnarcotics (acetaminophen, NSAIDS) b. moderate pain • combination of narcotic & nonnarcotic ( codeine & acetaminophen)

c. severe pain • narcotics (morphine & meperidine)

2. cancer pain (pressure on nerves & organs, metastasis to bones, blockage to blood supply) • narcotics (morphine& meperidine) 3. chronic pain (> 6 months, hard to treat)

• nonnarcotic drugs • narcotics used only: 1. be by oral route 2. have a long half-life 3. include adjunct therapy 4. not cause respiratory depression

4. somatic pain (skeletal muscles, ligaments & joints) • nonnarcotics (NSAIDs)

5. superficial (skin & mucous membrane)

• mild pain: nonnarcotic • moderate pain: combination narcotic & nonnarcotic

6. vascular pain ( headache/ migraines, PVD) • nonarcotics

7. visceral pain (smooth muscles & organs) • narcotics

WORK with reasons, not with excuses. anonymous