| A | B |
|---|
| Chemical mediators released by damaged cells | -prostaglandins, -bradykinins, -serotonin, nociceptors (in all tissues) |
| Non-opioids | -acetaminophin, -NSAIDs |
| Opioids | -codine, morphine, methadone, oxycodone |
| Adjuvants | -corticosteroids, anticonvulsants, tri-cyclic antidepressants |
| NSAIDs | Nonsteroidal, antiinflamatory drugs, non addictive, less potent than opiates, used for MILD to MODERATE pain, all have analgesic, antipyretic, anti-inflammatory effects, some antiplatelet action, available OTC |
| Releave pain by inhibiting cycloxygenase to decrease prostaglandin synthesis | NSAIDs |
| NSAIDS Cox 1 | protects stomach and regulates platelets |
| NSAIDS Cox 2 | triggers pain and inflammation |
| Salicalates (NSAID type) | Aspirin |
| NSAID's examples | naproxin (Aleve), indomethacin (Indoxin) |
| Cox 2 inhibitors (NSAID type) | celecoxib (Celebrex), rofecoxib (Vioxx) |
| Propionic acid group (NSAID type) | ibuprofen (Motrin, Advil) |
| Side effects of NSAIDs | Gastric irritation, ulcers, bleeding (take with food), may increase bleeding tendencies (increase effect of anticoagulants and menstural flow |
| Hypersessitivities of NSAIDs | vertigo (dizziness), bronchiospasm |
| NO ______to a child < 12 years for any fever | aspirin |
| Acetaminophen | does NOT have antiinflammatory effect, 25% of all OTC, no effect on gastric lining or platelets, short half life |
| Toxic effects of acetaminophen overdose | acute liver failure (hepatoxicity) hepatic necrosis, can occur if > 6gm/day or with ETOH |
| Narcotic (Opiate) analgesics | used for moderate to severe pain, acute or chronic, high abuse potential, dependancy, tolerance |
| How do opiates act on the CNS | suppress pain perception, suppress respiration and cough centers in the medulla, suppress GI motility |
| Legislation | controlled substances |
| Opioids--Morphine | used to determine equivalent doses of other narcotoc analgesics, may be given by many routes, effective in acute, severe pain, offers euphoria, releif of respiratory distress in terminal situation, effective if treating chronic pain if extended release forms |
| Synthetic narcotics--Meperdine (Demerol) | no antitussive effect (no releif of coughing), active metabolites, very dangerous in renal insufficiency, can be neurotoxic: tremors, seizures, does not diminish uterine contractions, less constipation urinary retention, NOT FOR CHRONIC PAIN |
| Example of Meperdine (Demerol), binds to receptors, no dependance | tramadol (ultram) |
| Side effects of Narcotic Analgesics | -respiratory depression, -orthostatic hypotension, -constipation, -nausea and vomiting, somnolence (prolonged sleepiness), pruritus (itching), tolerance and dependance, withdrawl symptoms |
| Contradictions of Narcotics | head injuries, respiratory disfunction, shock states, GI mobility problems |
| Combo: mixed narcotic agonist-antagonist examples | pentazocine (talwin) *most commonly used, butorphanol tartrate (Stadol), buprenorphine (Buprenex) |
| Advantages and disadvantages of mixed narcotic agonist-antagonists | lower narcotic dose needed, safe during labor, some can cause dependance |
| Narcotic Antagonists | antidotes for overdoses of narcotic analgesics, higher affinity for opiate receptors, blocks receptor to opiate, purpose: reverse effect of opiate such as respiratory depression, itching |
| Selected narcotic antagonists | naloxone (Narcan),* most commonly used, naltrexone HCL (ReVia) |
| What special way must Narcotic Antagonists be given? | slowly and carefully! |
| Norcotic addicted persons | methadone treatment program, replaces with less dependency prone narcotics -weaning program, maintenance program----CAN BE LETHAL ON FIRST DOSE!!! |
