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ANALGESICS
Opioid / Narcotic / Morphine Non opioid / Non-narcotic /
like analgesics
Aspirin like analgesics
WEEK 3 - PAIN
PAIN
MOA
Salicylate
ASPIRIN
NSAIDS
Propionic acid
IBUPROFEN
NAPROXEN
Heteroaryl
acetic acid
Diclofenac
blocks prostaglandin
synthesis at the
thermoregulatory
centres in the
hypothalamus and at
peripheral target sites
Aspirin may also supress
pain stimuli at subcortical sites (thalamus
and hypothalamus).
INDICATIONS
anti-inflammatory, anti-pyretic
and analgesics effects
Chronic Inflammation
RA
Severe OA
Chronic back pain
Acute injury with Inflammation
Dysmenorrhoea
Pain from lytic bone
metastases
OPIODS
MORPHINE
GI symptoms /
peptic ulcer disease
Liver or renal
impairment
Asthmatic with
aspirin sensitivity
Coagulation
disorders /
treatment
Aspirin should be
avoided in pregnancy
and during lactation
GI disturbances
Skin reactions
Fluid retention
worsening of CF
Renal effects
INTERACTIONS
CODEINE
ADVERSE EFFECTS
CONTRAINDICATIONS
Cough
Severe pain of cancer
5H
Hypotension
Hepatic disease
BPH
Head injury
3B
Bronchial asthma
Biliary colic
Babies & elderly
Respiratory
depression
Sedation
Euphoria
Pupil constriction
Nausea & vomiting
Reduced gut
motility
Constipation
Pruritis
Hypotension
Bronchospasm
Urinary retention
Oral anticoagulants
Lithium
antiHPT
digoxin
phenytoin with
ibuprofen
MTA
Insulin with
salicylates
Antacids with
naproxen sodium or
salicylates
Probenecid with
naproxen
TCA,
Phenothiazines,
MAO Inhibitors
potentiate
morphine
Morphine retards
absorption of many
orally administered
drugs by delaying
gastric emptying
N-OPIATE
OPIOID
WEEK 3 - PAIN
Tramadol
PARACETAMOL
GABAPENTIN
Moderate to moderately
severe pain
Analgesic / Antipyretic
Substitute aspirin for those
with gastric complaints
Children w/ viral infection
or chickenpox
Inhibits prostaglandin
synthesis in the CNS
Metabolized by Liver
can cause hepatic
toxicity
Acts on Ca channels
STEP 1
PRN/Regular paracetamol and
PRN/regular NSAID (if safe)
Patients on MAOi
Hepatic disease,
viral hepatitis
Alcoholism
Neuropathic pain
STEP 2
Regular paracetamol and
regular NSAID (if safe)
PRN weak opiate i.e. Codeine
STEP 3
Regular paracetamol and regular
NSAID (if safe)
Regular weak opiate i.e. Codeine
PRN opiate for breakthrough pain
i.e. Oramorph
SSRI
TCA
Renal tubular necrosis
Virtually free of any
significant adverse
effects
Alcohol
STEP 4
Regular paracetamol and
regular NSAID (if safe)
Regular opiate i.e. Oramorph
PRN opiate for breakthrough
pain i.e. Oramorph
STEP 5
REFER TO ACUTE PAIN SERVICE