Pain Medications

Types of analgesics:

A. Nonnarcotic Analgesics:
1. Non- steroidal antiinflamatorydrugs (NSAIDs)
• naproxen (Aleve) • diclofenac (Cataflam)
• ibuprofen ( Advil, Midol) • ketorolac ( Toradol)
• aspirin • ketoprofen (Orudis)
• piroxicam ( feldene)
• mefenamic acid (Dolfenal, Ponstan)
 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. gastric irritation
2. GI bleeding
3. nephrotoxic
4. aplastic anemia
5. hypersensitivity to ASA ( tinnitus, vertigo, bronchospasm, urticaria)
6. Reye’s syndrome
7. 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. addiction
2. pinpoint pupils
3. respiratory depression
4. CNS depression
5. constipation
6. 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