Analgesia Review

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Methadone (Dolophine)
Narcotic
Used in opiate dependency (to "wean" off opiates)
Also used for chronic pain management
Allopurinol (Zyloprim)
For gout
Used along with NSAIDS to manage pain
Inhibits uric acid production
Hydrocodone (Hycodan),
Narcotic
Effective antitussive
More sedation than codeine
NSAIDS
ASA, ibuprofen (motrin, advil), celecoxib (celebrex), ketorolac (toradol)
Inhibits cyclo-oxygenase (COX) to prostaglandin formation
Antipyretic ("anti-fever"), anti-inflammatory, anti-platelet aggregation
Can cause PUD, renal/liver impairment
Serotonin 5-HT1 Agonists
For severe migraine when NSAIDS and APAP fail to work
Activate 5-HT1 receptors to constrict intracranial and extracerebral blood vessels
Sumatriptan (Imitrex) and Ergotamine (Ergostat)
Morphine Sulfate
Narcotic
Endogenous opioid: Endorphin
Activate mu and kappa receptor sites in brain
Recommended for chest pain and congestive heart failure
Venous dilation
Avoid in gall bladder or pancreatic disease (biliary spasms)
Meperidine hydrochloride (Demerol)
Narcotic
Given as:
Adjunct to anesthesia
Preoperative sedation
Obstetric analgesic
causes less biliary spasm than morphine
Oxycodone
Narcotic
Most highly abused
Less n/v and hallucinations than other narcotics
Centrally Acting Non Opioids
Tramadol (ultram), clonidine (catapres)
Bind to mu receptor; inhibit norepinephrine and serotonin reuptake
Adverse Effects: CNS stimulation, seizure, respiratory depression, physical dependence
Acetaminophen
Tylenol
Inhibits prostaglandin synthesis, thereby blocking transmission of pain impulses to brain
Antipyretic only (no inflammatory or platelet effects)
Overdose: Hepatic impairment
Avoid ETOH while taking
Narcotic Antagonists
Naloxone (Narcan)
Competes with opioid agonists for mu and kappa receptors
Used in suspected opioid OD to reverse respiratory depression, sedation, hypotension and coma
May repeat doses every 5 minutes
Codeine
Narcotic
Direct central cough suppression in the medulla
Good for:
Mild to moderate pain
Antitussive at low doses
Post-op craniotomy or brain injury d/t less CNS depression
Hydromorphone (Dilaudid)
Strong narcotic analgesic
Used in PCAs
Less nausea but more othrostatic hypotension than morphine
Agents for RA
Aimed at slowing progression, relief of pain/inflammation
Include:
Analgesics
Anti-inflammatories
Chemo drugs (methotrexate)
Corticosteroids
Gold Salts
Antimalarial
Agonist-Antagonists Opioids
Butorphanol (Stadol), Nalbuphine (Nubain)
For moderate pain
Less respiratory depression than morphine
Less chance for dependence