Clindamycin

Dolor Sit Amet

Pain Medicines-Pharm1/2

 

Pain medications

 

NSAIDS Opiates IV MEDS inflammation Migraine

 

 

Chronic Pain meds

 

 

 

Nonsteroidal Anti-inflammatory Drugs (NSAIDS)

 

 

Aspirin (ASA)

 

 

Ibuprofen –Motrin/Advil First generation – Cox1/Cox2 inhibitors

 

 

Naproxen- Naprosyn/Aleve Drugs can cause decreased platelet aggregation

 

 

Indomethacin- Indocin Kidney Damage

 

 

Diclofenac- Voltaren

 

 

Ketorolac- Toradol

 

 

Meloxicam- Mobic

 

 

Selective Cox 2 inhibitor

 

 

Celecoxib- Celebrex

 

 

 

Uses for NSAIDS

 

Inflammation suppression Complications

 

 

Used for mild to moderate pain Gi discomfort- give with food

 

 

Osteoarthritis/ Rheumatoid arthritis GI Bleeding due to low plat

 

 

Fever reduction ( Give PPI –Omeprazole)

 

 

Dysmenorrhea

 

 

Inhibition of platelet Impaired Kidney Function

 

 

Protects against CVA/MI Decreased urine output

 

 

Increased Bun/Creatinine

 

 

Use with caution in elderly/CHF

 

 

Drug Interactions

Anticoagulants- Coumadin/ Heparin causes increased risk of bleeding

Monitor PTT, PT/INR

Instruct PT to report indications of bleeding

Black , tarry stools, bleeding from gums, nose bleeds, hematuria

 

Alcohol increases risk of bleeding

 

Dehydration from fever can lead to kidney impairment –

Drinks lots of water

 

 

Aspirin (ASA)

 

Uses- Fever reduction

Prevent platelet aggregation

Used to prevent stroke/ MI

Used in ER MONA- Morphine, O2, NTG,ASA

Side effects = Gastric distress bleeding

Use enteric coated to prevent bleeding

Have Pt report signs of bleeding- black, tarry stools, Hematuria

Bleeding from mouth, gums, or nose

Avoid use in children due to REYES syndrome-rare –CNS, Liver damage

Don’t give with viral illness –flu, varicella

 

 

 

Action- slows production of prostaglandins in CNS

Uses-Analgesic, Antipyretic

Used in pain relief, fever reduction

Effectiveness-

Pain relief of mild to moderate pain

Fever reduction especially effective in children

Acute Toxicity- nausea ,Diarrhea , vomiting, sweating

Hepatic failure, coma ,death

Dosage < = 4 GMs /24 hours

Antidote- Acetylcysteine- Mucomyst

Avoid alcohol, increases risk of bleeding with warfarin( metabolism)

Acetaminophen

Opioid Agonist

Opioid agonist

Morphine class

Fentanyl

Meperidine- rigors after epidural

Methadone-cocaine & heroin addiction /cancer pain relief/less sedation and side effects

Codeine

Hydromorphone

Oxycodone

Tramadol HI Acting NSAID

 

 

 

Uses and actions

Pain relief- opioid receptor

Relief of moderate to severe pain

Used in childbirth,

Post-operative pain

M/I

Renal colic

Chronic pain

Cancer pain relief

Routes /Actions

Opiate receptor- blocks or occupies

Routes-

IM ,Po,sublingual

IV/epidural

Intrathecal

Rectal, oral

Subq/transdermal

Side Effects

Contraindications/Precautions

Don’t use in neonates resp depression

Morphine- don’t use after biliary surgery causes spasm(ODI sphincter)

Hepatic /Renal Disease

Use in caution with elderly

CNS depression – no alcohol

Give Lax of Choice (LOC)

Interactions with TCA, MAOI,-Malignant hyperthermia

For Cancer Patients- give ATC with prn doses for effective pain management

Pain Contract to avoid addition / dependence

Recheck pain level with pt after administration for effectivenessr

Respiratory Depression

Orthostatic Hypotension

Constipation

Urinary Retention

Nausea/Vomiting

Sedation

Biliary Colic

Opioid Overdose

Opioid Agonist / Antagonist

Actions- Blocks opiate receptor sites/ occupies other receptor site

 

Blocks pain but reduces side effects

 

Low potential for abuse

 

Less sedation

 

Less analgesic effect

Uses –

Moderate to severe pain

Treatment of opioid dependence-Suboxone

 

Adjunct to balanced anesthesia

Relief of labor pain

 

 

 

 

Nalbuphine –Nubain

 

Butophanol- Stadol

 

Buprenorphine- Suboxone

 

Pentazocine- Talwin

 

Opioid Antagonist

 

 

Naloxone- Narcan- IV IM Subq

 

 

Blocks and competes for opioid receptors

 

 

Reverses effects

 

 

Resp depression

 

 

Overdose

 

 

Half life of opioid can exceed half life of Narcan

 

 

Monitor for 2 hours after to assess for further resp depression

 

 

Titrate dosage to get full effect

 

 

Rapid infusion can cause hypertension, nausea and vomiting tachycardai

 

 

 

 

 

Adjunct Pain Medications

Tricyclics- ( Amytriptyline)used to treat fibromyalgia, depression, neuropathic pain –burning, cramping, sharp stabbing pain.

Anticonvulsants-(Carbamazepine, Gabapentin)-neuropathic pain, neuralgia

CNS stimulants- (Methylphenidate)- oral, transdermal)

Glucocorticoids-Prednisone (oral), Dexamethasone- oral, IV.IM

Bisphosphonates-Etidronate (Oral) Pamadronate-IV

NSAIDS-Ibuprophen (oral, IV)

Acetaminophen- Used as adjunct in pain and cold meds-oral, IV

CNS effects, Increased bleeding, Grapefruit juice, steroids can cause superinfection or fungal infection, ulcerative colitis, Ibuprophen- ASA allergy can cause bronchospasm

 

Migraines

ASA like meds- Ibuprofen, NSAIDS

Serotonin Receptor agonist

Sumatriptan-oral subcutanous transdermal

Betablockers-propranolol Oral’

Anticonvulsants-Divalproex oral-Topiramate

Tricyclic Antidepressants

Many drug interactions/ side effects on these medications

Use sumatriptan as prophylaxis

Watch for cont/severe chest pain

CNS excitation – seizures, serotonin syndrome

Beta blockers –can mask hypoglycemia

CNS depression- increases with alcohol

Orthostatic hypotension =amitriptyline, propanolol