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)






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


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)


Opioid Agonist

Opioid agonist

Morphine class


Meperidine- rigors after epidural

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




Tramadol HI Acting NSAID




Uses and actions

Pain relief- opioid receptor

Relief of moderate to severe pain

Used in childbirth,

Post-operative pain


Renal colic

Chronic pain

Cancer pain relief

Routes /Actions

Opiate receptor- blocks or occupies


IM ,Po,sublingual



Rectal, oral


Side Effects


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


Urinary Retention



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






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



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