Copyright © 2015 Cengage Learning® 1 Chapter 19 Analgesics, Sedatives, and Hypnotics.

Copyright © 2015 Cengage Learning® 1Copyright © 2015 Cengage Learning®

Chapter 19Analgesics, Sedatives, and

Hypnotics

Copyright © 2015 Cengage Learning® 2

Introduction • Analgesics, sedatives, and hypnotics

– Depress central nervous system (CNS) action to varying degrees

– Some drugs can be classified into more than one category, depending on the dosage• Analgesics: relieve pain• Sedatives: calm, soothe, or produce sedation• Hypnotics: produce sleep


Introduction (cont’d.) • The following slides discuss various

analgesics, sedatives, and hypnotics– Refer to the chapter for specific side effects,

contraindications, and interactions


Analgesics• Pain is the most common reason for

patients to seek out medical care– Most common types: back, neck, migraine,

and facial or jaw pain– Is subjective: can be experienced or

perceived only by the individual subject– Can be blocked by endorphins

• Endogenous analgesics produced within the body as a reaction to severe pain or intense exercise


Analgesics (cont’d.)• Opioid analgesics

– Full or pure agonists, partial agonists, or mixed agonist-antagonists • Each bind to specific receptors with varying

degrees of action • Classified as controlled substances• Potential for abuse and psychological dependence• Tend to cause tolerance and physiological

dependence


Analgesics (cont’d.)• Tramadol (Ultram)

– Centrally acting synthetic analog of codeine with a dual mechanism of action

– Produces analgesia by weak inhibition of norepinephrine and serotonin reuptake; is an opioid receptor agonist

– Less potential for abuse or respiratory depression (although both may occur)

– Currently not classified as a controlled substance on the Federal level


Analgesics (cont’d.)• Nonopioid analgesics

– Many available without prescription as over-the-counter (OTC) medications

– Given for relieving mild to moderate pain, fever, and anti-inflammatory conditions

– Used as a coanalgesic in severe acute or chronic pain requiring opioids


Analgesics (cont’d.)– Salicylates (aspirin) are most commonly used

for their analgesic and antipyretic properties, as well as for their anti-inflammatory action

– Acetaminophen has analgesic and antipyretic properties, but very little effect on inflammation

– Aspirin and acetaminophen are frequently combined with opioids or with other drugs for more effective analgesic action


Analgesics (cont’d.)• Salicylates and other NSAIDS

– Analgesic and anti-inflammatory actions• Associated primarily with preventing formation of

prostaglandins and subsequent inflammatory response that prostaglandins help to induce

• Acetaminophen (Tylenol) – Used extensively to treat mild to moderate

pain and fever• Very little effect on inflammation, but fewer adverse

side effects than salicylates


Analgesics (cont’d.)• Adjuvant analgesics

– May enhance analgesic effect with opioids and nonopioids, produce analgesia alone, or reduce side effects of analgesics

• Tricyclic antidepressants– Treats fibromyalgia and nerve pain associated

with herpes, arthritis, diabetes, and cancer, migraine or tension headaches, insomnia, and depression


Analgesics (cont’d.)• Anticonvulsants (i.e., Neurontin and

Tegretol)– Commonly used for management of nerve

pain associated with neuralgia, herpes zoster (shingles), and cancer

– Implemented when patient describes pain as “sharp,” “shooting,” “shock-like pain,” or “lightning-like”


Local Anesthetic• Lidocaine patch (Lidoderm)

– Approved for management of postherpetic neuralgia

– Can provide significant analgesia in other forms of neuropathic pain• Diabetic neuropathy and musculoskeletal pain

such as osteoarthritis and low back pain

– Provides pain relief through a peripheral effect and generally has little, if any, central action


Local Anesthetic (cont’d.)• Antimigraine agents

– Simple analgesics, NSAIDs, and opioid analgesics can be effective, especially if taken at initial sign of migraine

• Serotonin receptor agonists (SRAs)– Action: serotonin levels decrease, while

vasodilation and inflammation of blood vessels in brain increase as migraine symptoms worsen • Effective in treating associated nausea and vomiting


Sedatives and Hypnotics • Medications used to promote sedation in

smaller doses – Promote sleep in larger doses

• Benzodiazepines (BZDs) and nonbenzodiazepines– Less abuse potential – Withdrawal effects are observed after long-

term use and respiratory depression (when taken with alcohol) can be potentially fatal


Sedatives and Hypnotics (cont’d.)• Melatonin receptor agonist

– Ramelteon (Rozerem): first FDA-approved prescription medication that acts on melatonin receptor• Mimics action of melatonin to trigger sleep onset• Dependence and abuse potential are eliminated• Not classified as a controlled substance• Works quickly, generally inducing sleep in less

than one hour

Copyright © 2015 Cengage Learning® 1 Chapter 19 Analgesics, Sedatives, and Hypnotics.

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