Medications for Pain and Inflammation
Transcript of Medications for Pain and Inflammation
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Pain and Inflammation
(General Key Points)
N203ATI (Unit
Pain & Inflamm
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Analgesicsrelieve pain
Narcotics / NSAIDs / Antimigraine agents
Anti-inflammatorymedications relieve inflammation
Salicylates / Glucocorticoids / Antigout / Disease-modifying
antirheumatics drugs (DMARDs
Some are antipyretic (salicylates! i"uprofen
Salicylates and NSAIDs reduce platelet aggregation
Salicylates! NSAIDs! and glucocorticoids pose ris# for ulceration
Acetaminophen has analgesic and antipyretic properties "ut not an
inflammatory$ It poses a ris# for liver in%ury
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NSAIs(!edi"ation #ist)
N203ATI (Unit
Pain & Inflamm
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Aspirin &etorolac ('oradol
eleco)i" (ele"re) *aldeco)i" (+e)tra
I"uprofen Indomethacin
Napro)en
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NSAIs
N203ATI (Unit
Pain & Inflamm
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Expected Action: Proto:aspirin! i"uprofen! #etorolac!
ycloo)ygenase inhi"ition , . inflammation! . 0 plat
Therapeutic Uses: Inflammation suppression / analgesia / fever
dysmenorrhea / suppression of platelet aggregation
Adverse Effects:
GI discomfort! aspirin induced ulceration and "leeding (use misoprostol
prophyla)is! and/or 11I and/or 2-receptor agonistris# of ulceration
Renal dysfunction
Reye syndrome (in #ids 3ith viral illnesses
Salicylism (tinnitus!
al#alosis! di44iness
Contraindications/Precautions:
1eptic ulcers / "leeding disorders / hypersensitivity / pregnancy / #ids 5 v
Interactions: Glucocorticoids (gastric "leeding , use
prophylactic li#e misoprostol (ytotec to 6arfarin ("leeding
7t2 ("leeding I"uprofen (antiplatelet effects of lo3-do
Education: Give 3ith food or mil# to reduce GI discomfort$ If can8t tolerate 0stgeneration! give ndgeneration (celeco)i"
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Ketorola" (Toradol)
N203ATI (Unit
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A"etamino$%en
N203ATI (Unit
Pain & Inflamm
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Expected Action:
Slo3s production of prostaglandins
Therapeutic Uses:
Analgesic and antipyretic
Adverse Effects: Ma) ; g daily
Acute liver to)icity Antidote< acetylcysteine (Mucomyst
Contraindications/Precautions:
Interactions:
7t2 ris# to liver / 6arfarin levels of 3arfarin
Education:
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$ioid A'onists
N203ATI (Unit
Pain & Inflamm
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Therapeutic Uses:
Proto:morphine! fentanyl! meperidine! methadon
Moderate to severe pain / Sedation / "o3el motility / ough suppress
Adverse Effects:
Respiratorydepression
Sedation
onstipation rthostatic 2ypotension :rinary reten
+iliary colic ough suppression 7mesis
Contraindications/Precautions: Increases cardiac 3or#load
Meperidine meta"olites are neuroto)ic (= >?? mg/;hr! = ;@ hours
Interactions:
NS depressants ("ar"iturates! pheno"ar"ital! "en4odia4epines! 7t2
Anticholinergics! antihistamines! tricyclic antidepressant anticholiner
MAIs (hyperpyre)ia! sei4ures Antihypertensives
Education: 6ithhold if RR=0 2ave nalo)one (Narcan and re
euipment availa"le$ Infuse I* slo3ly over ;-9 minutes
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$ioid Anta'onists
N203ATI (Unit
Pain & Inflamm
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Expected Action: Proto:nalo)one (Narcan! naltre)one!
ompetitively interfere 3ith opioid actions
Therapeutic Uses: D treatment Reversal of opioid effects
Adverse Effects:
'achycardia / 'achypnea A"stinence syndrome (cramping! hype
Contraindications/Precautions:
2ypersensitivity Dependency 1regnancy< +
Interactions:
Education:
Nalo)one has e)tensive first-pass modification
"serve for 3/d symptoms or a"rupt onset of pain
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'ricyclic Antidepressants ('A Amitriptyline (7lav
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'ricyclic Antidepressants ('A$$$$$$$$$$$$$$$$$$$$$$$$$Amitriptyline (7lav
Anticonvulsant$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ar"ama4epine ('egret
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Ga"apentin (Neurontin
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$1henytoin (Dilantin
NS Stimulants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Methylphenidate (Rital
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
De)troamphetamine (De)edrine
Antihistamines$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$2ydro)y4ine (*ista
Glucocorticoids$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$De)amethasone (Decadro
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
1rednisone (Deltasone
+isphosphonates$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$7tidronate (Didron
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
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Ad*ant !edi"ations
N203ATI (Unit
Pain & Inflamm
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Anti'ot !edi"ation
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Expected Action: Proto:olchicine! indomethacin! allopurinol!
olchicine/Indomethacin
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!i'raine !edi"ations(!edi"ation #ist)
N203ATI (Unit
Pain & Inflamm
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7rgot Al#aloids$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$7rgotamine (7rgost
Serotonin Receptor Agonists$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Sumatriptan (Imitr
+eta-+loc#ers$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$1ropanolol! Ateno
Anticonvulsants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Divalproe) (Depa#o 'ricyclic Antidepressants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Amitriptyline (7lav
alcium hannel +loc#ers$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$*erapam
7strogens$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Alora! lim
'riptans$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Almotriptan! Naratriptan!
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+r'ot Al,aloids
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Pain & Inflamm
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Serotonin e"e$torAnta'onists
N203ATI (Unit
Pain & Inflamm
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Expected Action: Proto:Sumatriptan (Imitre)! almotrip
1revent inflammation and dilation of the intracranial "lood vessels
Adverse Effects: hest symptoms (not dangerous! self-resolving
oronary vasospasm/angina
'eratogenic
Contraindications/Precautions:
1regnancy! hypertension! cardiac disease! AD
Interactions:
'riptans 7rgot Al#aloids spastic reaction of "lood vessels
MAIs oncurrent use leads to MAI to)icity (space 3ee#s apart
Education:
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.eta-.lo",ers
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Pain & Inflamm
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Expected Action: Proto:Metoprol
1revent inflammation and dilation of the intracranial "lood vessels
Adverse Effects:
'iredness! fatigue Depression
Asthma e)acer"ation
Contraindications/Precautions:
Interactions:
Education:
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Anti"on*lsants
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Pain & Inflamm
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Expected Action: Proto:Divalproe)
1revent inflammation and dilation of the intracranial "lood vesselsAdverse Effects:
Neural tu"e defects
Contraindications/Precautions:
Interactions:
Education:
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T/As
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Pain & Inflamm
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Expected Action: Proto:Amitriptyl
1revent inflammation and dilation of the intracranial "lood vesselsAdverse Effects:
Anticholinergic effects< dry mouth! constipation! urinary retention! tachy
Contraindications/Precautions:
Interactions:
Education:
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/al"im /%annel .lo",er
N203ATI (Unit
Pain & Inflamm
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!edi"ations for %ematoidArt%ritis
(!edi"ation #ist)
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Pain & Inflamm
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%ematoid Art%ritis !eds(Ad*erse +ffe"ts)
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Pain & Inflamm
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Cytotoxics: 2epatic fi"rosis / Marro3 suppression / GI ulceration /
death or a"normality
$old salts: 'o)icity! renal to)icity! "lood dyscrasias! hepatitis! GI
discomfort
Antimalarials: Retinal damage
%ulfasala&ine: GI discomfort / hepatic dysfunction / marro3 suppre
'io "esponse !odifiers: In%ection-site irritation
Penicillamine: Marro3 suppression
$lucocorticoids: steoporosis (vit D! aF! "isphosphonate
Adrenal suppression GI discomfort