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Analgesics/Antipyretics Musculoskeletal System and
Disorders
Welcome to Week 6Chapters: 16 and 24
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ANALGESICS
Drug Classes2
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Analgesics and Pain
What does “pain” look like? Evaluate pain based on:
Where pain is felt Duration Intensity (1-10 scale) Precipitating factors
Pain may be Acute or Chronic: Acute-short duration, responds to analgesics Chronic-over time, less responsive to
analgesics, tolerance
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Types of Analgesics
Three Classes
Opioid
Nonopioids
Adjuvant
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Opioid (Narcotic) and Opiate Analgesics
Strong and capable of reducing pain from any origin
Derivatives of opium or synthetic chemicals that produce effect similar to opium.
Examples: codeine, morphine, oxycodone, fentanyl, meperidine
Vary in potency, onset and actionTolerance and potential for dependence are
important concernsMany are schedule II
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Narcotic Analgesics Side Effects
Respiratory depressionConstipationItching (may subside in 4-5 days)Nausea (may subside in 4-5 days)ConfusionEuphoriaIdiosyncratic (restlessness and agitation)Sedation
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Drug Interactions with Narcotics
Alcohol –leads to CNS and Respiratory depression
Other medications that have CNS depression
What can we give to treat narcotic overdose?
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Nonopioid Analgesics
For mild to moderate painDiffer from narcotic analgesics
1. Not related to morphine2. Work on peripheral nervous system
rather than CNS (outside brain and spinal cord)
3. Do not produce physical dependency and tolerance
4. Do not alter consciousness or mental function
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Characteristics of Nonopioid Analgesics
Relieve low-intensity pain of inflammation and dull aches and vague pain
Reduce Fever Uses are -anti-inflammatory
-analgesic -antipyretic
Not every drug in this class has all three
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More Characteristics on Nonopioid Analgesics
Usually first step in pain controlCan be OTC or RxLess expensive that NarcoticsMay be combined with narcotics to become
Rx items: Hydrocodone and APAP, Hydrocodone and
ibuprofen, Oxycodone and APAPMay be combined with non-narcotics to
become Rx or OTC items: ASA and caffeine, APAP and caffeine and butalbital
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Salicylate Analgesics, ie. ASA (aspirin)
Oldest of nonopioid analgesics; not for childrenFour distinct therapeutic actions of ASA:
1. Analgesic – inhibits prostaglandin release from damaged tissues
2. Anti-inflammatory—reducing prostaglandin synthesis
3. Anti-pyretic—reduces fever by causing vasodilation and sweatin, resets temperature control in brain
4. Anti-coagulant—prevents platelets from aggregating (clump) to decrease clot formation
Beware GI effects, bleeding out
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Acetaminophen (APAP)
Has analgesic and antipyretic actions; No anti-inflammatory action
Reasons to use APAP over ASA: Can be used in all ages including children Good choice for people allergic to ASA or ASA-like
compounds Rarely causes GI upset and bleeding Can take with anticoagulation medications
Main disadvantage –liver damage with long term or high doseages or concurrent heavy alcohol use
NMT (no more than) 4 grams in 24 hours for adults with normal liver function!
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Nonsteroidal Anti-inflammatory (NSAID’s)
Examples: ibuprofen (Advil®, Motrin®), naproxen (Aleve®)
Treat mild to moderate painNormally used for inflammatory conditions,
dysmenorrhea, dental painInhibits cyclooxygenase (COX) which results in
decreased formation of prostaglandin precursorsSE- GIDo not take with ASA, APAP or other NSAID’s.Time limits 10 days for pain, 3 days for fever or as
directed by MD
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World Health Organization (WHO) Pain Ladder
•Mild Pain-APAP, ASA, other NSAIDS around the clock
•Moderate Pain- add mild opioid (codeine or hydrocodone)
•Severe Pain-DC Mild Opioid, give strong opioid (Demerol or morphine). The nonopioid should be continued.
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Adjuvant Analgesic
Used to enhance analgesic efficiency and prolong effects of opioid medications
Typically not prescribed alone for painGoal=Decrease amount of pain medication with
increase in pain controlHelp to reduce side effects of analgesics (ex: nausea)Examples of adjuvants:
Tricyclic Antidepressants (amitriptyline) *treat dull aches Corticosteroids (prednisone) *treat edema Anti-Convulsants (lorazepam, phenytoin) *treat sharp,
shooting, or burning pain Antihistamine (hydroxyzine) *treat anxiety/nausea
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Review
Name the three types of Analgesics
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Answer17
Opioid
Nonopioids
Adjuvant
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Musculoskeletal System – Chapter 24
(2) Different systems working closely together
Muscular System made up of Muscles Connective Tissue … ligaments, tendons Skeletal System made up of Bones -- osteoporosis Joints – arthritis, bursitis
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Osteoporosis and Rx Therapy
Osteoporosis = Bone resorption (Bone loss) Most patients are Not Aware it is occuring!
-as we age, resorption begins to exceed formation
-common causes: *decreasing Estrogen (women) *low/insufficient Calcium intake *decreased Physical-activity
(exercise) Biphosphonates -(Fosamax, Actonel, Boniva)Evista – for both prevention and treatment!Calcitonin-salmon –treatment only! (Miacalcin)Forteo – stimulates new bone growth
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Osteoporosis – Patient Education
Increase load-bearing exercise –walking, stairsCalcium supplement + Vitamin-D – don’t forget
the natural sources! – dairy products, etc.Biphosphonates: important guidelines … always take
on empty-stomach 30-60 minutes before breakfast with a full glass of water to make sure the tab doesn’t stick in the throat (may cause esophageal erosion!), and patient should remain upright 30-60 minutes after swallowing (to prevent reflux, erosion).
Miacalcin(nasal calcitonin-salmon) – alternate nostril every other day (apply in 1 nostril per day)
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Joint Diseases and Rx Therapy
Osteoarthritis – most common, generative noninflammatory, caused by ‘wear-and-tear’
Rheumatoid arthritis – autoimmune, various forms, all ages, progressive, pain/swelling/limits movement
Bursitis – inflammed ‘fluid-sacks’ in the jointsCommon Antiarthritis Medications:Salicylates – ASA(aspirin), salsalateNSAIDs – ibuprofen, naproxen, CelebrexDMARDs – methotrexate **dangerous drug!!Gluco-corticosteroids – prednisone, dexamethasone
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General Characteristics of Arthritis meds
Salicylates – fast-acting, inexpensive, GI s/e(enteric-coated)
NSAIDs – potency, duration, $, less GI side-effects, blocks both COX1 and COX2 enzymes (GI danger in long-term use)
COX2 Inhibitors – much greater potency and duration, much less GI side-effects(only block COX2), indicated for both Osteo and Rheumatoid arthritis (only one available is Celebrex)
Glucocorticosteroids – powerful in reducing inflammation, preferably only used for a limited time (specific courses of therapy)
DMARDs(immunosuppressants) – reduces the body’s own immune-response (autoimmune) to provide relief
These only produce short-term remission, disease will worsen!
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Gout
Hyperuricemia (excess uric acid accumulation)
Uric acid accumulates, then crystalizes (ouch!)
Symptoms: *acute pain *swelling *redness *tenderness (usually the big-toe, ankle, knee, elbow)
Medications:Acute attack – colchicineProphylaxis – allopurinol, probenecid
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Muscle Relaxants
Treat Muscle spasms and muscle spasticityMost spasm caused by local injury, seizure-
disordersMuscle-relaxants *decrease local pain/tenderness,
*increase range-of-motion, *cause sedationSoma (carisoprodol)Flexeril (cyclobenzaprine)Skelaxin (metaxalone)Robaxin (methocarbamol)CNS agents: diazepam, Lioresal (baclofen)
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Questions?25
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Questions26