CAP medications

non-opioid analgesic examples

• paracetamol

• ibuprofen

• diclofenac

• aspirin

• celecoxib

• naproxen

• indomethacin

paracetamol indications

• mild to moderate pain

• fever

paracetamol type

non-opioid analgesic

paracetamol mechanism

inhibits central prostaglandin synthesis--> reduces pain and fever

paracetamol effects

mild-moderate analgesia, antipyretic (reduces fever)

paracetamol side effects

• drowsiness

• rash

• itching

• overdose: - severe hepatotoxicity/liver failure

paracetamol clinical implications

• give 30-60 mins before physio,

• pre-activity for pain control

• short duration (4-6 hours)

NSAIDs type

non-opioid analgesic

NSAIDs indications

• mild to moderate pain

• reduce inflammation

• conditions

  • arthritis

  • headache

  • painful periods

  • musculoskeletal injuries

  • cold and flu

  • post-operative pain

NSAIDS mechanism

inhibit COX-1 and COX-2, decrease prostaglandins, decrease pain, inflammation, fever, aspirin, decrease platelet aggregation

NSAIDS effects

pain relief (mild-moderate), anti-inflammatory, antipyretic

NSAIDS side effects

• stomach ache, nausea, diarrhoea

• headache/tinnitus

• drowsiness

• dizziness

• allergic reactions

• peptic ulcers

• acute renal failure

• stroke

• myocardial infarction

NSAIDS clinical implications

• useful for inflammatory MSK conditions,

• caution in renal/cardiac patient

• may mask pain during rehab progression

opioids

morphine, codeine

semi-synthetic opioid

oxycodone, hydromorphone

synthetic opioid

fentanyl, tramadol, methadone, remifentanil

opioid indications

• moderate to severe pain

• post-operative analgesia

• trauma, musculoskeletal pain

• cancer and palliative care

opioid mechanism

binds opioid receptors, close Ca2+ channels, open K+ channels, hyperpolarisation, decrease neuronal excitability

opioid effects

strong analgesia

opioid side effects

• respiratory depression,

• constipation

• nausea

• confusion

opioid clinical implications

monitor sedation/respiratory status, may limit participation in physio due to drowsiness

semi-synthetic opioids clinical implications

common post-op analgesia, assess alertness and mobility tolerance

synthetic opioid clinical implications

ICU/acute care, high monitoring needs, may requires ventilatory support, affects mobilisation timing

intravenous anaesthetics examples

• ketamine

• dexmedetomidine

ketamine type

IV anaesthetic + analgesic

ketamine indications

• moderate to severe pain

• general anaesthesia for surgery

• sedation in ICU

• severe asthma

ketamine mechanism

blocks NMDA receptors--> dissociative anaesthesia + analgesia, bronchodilation

ketamine effects

sedation, strong analgesia, dissociation

ketamine side effects

• hallucinations

• confusion

• nausea/vomiting

ketamine clinical implications

useful in ICU/surgery, may allow partial wakefulness for physio depending on dose

dexmedetomidine type

IV sedative

dexmedetomidine indications

• general anaesthesia for surgery

• sedation in ICU

• delirium

• alcohol withdrawal

dexmedetomidine mechanism

decrease sympathetic activity, sedation, analgesia, anxiolysis (reduce anxiety)

dexmedetomidine effects

sedation with minimal respiratory depression

dexmedetomidine side effects

• bradycardia

• hypotension

dexmedetomidine clinical implications

useful for ICU patient who need to remain spontaneously breathing, may allow better participation in physio

local anaesthetic examples

• lidocaine (lignocaine)

• chloroprocaine

• procaine

• bupivicaine

• ropivicaine

lidocaine (lignocaine), chloroprocaine, procaine type

local anaesthetic, antiarrhythmic

bupivicaine, ropivicaine type

long-acting long anaesthetics

lidocaine (lignocaine), chloroprocaine, procaine indications

• local anaesthesia

• cardiac arrhythmias

lidocaine (lignocaine), chloroprocaine, procaine mechanism

blocks voltage-gated Na+ channels, prevents nerve impulse conduction

lidocaine (lignocaine), chloroprocaine, procaine effects

local numbness, antiarrhythmic effect

lidocaine (lignocaine), chloroprocaine, procaine side effects

• toxicity,

• CNS symptoms

• arrhythmias

lidocaine (lignocaine), chloroprocaine, procaine clinical implications

used for procedures (airway, lines, blocks), may affect sensation during rehab activities

bupivicaine, ropivicaine effects

regional numbness

bupivicaine, ropivicaine side effects

• cardiotoxicity

• motor weakness

bupivicaine, ropivicaine clinical implications

common in epidurals/nerve blocks, may reduce motor function, impacts mobility, gait, rehab participation