Pharm 2 Final: Opioids and NSAIDs

Morphine

MOA: Opioid agonist. Use: Severe pain (trauma, MI, cancer). SE: Significant first-pass metabolism; metabolites can accumulate in renal failure.

Methadone

MOA: Opioid agonist + NMDA antagonist. Use: Opioid dependence or chronic pain. SE: Monitor QTc.

Meperidine

MOA: Opioid agonist. Use: Obstetric or post-surgical analgesia. SE: Does not prolong labor as much as morphine.

Oxycodone

MOA: Opioid agonist. Use: Moderate to severe pain. SE: Long-acting form is OxyContin.

Loperamide (Imodium)

MOA: Activates opioid receptors in GI smooth muscle. Use: Diarrhea. SE: N/A.

Tramadol

MOA: Opioid agonist + serotonin and NE reuptake inhibitor. Use: Moderate pain. SE: Increased risk of suicidal thoughts and behaviors.

Codeine

MOA: Opioid agonist. Use: Mild to moderate pain. SE: Greater bioavailability than morphine; converted to morphine by CYP2D6.

Buprenorphine

MOA: Partial opioid agonist. Use: Opioid dependence or chronic pain. SE: Frequently combined with naloxone (Suboxone = buprenorphine + naloxone).

Fentanyl

MOA: Opioid agonist. Use: Chronic pain (transdermal). SE: Fast onset; no active metabolites.

Naloxone

MOA: Opioid antagonist. Use: Reversal agent for opioid overdose. SE: Frequently combined with buprenorphine (Suboxone).

Naltrexone

MOA: Opioid antagonist. Use: Opioid dependence; alcohol use disorder. SE: Available oral or injectable.

Acetaminophen

MOA: Inhibits prostaglandin synthesis (weak anti-inflammatory); inhibits hypothalamic heat-regulation center. Use: Acute pain. SE: Safe in low doses in pregnancy; caution in hepatic dysfunction; max dose 4 g/day.

Aspirin

MOA: Non-selective COX inhibitor; irreversibly acetylates platelet COX; COX-1 inhibition → antiplatelet effects. Use: Acute pain; secondary prevention post-stroke/MI. SE: Antiplatelet effect lasts 14 days.

Ibuprofen (Motrin)

MOA: Non-selective COX inhibitor; reversibly inhibits cyclooxygenase. Not cardioprotective due to short half-life and reversible COX-1 inhibition. Use: Acute pain. SE: GI bleeding, peptic ulcers; caution in renal disease; ceiling effect on analgesia.

Celecoxib

MOA: Selective COX-2 inhibitor; reversibly inhibits COX-2; no effect on COX-1 (no antiplatelet effects). Use: Acute pain. SE: Same GI adverse effects as ibuprofen.