Analgesics and Anti-Inflammatories

2 main classes of drugs for primary pain management

2 main classes of drugs for primary pain management

opioid and non-opiod (NSAID)

typical suffix for opiods

-ine

what are the 3 opioid receptors?

mu, kappa, delta

receptor that provides the best pain relief but worst side effects (respiratory depression/addiction)

mu

receptor that can cause euphoria or dysphoria

kappa

bind to mu, used to treat severe pain (ex: after surgery) morphine and meperidine

strong agonists

partial bind with mu combined with other receptors, codeine and oxycodone

mild to moderate agonists

binds to one receptor and blocks another, often mu in order to reduce side effects (nalbuphine, buprenophine)

mixed agonist antagonists

used to treat opioid overdose and overuse (narcan)

antagonists

how do opioids work?

inhibit pain pathways in the brain and spinal cord to alter perception of pain

Peripheral effect of opioids

decreases the excitability of sensory neurons

opioids _______________ pain rather than eliminating painful sensation

alter perception of

adverse effects of opioids

sedation, dysphoria, confusion, respiratory depression, orthostatic hypotension, GI effects, tolerance/dependence

complex interaction of factors that leads to lack of control over drug use

overuse

the need to progressively increase the dosage of a drug to achieve therapeutic effect after drug use fro prolonged period

tolerance

onset of withdrawl symptoms when a drug is abruptly removed

physical dependence

What precautions should a therapist use when treating a patient on meperidine considering the potential side effects?

caution with sitting up to quickly due to orthostatic hypotension

use of NSAIDs

treatment of mild to moderate pain

4 primary therapeutic effects of NSAIDs

analgesia, anti-inflammation, antipyretic(anti-fever), anticoagulation

common brand names for ibuprofen

motrin, advil

common brand name for naproxen

aleve

common brand name for acetominophen

tylenol

local hormones that regulate cell function

prostaglandins

How do NSAIDs work

inhibit prostaglandin production

Functions of COX1

protect stomach lining, platelet aggregation

Functions of COX2

bvs diameter balance, mediate erythema and edema, mediate pain and fever

what is the prototypical NSAID?

aspirin

What is aspirin used to treat?

pain, inflammation, fever, vascular disorders (blood thinner), cancer

what is the benefit of cox-2 selective inhibitors?

lower risk of GI irritation, does not inhibit platelet aggregation (beneficial to patients at risk of bleeding or bruising)

Major risk of Cox-2 selective inhibitors

heart attack and stroke (more platelets and bvs diameter cannot adjust due to inhibition)

is acetominophen anti-inflammatory

no

adverse effect of acetominophen

toxic to liver

common side effect of NSAID toxicity

tinnitus

adverse effects of NSAIDs

GI problems, cardiovascular problems, hepatic/renal problems, inhibition of bone healing

2 types of anti-inflammatory drugs

NSAIDs and glucocorticoids (steroidal)

when are glucocorticoids used?

moderate to severe inflammation

typical suffix seen in glucocorticoids

-one

how do glucocorticoids work?

by inhibiting phospholipase, immunosupressive prevents WBC’s from going to injury in order to stop inflammation

adverse effects of glucocorticoids

collagen breakdown, delayed wound healing, adrenocortical suppression, hyperglycemia