Module 5

Pain and substance abuse medications:

### 1. Adverse effects of opioid agonists

- Respiratory depression (most serious).

- Constipation, nausea, vomiting.

- Sedation and drowsiness.

- Dependency and addiction.

- Miosis (pupil constriction).

- Urinary retention.

### 2. Treatment options for acute opioid overdose

- Naloxone (opioid antagonist) is the first-line treatment.

### 3. Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs)

- Gastrointestinal: ulcers, bleeding, and irritation.

- Cardiovascular: increased risk of heart attack and stroke (especially with long-term use).

- Renal: impaired kidney function or failure.

- Allergic reactions: particularly in aspirin-sensitive individuals.

### 4. Pharmacological treatment for acute vs. prophylactic migraine treatment

- Acute migraine treatment:

- Triptans (e.g., Sumatriptan): serotonin agonists that stop a migraine attack.

- NSAIDs or acetaminophen: for pain relief.

- Prophylaxis (prevention):

- Beta-blockers: e.g., propranolol.

- Anticonvulsants: e.g., topiramate, valproic acid.

- Antidepressants: e.g., amitriptyline.

### 5. Definitions and examples of opioid drugs

- Opioid agonist: Fully activates opioid receptors.

- Example: Morphine, Fentanyl.

- Opioid partial agonist: Activates opioid receptors but produces a lesser effect than full agonists.

- Example: Buprenorphine.

- Opioid antagonist: Blocks opioid receptors and prevents opioid effects.

- Example: Naloxone.

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### Drug Monographs Summary:

- Acetaminophen: For pain and fever. Works by inhibiting prostaglandin synthesis in the CNS. Risk of liver toxicity in overdose.

- Amitriptyline: Tricyclic antidepressant used for chronic pain and migraines. Side effects include drowsiness, dry mouth.

- Aspirin: NSAID for pain, inflammation, and cardiovascular protection. Risk of GI bleeding, especially with long-term use.

- Baclofen: Muscle relaxant for spasticity, works by enhancing GABA activity. Can cause drowsiness and weakness.

- Benztropine: Used to treat extrapyramidal symptoms in Parkinson’s disease, has anticholinergic effects like dry mouth and constipation.

- Buprenorphine: Partial opioid agonist for pain and opioid dependence, lower risk of respiratory depression compared to full agonists.

- Bupropion: Antidepressant, also used for smoking cessation. Can cause insomnia, dry mouth, and an increased risk of seizures.

- Celecoxib: COX-2 selective NSAID for pain and inflammation, fewer GI side effects than non-selective NSAIDs but carries a risk of cardiovascular events.

- Dantrolene: Muscle relaxant used for malignant hyperthermia, can cause liver toxicity.

- Disulfiram: For alcohol dependence, causes unpleasant reactions when alcohol is consumed (flushing, nausea).

- Donepezil: For Alzheimer’s disease, cholinesterase inhibitor, can cause GI upset and bradycardia.

- Entacapone: Used in Parkinson’s, inhibits COMT to increase levodopa effect, can cause diarrhea and urine discoloration.

- Ibuprofen: NSAID for pain and inflammation, similar risks as other NSAIDs (GI bleeding, renal impairment).

- Levodopa/Carbidopa: For Parkinson’s disease, increases dopamine in the brain. Side effects include nausea, dyskinesia.

- Memantine: NMDA receptor antagonist for Alzheimer’s, can cause dizziness and confusion.

- Morphine: Opioid agonist for severe pain, risks include respiratory depression and constipation.

- Naloxone: Opioid antagonist used to reverse opioid overdose.

- Pramipexole: Dopamine agonist for Parkinson’s disease, side effects include nausea and orthostatic hypotension.

- Pregabalin: For neuropathic pain and seizures, can cause dizziness and weight gain.

- Selegiline: MAO-B inhibitor for Parkinson’s, can cause insomnia and headaches.

- Sumatriptan: Serotonin agonist for migraines, can cause chest pain, flushing.

- Tramadol: Opioid analgesic for moderate pain, risk of addiction and seizures.

- Varenicline: For smoking cessation, partial nicotine agonist, may cause vivid dreams and mood changes.