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Drugs for pain!!! Miss Katy Davidson, BSc (Hons) Jason
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WHO Pain ladder
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Paracetamol The exact mechanism of action for Paracetamol is unknown, although it is thought to selectively inhibit COX-2. Used in mild pain relief and has a mild antipyretic effect. What happens in a paracetamol overdose?
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Overdose
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NSAIDs COX-1 and COX-2 Inhibitors. Inhibits the synthesis of prostaglandins and thromboxanes. There are several different classes of NSAIDs, but they may not be worth learning… Examples include: Ibuprofen, aspirin, diclofenac, naproxen
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Complications Action on COX-2 gives your anti-inflammatory, antipyretic and analgesic effects Action on COX-1 gives you problems… Inhibition of COX-1 reduces synthesis of PGE2 in the stomach which in turn increases the amount of acid secretion and decreases the amount of bicarbonate secretion. How can this be countered? Omeprazole and taking NSAIDs with food, care to be taken when prescribing to patients with heartburn/previous gastroduodenal ulcers
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COX-2 selective Supposed to have fewer side effects as they do not target COX-1 Examples include: Celecoxib Etoricoxib This is all you really need to know
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Mild opioids Codeine Dihydrocodeine C0-codamol Used for moderate pain upward Broadly work on the mu, kappa and delta opioid type receptors Common side effects? Likely to cause constipation, especially in the elderly, at high doses or with long term use How is this countered? Avoid long term use if possible and co-prescribe laxatives in high risk patients.
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Strong opioids Morphine Diamorphine Tramadol Used in severe pain Can be highly addictive Often cause problems with overdose
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Opioid overdose Symptoms? Pin-point pupils (possibly), respiratory depression, tachycardia, hypotension, nausea/vomiting How do you treat it? Give IV naloxone, an opioid receptor antagonist Occasionally Naltrexone may be given (longer acting)
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Partial/mixed opioids Opioid addiction Buprenorphine – Also used in opioid addiction alongside methadone Pentazocine Need to be aware of them
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Neuropathic pain First line is normally TCAs i.e. amitriptyline/nortryptyline or duloxetine (SNRI) Second line is both of these combined Third line is gabapentin/pregablin Carbamazepine is often used in the treatment of trigeminal neuralgia
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The end Get out
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