1. Medicines and drugs
Analgesics

2. What is an analgesic?
How do you feel pain?
What does “physical dependence” mean?
What does ‘tolerance’ mean in this context?

3. Analgesics – reduce pain

4. Mild analgesics
Mild analgesics, such as aspirin and paracetamol, function by stopping the transmission of pain from source to brain as they intercept the pain stimulus at the source.
They do this by interfering with the production of substances, such as prostaglandins, that are produced by injured tissues and that cause pain, swelling or fever.

5. Strong analgesics - opioids
Strong analgesics such as morphine and diamorphine (heroin) work by temporarily bonding to receptor sites to pain impulses in the brain or other parts of the central nervous system such as the spinal cord.
This prevents the transmission of pain impulses i.e. blocking the signal without depressing the central nervous system.

6. Mild or strong? Mild analgesics eliminate pain at source
Strong analgesics alter our ability to perceive pain
Consider the relative value of these two approaches to pain management

7. Structures of analgesics
aspirin
paracetamol
benzene
ester
carboxylic acid
benzene
hydroxyl
amide
carbonyl

8. Structure of analgesics
ibuprofen
benzene
carboxylic acid

9. A derivative = a new compound from changing another compound
Aspirin – a derivative
salicylic acid…. into aspirin
A derivative = a new compound from changing another compound
To convert salicylic acid (2-hydroxybenzoic acid) into aspirin the hydrogen atom of the OH group is replaced by a COCH3 group to form an ester functional group which made the compound less irritating to the stomach and easier to take.

10. morphine
morphine

11. Strong analgesics morphine diamorphine/heroin codeine benzene
hydroxyl /alcohol (2)
ether
double bond
tertiary amine
ester (2)
hydroxyl
ether (2)

12. heroin- another derivative
Diamorphine or heroin is a derivative of morphine or a semi-synthetic opiate. An opiate is a chemical which has the same physiological effect as morphine.
Heroin’s structure is only slightly different from morphine. Both the hydroxyl or alcohol groups in morphine have been replaced with ester groups. This is achieved by reacting the morphine with ethanoic acid; as a result an esterification occurs during which also water is produced.
Also codeine is a morphine derivative.

13. aspirin advantage disadvantage
reduces fever more effectively – antipyretic (=drug which reduces fever)
also useful in preventing the recurrence of heart attacks and strokes and also thins the blood (beneficial side-effects) and reduces blood clotting
also anti-inflammatory – reduces inflammation or swelling
ulceration
stomach bleeding due to its acidic properties
allergic reactions
Reye’s syndrome in children (a potentially fatal liver and brain disorder) so not so suitable for children

14. paracetamol advantage disadvantage reduces fever – antipyretic
very safe in the correct dose as it does not upset the stomach or cause bleeding
suitable for children
can, in rare cases, cause blood disorders and kidney damage.
easier to overdose and overdosage can lead to serious liver damage, brain damage and even death.
not a good anti-inflammatory

15. Using morphine - advantages
strong analgesics and therefore can relieve extreme pain
wide therapeutic window
relieves anxiety
induces relaxation
can be administered intravenously which results in faster distribution of drug

16. Morphine - disadvantages
euphoria, lack of self-control even dangerous behaviour
kidney failure.
addiction or physical dependence which leads to withdrawal symptoms when drug is not taken e.g. restlessness, sweating, fever, cramping, …
tolerance can become an issue with this type of drug as more of the drug needs to be taken to achieve the same effect; in order to achieve the desired effect heroin users may take doses which exceed the lethal dose
Social:
heroin users are more likely to commit crimes to pay for gradually increasing doses of the drug
loss of job
diversion of energy and money
when administered intravenously can lead to transmission of dangerous infections e.g. AIDS.