1. Drugs for the Treatment of Pain
Dr. Steven I. Dworkin

2. Narcotic Analgesics Used to treat mild to severe pain
Opiate Activity and Effects
related to occupation of three opiate receptor subtypes.
Mu morphine-like supraspinal analgesia, respiratory and physical depression, miosis, reduced gastrointestinal motility.
Delta Dysphoria, psychotomimetic effects.
Kappa Sedation and miosis
Dr. Steven I. Dworkin

3. Narcotic Analgesics Actions related to receptor binding or occupancy
Agonists - binds to receptor produces an effect
Partial agonists – binds to receptor produces limited response
Antagonist – binds to receptor blocks effect of agonist
* partial agonist can antagonize the effects of a full agonist by binding to the site.
Dr. Steven I. Dworkin

4. Dr. Steven I. Dworkin

5. Dr. Steven I. Dworkin

6. Dr. Steven I. Dworkin

7. Uses of Narcotic Analgesics
Manage moderate to severe acute and chronic pain
Analgesic effects depend on several factors
Drug, dose, route of administration, type of pain, the patient.
Lessen anxiety and sedate a patient before surgery
Support anesthesia
Obstetrical analgesia
Treat severe diarrhea
To relieve severe, persistent cough
Manage opioid dependence
Dr. Steven I. Dworkin

8. Adverse Reactions to Narcotic Analgesics
Most common
Light-headedness, dizziness, sedation, constipation, anorexia, nausea, vomiting, sweating.
Other adverse effects include:
CNS - euphoria, weaknesses, pinpoint pupils, insomnia, agitation, tremor, impairment of activity.
Gastrointestinal – dry mouth, biliary tract spasms.
Cardiovascular – flushing, tachycardia, bradycardia, and palpitations
Genitourinary – spasm of ureters and bladder sphincter, urinary retention or hesitancy.
Allergic – pruritus, rash
Narcotic drug dependence
Dr. Steven I. Dworkin

9. Dr. Steven I. Dworkin