medications for pain and inflammation

8/13/2019 Medications for Pain and Inflammation

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Pain and Inflammation

(General Key Points)

N203ATI (Unit

Pain & Inflamm


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Analgesicsrelieve pain

Narcotics / NSAIDs / Antimigraine agents

Anti-inflammatorymedications relieve inflammation

Salicylates / Glucocorticoids / Antigout / Disease-modifying

antirheumatics drugs (DMARDs

Some are antipyretic (salicylates! i"uprofen

Salicylates and NSAIDs reduce platelet aggregation

Salicylates! NSAIDs! and glucocorticoids pose ris# for ulceration

Acetaminophen has analgesic and antipyretic properties "ut not an

inflammatory$ It poses a ris# for liver in%ury


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NSAIs(!edi"ation #ist)

N203ATI (Unit

Pain & Inflamm


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Aspirin &etorolac ('oradol

eleco)i" (ele"re) *aldeco)i" (+e)tra

I"uprofen Indomethacin

Napro)en


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NSAIs

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Pain & Inflamm


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Expected Action: Proto:aspirin! i"uprofen! #etorolac!

ycloo)ygenase inhi"ition , . inflammation! . 0 plat

Therapeutic Uses: Inflammation suppression / analgesia / fever

dysmenorrhea / suppression of platelet aggregation

Adverse Effects:

GI discomfort! aspirin induced ulceration and "leeding (use misoprostol

prophyla)is! and/or 11I and/or 2-receptor agonistris# of ulceration

Renal dysfunction

Reye syndrome (in #ids 3ith viral illnesses

Salicylism (tinnitus!

al#alosis! di44iness

Contraindications/Precautions:

1eptic ulcers / "leeding disorders / hypersensitivity / pregnancy / #ids 5 v

Interactions: Glucocorticoids (gastric "leeding , use

prophylactic li#e misoprostol (ytotec to 6arfarin ("leeding

7t2 ("leeding I"uprofen (antiplatelet effects of lo3-do

Education: Give 3ith food or mil# to reduce GI discomfort$ If can8t tolerate 0stgeneration! give ndgeneration (celeco)i"


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Ketorola" (Toradol)

N203ATI (Unit

Pain & Inflamm


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A"etamino$%en

N203ATI (Unit

Pain & Inflamm


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Expected Action:

Slo3s production of prostaglandins

Therapeutic Uses:

Analgesic and antipyretic

Adverse Effects: Ma) ; g daily

Acute liver to)icity Antidote< acetylcysteine (Mucomyst


Interactions:

7t2 ris# to liver / 6arfarin levels of 3arfarin

Education:


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$ioid A'onists

N203ATI (Unit

Pain & Inflamm


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Therapeutic Uses:

Proto:morphine! fentanyl! meperidine! methadon

Moderate to severe pain / Sedation / "o3el motility / ough suppress

Adverse Effects:

Respiratorydepression

Sedation

onstipation rthostatic 2ypotension :rinary reten

+iliary colic ough suppression 7mesis

Contraindications/Precautions: Increases cardiac 3or#load

Meperidine meta"olites are neuroto)ic (= >?? mg/;hr! = ;@ hours

Interactions:

NS depressants ("ar"iturates! pheno"ar"ital! "en4odia4epines! 7t2

Anticholinergics! antihistamines! tricyclic antidepressant anticholiner

MAIs (hyperpyre)ia! sei4ures Antihypertensives

Education: 6ithhold if RR=0 2ave nalo)one (Narcan and re

euipment availa"le$ Infuse I* slo3ly over ;-9 minutes


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$ioid Anta'onists

N203ATI (Unit

Pain & Inflamm


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Expected Action: Proto:nalo)one (Narcan! naltre)one!

ompetitively interfere 3ith opioid actions

Therapeutic Uses: D treatment Reversal of opioid effects

Adverse Effects:

'achycardia / 'achypnea A"stinence syndrome (cramping! hype


2ypersensitivity Dependency 1regnancy< +

Interactions:

Education:

Nalo)one has e)tensive first-pass modification

"serve for 3/d symptoms or a"rupt onset of pain


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'ricyclic Antidepressants ('A Amitriptyline (7lav


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'ricyclic Antidepressants ('A$$$$$$$$$$$$$$$$$$$$$$$$$Amitriptyline (7lav

Anticonvulsant$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ar"ama4epine ('egret

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Ga"apentin (Neurontin

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$1henytoin (Dilantin

NS Stimulants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Methylphenidate (Rital

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

De)troamphetamine (De)edrine

Antihistamines$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$2ydro)y4ine (*ista

Glucocorticoids$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$De)amethasone (Decadro

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

1rednisone (Deltasone

+isphosphonates$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$7tidronate (Didron

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$


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Ad*ant !edi"ations

N203ATI (Unit

Pain & Inflamm


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Anti'ot !edi"ation

N203ATI (Unit

Pain & Inflamm


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Expected Action: Proto:olchicine! indomethacin! allopurinol!

olchicine/Indomethacin


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!i'raine !edi"ations(!edi"ation #ist)

N203ATI (Unit

Pain & Inflamm


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7rgot Al#aloids$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$7rgotamine (7rgost

Serotonin Receptor Agonists$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Sumatriptan (Imitr

+eta-+loc#ers$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$1ropanolol! Ateno

Anticonvulsants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Divalproe) (Depa#o 'ricyclic Antidepressants$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Amitriptyline (7lav

alcium hannel +loc#ers$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$*erapam

7strogens$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Alora! lim

'riptans$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Almotriptan! Naratriptan!


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+r'ot Al,aloids

N203ATI (Unit

Pain & Inflamm


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Serotonin e"e$torAnta'onists

N203ATI (Unit

Pain & Inflamm


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Expected Action: Proto:Sumatriptan (Imitre)! almotrip

1revent inflammation and dilation of the intracranial "lood vessels

Adverse Effects: hest symptoms (not dangerous! self-resolving

oronary vasospasm/angina

'eratogenic


1regnancy! hypertension! cardiac disease! AD

Interactions:

'riptans 7rgot Al#aloids spastic reaction of "lood vessels

MAIs oncurrent use leads to MAI to)icity (space 3ee#s apart

Education:


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.eta-.lo",ers

N203ATI (Unit

Pain & Inflamm


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Expected Action: Proto:Metoprol

1revent inflammation and dilation of the intracranial "lood vessels

Adverse Effects:

'iredness! fatigue Depression

Asthma e)acer"ation


Interactions:

Education:


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Anti"on*lsants

N203ATI (Unit

Pain & Inflamm


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Expected Action: Proto:Divalproe)

1revent inflammation and dilation of the intracranial "lood vesselsAdverse Effects:

Neural tu"e defects


Interactions:

Education:


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T/As

N203ATI (Unit

Pain & Inflamm


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Expected Action: Proto:Amitriptyl

1revent inflammation and dilation of the intracranial "lood vesselsAdverse Effects:

Anticholinergic effects< dry mouth! constipation! urinary retention! tachy


Interactions:

Education:


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/al"im /%annel .lo",er

N203ATI (Unit

Pain & Inflamm


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!edi"ations for %ematoidArt%ritis

(!edi"ation #ist)

N203ATI (Unit

Pain & Inflamm


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%ematoid Art%ritis !eds(Ad*erse +ffe"ts)

N203ATI (Unit

Pain & Inflamm


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Cytotoxics: 2epatic fi"rosis / Marro3 suppression / GI ulceration /

death or a"normality

$old salts: 'o)icity! renal to)icity! "lood dyscrasias! hepatitis! GI

discomfort

Antimalarials: Retinal damage

%ulfasala&ine: GI discomfort / hepatic dysfunction / marro3 suppre

'io "esponse !odifiers: In%ection-site irritation

Penicillamine: Marro3 suppression

$lucocorticoids: steoporosis (vit D! aF! "isphosphonate

Adrenal suppression GI discomfort

medications for pain and inflammation

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