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Analgesics. Major Types. Nonnarcotic NSAIDS Acetaminophen Narcotic Opiates. Nonnarcotics : NSAIDS. “non-steroidal anti-inflammatory drugs” Work as analgesics, antipyretics, and anti-inflammatory agents. Different Types Salicylates : Aspirin

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major types
Major Types
  • Nonnarcotic
    • NSAIDS
    • Acetaminophen
  • Narcotic
    • Opiates
nonnarcotics nsaids
Nonnarcotics: NSAIDS
  • “non-steroidal anti-inflammatory drugs”
  • Work as analgesics, antipyretics, and anti-inflammatory agents
slide4

Different Types

    • Salicylates: Aspirin
    • Propiotic acid derivatives: Ibuprofen, Naproxen
    • Enolic acid derivatives (Oxicams): Piroxicam, Meloxicam
    • Acetic acid derivatives: Indomethacin, Diclofenac
    • Fenamic acid derivatives: Mefenamic Acid, Meclofenamic Acid
    • Selective COX-2 inhibitors: Celecoxib, Etoricoxib
slide5

Pharmacodynamics

    • Blocks prostaglandin synthesis by nonselective inhibition of cyclooxgenase (COX-1 and COX-2)
    • For ASA and PAD: decrease PMN migration to site of inflammation
  • Pharmacokinetics
    • absorbed by the GI tract, metabolized in the liver, excreted in the urine
    • Highly protein bound
    • For ASA and PAD: more able to penetrate joint fluid
    • Varying half-lives and peaks: ibuprofen: 1 to 2 hours (half-life, 2 hours) ; naproxen: 2 to 4 hours (half-life, 14 hours); ketorprofen: 1 to 2 hours (half-life, 2 hours)
slide6

Adverse Effects

    • GI iritation – less in COX II inhibitors
    • Renal Insufficiency – by decreasing prostaglandin-induced afferent arteriole vasodilation
    • Adverse Drug Reactions - hypersensitivity (particularly aspirin)
nonnarcotics acetaminophen
Nonnarcotics: Acetaminophen
  • Analgesic and antipyretic qualities
  • Less protein bound
  • More even distributed in body fluids
  • Adverse effects include hepatic necrosis at very high doses, nephropathy secondary to renal papillary necrosis from deposition of p-aminophenol (from chronic use)
narcotics opiates
Narcotics: Opiates
  • More potent analgesics for severe pain
  • Act largely on the CNS and GI tract
  • Analgesia is from decreased perception of pain, increased pain tolerance
slide10

Different Types

    • Weak Opioid: Codeine, Tramadol
    • Strong opioids: buprenorphine, fentanyl, hydromorphone, methadone, morphine, Oxycodone
slide11

Pharmacodynamics

    • Opioids bind to different opioid receptors in the CNS blocking pain signals and perception
  • Pharmacokinetics
    • Cleared by the liver
  • Side effects
    • Sedation, ventilatory depression, GI effects (constipation, nausea, vomiting), CVS effects (hypotension, vasodilation)