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D3 Analgesics By Cameron Precord and Quin Peek And edited by Ms. Smith Pain Pain-described as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage Pain receptors-free nerve endings located in various tissues that respond to thermal, mechanical or chemical stimuli When stimulated, these pain receptors generate an impulse Pain results from interaction between more than one impulse arriving at the spinal cord and brain When tissue is damaged, it releases chemicals known as prostaglandins and leukotrienes These sensitized receptors react to even slight stimuli, causing pain ( an injury being tender) Different people feel pain differently Analgesics are drugs that relive pain without causing a loss of consciousness. Two Types of Analgesics MILD ANALGESICS relieve “mild” pain and often fever non-addictive Examples include Aspirin Acetaminophen Phenacetin Ibuprofen NSAIDS (Nonsteroidal anti-inflammatory drugs) STRONG ANALGESICS (OPIATES) relieve severe pain controlled substances addictive Examples include Morphine Heroin Codeine Aspirin – MILD ANALGESIC – a derivative of Salicylic Acid Used in four different ways: Mild analgesic for minor aches and pains, to relieve headaches, sunburn and arthritic pain anti-pyretic to mitigate fever anti-inflammatory agent (reducing swelling) anti-platelet agent (decrease/prevent blood clotting) Disadvantages of Using Aspirin acidic; cause upset stomach, internal bleeding, ulcers When taken with alcohol may produce gastrointestinal bleeding .5% of people are allergic to aspirin develop skin rashes, respiratory issues, and may go into shock frequent causes of poisoning among infants May lead to REYES Syndrome a potentially fatal liver and brain disorder which may result in brain damage, coma, death Alternatives to Aspirin Phenacetin Acetaminophen Metabolic byproduct of phenacetic AKA Tylenol Known as paracetamol in some countries Properties - Advantages Anti-pyretic Mild analgesic Does NOT upset stomach does NOT cause internal bleeding Properties - Disdvantages Not anti-inflammatory Side effects include blood disorders… damage to kidnes… Not safe to take with alcohol Overdose can cause liver damage, brain damage, coma, death Strong Analgesics aka Opiates or Narcotics Opiate = any natural or synthetic drugs that produces morphine-like characteristics Narcotic = drug that has both sedative and analgesic action Examples include Morphine – natural – opium poppy plant Heroin - semi-sythetic Codeine – natural – opium poppy plant Structures are similar… but… Heroin has the two OH groups in morphine replaced with ester groups. Codeine replaces one OH group of Morphine with a OCH3 group. Strong Analgesics Heroin is most potent, then morphine, then codeine Advantages of Strong Analgesics Opiates impact Central nervous system Pain relief due to injury, surgery, chronic disease (cancer) Relieves coughing by relaxing the ‘cough center’ in the brain stem. Digestive system Produces a Constipating Effect – used for diarrhoea Impact Psychological state Relief from physical, emotional, and psychological pain. Disadvantages of Strong Analgesics Impact physical state Constipation Nausea Vomiting Sedation Can lead to tolerance and physical dependence Psychological state Mood changes metal clouding Anxiety Fear lethargy sedation, ack of concern inability to concentrate Can lead to psychological dependence Common Short and Long Term Effects Short LONG sedation / stupor pain relief euphoria impaired coordination reduced tension and fear suppressed coughing reflex occasional deaths from overdose loss of appetite constipation risk of infections through shared needles withdrawal loss of job / income crime sterility loss of energy Tolerance and Dependence Tolerance – body needs more of the drug to have the desired impact Cross tolerance - Users who develop tolerance for one opiate will begin to tolerate all other opiates. Physical Dependence – inability to function normally without the drug users experience withdrawal Restlessness, sweating, fever, chills, vomiting, increased respiration, cramping, diarrhoea, aches, pains Synthetic Opiates demerol methadone bocks euphoric high of heroin used to break addiction to heroin dextromethorphan can replace codeine non-narcotic Two Types of Anesthetics LOCAL ANESTHETICS Reversible loss of sensation (and pain) in a localized area Maintain consciousness Examples include Lidocaine Procaine used in dentistry GENERALIZED ANESTHETICS act on the brain produce reversible unconsciousness and insensitivity to pain Examples include Inhalants: Isoflurane, Desflurane; sevoflurane; Nitrous oxide IV : barbituates, benxodiazepines, ketamine Practice Problems Can Be Found on Page 434 of your Green and Damji Book