Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Pharmaceutical industry wikipedia , lookup
Pharmacokinetics wikipedia , lookup
Prescription costs wikipedia , lookup
Drug interaction wikipedia , lookup
Pharmacogenomics wikipedia , lookup
Cannabinoid receptor antagonist wikipedia , lookup
Nicotinic agonist wikipedia , lookup
NMDA receptor wikipedia , lookup
Neuropharmacology wikipedia , lookup
NEUROPATHIC PAIN - TOPICAL TREATMENT CONCEPTS Drugs that can be used in compounding formulations for the treatment of Neuropathic pain. Drug Topical Application Dose Range Classifications Mechanism of Action Amitriptyline 2-5% Antidepressant/Sympatholytic Antidepressants block the reuptake of noradrenaline and 5 - hydroxytryptamine (5HT); has direct and indirect actions on opioid receptors, inhibits histamine, cholinergic, 5HT and N - MethylD- Aspartate glutamate receptors; inhibits ion channel activity and blocks adenosine uptake. Bupivacaine 0.5-0.75% Anesthetic-Nerve Pain Stabilizes neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses. 2-5% NMDA / Sodium Channel Blocker Has shown real promise in dealing with painful Neuropathy. 0.1-0.2% Alpha-2 Agonist 5-10% NMDA / CA Channel blocker Carbamazepine Clonidine Dextromethorphan Blocks the effect of Norepinephrine at alpha receptors that have become hyperexcitable in the neuropathy process. Useful agent in the treatment of painful neuropathy. May be given orally 300mg three times a day. The exact mechanism of action is not clear, but it has shown some success in the treatment of neuropathy both topically and systemically. Gabapentin 6-10% Glutamate Antagonist Guaifenesin 10% Skeletal Muscle Relaxer 5-10% NMDA Antagonists 10% NSAID Nonsteroidal anti-inflammatory drug. Acts peripherally to reduce the production of prostaglandins that sensitize nerve endings at the site of the injury, generating analgesic effects.. Lidocaine 2-10% Anesthetic-Nerve Pain Stabilizes neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses. Loperamide 5-7% Mu Agonist Ketamine Ketoprofen Acts as a skeletal muscle relaxer topically in concentration of 10%. When applied topically, Ketamine has shown substantial promise for decreasing the pain of Neuropathy. It is a noncompetitive antagonist of NMethyl-D-Aspartate receptors in the peripheral nerves. Can be given orally 250mg at bedtime. Acts like an opioid topically in a minimum concentration of 5%. Morphine 5-30% Mu Agonist Opioid receptors are present on the peripheral terminal of thinly myelinated and unmyelinated cutaneous sensory fibers. Systemic use of opioids has caused adverse effects; therefore, the topical application of opioids with fewer systemic effects is an alternative. Nifedipine 2-16% L-Type Calcium Blocker Topically, Nifedipine produces an anti-ischemic effect by blocking calcium influx into cells, thereby decreasing vascular tone and increasing blood flow. max 160mg / day Orphenadrine 5-10% NMDA / L Ca+ Channel Blocker Pentoxifylline 5-10% TNF-1 Alpha Antagonist Used for its ability to enhance blood flow by reducing blood viscosity. Tetracaine 2-10% Anesthetic-Nerve Block Stabilizes neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses. Has been used as an antiparkinsonism, Antispastic and Analgesic drug for many years. Conclusion: As we learn more about the biochemical and pathophysiologic mechanisms of pain, we can develop targeted strategies for specific conditions. Historically, treatment with Ketamine, Ketoprofen and Clonidine in PLO gel is initiated, then one or more drugs are added if needed. Combination therapy is the most effective approach for managing the complex array of chemical mediators and other contributors to the individual's pain experience. Topical formulations can provide effective therapy with fewer systemic adverse drug effects and drug-drug interactions. R-8/07