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Analgesic
(also known as a painkiller) is any member of the group of
drugs used to relieve pain .
The word analgesic keerG morf sevired an- dna )"tuohtiw"(
algos“niap"( )
Analgesic drugs act in various ways on the peripheral and
central nervous systems . They are distinct from
anesthetics, which reversibly eliminate sensation.
Analgesics are those drugs that mainly provide pain
relief.
classes of analgesics
- Narcotics chemically based on the morphine molecule such as
morphine and opium
-nonsteroidal anti-inflammatory drugs such as the
salicylates
-acetaminophen.
they
include
paracetamol
acetylaminophenol, also known in the US as acetaminophen(
(para-

Narcotic analgesics (opioids)
derived from opium. The class includes morphine, codeine, and a
number
of
semi-synthetics
including
meperidine
(Demerol),
propoxyphen (Darvon) and others. The narcotic analgesics vary in
potency, but all are effective in treatment of visceral pain when used in
adequate doses. A variety of dosage forms are available, including oral
solids,
liquids,
intravenous
transcutaneous patches.
and
intrathecal
injections,
and

Opioid Toxicity

Symptoms include subtle agitation, shadows at the
periphery of the visual field, vivid dreams, nightmares,
myoclonic
jerks,
hallucinations.
confusion,
paranoia
and
visual
Failing renal function/dehydration may
precipitate these symptoms. The development of opioid
toxicity is dependent on previous opioid exposure, and the
rate of dose escalation. Management includes rehydration,
and reducing the opioid dose.
-NSAIDs
-are effective analgesics even at doses too low to have any antiinflammatory effects. There are a number of chemical classes, but all
have similar therapeutic effects and side effects. Most are appropriate
only for oral administration; however ketorolac (Toradol) is appropriate
for injection and may be used in moderate to severe pain for short
periods.
-Aspirin and the other non-steroidal anti-inflammatory drugs (NSAIDs)
inhibit cyclooxygenases, leading to a decrease in prostaglandin
production. This reduces pain and also inflammation (in contrast to
paracetamol and the opioids).
-
 Acetaminophen

is a non-narcotic analgesic with no anti-inflammatory properties. It is
appropriate for mild to moderate pain. Although the drug is well
tolerated in normal doses, it may have significant toxicity at high doses.

The exact mechanism of action of paracetamol/acetaminophen is
uncertain, but it appears to be acting centrally rather than peripherally
(in the brain rather than in nerve endings).

Because acetaminophen is largely free of side effects at therapeutic
doses, it has been considered the first choice for mild pain, including
that of osteoarthritis.
Paracetamol Toxicity
Overdose of paracetamol leads to 'paracetamol toxicity,' which mainly
results into liver injury but is also one of the most common causes of
poisoning all over world. Many people who develop paracetamol toxicity
may feel no symptoms at all in the first 24 hours that follow overdose of
paracetamol. As the paracetamol toxicity increases, signs of liver
failure like low blood sugar, low blood pH, easy bleeding, hepatic
encephalopathymay may develop, abdominal pain and nausea. The risk
of paracetamol toxicity increases with excessive alcohol intake, fasting
or anorexia nervosa, and also with the use of certain drugs like
isoniazid.


The exact mechanism of action of paracetamol/acetaminophen
is uncertain, but it appears to be acting centrally rather than
peripherally (in the brain rather than in nerve endings). Aspirin and
the other non-steroidal anti-inflammatory drugs (NSAIDs) inhibit
cyclooxygenases, leading to a decrease in prostaglandin production.
This reduces pain and also inflammation (in contrast to
paracetamol and the opioids).[citation needed]
Paracetamol has few side effects and is regarded as safe, although
intake above the recommended dose can lead to liver damage,
which can be severe and life-threatening, and occasionally kidney
damage. NSAIDs predispose to peptic ulcers, renal failure, allergic
reactions, and occasionally hearing loss, and they can increase the
risk of hemorrhage by affecting platelet function. The use of aspirin
in children under 16 suffering from viral illness has been linked to
Reye's syndrome, a rare but severe liver disorder.
-Topical analgesics
-(topical being those that are applied on the skin) have become much
more popular in recent years. Those applied for local effect include
capsaicin, methylsalicylate, and transdermal lidocaine. Transdermal
fentanyl may be applied for systemic (the entire body in general) effect. In
some cases, these topical agents reduce the need for drug therapy.
-Sales of pain relief patches have increased substantially in recent years.
They are particularly useful for elderly patients who may not want to take
a lot of tablets.
Recommended dosage
Appropriate dosage varies by drug, and should consider the type of
pain, as well as other risks associated with patient age and condition.
For example, narcotic analgesics should usually be avoided in patients
with a history of substance abuse, but may be fully appropriate in
patients with cancer pain. Similarly, because narcotics are more
rapidly metabolized in patients who have used these drugs for a long
period, higher than normal doses may be needed to provide adequate
pain management. NSAIDs, although comparatively safe in adults,
represent an increased risk of gastrointestinal bleeding in patients over
the age of 60.
Precautions
Narcotic analgesics may be contraindicated in patients with
respiratory depression. NSAIDS may be hazardous to patients
with ulcers or an ulcer history. They should be used with care in
patients with renal insufficiency or coagulation disorders.
NSAIDs are contraindicated in patients allergic to aspirin.
Side effects
The primary adverse effects of the narcotic analgesics are addiction,
constipation, and respiratory depression.
Because narcotic analgesics stimulate the production of enzymes that
cause the metabolism of these drugs, patients on narcotics for a
prolonged period may require increasing doses. This is not the same
thing as addiction, and is not a reason for withholding medication from
patients in severe pain.
NSAIDs can lead to ulcers and may cause kidney problems.
Gastrointestinal discomfort is common, although in some cases, these
drugs may cause ulcers without the prior warning of gastrointestinal
distress. Platelet aggregation problems may occur, although not to the
same extent as is seen with aspirin.
Adjuvant analgesics
•Tricyclic Antidepressants eg amitriptyline or nortriptyline are first line
treatment for neuropathic pain, which may be only partially controlled by
morphine. Often effective in sub-antidepressant doses, eg 10mg-25mg at
night.
•Anticonvulsants eg gabapentin and sodium valproate are useful as
second line treatment for neuropathic pain.
•NSAIDs eg diclofenac is useful in controlling bone and soft tissue pain.
•Corticosteroids eg dexamethasone, are effective in nerve damage pain
by reducing peri-neural oedema. Reduces headache and confusion in
cerebral metastases.
•
Anxiolytics eg diazepam, lorazepam and midazolam, can improve
pain control in conjunction with opioids. Useful in agitated states
and for dyspnoea. Lorazepam is an effective anxiolytic when used
sublingually. Midazolam is a very effective anxiolytic when added to
diamorphine in a continuous subcutaneous infusion.
•Muscle Relaxants eg baclofen, benzodiazepines and quinine are
useful in treating pain associated with muscle spasm. Use with care
as they may cause depression and weakness.
•Antimuscarinics eg hyoscine butylbromide, are useful in relieving
colic pain.
Prescription Drug Abuse- Prescription Drug
Addiction
The types of prescription drugs most commonly abused are:
Central
Nervous
Tranquilizers,
System
Xanax, Valium,
(CNS)
Depressants:
Barbiturates,
Rohypnol, Placidil, Ativan, Klonopine,
Librium, Quaalude
Prescription Painkillers Opioids, narcotics, hydrocodone, morphine,
fentanyl, codeine, Oxycontin, Percocet, Percodan, Darvon, Dilaudid,
Demerol
Prescription Stimulants: Adderall, Ritalin, Concerta, Dexedrine
Addiction
Users need larger and larger doses to get the same effect,
which brings them, continually closer to the fatal dose.
Overdose is more likely to occur when users mix
depressants with alcohol. Users become disoriented,
confused, and can’t remember how much they took. The list
of people who have died from depressants and alcohol is
long.
How are Prescription Painkillers Abused?
Prescription painkillers can be taken orally, or the pills may
be crushed and the powder snorted or injected. A number
of overdose deaths have resulted from the latter routes of
administration, particularly with the drug OxyContin, which
was designed to be a slow-release formulation.
Snorting or injecting opioids results in a rapid release of
the drug into the bloodstream, exposing the person to high
doses and causing many of the reported overdose
reactions.
What Adverse Effects Can be Associated with
Prescription Painkillers?
Prescription pain medications can produce drowsiness, cause
constipation, and, depending upon the amount taken, depress
breathing. Taking a large single dose could cause severe respiratory
depression or death.
These medications are only safe to use with other substances under
a physician’s supervision. Typically, they should not be used with
alcohol, antihistamines, barbiturates, or benzodiazepines. Because
these substances slow breathing, their combined effects could lead
to life-threatening respiratory depression.
Tranquilizers
Tranquilizers are drugs used to treat anxiety or problems with sleep.
They have a calming effect by depressing the nervous system in a way
similar to alcohol. Tranquilizers are among the most commonly
prescribed psychiatric medications.
In some ways, the term "tranquilizer" is inaccurate. Although they may
produce specific anxiety-reducing effects, the members of the
tranquilizer group of drugs have the same clinical effects as sedatives
such as the barbiturates (downers). The much-sought relaxing and
anxiety-reducing effects of the tranquilizers are simply the early stages
of the biochemical process of sedation. The effects of sedation are a
continuum from relaxation to significant sedation to coma to death.
Central nervous system depressants, including minor
tranquilizers, sedatives, and alcohol, place the user on the
sedation continuum. The specific dosage and drug used
determines how far the user goes on that pathway.
Tranquilizers are frequently abused because of their ability to
reduce anxiety. They are addictive because tolerance
develops rapidly, and more and more are needed to be
effective.
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