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Welcome to Week 6
Chapters: 16 and 24
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Analgesics/Antipyretics
Musculoskeletal System and
Disorders
Drug Classes
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ANALGESICS
Analgesics and Pain
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 What does “pain” look like?
 Evaluate pain based on:
Where pain is felt
 Duration
 Intensity (1-10 scale)
 Precipitating factors
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 Pain may be Acute or Chronic:
Acute-short duration, responds to analgesics
 Chronic-over time, less responsive to analgesics,
tolerance
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Types of Analgesics
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Three Classes
Opioid
Nonopioids
Adjuvant
Opioid (Narcotic) and Opiate Analgesics
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 Strong and capable of reducing pain from any origin
 Derivatives of opium or synthetic chemicals that
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produce effect similar to opium.
Examples: codeine, morphine, oxycodone, fentanyl,
meperidine
Vary in potency, onset and action
Tolerance and potential for dependence are
important concerns
Many are schedule II
Narcotic Analgesics Side Effects
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 Respiratory depression
 Constipation
 Itching (may subside in 4-5 days)
 Nausea (may subside in 4-5 days)
 Confusion
 Euphoria
 Idiosyncratic (restlessness and agitation)
 Sedation
Drug Interactions with Narcotics
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 Alcohol –leads to CNS and Respiratory depression
 Other medications that have CNS depression
Nonopioid Analgesics
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 For mild to moderate pain
 Differ from narcotic analgesics
1. Not related to morphine
2. Work on peripheral nervous system
rather than CNS (outside brain and
spinal cord)
3. Do not produce physical dependency
and tolerance
4. Do not alter consciousness or mental
function
Characteristics of Nonopioid Analgesics
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 Relieve low-intensity pain of inflammation and dull
aches and vague pain
 Reduce Fever
 Uses are -anti-inflammatory
-analgesic
-antipyretic
 Not every drug in this class has all three
More Characteristics on Nonopioid Analgesics
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 Usually first step in pain control
 Can be OTC or Rx
 Less expensive that Narcotics
 May be combined with narcotics to become Rx items:
 Hydrocodone and APAP, Hydrocodone and ibuprofen,
Oxycodone and APAP
 May be combined with non-narcotics to become Rx
or OTC items:
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ASA and caffeine, APAP and caffeine and butalbital
Salicylate Analgesics, ie. ASA (aspirin)
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 Oldest of nonopioid analgesics; not for children
 Four distinct therapeutic actions of ASA:
 1. Analgesic – inhibits prostaglandin release from
damaged tissues
 2. Anti-inflammatory—reducing prostaglandin synthesis
 3. Anti-pyretic—reduces fever by causing vasodilation and
sweatin, resets temperature control in brain
 4. Anti-coagulant—prevents platelets from aggregating
(clump) to decrease clot formation
 Beware GI effects, bleeding out
Acetaminophen (APAP)
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 Has analgesic and antipyretic actions; No anti-
inflammatory action
 Reasons to use APAP over ASA:
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Can be used in all ages including children
Good choice for people allergic to ASA or ASA-like
compounds
Rarely causes GI upset and bleeding
Can take with anticoagulation medications
 Main disadvantage –liver damage with long term or
high doseages or concurrent heavy alcohol use
 NMT (no more than) 4 grams in 24 hours for adults
with normal liver function!
Nonsteroidal Anti-inflammatory (NSAID’s)
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 Examples: ibuprofen (Advil®, Motrin®), naproxen
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(Aleve®)
Treat mild to moderate pain
Normally used for inflammatory conditions,
dysmenorrhea, dental pain
Inhibits cyclooxygenase (COX) which results in
decreased formation of prostaglandin precursors
SE- GI
Do not take with ASA, APAP or other NSAID’s.
Time limits 10 days for pain, 3 days for fever or as
directed by MD
World Health Organization (WHO) Pain Ladder
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•Mild Pain-APAP, ASA, other NSAIDS
around the clock
•Moderate Pain- add mild opioid
(codeine or hydrocodone)
•Severe Pain-DC Mild Opioid, give strong
opioid (Demerol or morphine). The
nonopioid should be continued.
Adjuvant Analgesic
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 Used to enhance analgesic efficiency and prolong effects of
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opioid medications
Typically not prescribed alone for pain
Goal=Decrease amount of pain medication with increase in
pain control
Help to reduce side effects of analgesics (ex: nausea)
Examples of adjuvants:
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Tricyclic Antidepressants (amitriptyline) *treat dull aches
Corticosteroids (prednisone) *treat edema
Anti-Convulsants (lorazepam, phenytoin) *treat sharp,
shooting, or burning pain
Antihistamine (hydroxyzine) *treat anxiety/nausea
Review
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 Name the three types of Analgesics
Answer
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 Opioid
 Nonopioids
 Adjuvant
Musculoskeletal System – Chapter 24
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 (2) Different systems working closely together
 Muscular System made up of
Muscles
Connective Tissue … ligaments, tendons
Skeletal System made up of
Bones -- osteoporosis
Joints – arthritis, bursitis
Osteoporosis and Rx Therapy
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 Osteoporosis = Bone resorption (Bone loss)
Most patients are Not Aware it is occuring!
-as we age, resorption begins to exceed formation
-common causes: *decreasing Estrogen (women)
*low/insufficient Calcium intake
*decreased Physical-activity (exercise)
 Biphosphonates -(Fosamax, Actonel, Boniva)
 Evista – for both prevention and treatment!
 Calcitonin-salmon –treatment only! (Miacalcin)
 Forteo – stimulates new bone growth
Osteoporosis – Patient Education
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 Increase load-bearing exercise –walking, stairs
 Calcium supplement + Vitamin-D – don’t forget the
natural sources! – dairy products, etc.
 Biphosphonates: important guidelines … always take on
empty-stomach 30-60 minutes before breakfast with a full glass of
water to make sure the tab doesn’t stick in the throat (may cause
esophageal erosion!), and patient should remain upright 30-60 minutes
after swallowing (to prevent reflux, erosion).
 Miacalcin(nasal calcitonin-salmon) – alternate
nostril every other day (apply in 1 nostril per day)
Joint Diseases and Rx Therapy
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 Osteoarthritis – most common, generative
noninflammatory, caused by ‘wear-and-tear’
 Rheumatoid arthritis – autoimmune, various forms,
all ages, progressive, pain/swelling/limits movement
 Bursitis – inflammed ‘fluid-sacks’ in the joints
 Common Antiarthritis Medications:
 Salicylates – ASA(aspirin), salsalate
 NSAIDs – ibuprofen, naproxen, Celebrex
 DMARDs – methotrexate **dangerous drug!!
 Gluco-corticosteroids – prednisone, dexamethasone
General Characteristics of Arthritis meds
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 Salicylates – fast-acting, inexpensive, GI s/e(enteric-coated)
 NSAIDs – potency, duration, $, less GI side-effects, blocks both
COX1 and COX2 enzymes (GI danger in long-term use)
 COX2 Inhibitors – much greater potency and duration, much
less GI side-effects(only block COX2), indicated for both Osteo and
Rheumatoid arthritis (only one available is Celebrex)
 Glucocorticosteroids – powerful in reducing inflammation,
preferably only used for a limited time (specific courses of therapy)
 DMARDs(immunosuppressants) – reduces the body’s
own immune-response (autoimmune) to provide relief
 These only produce short-term remission, disease will worsen!
Gout
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 Hyperuricemia (excess uric acid accumulation)
 Uric acid accumulates, then crystalizes (ouch!)
 Symptoms: *acute pain *swelling *redness *tenderness
(usually the big-toe, ankle, knee, elbow)
 Medications:
 Acute attack – colchicine
 Prophylaxis – allopurinol, probenecid
Muscle Relaxants
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 Treat Muscle spasms and muscle spasticity
 Most spasm caused by local injury, seizure-disorders
 Muscle-relaxants *decrease local pain/tenderness,
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*increase range-of-motion, *cause sedation
Soma (carisoprodol)
Flexeril (cyclobenzaprine)
Skelaxin (metaxalone)
Robaxin (methocarbamol)
CNS agents: diazepam, Lioresal (baclofen)
Questions
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