Drugs for Treating Pain - Jenelle Notes

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Questions and Answers

Which of the following statements accurately differentiates between opiates and opioids?

  • Opioids is a broader term encompassing both drugs derived from opium and synthetic drugs with similar effects, while opiates specifically refer to drugs obtained from the opium poppy. (correct)
  • Opioids are exclusively used for treating severe pain, whereas opiates are reserved for mild to moderate pain management.
  • Opiates and opioids are synonymous terms used interchangeably in all medical contexts.
  • Opiates are synthetic drugs that mimic the effects of opium, whereas opioids are naturally derived from the opium poppy.

Acetaminophen exhibits anti-inflammatory and anti-platelet properties, making it a suitable choice for patients with a history of gastritis.

False (B)

What is the primary reason for administering a higher dose of an opioid analgesic orally compared to parenteral routes?

  • Parenteral routes bypass the hepatic first-pass metabolism, resulting in a higher bioavailability of the drug. (correct)
  • The patient's perception of pain is diminished with oral medications, so the dose must be higher
  • Oral administration leads to slower absorption rates, necessitating a higher dose to achieve therapeutic plasma concentrations.
  • Gastric acid degradation reduces the potency of opioids, requiring an increased oral dosage to compensate.

A patient taking an opioid analgesic reports experiencing severe pruritus. Which of the following is the most appropriate initial intervention?

<p>Administer an antihistamine and closely monitor the patient for signs of anaphylaxis. (A)</p> Signup and view all the answers

Combining acetaminophen with alcohol can lead to increased production of a toxic metabolite, potentially causing ______.

<p>hepatotoxicity</p> Signup and view all the answers

Which of the following is the most critical consideration when prescribing opioids for acute pain management in an outpatient setting?

<p>Initiating treatment with the lowest effective dose of an immediate-release opioid and regularly reassessing the patient's pain and functional status. (C)</p> Signup and view all the answers

Topical analgesics, such as those containing menthol and camphor, provide pain relief by directly reducing inflammation in the underlying tissues.

<p>False (B)</p> Signup and view all the answers

Explain the mechanism by which local anesthetics exert their analgesic effect and briefly describe a potential adverse effect associated with their use.

<p>Local anesthetics inhibit nerve impulse transmission by blocking sodium channels. Infrequent adverse effects include cardiac arrest/ heart block, typically only occurring at high concentrations.</p> Signup and view all the answers

Why is methadone used in the treatment of opioid addiction?

<p>Due to its long duration of action, preventing withdrawal symptoms and reducing cravings over an extended period. (B)</p> Signup and view all the answers

The term ______ refers to any controlled substance in a legal context and is not strictly confined to drugs with analgesic properties.

<p>narcotic</p> Signup and view all the answers

Match each opioid with its distinguishing characteristic or primary use:

<p>Morphine = Better for constant, dull pain and causes drowsiness. Codeine = Less potent opioid often used as an antitussive. Meperidine = Short duration; adverse effects: tremor, seizures; avoid with MAOIs. Fentanyl = More potent than morphine; often administered via transdermal patch for chronic pain. Tramadol = Now Schedule I controlled substance; poses risk of abuse.</p> Signup and view all the answers

When using topical analgesics, applying a heating pad over the treated area will enhance the rubefacient effect and improve pain relief.

<p>False (B)</p> Signup and view all the answers

A patient with a known allergy to aspirin requires an analgesic for mild to moderate pain. Which of the following medications would be most appropriate?

<p>Acetaminophen (B)</p> Signup and view all the answers

Explain the rationale behind using Patient-Reported Outcomes (PROs) in pain management.

<p>PROs help capture the patient's subjective experience of pain, functional limitations, and treatment outcomes, aiding in personalized and effective pain management.</p> Signup and view all the answers

______ is an opioid antagonist used to reverse opioid overdoses by blocking opioid receptors in the central nervous system.

<p>naloxone</p> Signup and view all the answers

An athletic therapist is educating a patient on the appropriate use of topical capsaicin for pain relief. Which instruction would be most important to include?

<p>Avoid touching sensitive areas, such as the eyes or mucous membranes, after applying capsaicin. (A)</p> Signup and view all the answers

Codeine is a potent opioid analgesic that is generally preferred over morphine for managing severe pain due to its lower risk of respiratory depression.

<p>False (B)</p> Signup and view all the answers

Match the following properties/effects to the appropriate drug:

<p>Acetaminophen = Analgesic and antipyretic but not anti-inflammatory NSAIDs = Analgesic, antipyretic and anti-inflammatory. Local Anesthetics = Inhibits nerve impulse transmission in a localized area.</p> Signup and view all the answers

List 3 possible adverse effects with opioid analgesic use.

<p>Respiratory depression, constipation, sedation, orthostatic hypotension, miosis, urinary retention, pruritis, tolerance, dependence, addiction</p> Signup and view all the answers

A drug used to alleviate pain without causing loss of consciousness is known as an ______.

<p>analgesic</p> Signup and view all the answers

A patient reports experiencing nausea, vomiting, drowsiness, and abdominal pain a few days after overdosing on an analgesic. Which medication is most likely the cause?

<p>Acetaminophen (B)</p> Signup and view all the answers

Acetaminophen has anti-inflammatory and anti-platelet properties.

<p>False (B)</p> Signup and view all the answers

What is a key advantage of acetaminophen over NSAIDs in terms of gastrointestinal effects?

<p>Acetaminophen does not typically cause stomach irritation or ulcers.</p> Signup and view all the answers

Co-administration of acetaminophen with ______ can increase the risk of liver damage due to increased production of toxic metabolites.

<p>alcohol</p> Signup and view all the answers

Match the following types of pain with their descriptions:

<p>Acute pain = Sudden onset, limited duration; generally related to a specific injury or cause Chronic pain = Persistent pain lasting beyond the typical healing time, often for 3 months or more Nociceptive pain = Caused by damage to body tissue and is usually described as a sharp, aching, or throbbing pain Pathological pain = Arises from abnormal functioning of the nervous system.</p> Signup and view all the answers

Which of the following best describes the term 'opioid'?

<p>Drugs with similar effects as opiates, whether natural or synthetic (D)</p> Signup and view all the answers

Due to first-pass metabolism, oral administration of opioids typically requires a lower dose compared to parenteral routes.

<p>False (B)</p> Signup and view all the answers

What is one potential adverse effect, besides respiratory depression, associated with opioid analgesics relating to the gastrointestinal system?

<p>Constipation</p> Signup and view all the answers

Combining opioid analgesics with other CNS depressants can result in ______ CNS and respiratory depression.

<p>excessive</p> Signup and view all the answers

Why is methadone used in the treatment of heroin withdrawal?

<p>It has a long duration of action, which helps to reduce withdrawal symptoms gradually (A)</p> Signup and view all the answers

Extended-release opioids are recommended for managing acute pain.

<p>False (B)</p> Signup and view all the answers

What strategies can be used to appropriately address the role athletic therapists play in pain management, and what should be prioritized?

<p>Prioritize nonpharmacological/nonopioid options and start with OTC medications under physician direction.</p> Signup and view all the answers

Topical analgesics produce a ______ effect, causing localized vasodilation when applied to the skin.

<p>rubefacient</p> Signup and view all the answers

Which of the following is a primary mechanism of action for local anesthetics?

<p>Blocking localized nerve impulse transmission (A)</p> Signup and view all the answers

Naloxone is an opioid agonist used to treat severe chronic pain.

<p>False (B)</p> Signup and view all the answers

Why is it essential for athletic therapists to be proficient in naloxone administration?

<p>To be able to reverse opioid overdoses.</p> Signup and view all the answers

When initiating opioid therapy for acute pain, clinicians should start with a low dose of ______-release formulations and monitor the patient closely.

<p>immediate</p> Signup and view all the answers

What adverse effect distinguishes meperidine from other opioids, making it a less favorable choice especially when used with MAOIs?

<p>Tremors and seizures (D)</p> Signup and view all the answers

Caffeine enhances the effects of opioid analgesics, reducing sedation.

<p>True (A)</p> Signup and view all the answers

Match each opioid with its primary clinical use or characteristic:

<p>Morphine = Relieves moderate to severe pain, especially constant, dull pain Codeine = Less potent; treats mild to moderate pain; also used as an antitussive Methadone = Long duration of action; used for pain management and heroin withdrawal treatment Fentanyl = Highly potent; often administered via transdermal patch for chronic pain</p> Signup and view all the answers

Which of the following best explains why oral administration of opioid analgesics typically requires a higher dose compared to parenteral routes?

<p>Extensive first-pass metabolism in the liver (D)</p> Signup and view all the answers

Acetaminophen exhibits anti-inflammatory properties similar to NSAIDs.

<p>False (B)</p> Signup and view all the answers

What is the primary mechanism by which local anesthetics alleviate pain?

<p>Inhibition of localized nerve impulse transmission</p> Signup and view all the answers

Opioid analgesics exert their effects by binding to opioid receptors located in the central nervous system, peripheral nervous system, and the ______ tract.

<p>gastrointestinal</p> Signup and view all the answers

Match each opioid analgesic with its distinguishing characteristics or primary use:

<p>Morphine = Effective for severe pain and causes drowsiness Codeine = Less potent, often used as an antitussive Methadone = Long-acting; used for pain management and opioid withdrawal Fentanyl = Highly potent; often administered via transdermal patch for chronic pain</p> Signup and view all the answers

Which physiological effect is NOT typically associated with opioid analgesics?

<p>Increased gastrointestinal motility (D)</p> Signup and view all the answers

Extended-release opioid formulations are generally recommended as a first-line treatment for acute pain management.

<p>False (B)</p> Signup and view all the answers

What is the primary mechanism by which topical analgesics containing menthol and camphor alleviate pain?

<p>Counterirritation and localized vasodilation</p> Signup and view all the answers

The potentially fatal adverse effect of acetaminophen overdose is ______, which may manifest as nausea, vomiting, and abdominal pain.

<p>hepatotoxicity</p> Signup and view all the answers

Match the following ingredient found in topical analgesics with its mechanism of action:

<p>Salicylates = Mild analgesic and anti-inflammatory effects Menthol = Cooling sensation; counterirritant Camphor = Warm sensation; rubefacient (vasodilation) Capsaicin = Depletes substance P, reducing pain signals</p> Signup and view all the answers

Which of the following is the most accurate definition of an 'opioid'?

<p>A broader term referring to drugs with similar effects as opiates. (B)</p> Signup and view all the answers

Naloxone is an opioid analgesic used to treat moderate to severe pain.

<p>False (B)</p> Signup and view all the answers

What is the recommended approach to prescribing opioids for acute pain in terms of dosage initiation?

<p>Start low, go slow</p> Signup and view all the answers

Athletic therapists play a vital role in pain management, with an emphasis on education and prioritizing ______ and ______ options before considering opioids.

<p>nonpharmacological, nonopioid</p> Signup and view all the answers

Match the following opioids with a unique consideration for their use:

<p>Meperidine = Avoid with MAOIs due to potential for serious adverse effects Tramadol = Now classified as a Schedule 1 controlled substance Oxycodone = Often combined with acetaminophen or aspirin Fentanyl = Available in a transdermal patch for chronic pain management</p> Signup and view all the answers

Which of the following best describes the effect of caffeine on opioid analgesics?

<p>It may counteract some of the sedative effects of opioids. (D)</p> Signup and view all the answers

Acetaminophen is a suitable alternative to NSAIDs for patients with kidney dysfunction or a history of peptic ulcers because it does not affect kidney function or cause stomach irritation.

<p>True (A)</p> Signup and view all the answers

What specific patient-reported outcomes (PROs) should athletic therapists use to monitor pain and function in patients using analgesics?

<p>Pain scales and functional assessments</p> Signup and view all the answers

The use of opioids for chronic pain management requires careful monitoring and reevaluation, including tapering and discontinuation if ______ is not achieved.

<p>measurable goal</p> Signup and view all the answers

Match each listed item with its definition relating to pain management:

<p>Analgesic = A drug used to alleviate pain without causing loss of consciousness Opiate = Drugs obtained from the opium poppy Opioid = Broader term referring to drugs with similar effects as opiates Narcotic = Any controlled substance in a legal context</p> Signup and view all the answers

Which of the following statements best encapsulates the definition of pain as defined by the International Association for the Study of Pain?

<p>Pain involves a subjective, emotional experience linked to actual or potential tissue damage. (C)</p> Signup and view all the answers

Acetaminophen possesses anti-inflammatory and anti-platelet properties, making it suitable for patients with ulcers.

<p>False (B)</p> Signup and view all the answers

What is the primary mechanism of action by which opioid analgesics exert their effects on the body?

<p>Binding to opioid receptors in the CNS, PNS, and GI tract</p> Signup and view all the answers

Due to its extended duration of action, ______ is utilized in the treatment of both chronic pain and heroin withdrawal.

<p>methadone</p> Signup and view all the answers

Match the specific opioid with its distinguishing characteristic or clinical application:

<p>Morphine = Effective for constant, dull pain; induces drowsiness. Codeine = Less potent; used for mild to moderate pain and as an antitussive. Meperidine = Short duration of action; avoid with MAOIs due to potential for tremor/seizures. Fentanyl = Highly potent; often administered via transdermal patch for chronic pain.</p> Signup and view all the answers

Why is it recommended to avoid using extended-release opioid formulations for acute pain management?

<p>Extended-release opioids are more difficult to titrate effectively for acute pain. (A)</p> Signup and view all the answers

Topical analgesics, such as those containing menthol and camphor, exert their effects primarily by directly blocking pain signals at the nerve endings.

<p>False (B)</p> Signup and view all the answers

What rare but severe adverse effects can occur with local anesthetics if administered in excessively high concentrations?

<p>Heart block or cardiac arrest</p> Signup and view all the answers

As part of their role in pain management, athletic therapists prioritize ______ and ______ options before considering pharmacological interventions.

<p>nonpharmacological, nonopioid</p> Signup and view all the answers

Match each term related to pain management with its correct definition:

<p>Analgesic = A drug that alleviates pain without causing loss of consciousness. Opiate = Drugs derived from opium. Opioid = A broader term referring to drugs with similar effects as opiates. Narcotic = Any controlled substance in a legal context.</p> Signup and view all the answers

Which of the following is the most critical reason for athletic therapists to be proficient in the administration of naloxone?

<p>To reverse opioid overdose and prevent respiratory depression. (D)</p> Signup and view all the answers

The primary indication for acetaminophen is the treatment of moderate to severe pain associated with significant inflammation.

<p>False (B)</p> Signup and view all the answers

What specific advice should be given regarding alcohol consumption for a patient taking acetaminophen regularly?

<p>Avoid alcohol due to increased risk of hepatotoxicity</p> Signup and view all the answers

When initiating opioid therapy for acute pain, clinicians should adhere to the principle of 'start ______, go ______' to minimize potential adverse effects.

<p>low, slow</p> Signup and view all the answers

Match the route of administration with the corresponding opioid pharmacokinetic consideration:

<p>Oral = Requires a larger dose due to significant first-pass metabolism. Parenteral = Avoids first-pass metabolism, resulting in higher bioavailability. Transdermal = Provides sustained release of the opioid over an extended period.</p> Signup and view all the answers

Which of the following best describes the primary reason why meperidine should be avoided in patients taking MAOIs (Monoamine Oxidase Inhibitors)?

<p>Increased risk of serotonin syndrome, potentially leading to tremors and seizures. (B)</p> Signup and view all the answers

Nociceptive pain originates exclusively from damage to somatic tissues, such as skin and muscle.

<p>False (B)</p> Signup and view all the answers

What Patient-Reported Outcomes (PROs) can athletic therapists utilize to monitor the effectiveness of pain management interventions?

<p>Pain intensity, functional capacity, quality of life</p> Signup and view all the answers

Local anesthetics function by inhibiting the transmission of ______ in localized areas.

<p>nerve impulses</p> Signup and view all the answers

Match the following adverse effect with the opioid most likely to cause it:

<p>Morphine = Respiratory Depression Codeine = Constipation Oxycodone = Sedation Fentanyl = Pruritus</p> Signup and view all the answers

Flashcards

Pain

An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Analgesic

A drug used to alleviate pain without causing loss of consciousness.

Opiate

Drugs obtained from the opium poppy.

Opioid

A broader term referring to drugs with similar effects as opiates.

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Narcotic Analgesic

Relieves pain and produces drowsiness or sleep, with abuse potential.

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Acetaminophen Properties

Analgesic and antipyretic (not anti-inflammatory nor anti-platelet).

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Opioid Mechanism of Action

Binding to opioid receptors (CNS, PNS, GI tract).

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Opioid Adverse Effects

Respiratory depression, constipation, sedation; tolerance, dependence, addiction.

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Opioid Interactions with CNS Depressants

Excessive CNS and respiratory depression.

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Morphine

Relieves moderate to severe pain (better for constant, dull pain); causes drowsiness.

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Codeine

Less potent; treats mild to moderate pain; cough suppressant.

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Methadone

Long duration; used for pain and heroin withdrawal treatment.

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Fentanyl

More potent than morphine; transdermal patch for chronic pain.

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Naloxone

Opioid antagonist (reverses overdose).

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Topical Analgesic Ingredients

Salicylates, menthol, camphor, capsaicin.

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Topical Analgesic Effects

Counterirritants; rubefacient (localized vasodilation).

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Local Anesthetics

Inhibits localized nerve impulse transmission.

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Pain Management

Vital part of therapeutic intervention.

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Monitoring Pain

Recognize signs of abuse/misuse; use PROs (Patient-Reported Outcomes).

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Naloxone Proficiency

Essential for overdose reversal.

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Narcotic

Broader term for any controlled substance regulated by law.

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Opioid Absorption

GI absorption is efficient, but requires larger doses due to liver processing.

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Meperidine Concerns

Avoid this opioid with MAOIs due to risk of tremor/seizures.

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Oxycodone

A controlled-release opioid often combined with aspirin or acetaminophen.

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AT Intervention: Pain

Start with OTC options, with opioid use guided by a physician.

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Local anesthetic action

Localized nerve impulse transmission is blocked.

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Athletic Trainer's Role

ATs educate, encourage non-drug options, and watch for misuse.

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Acetaminophen

Analgesic that lacks anti-inflammatory or anti-platelet effects.

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Hepatotoxicity Symptoms

Nausea, vomiting, drowsiness, and abdominal pain showing up 2-4 days after overdose.

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Acetaminophen Indications

Mild to moderate pain, fever.

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Alcohol interaction with Acetaminophen

Increases toxic metabolite production.

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Warfarin interaction with Acetaminophen

Inhibits metabolism, increases bleeding time.

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Opioid Distribution

Binds to plasma; reaches brain, liver, lungs, kidneys; accumulates in adipose/muscle tissue.

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Opioid Metabolism

Extensive first-pass in liver.

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Opioid Excretion

Primarily urine.

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Appropriate Opioid Use

Not first-line for chronic pain. Set measurable goals. Discuss risks/benefits.

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Opioids for Acute Pain

Start low, go slow; use immediate-release only.

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Opioid Monitoring

Monitor and reevaluate; taper/discontinue if needed.

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Topical Anesthetics Definition

Provide short-term pain relief on skin/mucous membranes.

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Topical Anesthetics Uses

Sunburn, minor burns, insect bites, hemorrhoids, sore throat, dental irritation.

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NSAIDs and Corticosteroids

Nonsteroidal anti-inflammatory drugs and corticosteroids may be used to treat pain.

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Rubefacient

Localized vasodilation, often the effect of topical pain relief medications.

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Tramadol Classification

Tramadol is now classified as a controlled substance with a high potential for misuse.

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Patient-Reported Outcomes

Measurement tools to track patient outcomes.

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Topical Anesthetics Side Effects

Mild skin irritation, burning, or dermatitis.

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Study Notes

  • Pain is defined as an unpleasant sensory and emotional experience linked to actual or potential tissue damage.

Types of Pain

  • Acute pain is a type of pain
  • Chronic pain is a type of pain
  • Nociceptive pain (somatic or visceral) is a type of pain
  • Inflammatory pain is a type of pain
  • Pathological pain is a type of pain

Terminology

  • Analgesic: A drug that alleviates pain without loss of consciousness.
  • Opiate: Drugs derived from the opium poppy.
  • Opioid: A broad term for drugs with effects similar to opiates.
  • Narcotic: A controlled substance in a legal context.
  • Narcotic Analgesic: Another term for opioids, which relieve pain, produce drowsiness or sleep, and carry abuse potential.

Drugs for Treating Pain

  • NSAIDs and corticosteroids are used in pain treatment
  • Acetaminophen is used in pain treatment
  • Opioids are used in pain treatment
  • Topical analgesics are used in pain treatment
  • Topical and local anesthetics are used in pain treatment

Acetaminophen

  • Possesses analgesic and antipyretic properties, but lacks anti-inflammatory and anti-platelet effects.
  • Advantages include not causing stomach irritation, ulcers, or affecting platelet/kidney function.
  • Available in tablets, capsules, chewable tablets, suppositories, elixirs, suspensions, and IV forms.

Pharmacokinetics of Acetaminophen

  • Readily absorbed from the gastrointestinal tract
  • Half-life is approximately 2 hours.
  • Metabolized by the liver and excreted in urine.

Indications for Acetaminophen

  • Used for mild to moderate pain and fever
  • Dosing: 325mg–650mg strength in combination products; maximum 4000mg daily due to ceiling effect.

Adverse Effects of Acetaminophen

  • Can cause hepatotoxicity, with symptoms including nausea, vomiting, drowsiness, and abdominal pain, evident 2–4 days post-overdose

Drug Interactions with Acetaminophen

  • Alcohol increases the production of toxic metabolites.
  • Warfarin inhibits metabolism, increasing bleeding time.

Opioid Analgesics

  • Include endogenous opioids such as endorphins, enkephalins, and dynorphins, as well as exogenous opioids
  • Mechanism of Action: Bind to opioid receptors in the CNS, PNS, and GI tract.

Pharmacokinetics of Opioid Analgesics

  • Absorption: Well-absorbed, but oral administration requires a larger dose due to first-pass metabolism.
  • Distribution: Binds to plasma, reaching the brain, liver, lungs, and kidneys, and accumulates in adipose/muscle tissue.
  • Metabolism: Undergoes extensive first-pass metabolism in the liver.
  • Excretion: Primarily through urine.

Indications for Opioid Analgesics

  • Used for moderate to severe pain, cough suppression, and diarrhea

Adverse Effects of Opioid Analgesics

  • Respiratory depression, constipation, sedation, orthostatic hypotension, miosis, urinary retention, nausea/vomiting, and pruritis may occur
  • Tolerance, dependence, and addiction are potential adverse effects.

Drug Interactions with Opioid Analgesics

  • CNS depressants can cause excessive CNS and respiratory depression.
  • Caffeine is an interacting substance
  • Routes of Administration: Oral and parenteral

Specific Opioids

  • Morphine relieves moderate to severe pain, especially constant, dull pain, and causes drowsiness.
  • Codeine is less potent, treats mild to moderate pain, and acts as an antitussive.
  • Meperidine has a short duration, with adverse effects including tremor and seizures, and should be avoided with MAOIs.
  • Oxycodone is available in controlled-release form (OxyContin) and is often combined with aspirin or acetaminophen.
  • Methadone has a long duration and is used for pain management and heroin withdrawal treatment.
  • Fentanyl is more potent than morphine and is available as a transdermal patch for chronic pain.
  • Tramadol is now classified as a Schedule I controlled substance.
  • Naloxone is an opioid antagonist used to reverse overdoses.

Appropriate Use of Opioids

  • Opioids should not be the first-line treatment for chronic pain.
  • Set measurable goals for pain and function.
  • Discuss the risks, benefits, and nonopioid options with patients.
  • For acute pain, start with a low dose and increase slowly, using immediate-release formulations only.
  • Avoid extended-release formulations for acute pain.
  • Monitor and reevaluate regularly, and taper/discontinue opioids if needed.

Topical Analgesics

  • Contains ingredients like salicylates, menthol, camphor, and capsaicin
  • Effects: Act as counterirritants and produce localized vasodilation (rubefacient).
  • Adverse Effects: May cause skin reactions.

Topical Anesthetics

  • Provide short-term pain relief on the skin and mucous membranes.
  • Forms: Available in solutions, sprays, gels, and ointments
  • Uses: Treat sunburn, minor burns, insect bites, hemorrhoids, sore throat, and dental irritation.
  • Adverse Effects: May cause skin irritation, burning, and dermatitis.

Local Anesthetics

  • Inhibit localized nerve impulse transmission.
  • Uses: Used in dental procedures and minor surgery.
  • Adverse Effects: Rare, but high concentrations may cause heart block or cardiac arrest.

Role of the Athletic Therapist (AT)

  • Pain Management: A vital part of therapeutic intervention.
  • Education: ATs should understand analgesics and prioritize nonpharmacological/nonopioid options.
  • Monitoring: ATs should recognize signs of abuse/misuse and use Patient-Reported Outcomes (PROs).
  • Intervention: Start with OTC medications; use opioids only under physician direction.
  • Naloxone Proficiency: Essential for overdose reversal.

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