Analgesics.pptx

ANALGESICS OPIOIDS & NON-OPIOIDS By: Ass Prof Dr. Nassem Samir Saker ‫د نسيم سمير علي صقر‬. ‫م‬.‫أ‬ 2022 1 2 3 By: Ass Prof Dr. Nassem Samir Saker 4 NON-OPIOID ANALGESICS //NSAIDS// Examples Group NSAIDs COX1 & COX2 Inhibitors: Diclofenac potassium ,Diclofenac sodium Ibuprofen, , Ketoprofen, Indomethacin Ketorolac, Meloxicam , Naproxen, Piroxicam COX2 Inhibitors: Celecoxib Salicylates Aspirin , Sodium salicylate Miscellaneous Acetaminophen 5 By: Ass Prof Dr. Nassem Samir Saker NON-OPIOID ANALGESICS General Uses Used to control mild to moderate pain and/or fever. 1. Headaches, 2. Arthritis, Osteoarthritis 3. Ankylosing spondylitis, 4. Sports injuries, 5. Menstrual cramps By: Ass Prof Dr. Nassem Samir Saker 6 NON-OPIOID ANALGESICS General Action and Information Most non-opioid analgesics inhibit prostaglandin synthesis peripherally for analgesic effect and centrally for antipyretic effect. Tramadol is a centrally acting agent. Aspirin, NSAIDs, and acetaminophen inactivate cyclooxygenases,// COX1.COX2// this enzymes required for prostaglandin formation By: Ass Prof Dr. Nassem Samir Saker 7 By: Ass Prof Dr. Nassem Samir Saker 8 NON-OPIOID ANALGESICS COX-1 is normally synthesized continuously and present in all tissues and cell types, especially platelets, endothelial cells, the gastrointestinal (GI) tract, and the kidneys. Prostaglandins produced by COX-1 are important: 1. In the stomach, they decrease gastric acid secretion, increase mucus secretion, and regulate blood circulation. 2. In the kidneys, these prostaglandins help to maintain adequate blood flow and function. 3. In the cardiovascular, the prostaglandins help regulate vascular tone (ie, vasoconstriction and vasodilation) and 9 By: Ass Prof Dr. Nassem Samir Saker NON-OPIOID ANALGESICS COX 1 Concepts: Drug-induced inhibition of these prostaglandins results in the adverse effects associated with aspirin and related drugs, especially gastric irritation, ulceration, and bleeding. Inhibition of COX-1 activity in platelets may be more responsible for GI bleeding than inhibition in gastric mucosa 10 By: Ass Prof Dr. Nassem Samir Saker NON-OPIOID ANALGESICS COX-2 is normally present in several tissues (eg, brain, bone, kidneys, GI tract, and the female reproductive system). In inflamed tissues, COX-2 is induced by inflammatory chemical mediators such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF alpha) Inhibition of COX-2 results in the therapeutic effects of analgesia and anti-inflammatory activity. The COX-2 inhibitor drugs NSAIDs designed to selectively inhibit COX-2 and relieve pain and inflammation with 11 By: Ass Prof Dr. Nassem Samir Saker NON-OPIOID ANALGESICS Interactions of NSAIDs Long-term use of acetaminophen with NSAIDs may increase the risk of adverse renal effects. Prolonged high-dose acetaminophen may increase the risk of bleeding with warfarin. NSAIDs increase the risk of bleeding with warfarin, thrombolytic agents, antiplatelet agents, some cephalosporins, and valproates 12 NSAIDs may decrease the effectiveness of diuretics and By: Ass Prof Dr. Nassem Samir Saker NON-OPIOID ANALGESICS Patient/Family Teaching L 1. Instruct patient to take salicylates , NSAIDs with a full glass of water and to remain in an upright position for 15–30 min after that 2. Adults should not take acetaminophen longer than 10 days and children not longer than 5 days unless directed by health care professional. 3. Short-term doses of acetaminophen with salicylates or NSAIDs should not exceed the recommended daily dose of either drug alone. 4. Caution patient to avoid concurrent use of alcohol with this medication to minimize possible gastric irritation; may increase risk of 13 bleeding By: Ass Prof Dr. Nassem Samir Saker NON-OPIOID ANALGESICS avoid taking acetaminophen, salicylates, or NSAIDs for more than a few days. Advise patients on long-term therapy to inform health care professional of medication regimen prior to surgery. NSAIDs reduce blood flow to the kidneys and therefore reduce the action of diuretics and decrease the elimination of lithium and methotrexate a result, the blood levels of these drugs may increase as may their side effects. NSAIDs also decrease the ability of the blood to clot and therefore increase bleeding. When used with other drugs that also increase 14 bleeding (for example, warfarin) By: Ass Prof Dr. Nassem Samir Saker NSAIDs also may increase blood pressure OPIOID ANALGESICS Examples Morphine, Fentanyl, , Meperidine, Methadone Hydrocodone , Codeine Oxycodone , Propoxyphene 15 By: Ass Prof Dr. Nassem Samir Saker OPIOID ANALGESICS 16 By: Ass Prof Dr. Nassem Samir Saker OPIOID ANALGESICS Opioids Action and receptors: Opioids produce effects on neurons by acting on receptors located on neuronal cell membranes. Three types of opioid receptor, m, d and k (mu, delta and kappa) Endorphin, interacts preferentially with m receptors, Enkephalins with d receptors By: Ass Prof Dr. Nassem Samir Saker 17 OPIOID ANALGESICS Morphine has considerably higher affinity for m receptors than for other opioid receptors. The opioid antagonist, Naloxone, inhibits all opioid receptors, but has highest affinity for m receptors. All 3 receptors produce analgesia when an opioid binds to them. 18 Activation of k receptors does not produce as By: Ass Prof Dr. Nassem Samir Saker OPIOID ANALGESICS General Use: pain. Management of moderate to severe 1. Postoperative pain 2. Cancer pain 3. Bone break 4. Burn pain 5. Kidney stones 6. Herniated disc By: Ass Prof Dr. Nassem Samir Saker 19 OPIOID ANALGESICS Other uses: 1. Anesthesia adjunct 2. Tooth extraction 3. Cough/ hydrocodone/ 4. Light sedation 5. Opiate dependence and withdrawal 6. Pulmonary edema / morphine/ 20 By: Ass Prof Dr. Nassem Samir Saker OPIOID ANALGESICS Interactions Increases the CNS depressant properties of other drugs, 1. alcohol, 2. antihistamines, 3. antidepressants, 4. sedative/hypnotics, 21 5. phenothiazines, and MAO inhibitors By: Ass Prof Dr. Nassem Samir Saker OPIOID ANALGESICS Side effects of Opiods: CNS: confusion, sedation, dizziness, dysphoria, hallucinations, Resp: brady-penia respiratory depression Cardiovascular: Hypotension Gastrointestinal: constipation Urinary: retention 22 By: Ass Prof Dr. Nassem Samir Saker OPIOID ANALGESICS Nursing implications: Assessment 1. Assess type, location, and intensity of pain prior administration. 2. A repeat dose can be safely administered at the time of the peak if previous dose is ineffective and side effects are minimal. 3. Opioid agonist-antagonists are not recommended for prolonged use or as first-line therapy for acute or cancer pain. 23 4. Assess blood pressure, pulse, and respirations By: Ass Prof Dr. Nassem Samir Saker OPIOID ANALGESICS Nursing implications: Assessment Assess prior analgesic history. Antagonistic properties of agonist-antagonists Prolonged use may lead to physical and psychological dependence and tolerance. This should not prevent patient from receiving adequate analgesia. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk, stool softeners, and laxatives to minimize constipating effects. 24 Monitor intake and output ratios. If significant discrepancies By: Ass Prof Dr. Nassem Samir Saker occur, assess for urinary retention and inform physician OPIOID ANALGESICS Patient/Family Teaching Medication may cause drowsiness or dizziness. Caution patient to call for assistance when ambulating or smoking and to avoid driving or other activities requiring alertness until response to medication Advise patient to make position changes slowly to minimize orthostatic hypotension. Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication. 25 By: Ass Prof Dr. Nassem Samir Saker

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