Drugs Treating Sever Pain PDF

Click to edit Master title style Drugs Treating Sever Pain Fathiya AL-Harrasi OCHS-2024 1 Click to edit Master title style Drugs Treating Sever Pain I. Morphine/Naloxone II. Codeine...

Click to edit Master title style Drugs Treating Sever Pain Fathiya AL-Harrasi OCHS-2024 1 Click to edit Master title style Drugs Treating Sever Pain I. Morphine/Naloxone II. Codeine 2 2 Click to edit Master title style What Is Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is a multidimensional, subjective experience. Pain may be a major indication for drug therapy. 3 3  Click to edit Master title style Pain Transmission Pathway 4 4  Click Therapy Drug to edit Master to title style Pain Manage Pharmacologic methods Non-pharmacologic methods Opioid Analgesics Cognitive strategies for relaxation. NSAIDs physical strategies that interrupt pain Adjunct Analgesics or Co-analgesics transmission. 5 5 Click to edit Master title style 6 6  Narcotic Click Analgesics to edit Master title style Are required for conditions, disorders, or treatments that are accompanied by moderate-to-severe pain. Are the most effective drugs for pain management. The narcotic analgesics include opiate agonists, mixed agonist-antagonists, and antagonists based on their activity at opioid receptors. Although 5 types of opiate receptors are known to exist, activity occurs at only 3 sites (mu, kappa & delta) with the narcotic analgesics available. 7 7 Click to edit Master title style Narcotic Analgesics Narcotics have an important role in pain management and control. However, they are typically underprescribed and underused. Prototype drug: Morphine The narcotic antagonist naloxone is significantly different from morphine. 8 8 Click to edit Master title style Drugs Treating Sever Pain I. Morphine/Naloxone II. Codeine 9 9 Click to edit Master title style Morphine: Core Drug Knowledge Pharmacotherapeutics: Moderate-to-severe acute or chronic pain Post – operative pain Used to treat chronic pain that is either cancer pain or noncancerous chronic pain Administered via PO, SC, IM, IV, Epidural, Rectal & Topical. 10 10 Click to edit Master title style Morphine: Core Drug Knowledge Pharmacokinetics: Onset: 15 to 30 minutes. Duration: 3 to 7 hours. Metabolism: liver & gut wall. Half-life: 1.5 to 2 hours. 11 11 Click to edit Master title style Morphine: Core Drug Knowledge Pharmacodynamics Agonist at the mu, kappa, and possibly delta opiate receptors Reduces the release of neurotransmitter in the pre- synaptic space and produces hyperpolarization of post- synaptic dorsal horn neurons; thus prevent transmission of nociceptor pain. Decreases the release of substance P, which modulates pain perception. 12 12 Click to editCore Morphine: Master title Drug style Knowledge Morphine binds to mu (μ), kappa (κ), and delta (δ) opioid receptors Pharmacodynamics Inhibiting excitatory nociceptive pathways (brainstem, Mu receptors responsible for supraspinal medial thalamus, hypothalamus, and limbic system) analgesia. Reducing neurotransmitter release in the presynaptic space(reduces transmission of pain signals) Kappa receptors responsible for spinal analgesia. Hyperpolarizing postsynaptic dorsal horn neurons, (inhibiting pain signal relay) Delta receptors responsible for dysphoria and Decreasing release of substance P, which modulates pain psychomimetic effects. perception in the spinal cord and brain. 13 13 Click to edit Master title style 14 14 Click to edit Master title style 15 15 Click to edit Master title style Morphine: Core Drug Knowledge Contraindications: Morphine causes respiratory depression. Generally contraindicated in head injury and increased ICP; if it must be used, give with extreme caution. Main contraindications – hypersensitivity, pre-existing respiratory depression, acute or severe bronchial asthma & upper airway obstruction. Avoided – in premature infants & during labor when delivery of a premature infant is anticipated. Because of its stimulating effect on the spinal cord, it should not be used during convulsions. 16 16 Click to edit Master title style Morphine: Core Drug Knowledge Precautions: Caution must be used to patients receiving other CNS depressants. Caution should also be used for older or debilitated patients or those with renal or hepatic impairment. Caution should be used to patients who are sensitive to CNS effects. 17 17 Click to editNaloxone Master title style ❑ ❑ “Naloxone (Narcan) is narcotic antagonist, used to reverse the effects of opiates (respiratory depression) and to treat opioid overdose. Can be giving by: IM,SC & IV ( most rapid-2 minutes). Repeated dose?! ❑ Combined with sublingual preparations of buprenorphine to treat drug addiction. ❑ Reversal of narcotic depression may result in the adverse effects of nausea, vomiting, sweating, tachycardia, increased blood pressure and tremors. 18 18 Click to edit Master title style Drugs Treating Sever Pain I. Morphine/Naloxone II. Codeine 19 19 Click to edit Master title style Codeine: Core Drug Knowledge Pharmacotherapeutics: Control mild to moderate pain in adult & children. ( tables & injection). Post operative pain control and cough suppression Combined with acetaminophen or with nonsteroidal anti-inflammatory drugs. Standard dose 60mg. 20 20 Click to edit Master title style Codeine: Core Drug Knowledge Pharmacokinetics: Onset: 15 to 20 minutes. Duration: 4 to 6 hours. Metabolism: liver & excreted in the urine. Half-life: 3 hours. 21 21 Click to edit Master title style Codeine: Core Drug Knowledge Pharmacodynamics Codeine activate mu (μ) opioid receptors in the CNS mediates its analgesic and sedative effects. Work at specific receptors in the CNS to produce weaker sense of euphoria analgesia, euphoria and sedation. Medullary cough center to depress the cough reflex. milder pain relief and potential for addiction. Increase the viscosity of respiratory secretions. 22 22 Click to edit Master title style Codeine: Core Drug Knowledge Contraindications & Precautions: Should not be administered with other analgesia for pain relief. Avoided – post operative patients, asthma and emphysema. Caution – cardiac disease due to its potential to induce bradycardia and peripheral vasodilation. Pregnancy and lactation ? , head injury undergone a craniotomy? 23 23 Click to edit Master title style Patient an Family Education Drowsiness and impaired orientation. Avoid combining use of codeine with alcohol or other CNS depressant. Report respiratory issues immediately. General pain control information 24 24 Click to edit Master title style Thank You 2 25