PPT_Chapter_26_Karch - Narcotics Narcotic Antagonists and Antimigraine Agents Chapter 26 Copyright 2013 Wolters Kluwer Health | Lippincott Williams

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Pain • Definition – Sensory and emotional experience associated with actual or potential tissue damage • Drugs Used to Relieve Pain – Narcotics: Opium derivatives used to treat many types of pain – Antimigraine Drugs: Reserved for the treatment of migraine headaches

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Location of Opioid Receptors Location of Opioid Receptors • CNS • Nerves in the periphery • Cells in the gastrointestinal (GI) tract

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Narcotic Agonists Narcotic Agonists • Actions – Act at specific opioid receptor sites in the CNS – Produce analgesia, sedation, and a sense of well- being • Indications – Relief of severe acute or chronic pain – Analgesia during anesthesia – Cross placenta

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Narcotic Agonists (cont.) Narcotic Agonists (cont.) • Pharmacokinetics – IV most reliable way to achieve therapeutic response – IM and sub-q rate of absorption varies – Hepatic metabolism and generally excreted in the urine and bile • Contraindications – Known allergy – Pregnancy, labor, lactation – Diarrhea caused by poisons

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Narcotic Agonists (cont.) Narcotic Agonists (cont.) • Cautions – Respiratory dysfunction – GI or GU surgery – Acute abdomen or ulcerative colitis • Adverse Reactions – Respiratory depression with apnea – Cardiac arrest

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Narcotic Agonists (cont.) Narcotic Agonists (cont.) • Adverse Reactions (cont.) – Shock – Orthostatic hypotension – Nausea, vomiting, constipation – Biliary spasm – Dizziness, psychoses, anxiety, fear, hallucinations • Drug-to-Drug Interactions – Barbiturate general anesthetics, phenothiazines, and MAOIs