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Pharmacology-Diabetes:Contra:HTN - Pharmacology...

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Pharmacology: Opiods/Contraception/Hypertension Pain Slides Cont’d Pain can be treated through: Non-pharmacological therapies: Somatic (can range from heat/cold-simple, to acupuncture/ultrasound-minimally invasive, to surgery/radiation- invasive) or Psychological (psychotherapy through counseling/support and self help groups, meditation, hypnosis, and patient education) Pharmacological therapies: Primary analgesics (simple analgesics or opids/narcotics), Adjuvant medications, and Neuropathic pain treatment Opiod Analgesics: Mainstay class of analgesics, Effective for moderate to severe pain (easily titrated with NO ceiling effect), Mechanism of action: Binds to opiate receptors in the CNS altering the perception and response to pain, Agonist/Partial Agonist/Antagonist. *for moderate to severe pain, the more dosage the more CNS depression it will cause. There is no cox1 and involved. You are not decreasing the cause of the pain, but your perception of the pain. Opiod Classification: Full Agonist: Sits on a receptor and elicits a response. o Morphine, Meperidine, Methadone, Fentanyl, Oxycodone, Codeine, Propoxyphene, Hydrocodone o Usually associated with opiods? o Morphine like agonists: Morphine, Hydromorphone, Oxycodone, Codeine, and Hydrocodone. Morphine is the standard that we compare everything else to. All have the same potential of causing the same level of analgesics, or pain relief. Morphine is a prototype opiod analgesic. The natural substance is isolated from the opium plant. It is the first line agent to treat moderate to severe pain. It can be given PO, IV, IM, SubQ, PR (per rectal), IT (intrathecal) or Immediate and sustained release formulations. Morphine, however, wears off pretty quickly. Hydromorphone is involved in the management of moderate to severe pain. It is more potent than morphine. It can be administered IV, Im, SubQ, PO (better oral absorption that morphine). You can give smaller dosages to reach the same level of a morphine. Oral absorption is more complete and better. Oxycodone: Used to treat moderate to severe pain. Immediate and sustained release products. Only available PO. Similar potency to morphine. It is available as combination products with ASA, APAP, and Ibuprofen. Given ONLY orally. It is often used
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in combination with other analgesics: you can use smaller doses of oxycodone. o Meperidine like agonists: Meperidine, Fentanyl. Meperidine is less potent that morphine and has a shorter duration of action than morphine. It can be given IV, IM, SubQ, or PO. The active metabolite (normeperidine) can cause tremor, muscle twitching, and seizues. (caution in renal impairment- because you can’t get rid of the drug, and the elderly.). It works quickly but doesn’t last long, and this is why you must keep redosing patients. This lowers one’s seizure threshold and they are more likely to have seizures. Fentanyl: is more potent that morphine, but have a short duration of action. It is often used in anaesthesiology as adjunct to general anesthesia
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Pharmacology-Diabetes:Contra:HTN - Pharmacology...

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