pain.txt

• Pain, should be accessed and monitored in all patients.
• an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

• Associated with surgery, other medical procedures or trauma
• Last only hours or a few days
• Treated primarily with analgesics, often narcotic analgesics

• Associated with cancer or other progressive diseases
• May last months or years
• May be complicated by depression
• Treated with analgesics, often narcotic analgesics

• caused by ongoing disease that is not life-threatening, pain that has continued after the underlying cause is resolved or pain that has no identifiable cause
• Includes arthritis pain, headache pain, neuropathic pain and fibromyalgia
• May be complicated by depression, anxiety and other psychological disorders
• Treatment is complex involving use of analgesics as well as other therapies

• the immediate defensive action of tissue to any injury, which may be caused by infection, chemicals or physical agents.
• involves pain, heat, redness, swelling, and loss of function of the affected part.

the poppy, papaver somniferum

• produce most of their effects on the central nervous system (CNS) and the bowel.
• an agonist-receptor (lock and key) interaction.
• The relative potency of the different narcotic analgesics correlates well with their affinity for these receptors

• Pupil: cause constriction of the pupil, pinpoint pupils in a patient are said to be an indicator of narcotic use. Note: meperidine (Demerol�) can cause dilation of the pupils, good for shavering after surgery.
• Respiration system: all cause depression of respiration
• GI: Inhibit GI motility, and stimulate the CTZ. Mepergin can antagonist the vomiting after surgery , Opium was used for relief of diarrhea. Opiates decrease propulsive movements in the GI tract and increase muscle tone of the sphincters.

Atropin

• Acetaminophen/Codeine (Tylenol #3�)
• Propoxyphene/Acetaminophen (Darvocet N 100�)
• Hydrocodone/Acetaminophen (Lortab�, Vicodin�)
• Hydrocodone/Ibuprofen (Vicoprofen�)
• Oxycodone (OxyContin�, Roxicodone�, M-Oxy�, Percolone�)
• Oxycodone/Acetaminophen (Percocet�, Tylox�, Roxicet�)
• Tramadol/Acetaminophen (Ultracet�)
• Tramadol (Ultram�) still addictive
• Tapentadol ( Nucynta�)
• Hydromorphone (Dilaudid�)
• Morphine (MS Contin�, Roxanol�) highest pain relief
• Propoxyphene (Darvon�) low in pain relive ability, high in

• that fits the lock of the narcotic receptor but doesn't turn the key.
• also blocks the receptor from getting stimulation from any narcotic agonist.
• Treat narcotic Addiction, reverse response of narcotic
• Naloxone (Narcan)
• Naltrexone (Trexan)
• Nalmefene (Revex)

• Psychological Dependence: euphoria is responsible for a large part of the problem with drug abuse.
• Physical Dependence: When narcotic analgesics are used on a regular (usually daily) basis, the body tends to revolt if a scheduled dose is missed. This missing of a dose is very uncomfortable and is responsible for much of the "drug seeking behavior".

• Patients who regularly take narcotic analgesics will develop tolerance to the euphoria, analgesia, sedation and respiratory depression caused by these agents.
• However, they do not develop tolerance to the GI effects.

• Symptoms of withdrawal from narcotic analgesics begin shortly before the next scheduled dose (usually about 8 to 12 hours after the last dose).
• These symptoms will usually continue for 7 to 10 days.

• Initial Period: Anxiety, restlessness, Insomnia, Perspiration, Yawning, Tremor
• Peak: Irritability, Nausea, vomiting, diarrhea, High blood pressure
• Others: Body aches, muscle cramps, Dilated pupils, Hot flashes, excessive sweating, Fever, chills, Abdominal cramps

• Narcotic withdrawal by a licensed detox center
• Maintenance of an addict while in the hospital for another reason
• Pain, long acting, one dose before leaving the hospital.

• Cyclooxygenase is an important enzyme in the synthesis of prostaglandins.
• Inhibition of cyclooxygenase may result in analgesic, antipyretic and anti-inflammatory effects.

• Works by inhibiting prostaglandin synthesis both in the central nervous system and peripherally (COX-1 and COX-2)
• Also has antipyretic action
• Also has anti-inflammatory properties

• Works by inhibiting prostaglandin synthesis only in the central nervous system (COX-3)
• Also has antipyretic activity
• Has no anti-inflammatory properties

• Work by inhibiting prostaglandin synthesis both in the central nervous system and peripherally (COX-1 and COX-2)
• Also have anti-inflammatory properties
• Also have antipyretic action
• Combination of NSAIDs with other drugs such as omperazole or misoprostol, can help prevent ulcer formation.

• Arthritis
• Bursitis
• Tendonitis
• Gout
• Headache
• Menstrual cramps
• Aches and sprains of muscles

selective COX-2 inhibitors. It is hoped that these agents will have a lower incidence of bleeding and other GI disturbances.

• Ibuprofen (Motrin�, IBU�)
• Naproxen (Anaprox�, Naprosyn�)
• Meloxicam (Mobic�)

• Misoprostol
• Designed specifically for people on long-term NSAID therapy
• A synthetic prostaglandin that stimulates the GI tract to produce mucus
• Does not affect inflammatory response pathway
• Helps prevent ulcers without hindering the NSAIDs designated task

recurrent attacks of acute inflammatory arthritis�a red, tender, hot, swollen joint.

• Carisoprodol (Soma�)
• Cyclobenzaprine (Flexeril�)

III

IV

III

II

no

III

II