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Pain Management

Mu receptors produce analgesia, resp depression, sedation, euphoria, dependence, constipation
K receptors analgesia, resp depression, anxiety, hallucinations
Delta receptors analgesia without adverse events
pure opioid agonists (mu mostly, some kapp) examples fentanyl, hydromorphone, levophanol, mepiridine, methadone, morphine, oxycodone, oxymorphone
moderate-mild opioids examples codeine, hydrocodone, propoxyphene
mixed agonist-antagonist (Kappa, weak on mu) examples pentazocine, butophanol, nalbuphine, buprenorphine, dezocine
Opioid antagonists that block but mu and kappa examples Naloxone, Naltrexone, Nalmefene
mixed agonist-antagonist effects more euphoria, psychomimetic effects, less resp depression
opioid antagonists effects used to reverse resp depression and CNS depression
opioid ADRs CNS effects, chronic sedation, muscle jerks, changes in hormone levels, high doses create convulsions, resp depression, orthostatic hypotension, N/V, constipation, bladder spasm and urgency, urinary retention, flushing of face, sweating, pruritis
opioids DDI CNS depressants, anticholinergics, TCAs, atropine, antihypertensives, MAOI's
ASA + APAP + Caffeine Excedrin
Abortive therapy for migraines Ergotamine, Combinations with caffeine, Dihydroergotamine, triptans
Ergotamine ADR N/V, weakness in legs, myalgia, numbness/tingling, angina-like, tachycardia, bradycardia; overdose can cause ergotism -- ischemia, myalgias, parethesias, gangrene
Ergotamine DDIs/Drug-dz interactions SSRIs (separate by 24 hrs), Ci in renal or hepatic impairment, sepsis, CAD, PVD
Ergotamine Ergomar, Ergostat, Wigrettes, Gynergen, Medihaler-Mergotamine
Ergotamine/Caffeine Cafergot, Wigraine
Ergotamine/pentobarbital/bellafoline bellergal
ergotamine/pentobarbital/belladona/caffeine cafergot PB
Isometheptene/dichloralphenazone/APAP midrin
Dihydroergotamine little peripheral vasoconstriction, n/v or physical dependence but diarrhea predominant
DHE CI CAD, PVD, pregnancy, sepsis, hepatic or renal impairment; dont give within 24 hrs of SSRI
Triptan ADR tingling, parethesias, warmth of head, neck, chest, limbs, dizziness, flushing, back pain, stiffness, chest symptoms, heavy arms, agina (rarE), vertigo, malaise, fatigue
Triptan DDI/D-DzI ergots, triptans, MAOI's; CI in IHD, MI, uncontrolled HTN
Almotriptan Axert
Sumatriptan Imitrex
Eletriptan Relpax
Frovatriptan Frova
Rizatriptan Maxalt
Zolmitriptan Zomig
Naratriptan Amerg
migraine prophylaxis beta blockers, anticonvulsants, antidepressants, CCBs, methysergide
Beta blockers in migraine prophylaxis propranolol and timolol DOC
Antidepressants in migraine prophyalxis amitriptyline, fluoxetine
Divalproex ADR weight gain, hair loss, tremor, teratogenic
Topiramate ADR parethesia, fatigue, nausea, dizziness, difficulty concentration, wieght loss, anorexia
Methysergide ergot alkaloid
Methyseride ADR retroperitoneal, pleuropulmonary, cardiac fibrosis, vascular insufficiency, insomina, altered mood, depersonalization, hallucinations, nightmares, GI disturbances, N/V, diarrhea
Created by: cytoskeletor