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Pain Meds

Pain medications, NSAID, Opiates, Opioids, Triptans, Antiemetics, Ergot Alkaloid

QuestionAnswer
Aspirin (Acetylsalicylic Acid) NSAIDs / Acetylates COX-1 & COX-2 and inhibits them irreversibly /
Ibuprofen NSAIDs / Reversibly inhibits COX-1 & COX-2 / Lowest incidence of GI side effects of all NSAIDs
Naproxen NSAIDs / Reversibly inhibits COX-1 & COX-2 / Smallest overall cardiovascular risks of NSAIDs
Celecoxib NSAIDs / Reversibly inhibits COX-2 / Lower risk of GI events
Acetaminophen NSAIDs / Only acts as an Analgesic & Antipyretic but not anti-inflammatory
Morphine Opioid (Mu agonist) / Analgesia & suppression of cough / Hydrophobic so it slowly crosses the membrane
Codeine Opioid (Mu agonist) / Analgesia for mild-moderate pain esp when combined with aspirin or acetaminophen / Metabolized to morphine (only 0-15%) by CYP2D6 but produces less analgesia than morphine
Methadone Opioid (Mu agonist) / Analgesia esp for difficult-to-treat pain / Binds extravascularly and is slowly released back into plasma leading to long half-life
Meperidine Opioid (Mu agonist) / Used in labor because it does not reduce force of uterine contraction / Metabolized to normeperidine which has significant antimuscarinic effects/
Fentanyl Opioid (Mu agonist) / Analgesia, popular for postoperative or labor analgesia / Very lipid soluble so it easily passes through skin and mucous. So has fast onset of action and short duration
Pentazocine Opioid Partial/Mixed Agonist (Kappa agonist, mu antagonist) / Analgesia for moderate to severe pain / Increased heart rate and blood pressure at high doses
Nalbuphine Opioid Partial/Mixed Agonist
Nalorphine Opioid Partial/Mixed Agonist
Buprenorphine Opioid Partial/Mixed Agonist (Mu partial agonist, kappa antagonist) / Analgesia esp for difficult to treat pain / Resistant to naloxone reversal
Naloxone Opioid Antagonist / Used for poisoning / Given IV and a short duration of action
Naltrexone Opioid Antagonist / Used for poisoning / Well-absorbed orally with a long duration of action
Hydromorphone Opioid (Mu agonist) / Moderate-to-severe pain / Less histamine release and no opioid-active metabolites
Remifentanil Opioid (Mu agonist) / Analgesia and anesthetic adjuvant / Has more flexible body than fentanyl so it can easily rotate to better fit receptors. Much faster onset but a short half-life due to ester linkage that can be broken by plasma esterases
Oxycodone Opioid (Mu agonist) / Used for mild to moderate pain
Hydrocodone Opioid (Mu agonist) / Mild-moderate pain / Metabolized to hydromorphone by CYP2D6
Heroin Opioid (Mu agonist) / Commonly abused / Metabolized to morphine and is VERY lipid soluble, half-life of 3 min.
Tramadol Its own class / Used for mild-moderate pain, may modulate emotional aspects / Weak MOR agonist, inhibits norepinephrine and serotonin uptake / Many antidepression interactions
Amitriptyline TCA / Used for depression, neuropathic pain, migraine prophylaxis / Inhibits reuptake of 5-HT and NE but also inhibits muscarinic, histamine, and alpha1 adrenergic receptors
Duloxetine SNRI / Depression, neuropathic pain, anxiety disorders / Inhibition of serotonin and norepinephrine uptake
Venlafaxine SNRI / Depression, neuropathic pain, anxiety disorders, migraine prophylaxis / Inhibition of serotonin and norepinephrine uptake
Pregabalin Anticonvulsants / Neuropathic pain, fibromyalgia, epilepsy / Bind voltage-gated calcium channels in CNS to inhibit neurotransmitter release
Gabapentin Anticonvulsants / Neuropathic pain, fibromyalgia, epilepsy, migraine prophylaxis / Bind voltage-gated calcium channels in CNS to inhibit neurotransmitter release
Sumatriptan Triptan (1st Gen) / Moderate-severe migraines bind 5-HT1 receptors on intracranial blood vessels causing constriction / Not for prophylaxis or long term use / Gold standard, many administration routes
Eletriptan Triptan (2nd Gen) / Moderate-severe migraines bind 5-HT1 receptors on intracranial blood vessels causing constriction / Not for prophylaxis or long term use / Expensive but effective
Dihydroergotamine Ergot Alkaloid / Moderate-severe migraines partially bind 5-HT1 receptors / Causes severe nausea and works best when administered at prodromal period. / Last resort, not for prophylaxis.
Mirtazapine NaSSA / Migraine prophylaxis
Topiramate Anticonvulsant / Most frequently prescribed for migraine prophylaxis, tension headaches / Primary MOA: blocks voltage-dependent sodium and calcium channels; inhibits glutamate, enhances GABA inhibition
Propranolol Beta-blocker / Migraine prophylaxis, cluster headache prophylaxis, tension headaches / Blocks the action of epinephrine and norepinephrine on both β1- and β2-adrenergic receptors
Metoprolol Beta-blocker / Migraine prophylaxis, cluster headache prophylaxis, tension headaches / Blocks the action of epinephrine and norepinephrine on both β1- and β2-adrenergic receptors
Methysergide Ergot Alkaloid / Moderate-severe migraines partially bind 5-HT1 receptors / Causes severe nausea and works best when administered at prodromal period. / Last resort prophylaxis.
Verapamil Calcium channel blocker / Approved for treating high blood pressure, chest pain and irregular heartbeats / Off-label use of migraine & cluster prevention
Cyproheptadine Serotonin Antagonist (first-generation antihistamine) / Migraine prophylaxis (safe in kids)
Created by: carchase
 

 



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